Baby

One of the most important things you must consider when choosing a dog for your child is that you will probably be the one taking care of it even when your child becomes older. For that reason you want to choose a breed that will be easy to feed, groom, and walk. You also need to look to dog breeds that are good with children and not ones that are overly aggressive like a Pit Bull. Under no circumstances should any parent take a chance on a breed that has the potential to turn even on its owners. Of course, some people will tell you that even Collies or German Shepherds have that potential, but you certainly don’t read it in the newspapers.

For a small child, a small dog is your best choice. Children tend to want dogs with which they can play and that are smaller than they are. The toy and small breeds such as Chihuahuas, Yorkshire Terriers, Boston Terriers, and other similar sized breeds are perfect for children. Chihuahuas are very noisy, but they are also very gentle and lovable with their human families as are Yorkies and Boston Terriers. The small breeds are also better for your child to learn to feed and walk. It would be rather difficult for even a six year old to walk a Collie or German Shepherd no matter how gentle it might be.

Some breeds tend to be one-owner dogs, and since you will be sharing the care of the dog with your child, this is not the breed you want. If it becomes attached to you instead of your child, he or she will become very upset. Some breeds are also very picky about who feeds and bathes them, and though this may not be a problem when your child is young, it may be a potential problem as he or she grows older and wishes to take over care of their dog.

Before choosing a dog for your child, make sure the two of them are going to get along. This may require a trip to the pet store or breeder so that your child can interact with several dogs and choose the one that best suits him. A dog will attach to a person even as a puppy, so you want to choose the one that chooses your child. Never go out and just buy a puppy for your child because just like humans, they have their own personalities and may not be the right match for your child.

Even if you decide to get a dog from the animal shelter, let your child pick the one with the sad eyes looking to go home with him. Instead of saying there is a dog for every child, you must understand there is a child for every dog, and each dog will pick out the child he feels is right for him or her. Allowing it to happen naturally will assure you that dog and child are a perfect match for one another.

Labor varies form woman to woman; even in the same woman labor each is different. Some labors are very fast, lasting only a few hours; some are average in length [about fifteen or sixteen hours for first time mothers and seven or eight hours for women who have had babies before]; some are very long, lasting a day or two. Some start slowly and then speed up unexpectedly; others start rapidly and then slow down. The amount of pain and fatigue varies also. It is best not to have definite expectations, but to prepare yourself for the wide range of possibilities.

Many factors play a part on how long and hard; labor will be. You can influence some of these factors but not others.

Factors Influencing Labor

Factors you cannot control

• Size and shape of your pelvis
• Size and shape of baby’s head and shoulders
• Baby’s station, presentation, and position*
• The condition of your cervix when contractions begin
• The power of your contractions
• The amount of rest you have between contractions
• Some aspects of your general health and your baby’s well-being

Factors you control, to some extent

• Your emotional state and attitude toward birth [anxiety, fear, and tension versus optimism, confidence, and relaxation]
• Presence of helpful, caring partner[s]
• Knowledge of what to expect
• An environment and professional staff that help you feel secure and well cared for
• Good care of yourself [including good nourishment and health habits]

* Station refers to how low the baby is in the pelvis.

Presentation refers to which part of the baby’s body will come first [usually it is the head, but on occasion it may be the buttocks, feet, or even a shoulder]

Position refers to location-on the right or left side of the mother-and the orientation-anterior [towards the mother's front], posterior [toward the mother's back], or transverse [lying crosswise]-of a given part of the baby, specifically, the occiput [back of the head], brow, chin, shoulder, or sacrum [the bone at the end of the spinal column]. For example, if the baby’s position is left occipitoanterior, the back of the head is on the left , pointing toward his mother’s front.

As you recognize your life to adjust to having a baby, do not forget your own requirement to have some time for yourself, however difficult it may be to schedule. You need private time to be a person in your own right and not only a parent, a homemaker, a spouse, and perhaps an employee. You need the time to build and maintain the self- esteem that makes you effective in all those roles and effective at being yourself. You need time to exercise, to groom yourself, to read, or to work on a hobby… or to look at sky or water and let your mind wander. Finding this time will probably never be easy for you again, but it will continue to be very important that you do find it. Always look on it not as a luxury or a reward, but as an obligation to yourself. You won’t always be able to have the hour or more that would do you the most good and be the most enjoyable, but you’ll find that even a few minutes snatched from a busy day will refresh you.

If you are a early riser, at your best in the morning, you may enjoy a few minutes of peace and privacy over a cup of coffee before the rest of the family is awake. Your baby’s daytime naps may give you some precious time. Even later, when you may not feel the need to sleep every time your baby does, nap time should be for you, not for housework. Evening is a wonderful time for a leisurely bath, even for a good read in a warm tub.

And evening is probably also the best time for a quiet hour or two for spouses. As important as it is for each to have some solitary time, it is equally necessary for a married couple to spend at least some time together alone.

You’ll probably feel a little awkward and clumsy the first few times you diaper and dress your baby, but with a little practice, you’ll be handling him with ease and confidence. Use a waist high table of some kind even for a tiny baby so you won’t have backaches. An old dresser with a pad on top will now, but modern changing tables have built-in safety straps to hold your baby when he is old enough to squirm and resist. If you use disposables, diapering is almost automatic: lay the baby on the diaper, fold the front half of the diaper up over the baby and fasten it with the convenient attached tapes. [Those tapes sometimes tear, instead of throwing a diaper away, mend it with masking tape.] To keep wetness from soaking into outer clothing, use disposables with elasticized legs and turn the plastic top of the diaper to the inside. A cloth diaper can be given a figure eight twist at the crotch for both double thickness and a tighter fit. Pin the back of the diaper over the front, slipping one or two fingers between the cloth and the baby’s skin to keep the pin from sticking the baby. Use a pincushion or bar of soap to hold diaper pins [do not use ordinary safety pins, and keep them out of the baby's reach] Never hold pins in your mouth. Whichever kind of diaper you use, lay an extra one over your baby boy to avoid being squirted while you change him.

The kinds of clothing you select for your baby will reflect your own taste and inclinations. Some parents are willing to spend the extra time necessary to iron natural-fiber, woven- fabric because they like the look of a dressed up baby; others opt for simple knit clothing that needs little care. Whichever kind of clothing you prefer, look for garments that will be easy for you to put on and take off the baby-those with few, if any buttons, necklines with large enough openings to fit easily over the baby’s head, and sturdy crotch fasteners that make diaper changing easier.

Most babies come home from the hospital with remnants of the umbilical cord still attached to the belly button, or the umbilicus. Until this falls off give your baby only sponge baths. Clean the navel area twice a day or so with a cotton swab dipped in antiseptic. Do this gently but thoroughly, making sure to get to the base of the cord stump. Watch for yellow matter, a sort of “weeping” that may develop, and for redness. These are signs of possible infection-notify your doctor if they persist. Keeping the top edges of the baby’s diaper folded down below the navel will help to keep the area dry. When the cord falls off, usually within ten days to two weeks after the baby’s birth, it is not unusual for a few drops of blood to be left on the navel. No bandage, binding, or tape is required. If the umbilicus doesn’t dry up in a few days after the cord comes off, an umbilical granuloma may be present. This is a little nubbin of tissue in the umbilicus at the junction of the old cord and the new skin. Your doctor can remedy the situation easily at the baby’s first checkup. If there is much bleeding or a foul odor coming from the cord, consult your doctor earlier for any special instructions needed.

For a sponge bath, you will need a warm, draft free room, a basin of lukewarm water, and two big towels-one to bathe the baby on, and the other to wrap him in after the bath. If your baby cries when totally undressed, give him a bath in stages, removing only part of the clothing at one time. Many babies love the feeling of being totally naked, though and enjoy waving their arms and legs about freely. You don’t really need soap for a newborn, some parents don’t use it for several months. If you can’t bring yourself from skipping it altogether, use very little because soap will dry up your baby’s delicate skin. Ordinary scented soap may trigger an allergic reaction, and it will disguise the wonderful “baby smell” that lets everyone in the house know that an infant is present.

Infants do not need to be bathed every day. The diaper area is of course, cleaned frequently, and two or three full baths a week are sufficient.

* Hospitals and doctors vary on this. For some it is optional; others believe every woman and baby should have it. You will need to investigate the policies in your area.

It’s almost certain that every parent trying to find a good day care situation has thought of the sexual abuse that has been reported in the media. How do you know that you are leaving your child in a safe place and what are the different options?

Breastfeeding can be a problem of convenience, though for some working women who are adaptable and willing to experiment, it is possible to have the best of both worlds-working and nursing. Your success will depend on your working conditions, your day care arrangements, your milk supply, and other factors. The tiniest of babies can be incredibly flexible, and you may be able to nurse the baby in the evenings and on the weekends when you are at home and have your caregiver feed the baby bottles of formula or your expressed breast milk. Your breast milk can be safely stored by refrigerating it for up to twenty-four hours or freezing it for two weeks. An occasional woman is lucky enough to find as a caregiver a nursing mother who will feed her infant charge as well as her own baby.

First, consider your child’s needs. Some centers may expect your child to play quietly all day, others may provide a pre-school atmosphere with structured activities. Consider how many children will be there during the day, large groups may not work well for a shy, easily “lost” child. The point here is that the “ideal” daycare situation will be different for each child. One one-year old may be ready for a structured pre-school type day care center, while another may be much happier staying with a neighbor.

Consider your needs. What hours will you need care, and what location will be the most convenient? And don’t forget to consider how much you can afford.

The most difficult problem is leaving a baby only a few weeks old is that of finding adequate care for him of her while you are gone. Most new mothers who return to work leave their babies with trusted and competent relatives. If you do not have family members who can provide this care, you my have trouble finding a sitter or day care center that will accept responsibility for such a young baby, and charges will probably be higher than they would for an older baby.

Learn to save your strength as you care for your twins [or any baby] by lifting them as seldom as possible, and when you do lift them, by using the muscles in your legs instead of those in your back. When they can crawl or walk, save steps by letting them come to you for playing and loving as you sit on the floor. Childproof your home very carefully, two inquisitive little people will find more than twice as many things to get into as one.

It’s wise to prepare yourself for strong jealousy of your twins among other children, both older and younger. Twins receive a great deal of admiration and attention from outsiders, they take more of their parent’s time, and they are so often so devoted to each other that they shun other children. On the other hand, many twins wish they were singletons. They tire of always having to contend with a sibling of the same age who receives the s me treatment.

That is one reason you will continue to treat your twins as individuals. Provide two birthday cakes. Don’t always dress them alike. Encourage them to have different interests. Don’t use nicknames that marks them as twins ["Pete and Repeat" for example] and try to discourage others from doing so.

Make a point of not worrying about your twins’ development in comparison with other children their age. If they were born prematurely, think of them in terms of their gestational age-their expected birth date-rather than their chronological age. They may be so content with each other’s company that they aren’t in a hurry to move from one stage to another. Twins often develop their own special language, which only they can speak and understand; discourage this by speaking to one twin at a time and waiting for him or her to answer.

Whenever your child is ill, your observations of what’s going on are very important. When you are assessing your child’s illness, you’re really looking at two different things-signs and symptoms. These terms have specific meanings to your doctor.

A symptom is something a patient complains about. A sign is something the doctor [or you] can see, measure, hear, taste or smell. So, if your child complains of her ear hurting, that’s a symptom; if she’s pulling on her ear, that’s a sign.

Signs and symptoms are indications of illness, but they are not illnesses themselves. When your doctor treats your child, he or she may treat the signs and symptoms of the illness, the illness itself, or both. For example, aspirin or acetaminophen is frequently given to a child with a fever, either may reduce the fever, but neither affects the underlying illness causing the fever. However, an antibiotic given to your child when he has an ear infection, actually helps the body to fight off the infection and, so, is treating the illness. The earache [a symptom] and the fever [a sign] will go away because the infection [the illness] is being treated.

Most of the medicines you can buy in the drugstore without a prescription treat symptoms but doesn’t treat the illness itself. So the “cold” medicine you may buy for your child doesn’t make the cold go away any more quickly, but they may make your child feel a little better.

There’s an ongoing debate about treating signs and symptoms of common illnesses. Some doctors believe that unless the signs and symptoms are severe, you’re better off not treating them. Some of the symptoms of an illness may actually be beneficial and speed recovery. Every medicine has side effects, and sometimes these can be worse than the illness itself.

Your doctor’s well-baby examination consists of many different parts, each designed to help her find certain information. You may have to watch closely to see her do each part of the exam because she probably has developed her own tricks and techniques. Some doctors like to have the baby on the examination table; others prefer that the parents hold the baby. Sometimes the doctor will be talking to you while examining your baby.

Here are some of the major areas your doctor will consider and what she looks for in each category:

• General Appearance: cleanliness, nutrition, alertness
• Skin: color, rashes. Bruises, swelling, condition of hair and nails
• Head: Shape, softness of the anterior fontanel [soft spot]
• Eyes: redness, good movement, light reflexes [checked with an instrument called an ophthalmoscope, looking for problems with the retina]
• Ears: irritation or infection of the ear canals or ear drums
• Nose: congestion, discharge
• Mouth: gums, tongue, throat, tonsils
• Neck: swelling of the thyroid or lymph nodes, mobility
• Heart: rate and rhythm, murmurs
• Lungs: breathing rate, abnormal noises, air exchange
• Abdomen: bowel sounds [normal stomach gurglings], enlarged organs or tenderness
• Genitals: In girls-normal appearance of external genitals, redness. In boys-penis [if circumcised, check that it has healed well; if not, check that foreskin is normal], both testicles are in scrotum
• Arms and Legs: normal movement and color, absence of swelling and discoloration
• Pulses: equal femoral pulse [same on both sides]
• Neurologic: tone, muscle movement and coordination, strength

As your baby grows, he will not need to be seen routinely as often as when he was an infant. Instead of every three months, most doctors see children once every six months. These visits are for the same reasons as the earlier ones-to make sure your child is growing and developing as he should and to provide you with an opportunity to ask questions. New topics will become important, although many of the old ones such as behavior and eating may need to be discussed again.

Your child’s doctor will continue to examine your child completely at each visit. These exams may become more difficult as your baby begins to resist, not wanting a stranger to touch him. This reaction is normal as your baby grows and matures. Doctors expect to see this resistance and actually become a little concerned if it isn’t present.

You may wonder how doctors can examine a screaming child and get useful information. Surprisingly, the doctor can usually find out most of what she needs to know. Some decide not to force the issue if the child is getting extremely upset, but a fair amount can be learned from a screaming baby.

As your child grows, more emphasis is put on his behavioral growth and development. Developmental milestones are still very important. Walking, talking, toilet training, and setting limits are some of the topics you should discuss with your doctor. Safety continues to be a concern because accidents are the number one killer of young children.

From your discussions with your doctor, you will know how she wants to deal with emergencies and after hour’s calls. Keep her guidelines in mind when you think about calling her. However, if you are very concerned about your child, then call. Most childhood illnesses can be handled over the phone, and the child won’t have to be seen by the doctor until morning.

Before you call your doctor, you need to gather some information and think about what information you want to get from the call. For example, if you feel your child is going to need some medicine, don’t wait to call until all the local drugstores are closed. In some communities, it’s next to impossible to get any medicines after the pharmacies are closed. It’s better to call your doctor earlier instead of later. Also, almost all illnesses seem to get worse as the night progresses, so if your child isn’t well at seven o’clock, there’s little chance that he’ll be a lot better by ten o’clock. If you are concerned, call at seven o’clock instead of ten o’clock. If you really want your child to be seen, tell the doctor right from the beginning. It’s helpful for her to know that. She will realize that all the reassurances she can give you over the phone won’t help if you really want to have your child examined. However, if you just want some advice over the phone, let her know that also. It will make her job easier.

Be sure your after hours call is really necessary. Think about what you would do if you didn’t have that information until morning. Would that delay change things? Remember that doctors have families and things they like to do besides practice medicine. Out of consideration for them and their families, all non-emergency calls should wait until office hours.

Once you have decided to make the call to your doctor, there’s some important information you should have on hand. By preparing for the call, it will be easier for you to let your doctor know exactly what’s going on. Here are some questions you should be ready to answer when you call:

What are the basic data on your child? Start with your child’s name, when he was last seen by a doctor, and who that was. This will help your doctor place your child. Tell her his age and weight, what medicines he’s taking, and what illnesses he’s had.

What’s wrong with your child? This may sound like a silly question to prepare for, but all too often a parent can’t answer it concisely. Think about your child’s problem and be prepared to describe exactly what’s going on. Things to think about include the following: What is your child eating [solids, liquids, nothing]? Is he urinating a normal amount? Is he having diarrhea? Is he acting normal? If not, what’s abnormal about his actions? Is he running a fever? If so. How high his temperature is and what method did you use to take it?

What’s happened or changed to make you decide to call the doctor now? This is an important question for you to think about. For example, your child’s temperature may have gone up a lot, or he may have suddenly begun to cry and pull at his ear, or he may just begin to vomit violently. Or perhaps you are just concerned and want some advice. If your questions can wait, your call can probably wait until morning.

What do you think is ailing your child? Often, parents know what’s wrong with their child. This is particularly true if their child has had many episodes of the same illness. For example, many parents know when their child is coming down with another ear infection. Or, if other members of the family have had a similar illness, there’s a good chance your child is getting the same thing. Let the doctor know what you think is going on.

Where do you want a prescription filled? You should decide which drugstore you want to use and make sure it’s opened and has a pharmacist on duty before you call. Have the phone number ready to give your doctor.

Doctors who take care of children expect interruptions and emergencies-they go with the age group. Most have no problems with appropriate phone calls at any hour. What irritate even the most caring physician are inappropriate calls and patients who abuse their services.

Over the years, a commonly accepted immunization schedule has evolved. Most doctors follow it, although there are some acceptable variations. The schedule is designed to give your child the maximum protection available as soon as possible. The reason some shots are not given earlier is that the child’s own defense system hasn’t matured enough to develop immunity. For example, a number of years ago, the measles, mumps, and rubella vaccine were given to infants at twelve months. It was discovered that many of these infants didn’t develop protection against these illnesses because their own defense systems weren’t able to react to the vaccine correctly. The date was changed, and now the vaccine is much more effective.

Immunization and Testing Schedule

DIP [diphtheria-tetanus-pertussis vaccine]: This immunization is given as a shot, usually in the thigh. Many children have no reaction to it. Some have swelling and redness at the injection site, as well as some fussiness.

TOPV [trivalent oral polio vaccine, also called the Sabin vaccine]: Your child is given a small amount of liquid to swallow. Side effects from this vaccine are very rare.

MMR [measles, mumps, and rubella vaccine]: This vaccine is given as a shot. Your child needs only one shot to have lifelong protection from all three viruses.

TB Test [tuberculosis test]: Some doctors feel that routine tuberculosis testing is necessary and do it on all children. Other doctors feel that this testing is not needed and do it only when they believe the child is at risk of exposure to this disease.

HiB [hemophilus influenza type B vaccine]: This relatively new vaccine protects children against developing several types of infections including one type of meningitis [infection of the coverings of the brain and spinal cord]. This meningitis is more common in children two to six years old who are exposed to a number of other children, such as in day care centers, or who stay with babysitters who care for four or more children. Although this type of meningitis isn’t common, if your two to six year old child is in day care or with a babysitter, you should discuss the HiB vaccine with your doctor.

Boosters: After your child has his childhood shots, he’s all set unless he is going to be traveling in certain foreign countries or until he turns twelve. The tetanus shot provides protection for five to ten years.

Smallpox: The immunization used to be routine, but it has been discontinued because the risk from the vaccine itself is greater than the risk of getting smallpox. This disease has almost been wiped out worldwide.

It’s often helpful to know your child’s temperature. It is sometimes an indicator of the seriousness if the illness, although this isn’t always true. A normal oral temperature is 98.6 degrees Fahrenheit. A rectal temperature is one degree higher; an axillary [armpit] is one degree lower. “Normal” means average-some people run a slightly higher or lower temperature, and that is “normal” for them. Temperature varies throughout the day; a person’s temperature is usually a little higher in the afternoon and evening.

The most accurate way to take the temperature of a young child is rectally. Any thermometer will do, although one designed for rectal use is shaped a little differently so it will go in more easily. If your child can’t keep a thermometer under her tongue and can’t keep her mouth closed for three minutes, it’s more accurate to use a rectal thermometer.

When you are taking your child’s temperature with a rectal thermometer, it’s easiest if you lay your child on her stomach. Shake down the thermometer to 96 degrees or lower and lubricate it with some petroleum jelly. After separating her buttocks with the thumb and first finger of one hand, gently insert the thermometer to a depth of about one inch. Then pinch closed her buttocks. Hold the thermometer in place for three minutes to be sure you get an accurate reading.

Taking the oral temperature of a young child may be difficult. After shaking down the thermometer, put it under her tongue. She should close her mouth around the thermometer and keep her mouth shut for three minutes. Be sure she hasn’t drunk anything cold within fifteen to thirty minutes before you take her temperature [if she has, the reading will be artificially low].

Axillary temperatures are not very accurate. The same applies to the strips that are held against a child’s forehead.

The new electronic thermometers are accurate and much easier to use than the older, glass ones. They are quicker and easier to read, and they signal you when they have reached their final reading.

There’s nothing scarier for a new parent than a sick baby. Your infant is fussy, not eating well, and has a fever. Should you take her to the hospital? Should you call your doctor? Or are you overreacting? As a well-informed parent, you want to know what you should do-when to be concerned and when not to worry. You want to know when to call the doctor and what to tell him. That’s what this section is all about.

What You Need to Know

All parents need to learn to tell when their child is sick, when to seek professional help, what to do in emergencies, and how to give medicines. Once you know these facts, you will be able to make the best decisions
One of the best ways to deal with illness is to be prepared. This includes knowing about common childhood illnesses and emergency measures, as well as having and knowing how to give the appropriate medicines. There are some general steps you should take to prepare yourself for illness or accident:

• Know the telephone numbers of your doctor, the hospital you use, the local poison control center, the fire department, and the ambulance service. These numbers should be posted near the telephone. Make sure your babysitters know where these numbers are located.
• Ask your doctor what he wants you to have on hand for emergencies and treatment of common ailments. Many doctors recommend that you have syrup of ipecac and activated charcoal on hand for poisonings. Some want their patients to keep certain common medicines on hand for late night illnesses.
• Discuss with your doctor what you should do in case of an emergency. If your child eats a bottle of pills or drinks a poison, should you call your doctor, the local emergency room, the poison control center? [Most doctors recommend you call the poison center, first.] If your child is injured, should you call your doctor first, or take your child to the emergency room? Asking these questions before an accident occurs will make things easier for both of you.
• Read about childhood illnesses and accidents. Books will help you be prepared for the inevitable illnesses and injuries that befall all children.
• Take a first aid course and learn CPR [cardiopulmonary resuscitation] and the Heimlich maneuver [for choking]. Be sure the instruction pertains to both children and adults [many courses only deal with adults]. Taking a class on these topics is much better than just reading about them. In the classes you have the opportunity to practice these skills on specially constructed models that are very life-like.
• Most important, in an emergency, DON’T PANIC! Your calmness is essential if you’re going to react properly to the situation and get your child the appropriate care.

An important part of most baby visits is immunizations. They are designed to lessen the chance that your baby comes down with certain diseases. There was a time, not too long ago that many babies died of infections. Now we can prevent many of these killers with immunizations. It’s rare to see a child with polio, diphtheria, pertussis [whooping cough] these days, although there’s been more whooping cough recently since fewer parents are protecting their children. The number of people, both children and adults, who get rubella [German measles], has declined drastically since immunization became common.

If immunizations are so beneficial, why has there been such an outcry against them recently, particularly the one against pertussis? There has been much publicity about some of the adverse side-effects of this vaccine. These side effects may be very serious. They include severe neurological damage and mental retardation.

There are two important perspectives from which to consider the risks of immunizations: the risks of having the vaccine and the risks of not having the vaccine. From the first perspective we consider the risk/benefit ratio-that is, the relationship between the risk of a possible negative outcome and the benefit of the favorable outcome. For example, if one of every 100,000 children given a certain immunization died or suffered a serious side-effect, that is certainly one child too many. However, if we consider that 99,999 of the 100,000 children did not die but instead developed immunity to a deadly disease, the relative risk foe any individual child is very small indeed.

From the second perspective, we consider the risk of no treatment-that is, we ask if the risk of getting the vaccine is greater than the risk of getting the disease. For example, if one of every 100,000 children who get the vaccine suffers a serious side-effect, it might seem like an unnecessary risk to take. However, if one hundred of every 100,000 children who did not get the vaccine suffered permanent damage or even die because of the disease, then clearly the risk of no treatment is one hundred times greater than the risk of treatment.

The figures used are merely used for purpose of illustration, but the principles involved are important considerations when you are deciding whether to have your baby immunized against diseases. The benefits to be reaped from immunization are great, but there is always some degree of risk. Researchers are at work at further reducing the risks involved with some vaccines. Ask your physician her opinion of currently available vaccines.

Fever in a child strikes fear in the hearts of many parents. They wonder if their child will have a seizure and develop epilepsy, or if the temperature will go high enough to “cook” their child’s brain and cause permanent damage. You may be concerned about the proper way to treat your child’s fever and when you should call your doctor. Fever is perhaps the most misunderstood sign in all of medicine. It’s the body’s normal response to infection.

Everyone has an “internal thermostat’ that controls his body temperature. When an infection is present certain chemicals are released in the body that “reset” the thermostat to a higher setting. This helps to explain the chills your child may experience when his temperature is going up. He feels cold because his body wants to be a higher temperature. Once the fever breaks, he feels hot because his body wants to be at a lower temperature. The breaking of the fever means that his internal thermostat has been turned down to normal.

Understanding how a fever occurs helps you treat the chills and sweats that often accompany an illness. When your child has the chills, it’s best to add some blankets until he feels comfortable. Similarly, when he begins to sweat and feels warm, you should take off clothes or blankets. Bundling him up when he feels warm is defeating what the body is trying to do.

Doctors like to see infants at regular intervals to monitor their growth, development, and health. These visits are important because if any health problem is developing, it’s best to find it early and treat it appropriately. Although your doctor may have a slightly different schedule of visits, most infants are seen when they are two, four, six, nine, twelve, fifteen, eighteen, twenty-four, thirty, and thirty-six months old.

At each visit, your doctor will examine your undressed baby completely. He will ask you questions about your baby’s behavior and development. He’ll be looking for certain developmental milestones-things babies are usually doing at certain ages. These milestones are only guidelines, but if a baby consistently fails to meet them by certain ages, further investigation needs to be done.

During your baby’s first three years of life, she will see the doctor a number of times. These visits are important to make sure she is growing and developing appropriately. Your doctor will ask you a number of questions to see how things are going, and he will examine your baby, checking for normal growth and looking for problems. Routine and regular checkups are particularly important for you r baby during her first three years of life. Problems at this age, if not treated early, may have serious implications for her later in life.

The first time your baby’s doctor sees her will be within twenty-four hours after her birth. The doctor will do a complete examination of the baby and will want to talk to you about your pregnancy, labor and delivery. If you smoked, took any drugs, [prescribed or "recreational"], or drank much alcohol, you need to tell this to the doctor. These factors may affect your baby’s health or growth. The doctor will examine your baby daily while she’s in the hospital and also talk to you. These visits to you are important. Not only will you find out how your baby is doing, but you will have an opportunity to ask questions. Prepare for these visits; write down your questions ahead of time. Your doctor will give you advice on taking care of your new baby, such as feeding instructions and safety ideas.
One of the most important office visits is the first one. Most doctors like to see the baby when she is two to three weeks old. During her first month, the baby will change a lot. You will have many questions and concerns about your new baby, and this visit gives you the opportunity to ask them.

The doctor’s staff will probably ask you some questions before you see the doctor. How is the baby feeding? Is she sleeping well? Are there any problems with her bowels? Are there any skin problems? These are just a few of the questions you may be asked. They will also measure the baby’s weight, head circumference, [the distance around her head], and body length. These measurements are important for monitoring your baby’s growth. Each will be plotted on a growth chart. These charts are the best way to determine if your baby is growing well.

When you see the doctor, he will go over all this information and ask more questions if needed. Next comes the examination of your baby. Your baby should be completely undressed for this examination. The doctor will begin the examination at the top of her head and go to the tips of the toes, examining everything in between.

After examining your baby, he’ll tell you his findings and if there are any problems. Rarely are there any surprises found at this visit, although occasionally a congenital abnormality [a birth defect] is found that was not apparent when the baby was in the hospital. At this age, no immunizations are given.

Two relatively new health care practitioners are seeing more and more children. These are nurse practitioners and physician’s assistants-often collectively referred to as physician extenders. Nurse practitioners are registered nurses who take one or two tears of further training in physical examination, diagnosis, and prescribing medicines. Many work with physicians, although a number of them practice by themselves. Physician’s assistants graduate from a two year program in which they learn the same things as the nurse practitioner.

Many physicians employ a physician extender who sees patients in the office. Frequently, they see children for routine health care. They can spend more time talking with you, answering your questions, and teaching you what you need to know. Most often the charge is the same whether you see the physician extender or the doctor.

When you go for the “get acquainted visit” before your baby is born, you should bring with you a list of questions. The doctor’s answers to your questions are important and you should make notes. Follow up on any answers you don’t understand. Be aware of the doctor’s style and how he answers the questions.

Here is a list of some questions you should ask:

• What hospitals do you use/ you may want to be sure the doctor uses the hospital you prefer. Does he have a preference for a hospital far from your home? If so, find out why. Perhaps that hospital offers special services or has a different approach to taking care of children.
• What hours is your office open? With medicine becoming more competitive, doctors are doing more to attract and keep patients. This includes offering evening and Saturday office hours. If a doctor’s office hours are inconvenient for your family, you may want to find another doctor.
• What services do you provide in your office? Many doctors’ now provide a number of services in their offices to make things easier for you. For example, they may perform many laboratory tests there, or take blood samples that need to be sent out to a laboratory for special tests. Many doctors perform hearing and vision tests in their offices. The more done in the office, the fewer places you may have to take your child.
• What should I do if my child is sick at night or on the weekend and I can’t reach you? Most doctors arrange to have other physicians “cover” for them [take care of their patients] when they are not working or out of town. Be sure the doctor has such a system. Find out who the covering doctors are because you may have to deal with them. Be wary of a doctor who tells you to take your sick child to the emergency room when he’s not around.
• How do I fit in to the care of my child? Some doctors want parents to active participants in the medical care of their children. Other doctors want to be completely in charge and make all the decisions without input from parents. You need to know the doctor’s feelings in this area. If they conflict with yours, the doctor probably isn’t right for you.
• How do you feel about patient education? In this day of increasing medical awareness by parents, most doctors encourage parental education. However, there are still some doctors who buck this trend, believing that a little learning is a dangerous thing.
• What are your feelings on “routine” medical care? There is a controversy about some aspects of pediatric care [for example, routine immunizations and circumcisions]. Is this doctor dogmatic in his approach? Is his way the only right way? If you have strong feelings about your child’s care, such an approach may lead to conflict.
• What are your fees? This used to be a difficult question, one that both parents and doctors avoided, but this is changing. There are large differences in what doctors’ charge for the same services. Get a price list for the routine things like well-baby examinations.
• What type of training did you receive? Any doctor should be willing to tell you about his training-medical school, residency, and any special training. Don’t be impressed by a wall full of fancy diplomas. In and of themselves, they may not mean much. Almost every medical organization sends out diplomas, and many don’t signify much except the doctor paid his dues. The competence of the physician isn’t measured by the number of diplomas and certificates he has. It is, however, a good idea to ask him if he is board certified-that is, if he has demonstrated by completion of certain requirements and passage of an examination competency in his specialty.

After you have made your visits, talk to some of your friends. Find out whom they use and why. Ask them the questions you asked the doctor [especially about service and availability], and see if you get the same answers.

When you have all this information, you will be in a position to make an educated decision. Once you decide, let the doctor know. Find out if there’s any information her office needs to know about you. If your children have records with another doctor, arrange for them to be sent.

After all this work, there’s still a chance you’ll decide, after a few visits, that your new doctor isn’t what you expected. You should discus this with her. Try to explain why you aren’t satisfied. Maybe there’s a misunderstanding that’s easy to correct. Your doctor’s reaction to what you say is important. If she gets mad or rude, you should look for another doctor. Don’t feel obligated to stick with her if you don’t agree with her on some important matter, like her approach, treatment, or fees.

When you change doctors, you should get your child’s old medical records. This is easy to do. Just send a note to his former doctor asking that his records be sent to the new doctor. Physicians will do this as a service to all patients. Most states require doctors to do this. The law says the contents of the records belong to the patient even though the actual records belong to the physician. When you send your request, be sure to sign it. Without a signature, the records cannot be sent.

There are two different specialists that take of babies-family practitioners and pediatricians. Both have completed a residency [extra training after graduating from medical school]. A family practitioner’s training covers all areas of medicine including adult medicine, pediatrics, obstetrics, and surgery. A pediatrician’s residency is focused primarily on pediatrics. He has spent more time dealing with ill children and children with special problems. A family practitioner will take care of your entire family-from the very young to the very old. Most family practitioners encourage this. They find it easier to treat an individual if they know the whole family. Family practitioners frequently are better able to deal with emotional or family problems that affect everyone in the household… A pediatrician takes care of children exclusively. Usually they stop seeing a child when he is in his mid teens.

Both kinds of specialists can take care of normal children equally well, however, if your child ha special problems, a pediatrician may be better.

One of the most important decisions you’ll make about your baby’s health is selecting his doctor. Finding the right doctor isn’t easy. There are many questions that must be asked and answered before you make the selection. It’s important to find a doctor you feel comfortable with-someone whom you can talk to and who’ll answer your questions to your satisfaction. The doctor’s style must be right for you!

You should meet with several doctors before you have your baby. This will give you an opportunity to find out what they are like-their style, their approach, their fees, and so forth. Most doctors encourage this and don’t charge for it.

Recovery time is very individualized. It depends on what kind of shape you were in before and during pregnancy, in addition to how much effort, effort, time, and planning you are now willing to give to your body. If your abdominals were strong and if you exercised them regularly before and throughout pregnancy, one to two months-at the most, three months-should see you back to normal.

On the other hand, if your abdominals were not strong and you did not exercise them regularly, then it will probably take between six and twelve months of regular exercise to become a better you. [These time frames assume that you are performing abdominal exercises four to six days a week.

What if you took up regular exercise for the first time in your life during pregnancy? This does give you something of a head start. However, the advancing growth of the baby did not allow as adequate workout of the abdominals as if you had also exercised before pregnancy. In this case, the return of strong, firm abdominals should take between three and six months [which is still much faster than someone who neglected to exercise in pregnancy].

If you never put into action your resolve to re-strengthen your abdominal wall, there is no telling how long the process will take. In fact, some women’s abdominals never return to their original shape. The truth is that it takes action on your part to improve your figure. A slack set of abdominals will probably mean you will have a lot of backache and fatigue.

The abdominals do forty percent of the work involved in supporting the trunk of your body as you move through your daily activities. If they are doing only ten percent, the back muscles will pick up the food-or attempt to anyway. The back muscles are responsible for sixty percent of the work of keeping the body upright and helping to lift, move and bend. Increase that workload by ten to thirty percent and the muscles respond by fatiguing faster ["tired back"], and by having painful spasms, especially in the lower back. Sometimes the back muscles become so tight that the angle of the normal pelvic tilt is changed. These tight muscles squeeze or press on the nerves coming off the spine in the lower back area. These nerves, in turn, divide and branch out to each leg. Pain may be felt in the lower back, one or both buttocks, and one or both legs, [upper or full length]. Don’t allow this problem to decrease the joy of those first beautiful months with your new baby.

Other factors to consider is estimating recovery time and how much weight you gained and how much your abdominal wall expanded [partially due to the size of the baby and how you carried the child]. Diet, the amount of rest you are currently getting, and the types of activities you’re involved in must also be considered.

After delivery, the abdominal muscles are always loose and soft. The abdomen looks and feels like gelatin, which can be quite a shock. It is important to check the linea alba between the rectus muscles for separation, called diastasis. The opening between the muscles may be slight or so large that the uterus or abdominal contents can be felt bulging through the opening.

Since there must be a good balance between back and abdominal muscles, a large diastasis will eventually cause backaches [and possibly radiating leg pain] jut from moving through the normal day’s activities of caring for an infant or managing a full-time job at or away from home. If no corrective attempts are made to close the opening, reestablishing muscle balance and strength, there will be little support for a subsequent pregnancy. Posture will be poor and many aches and pains will develop, all from lack of abdominal strength.

Check for diastasis on the third or fourth day after delivery. Until this time the area will feel too slack for you to get an indication of the state of the abdominals. Also, you will have had a few days worth of abdominal exercises to help improve your strength.

To check:

1. Lie on your back, with your bent. Place the fingers of one hand on your abdomen covering your navel [your fingers should point toward your pubic bone]. Apply firm pressure…
2. Inhale deeply. Then exhale slowly and at the same time lift your head and neck slowly. As you lift, you’ll feel each of the rectus muscles tighten and pull toward the center [toward your fingers].
3. Check to see how many fingers will fit in the gap. One or two finger widths are normal and to be expected, this will gradually decrease with exercise. Three or four finger widths will require special attention from you to repair and rebalance the muscles.
   Don’t hesitate to ask for help from a nurse [preferably a registered nurse] or your physician if you have difficulty checking your abdominals.

The following special exercise is very effective for closing a large diastasis. Raising just the head in this exercise ensures that only the rectus muscle will be activated. As they become stronger you will be able to lift your shoulders, thus working the other abdominal muscles, also, it is important to strengthen the rectus muscles first, thus ensuring their stabilization and alignment as the other muscles come into play.

Repeat this special exercise often, at least fifty times a day. To speed progress, do ten each hour you are awake. Remember to use slow, controlled movements, resting whenever you feel the need. The gap should be back to the normal half an inch within a week or so. If you do fewer repetitions than those recommended above, closing the gap will take longer.

Because the other abdominal muscles are attached to the rectus muscles and because the abdominals in general are week and out of balance, avoid the following exercises, which will serve only to increase the diastasis: [1] those rotating the trunk of the body. ["Waist twists"], [2] those twisting the hips, and, [3] those that cause the trunk to bend to the side ["waist or side stretches"].

If you breathe out while raising your head and shoulders, the intra-abdominal pressure will not be increased [as it would be if you held your breath.] Increased intra-abdominal pressure would just increase the diastasis which would defeat the whole purpose of the exercise and just add time to the muscle rehabilitation.

Do not let the abdominal muscles bulge. Tighten your abdomen at any time you strain.

Do at least fifty times a day.

1. Lie on your back with knees bent. Close your hands over the abdominal area so you will be able to pull the muscles toward the center of the abdomen as you slowly raise your head.
2. Take a deep breath. As you slowly exhale, lift your head [and later your shoulders, to a forty-five degree angle], at the same time pulling the muscles together with your hands. Return your head [and shoulders] to the bed or floor.

Much literature has been written on the benefits of aerobic exercise. The benefits we are most concerned with here are those specifically dealing with a new mother. Those benefits are increasing stamina and endurance-the ability to do more but feel les tired-and decreasing body fat.

Decreasing Body Fat

After delivery and with exercise, your body will slowly begin losing some of stored fat it laid down during pregnancy. How much you accumulated during the nine months depended on your percentage of body fat going into the pregnancy and the kinds and amounts of foods you ate during pregnancy. The leaner your body was, the less likely it is that you laid down large fat stores. Hereditary factors also come into play.

After delivery, the fat stores will gradually decrease over a period of four to six months. There are no miraculous changes that occur within the first six weeks, as many sources lead you to believe. You may notice a difference in your body during the first two weeks after delivery, when much of the accumulated pregnancy related fluids is lost through urination. After that, it’s up to you.

Breastfeeding women initially lose weight faster than women who bottle feed. However, because of the hormonal factors in operation throughout breastfeeding, their body fat level remains slightly higher, their breast tissue weighs more, and they retain a small amount of extra fluid beneath their skin as a reserve. As a result, breastfeeding women tend to weigh about three to seven pounds than their pre-pregnancy weight during breastfeeding, regardless of efforts of losing weight. Having taken that fact into consideration, if you still don’t seem to be losing the weight you expected to lose, take a good look at your diet and calorie intake. A diet with excessive amounts of sweets and fats will not help you return to your pre-pregnancy weight easily. Check with your physician if planning a reducing diet while breastfeeding: many breastfeeding women can lose weight on seventeen hundred to eighteen hundred calories a day and still maintain a good milk supply; others must have two-thousand calories a day to maintain an adequate milk supply. Making milk itself takes up lots of energy [hence, uses up calories]. Add aerobic activity for twenty to thirty minutes a day, five or six days a week and you will lose weight.

Breastfeeding should not be seen as an impediment to recovering your pre-pregnancy figure-or as an excuse for not trying. On the other hand, don’t let the fear of extra weight gain keep you from breastfeeding in the first place. The few pounds of weight that can be attributed to breastfeeding will be with you temporarily; the benefits of breastfeeding will be with you forever.

Remember, it may take four to six months for your body fat to start dropping. A daily nudge with aerobic exercises will start things happening. Be patient. Many answers still lie ahead of us as more and more studies are being done to help us understand the mechanisms of the body that just gave birth to new life. One thing is absolutely certain: having a new baby is not an excuse for looking or feeling out of shape.

Reverse Sit-Up

Start with five and increase gradually.

1. Lie on back with knees bent and arms at sides, palms down.
2. Keeping knees bent, raise legs until knees are past level of breasts or above face. Raise buttocks toward upper body. Head and shoulders stay flat.
3. Return to starting position and repeat.

Note: You may notice a tendency to press down or grip the floor with the hands, or you may feel a strain in the neck or upper shoulders as you attempt to reach the desired height with the knees. This will disappear as you become stronger and more relaxed with the movement. [Remember to breathe with this exercise]
This exercise works the lower fibers of the rectus muscles as well as the external obliques. To work the horizontal fibers you should also perform the reverse trunk twists.

Reverse Trunk Twists

Start with five and increase gradually.

1. Lie on back with arms out at sides with legs raised ninety degrees from the floor. With knees bent slightly.
2. Lower legs to right and touch floor with outside of foot. Shoulders and arms must remain on floor at all times.
3. Return to starting position and repeat, alternating sides on each repetition. [After a time, you will probably notice increased flexibility of your midsection while performing this exercise.]

Advanced action:

Begin with same starting position, but with legs straight out. Legs should remain straight as they are lowered to side. Be sure to press your back to the floor as you come toward the center each time.

Note: If your shoulders come off the floor as you drop your legs to the side, have someone hold them down. This person should be on all fours with his or her hands on your shoulder joints [not the neck area], arms straight and shoulders directly above yours. As flexibility and strength increase, you will not need assistance.

On the advanced exercise, if you have difficulty in keeping the legs straight because of tight hamstring muscles bend your knees slightly but keep the legs together. The more the knees are bent, the easier it is to do this exercise. Doing it in the straight-leg position is the most effective so try to work up to it.

The reverse trunk twist works all portions of the external and internal obliques, tightening the front and sides of the abdominal wall much more than any other abdominal exercise. This exercise also strengthens the spine because it uses the small muscles-both the deep and the surface muscles-that hold the bony vertebrae together and twist the spine. Strengthening these muscles will ease the typical overuse backache and may help prevent injuries that occur when quick twisting movements are executed.

The U-Seat

Start with five and increase gradually to a maximum of twenty.

1. Lie on back with arms behind head, knees bent and feet on the floor.
2. At the same time, raise head and begin raising knees towards chest. As the head and knees are in motion, begin raising shoulders and buttocks off floor. Continue both actions and try to touch knees to chest. At the end of these movements, your pelvis and upper body should be off the floor. Do not push head and neck forward with hands-simply rest head in hands, letting the shoulders do the work.
3. Return to starting position and repeat.

Note: Knees should be brought up quickly but smoothly using the abdominals to develop momentum, this action makes it easier to raise the pelvis. Think of it as two steps [1] raise head and knees, then [2] raise shoulders and buttocks. This timing allows for proper coordination and smooth movement between pelvis and chest.

When performed correctly and smoothly, the U-seat exercise maximally involves both the upper and lower portions of your abdominals.

Once you have completed the appropriate exercises for after your type of delivery, gradually replace the post-delivery exercises with the ones you did during pregnancy. These exercises also work all the muscle groups that are important during the postpartum period, with no muscle or joint strain. The pelvic rock, which can now be done while lying on your back with your knees bent, will improve your posture and ease back strain. It is wonderful for working buttocks, abdominal and pelvic floor muscles all at the same time, and provides a great back stretch. Remember to do it slowly with control and gradually increase the time you hold the tilt.

Begin with the first eight exercises for Strengthening Exercises for Pregnancy & after Delivery. When you feel comfortable with these, gradually increase the repetitions, and then add the remaining four exercises. Gradually increases your repetitions with these also, letting comfort be your guide. Don’t rush through them. Be sure to warm up [walk or march in place for three to five minutes] and then stretch for five minutes before beginning any floor exercise. Turn on music with a strong, regular beat. Music will help you move smoothly, make time pass quickly, and add an element of fun.

Extra Help

The following exercises are good for a stubborn protruding abdominal wall [potbelly].Because the rectus muscles are long, vertical muscles that run from the breastbone to the pubic bone, you need to have exercises that cause action at both ends of them. To shape and to strengthen these muscles, at least two exercises must be performed. Reverse sit-ups and reverse trunk-twists. The reverse sit-ups can be alternated with the U-seat, or all three can be done at each session. For all these exercises begin with five of each and gradually increase the repetitions as you get stronger. The key to success is controlled movements, with no “sling and fling” moves.

 

Warm-up Stretch

 Walk

Cool-down Stretch

Weeks 1 & 2

5 - 10 Minutes

5 minutes slowly

15 minutes briskly

5 minutes slowly

5 - 10 Minutes

Weeks 3 & 4

5 - 10 Minutes

5 minutes slowly

30 minutes briskly

5 minutes slowly

5 - 10 Minutes

Weeks 5 & Onward

5 - 10 Minutes

5 minutes slowly

45 minutes briskly

5 minutes slowly

5 - 10 Minutes

• Remember: Walk with your pulse in your target zone.
• Never exercise to exhaustion. End your workout at the point at which you feel you could go on for another ten minutes.
• After delivery, start at Week 1 Listen to your body-it will tell you how fast to progress.

Women often say, “I already walk a lot just caring for the baby, and I’m very tired. The last thing I want to do if I have some spare time is walk-I just want to sit down and relax or nap!” But walking while caring for the baby is a lot of stop and start movements, never really going very far from one place to another. What is needed is slow, steady, rhythmic movement for a period of five to fifteen minutes uninterrupted. This kind of activity, after you get over the initial tiredness of doing it for the first few times, will actually give you energy and release you from being tired and sluggish.

When to Begin or Resume Aerobic Exercise

This depends on a number of factors, such as how fit you were before giving birth, whether delivery was vaginal or abdominal, whether there were any complications, how much sleep you are getting, and what your emotional reaction is to the birth was.[Some women take, days, weeks, or even months to work through unexpected or unpleasant birth related events. They may feel sad, angry, or depressed. Emotional factors may sometimes prevent women from taking hold of her situation and following through with desired action].

General guidelines are as follows: If a woman exercised regularly for eight to twelve weeks before delivery, she can safely resume moderate aerobic exercise ten to fourteen days after an uncomplicated vaginal delivery, or approximately twenty-one days after a cesarean delivery. If a woman had a high fitness level before pregnancy and exercised regularly all through pregnancy, she will probably find it comfortable to begin short, brisk walks during the first week after a vaginal delivery, or after the second week after a cesarean delivery.

Whatever aerobic activity you choose to begin with, be sure to monitor your pulse; work at about sixty percent of your SHR for the first few weeks. Do not start a level of seventy to seventy-five percent. Remember that you have just had a baby [and if by cesarean, major surgery as well]. Remember also, that you are almost certainly getting less sleep than usual. Start your exercise program at sixty percent and work gradually to seventy-five. If you are new to exercise, take twelve weeks to make this transition. To develop stamina and endurance and to retrain your body to burn fat as fuel, you never need to work at a pulse rate higher than eighty percent of your SHR. The old “no pain, no gain” slogan is not true-pacing, regularly, and persistence are the keys to successful exercise.

The very best guideline for resuming aerobic exercise is to tune into your body. And remember, never exercise to exhaustion. If you find yourself tiring, slow down and stop. End your workout at the point at which you could go another ten minutes. Learn to pace yourself.

This is the time to think about joining [or rejoining] an exercise class. A pregnancy/new mother class is ideal. You have the support, advice, and caring of women in your same life situation. Although you may not do all the exercises in the class during your first weeks of attendance, getting out of the house, forcing your self to be organized, being with other mothers, and being in a formal class can do you wonders, beyond the benefits of the exercises themselves.

Begin the day of delivery [as soon as you return from the recovery room]. Do them in bed. Perform them until you are up on a regular basis.

Deep Breathing

Five times every hour you are awake.

1. Breathe slowly and deeply to expand the upper, middle, and lower portions of your chest.

Huffing

Two or three times every hour you are awake.

This is especially important if you had general [gas] anesthesia. In response to the anesthetic, the lungs produce mucus, if which not removed, can clog the small air sacs and breathing tubes of the lungs. “Huffing” should be used instead of coughing.

Here’s how:

A huff is a quick outward breath. It is like saying “ha”-a short, quick breath, with force from the abdominal muscles. The outward breath must be done quickly. Otherwise the force is not sufficient enough to dislodge any mucus. Spit out the mucous you cough up, don’t swallow it.

If huffing still doesn’t bring up any mucous and you still hear a rattle in the chest, try deep breathing again to loosen it.

With huffing, the abdominal wall is pulled in instead of out; therefore, huffing is more comfortable than deep breathing. Still, you may want to support the abdominal wall with your hands or a pillow. Be reassured that the stitches will not be pulled out.

Foot Exercise

Five times every hour that you are awake.

1. Do five ankle circles to the right and five ankle circles to the left. Make them slow and big. Repeat with the other ankle.
2. Slowly point and flex the foot. Repeat with the other foot.

Pelvic Floor Squeeze

Twenty a day, moving toward sixty, in sets of three or four. Begin when the catheter is removed.

1. Lie or sit [later you will be able to stand] comfortably with the legs apart. [The farther the legs are apart, the more challenging.]
2. Thinking about the vagina and perineum. Tighten the pelvic floor as if to lift the internal organs or to stop urination in midstream. Hold as tightly as possible for a slow count of three [gradually work up to a count of ten]. Be sure to breathe.
3. Relax completely.
4. Note: Because these muscles fatigue easily, repeat in sets of three or four squeezes throughout the day, anytime, anywhere.

Concentrate on the sensations of tension and lifting, relaxing and lowering within the pelvis.

Leg Squeeze

Three times every hour you are awake.

1. Lie on back with one leg bent and the other leg straight with the foot flexed.
2. Slowly press the straight leg to the bed and tighten all the muscles in that leg, gently pulling the toes toward the face.
3. Repeat with opposite leg.
4. With both legs straight and ankles crossed, tighten all the muscles in your legs-press knees down, tighten thigh muscles, and squeeze the buttock muscles. Hold while you slowly count to five [don't hold your breath].
5. Release.
6. Repeat.

Note: If needed, prop yourself up on pillows.

Pelvic Tilt

Three to five times every hour you are awake.

1. Lie on back with knees bent and heels close to buttocks.
2. Inhale and press your back to the bed. Hold for a slow count of five [working toward ten]. Concentrate on pressing the back to the bed by using your abdominals-do not push with the feet. For an extra benefit, squeeze your buttock muscles and the pelvic floor.
3. Relax, and then repeat.

Note; Slow, controlled movements are the key to success with this exercise. In the beginning, abdominal pain will let you do only a third or a half of this movement. That’s fine-listen to your body. Improving pelvic circulation is important-do the best you can with this movement. As your body heals more and more each day, hold the tilt longer and longer. Remember to breathe. Add a pelvic floor squeeze to.

Add on Third Day

Bend and Straighten Legs

Repeat variation A three to five times, twice a day. Using comfort as your guide, progress through variations B and C to variation D as soon as possible.

Variation A

1. Lie on back with both legs bent, feet flat on the bed.
2. Slowly straighten the right leg and bend back to place.
3. Repeat with opposite leg.

Variation B

1. Lie on back with one leg bent and the other leg straight.
2. Slide the bent leg out straight and then back to a bent knee position.
3. Repeat with the straight leg, returning to a straight leg position.

Variation C

1. Lie on back with one leg bent and the other leg straight.
2. Bend one leg as you straighten the other [Both legs are moving at the same time, slowly in opposition.]

Variation D

1. Lie on back with both legs bent.
2. Move both legs down and up at the same time.

Add on Seventh Day

Head-Up Lift

Three to five times twice a day. Add more as comfort guides you.

1. Lie flat on back with no pillows, knees bent.
2. Press back down [pelvic tilt], inhale slowly and lift just the head. Hold for a count of three.
3. Lower head and relax.

Note: Using comfort as your guide, progress to lifting head and shoulders on exhalation. Concentrate on lifting head and shoulders as a unit toward ceiling, just an inch or two of floor. Do not thrust head forward on the lift.

Begin the day of delivery, while in bed. Do them on the floor once home.

Head Curl Up

Begin with five to ten twice daily, move toward twenty.

1. Lie on back with knees bent and feet close to buttocks. Press back down. Inhale slowly and deeply.
2. Exhale slowly; at the same time lift up just the head. Hold as you complete the outward breath.
3. Relax.
4. Repeat for a total of five times.
5. Note: Do this as many times during the day as you can. Then progress to head and shoulders curl-up.

Head and Shoulders Curl-Up

Begin with five twice daily, move toward twenty.

1. Lie on the bed or floor, with knees bent and feet close to buttocks. Pres the back down and inhale slowly and deeply.
2. Exhale slowly, at the same time, lift head, and then shoulders. Hold as you complete the outward breath. Perform slowly with control [no jerky movements]. Head should stay in line with the spine, do not throw hawed forward! The “lift” comes from the shoulders and should be straight up, about six inches maximum, face toward ceiling.
3. Relax, return to starting position, and repeat.

Pelvic Floor Squeeze

Do sixty or more each day in sets of three or four.

1. Sit or stand comfortably [you can do this exercise in most positions]. The farther the legs are apart, the more challenging.
2. Thinking about the vagina and the perineum, tighten the pelvic floor as if to lift the internal organs or to stop urination in midstream. Hold as tightly as possible for a slow count of three [gradually work up to a count of ten]. Be sure to breath.
3. Relax completely.

Note: Because these muscles fatigue easily, repeat in sets of three or four squeezes throughout the day, anytime, anywhere. Concentrate on the sensations of tension and lifting, relaxing and lowering, within the pelvis.

Pelvic Tilt

Begin with ten a day and work toward twenty.

1. Lie on back, with knees bent and heels close to buttocks.
2. Inhale and press back to the floor. Hold for a slow count of five [working toward ten]. Concentrate on pressing the back to the floor by using your abdominals-do not push with the feet, for an extra benefit, squeeze your buttock muscles and the pelvic floor.
3. Relax, and then repeat.

Note: This is a wonderful stretch that will help relieve a tired or achy back.

Bend and Straighten Legs

Start with ten a day, progress to twenty. Start with Variation A. Using comfort as your guide, progress through Variation B and C to Variation D, as quickly as possible.

Variation A

1. Lie on back with both legs bent, feet flat on bed or floor.
2. Slowly straighten the right leg and bend back to place.
3. Repeat with opposite leg.

Variation B

1. Lie on back with one leg bent and the other leg straight.
2. Slide the bent leg out straight and then to a bent knee position.
3. Repeat with the straight leg, returning to a straight leg position.

Variation C

1. Lie on back with one leg bent and the other leg straight.
2. Bend one leg as you straighten the other [Both moving at the same time, slowly, in opposition].

Variation D

1. Lie on back with both legs bent.
2. Move legs down and up at the same time.

Body conditioning and toning should be started in bed, the day of delivery. The sooner you start, the sooner your body will respond with firm, toned muscles, especially pelvic floor and abdominal muscles. Follow the exercises as shown in “Exercises for immediately After a Vaginal Birth” or “Exercises for Immediately after a Cesarean Delivery,” depending on the type of delivery you had. Unless you experienced multiple complications and find yourself extremely fatigued, you can begin performing these movements as suggested.

Once you get home, don’t wait to exercise until the baby is asleep. Just lay out two blankets-one for each of you-and begin. The baby will enjoy the movement, the music and your smiles. If baby tires, she’ll drop off to sleep, whether there is music on or not. Get moving-don’t wait or waste precious hours or days!

If your physician says not to exercise for six weeks or more after delivery, show her the list of exercises you want to do. Do not just ask to “exercise”-be specific. These exercises are so gentle and safe that she will probably give her consent. If, however, your physician feels that even these exercises are inappropriate for you just yet, of course follow her advice.

The Pelvic Floor

When thinking of exercise after delivery, most new mothers think of a flat abdomen as a first priority. Actually, the pelvic floor should receive prime attention, with the abdominal muscles coming in second. Strong pelvic floor muscles ensure good support of internal organs and sphincter control [urethra, rectum, and vagina]. They also ensure pleasurable sensations during sexual intercourse for the both the woman and her partner.

After vaginal delivery, the pelvic floor may be bruised, swollen and tender. After a cesarean section, it may be lax, with loss of tone or elasticity from the weight of the baby and months of sluggish circulation. Initial attempts of tightening or “lifting up” the muscles of the pelvic floor immediately after delivery are often accompanied by surprise-you feel little or nothing! Many times, muscles have been torn or cut and nerves have been damaged. It’s no wonder there is little sensation. Perhaps too, the structure of the pelvic floor was surgically repaired. Exercise can improve all these situations by [1] alleviating discomfort [although it is uncomfortable at first to even gently squeeze those muscles] and [2] improving circulation to the area which will increase the oxygen supply, remove waste products, decrease swelling, and promote the prompt return of urine control.

If you neglect this important area, the muscles will remain stretched and loose. They will become further weakened as you resume your usual schedule. The sooner you start after delivery, the faster the muscles will respond. Waiting will only result in more time and effort being necessary than would have been required if you had started immediately after delivery. You have only benefits to gain.

The Abdominal Wall

Right after delivery, you may wonder if your stomach will ever be flat again. If you begin an exercise program early [within twenty-four hours of giving birth] and are fiercely persistent with frequent repetitions of the appropriate exercises, your stomach will indeed be flat once more.

The abdominal muscles that we feel and notice the most often are the rectus muscles. They are long, slender muscles located along the center of the abdominal wall. They run vertically from the end of the sternum [breastbone] and the lower ribs to the pubic bone. There are right and left rectus muscles, which are separated by a band of fibrous connective tissue about half an inch wide that is called the linea alba.

The internal and external oblique muscles lie on the sides of the rectus muscles. They cover the waist-a hard area to tighten even when you haven’t had a baby. The external obliques cover the front and the sides of the abdomen from the rectus muscle to the back muscles. The external obliques are attached to the ribs at the top edges and have a wide area of attachment, running from the lower eight ribs to the front surface of the pelvis and on down to the pubic bone.

The internal obliques are located directly below the external obliques. Their muscle fibers run at almost a ninety degree angle to those of the external obliques, most of them nearly horizontal. The internal obliques run from approximately the waist area down to the pubic bone.

All this may sound unnecessarily technical when you just want to have a flat belly again, but getting to know how your body is put together will enable you to understand how the exercises work and what kinds of exercises are needed to “renovate” those muscles after delivery. Getting in touch with your body and learning to listen to it are primary steps in getting started.

The lower ends of the rectus muscles go through a slit in the deep abdominal muscles before they become attached to the pubic bone. When the rectus muscles are relaxed as they are when you walk and move around, they follow a curved line; they become straight only when they contract [when you consciously and tightly hold your stomach in].

Hereditary factors come into play in the deposition of fat in the lower abdomen, even when weight is lost and body fat is at the ideal level [twenty-two to twenty-four percent for women]. Even then, because the rectus muscles are curved and become small deposits of fat are stubbornly held in that area, most women find that their “stomach” is slightly rounded.

Health and Well-Being of Mother and Baby

This postpartum period is an exhilarating, exhausting, rewarding, tearful time of discovery. Often thought of just six weeks of recovery until you are “back to normal,” the postpartum period actually extends a full three months. At the end of this twelve month cycle, the physical and psychological aspects of the new mother-body and mind-have reached a new level of adjustment. Your physical appearance, feelings, and attitudes are a direct reflection of your efforts. Your rewards can be great.

You will probably never be your “old self” or “back to normal” again. Your body underwent an enormous effort to grow and give birth to [and perhaps now feed] your new baby. But you can be on your way to a new and better self!

Rest and Relaxation

This may sound like a contradiction for the postpartum period-a time that is often associated with sleepless nights, baby blues, tears, and fatigue. Babies get hungry around the clock at two to four hour intervals-more often if they are breastfed because human milk is digested faster and more easily than cow’s milk. So mothers [and many fathers] find that they get only one or two hours sleep at one time, if that! Ongoing sleep disturbances-for days, weeks, or even months at a time-can leave you feeling cross, irritable, and depressed. When you are this tired even little problems become difficult to solve, and it’s hard to make decisions about even the smallest things. In the extreme, especially for those individuals who require more sleep than others, disorientation and confusion set in.

Yet it can be a time to tune into your body and use part of the natural scheduling of your day to release the tension. If friends or family offer help after the birth, let them take over the cooking, grocery shopping and housework. [Have them cook a little extra each time and freeze it in boilable bags. With a bit of planning and thought, you might not have to cook for a week or more after your help has left.] Your help should mother you, while you mother the baby. Continuing the relaxation techniques learned in your prepared childbirth classes is extremely important. There is less uninterrupted time for yourself, so make the most of the time you do have. During feedings take a few deep breaths and clear your mind-just enjoy this quiet time and free your body of tension. [If you're nursing, be sure to have a glass of water or juice nearby to sip, since you may get thirsty] as soon as you lay the baby down for a nap, lie down yourself; walk directly from the baby to your own bed or couch. Resist any temptation to clean up or catch up on chores or calls; otherwise, before you know it the baby will be up again and you won’t have a chance to relax.

The postpartum period is a time to reset priorities and decide what is really important to you personally. You’ll find that six months from now you won’t remember how clean your house was, or if dinner was on time, but you will remember if you were tired and frazzled or peaceful and rested, enjoying this special time.

Rest and relaxation are the complement of a fitness program-you must have both to rejuvenate your strength and vitality.

No, your cat will not suffocate your infant in the crib. The myth that says it will dates back to the days of witchcraft, when infant mortality was high and standards of hygiene were low. Someone always seemed to remember seeing a cat in the crib of a baby who subsequently died. The unfed animal was probably attracted to the crib by the smell of the milk. A cat, or any other animal, for that matter, is incapable of forming a complete seal around a baby’s mouth and nose, and so could not possibly suffocate him or her.

However, it is wise to consider the possible reactions of your dog or cat to a new baby. If you have no other children and have had your pet for some time, it is probably accustomed to being “the baby,” a valued and well loved member of the household, and may very well be jealous of a rival for your attention. The animal will most likely adjust quickly and learn to love the baby as much as it does you. You can ensure this acceptance by preparing the pet for the baby, much as you have prepared an only child. First, consider obedience training for a dog that will not obey your commands to sit, stay, and be quiet, or that cannot be kept from jumping up on people or furniture. If your dog or cat is not accustomed to children, try to arrange for it to spend some time with a baby occasionally. Speed up the process of your pet becoming acquainted with your baby by bringing home from the hospital something the baby has used so the dog or cat will get used to the unfamiliar scent. Some parents put a cloth diaper or a small blanket in the hospital bassinet with the baby to pick up this odor. And when you get home from the hospital with the baby, try to spend a few minutes alone with the pet to assure it of your love, just as you would an older child.

Of course, you don’t want even the most loving dogs or cats in your infant’s crib. If you have not been able to train your dog to stay off beds or other furniture, or if your cat shows an interest in leaping into the crib to investigate the new arrival, block the door of the baby’s room with the gate that you will be using later on to keep your baby from tumbling down the stairs or otherwise getting into dangerous trouble. This will allow you to see into the baby’s room, but will keep the pet out.

The possibility that your dog or cat will not adjust to having a baby in the house and have to be banished is remote, but the chances that your baby will be allergic to your pet. May not be. About one child in five develops allergies to one or another substance. Pollen, food, or dust may be responsible-even the bacteria that survives in your water bed-anything that can be touched, eaten, or breathe, or even the tiny particles of dog or cat hair or skin [called dander] that are suspended in the air of your house. A tendency toward allergies is often inherited, but the specific allergies, do not always take the same form in one family member as in another. For example, you yourself may be sensitive to certain foods or a plant that blooms at a certain season of the tear, but not to animals. Your child may inherit your tendency to allergies, but react, at least in infancy, only to animals.

The symptoms of allergy to animal hair are similar to those of hay fever caused by pollens of trees, grass, and other plants. You may at first confuse them with the symptoms of a cold; itchy, runny eyes and nose, a general stuffiness of the head, an ear infection or perhaps even a little wheezing in breathing. If you suspect that an allergy to your pet is causing your baby’s discomfort, see your doctor. Until something is done, the symptoms will increase and can cause sleeplessness, loss of appetite, inflammation of the eyes, ears, sinuses, throat and bronchial tubes, and perhaps even a full blown asthma attack. Unfortunately, your only solution will be to get the animal out of the house. Allergies do change as people grow older, and at some time in the future your child may outgrow this one and be able to enjoy the benefits of having a dog or cat.

Do be aware that pests, such as fleas, and even some illnesses can be transmitted from pets to children. Keep your pet clean and insect free. Wash your hands carefully after handling or cleaning up after your pet. Ask your veterinarian’s advice if your dog or cat is sick, or if there are animal illnesses prevalent to your community.

With goodwill and a sincere desire for communication, you may very well be able to take the best that your parents and other older relatives have to offer and tactfully teach them the best of what you know, without lowering your standards or sacrificing your values. First, use the many available resources to back up your opinions. We all tend to believe what we read, and women of the older generation held doctors and experts in high regard, so show Grandma the passages in books and magazines that reinforce your opinion. Quote your pediatrician to her. Share with her the literature you have from organizations such as the La Leche League (International, USA, Canada) and the National Childbirth Education Association. Tell her what you’ve learned from people whose opinion she respects-you neighbor, whose children she always admires, or your sister or sister-in-law. Sometimes simply stalling is a good technique. Thank her for her advice, and say and do nothing more about the matter. Or “forget” to try her method, or tell her you’ll probably “start soon.” With good humor and consideration, you can probably work things out with Grandma so you at least approach the ideal relationship, in which you are working together for the benefit of your child and in which the child is more important to both of you than each other’s opinions about child care are. Bear in mind that the ultimate benefits of your rapport with Grandma will go to your child, whose relationship with her is priceless.

The bottom line in dealing with Grandma or anyone else is that you are the parent, an intelligent and well informed person, and you have the right to determine what is best for your child and to raise him or her as you see fit. In the end, if you have to, you can remind these people that they chose their ways and you will choose yours. Of course, all this is easier with acquaintances or strangers, who will perhaps surprise you with their audacity in telling you what to do or asking you impertinent questions about the way you are caring for your child. You do not need to justify your actions to such people; you can avoid confrontations by simply thanking them politely for their interest and going your way.

Do be sure that you are actually being criticized before you react. Remember that the more insecure we are, the more we tend to infer criticism when none was intended, and that we all tend to overreact to situations in which our children are concerned. There are few issues important enough to force confrontations with relatives and friends.

Real jealousy will almost surely rear its ugly head sooner or later among children younger than school age. Busy and independent older ones will probably take the new arrival in stride, suffering little if at all from feelings of rejection. Very likely they will be proud to have a baby in the family. They will look upon the infant as a sort of live plaything to be loved and cuddled and shown off to their friends. The best way to help the little ones through their feelings of displacement and rejection are to show them your love in every way you can and to spend as much time alone with them as you possibly can.

Your toddler is too unsophisticated to be anything but up-front about his or her feelings; life with the interloper who makes so much noise and takes Mommy’s time is unbearable. He or she will likely ask you to take the baby back and will be frankly envious of the attention the baby is getting. You may be able to cheer up the child a little by stressing how lucky the baby is to have such a fine big brother or sister and by letting him or her help you care for and entertain the baby. This child isn’t old enough yet to have developed much feeling about right or wrong, and pinching, hitting, or sitting on the baby won’t seem a crime to him or her. You’ll need to watch the child closely and lay down a no nonsense law that the baby must not be hurt. This may be one of the rare times you choose to use strong discipline.

By the age of three, your child understands that deliberately hurting the baby is wrong. Do however, watch the pats and squeezes and hugs, they may be a bit too hard. This child may be so angry about the baby’s appearance that he or she won’t talk to you, won’t cooperate in any way. Or, he or she may be afraid to displease you by showing the anger. The child may be excessively good or fake exaggerated and unfelt love for the baby. You can admit to this child that yes, the baby can be a nuisance, bothering you when you two are reading or playing. Be careful not to give the idea that there’s any solution other than the baby’s ultimate growing up into a reasonable child.

Your preschooler will probably try to take your attention away from the baby by showing off his or her feats of strength and skill and cleverness. The child feels rejected and cannot understand what you see in this infant who can’t do anything interesting or worthwhile. A little girl may be particularly jealous of Mommy, a boy of Daddy, and each may try to take over the other parent. Feelings are strong and you will do well to acknowledge them and encourage the child to talk about them.

Your doctor may know if your community is served by a branch of the Mother of Twins Club Inc. If there is not one near you, or if you would like more information, write the national club at 12404 Princess Jeanne NE, Albuquerque NM 87112. Joining this group while you are pregnant may be the best thing you can do for yourself and your babies. After coming home from the hospital, you’ll receive the moral support of others in your situation and possibly some physical support as well. Club meetings offer speakers, workshops, and clothing and equipment exchanges, as well as social benefits. The national group publishes a quarterly newsletter and other helpful and informative literature.

The Center for the Study of Multiple Birth [333 E. Superior Street, Suite 476, Chicago Il. 60611] provides information for parents, serves as a clearinghouse for information on twin research, and operates a bookstore. If you live in Canada, you can obtain information about twins by writing to Parents of Multiple Births Association of Canada, 283 7th Avenue South, Lethbridge, Alberta, Canada T1J 1H6.

Your children will react to the actual presence of the baby in different ways, depending upon their ages and personalities. However well prepared they are, they will at first almost surely be surprised and most likely be disappointed. The baby is neither the playmate your toddler or preschooler secretly expected, in spite of your warnings to the contrary, nor the smiling, gurgling picture perfect, infant your older child probably visualized. Even the baby’s sex may be disappointing, and the fact that he or she does nothing but eat, sleep and cry-and monopolize your attention-surely will be.

Your main enemy at home will be time, especially if you have a toddler or preschooler, there’ll never be enough of it. Many mothers feel guilty of neglecting the older child, because the infant takes so much time. Psychologists tell us that underlying that guilt is anger at being torn between the two children. One way to help yourself feel better and to make your older child feel wanted is to include him or her in every possible part of care for the baby. Even a two year old can fetch a diaper from upstairs, perch on a stool beside you at the dressing table, or help you pat the baby dry after a bath. Little kids can sort the baby’s laundry, help you gently pat up a burp after a feeding, and “entertain” the baby with nursery songs and finger plays.

Let your hold the baby on a pillow, in a big chair, when you are close. If your bottle- feeding let him or her hold the bottle for a few minutes, and demonstrate the way to gently pat the baby’s cheek to see the baby’s head turn. Warn the child about the anterior fontanel [the soft, boneless spot at the top of the baby's head], but don’t be unduly alarmed if he or she touches it; it’s protected by a firm membrane. Do be sure to supervise very carefully any “help’ or playing with the baby. Be sure your child understands that he or she must never try to pick up or carry the baby. Avoid any possibility of harm to either child by putting the baby in the crib or in an infant seat inside the playpen if you have to leave the room.

Feeding time may be difficult, especially if you are nursing the baby-a time when your toddler or preschooler feels left out and is apt to show displeasure with you by getting into trouble. The feedings that come when your older child is napping or gone to bed for the night, or when someone else is in the house to provide distraction, will be the ones to which you can devote your attention entirely to the baby, providing the eye contact that is important. When your older child is present during feedings, settle yourselves on the sofa and cuddle him or her with your free arm as you read or watch television together. Or sit comfortably on the floor, with your back braced against a piece of furniture, and watch or help while the child works with puzzles, games, or coloring projects. The baby won’t suffer; your touch and the sound of your voice will be soothing.

What if your older child wants to try nursing again? It won’t hurt, if you are agreeable to the idea. The chances are that one quick try will be enough. The child won’t like the taste of your milk and probably won’t be able to suck properly.

Wanting to go back to nursing is only one of several signs of regression you might expect, and they won’t necessarily show up immediately after the baby arrives. A return to baby habits concerning toilet training, eating, sleeping talking, or dressing may be more of a sign of stress than of jealousy. Whatever the cause, your child is trying to get your attention by competing with the baby on the baby’s own level. The best way to deal with regression is to go along with it patiently and without showing anger or disappointment; it will pass. Be generous with praise with any mature behavior and reward it with grown up privileges, such as staying up a bit later than usual or going on an important errand with Daddy.