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02 Mar

20If you’re a parent of a new baby, you’re probably tired! Most new babies wake up frequently. Tiny tummies fill up and empty quickly, and babies seek comfort as they adjust from womb to world. Child development experts tend to agree that for the first 4-6 months, it’s best to wake up with your baby at night to ensure that she is fed and comforted.

The good news is that if your baby is healthy and your pediatrician gives you the okay to stop feeding her at night, you can consider sleep training.

What is Sleep Training?

Sleep training is a wide range of methods aimed at teaching your baby to fall asleep on her own at bedtime and when she wakes in the night. Before starting, see our article on creating good sleep habits, which are a common thread in all of the approaches below.

How do I Choose a Method?

To decide which method to try, think about your baby’s personality, and yours. Consider how different approaches might affect other family members, like older siblings. If you share caregiving with anyone else, talk to that person about what would work for both of you. The dynamics of every household are different, so choosing how to sleep-train your baby will be a personal decision based on what feels right for your family.

The Three Most-Common Sleep Training Approaches

While there are many sleep training methods, most of them fall into one of the categories below.

Cry It Out

Cry It Out (CIO) involves allowing your baby to cry when you put her to bed or when she wakes in the night. Supporters say it works quickly to teach babies how to self-soothe and fall asleep without needing you to intervene.

CIO might be a good fit if your baby is generally easy-going, or if sleep deprivation is negatively affecting your functioning.

Two popular proponents of CIO are Dr. Richard Ferber, author of “Solve Your Child’s Sleep”, and Dr. Marc Weissbluth, author of “Healthy Sleep Habits, Happy Child.” Ferber developed a method that guides you to respond briefly to your baby’s cries (without picking her up) at increasingly longer intervals until she falls asleep. Weissbluth advocates for a stricter CIO method involving less parental intervention.

No-Cry

No-Cry methods encourage parents to use gentle approaches to help baby sleep, and say it’s okay to respond to babies by picking up, holding, rocking or feeding them when they wake in the night. Supporters say it promotes bonding, baby’s emotional development, and a positive association with sleep.

This might be a good fit if you don’t mind waking up in the night with your baby, or you want to try the most gentle approach first.

Elizabeth Pantley, a parent educator and author of “The No-Cry Sleep Solution”, is a well-known proponent of no-cry methods. Pantley offers tips for gradually teaching your baby to self-soothe without allowing her to cry, like rocking her until she's very drowsy but not fully asleep before putting her in her crib.

In-Between Methods

“In-Between” methods are a middle ground between CIO and no-cry approaches. Parents intervene in limited, systematic ways to help baby fall asleep. Supporters of this approach say it teaches independent sleep with very little crying.

This might be a good fit if you prefer a middle-ground approach and are willing to put in some time, effort, and patience to follow the method you choose.

Kim West, a licensed clinical social worker and author of “Good Night, Sleep Tight”, suggests sitting next to your baby’s crib for a few nights, where you can offer a pat or reassuring word if she becomes upset. Every few nights, she says, move further from the crib ­to the other side of the room, then the doorway, then the hall, and so on, until your baby can fall asleep without you in the room. Tracy Hogg, nurse and author of “The Baby Whisperer” books, developed the Pick Up/Put Down method: Pick up your baby from her crib when she cries, then put her down as soon as she is calm, and repeat this until she is asleep.

No matter how you choose to sleep-train your baby, one of the most important things to remember is this: Research shows that all of these methods are effective if followed consistently. Choose one that feels right for you, and stay the course. Before long you should be seeing zzzs!

21 Feb

EatingOne of the biggest questions new parents have is when to introduce different types of solid foods. As specialists in feeding, speech and language, Integrated Children’s Therapy (ICT) has a simple approach: When your baby reaches new gross motor milestones (like sitting up, crawl-ing, or walking) that’s your cue to introduce new types of food. This is because your baby’s oral motor skills (like biting, chewing, and swallowing) develop alongside his gross motor skills. When he’s ready to do something new with his body, he’s also ready to do something new with his mouth.

Why is it important to introduce solid foods at the right times?

According to ICT co-founder Mandy Alvarez and one of their speech language pathologists, Chris Rowlee, introducing solid foods either too early or too late can lead to food aversions, obesity and other health problems, and speech-language delays. By introducing foods at the right times, you can avoid these problems and set your baby up for a lifetime of healthy eating.

Here’s more information about how three gross motor milestones relate to feeding and speech, and how you can set your baby up for success!

Sitting Up = Purees on a Spoon

Feeding

We recommend that unless your baby has a medical issue (like reflux), you stick with breast milk, formula, or a combination of the two until your baby can hold his head up and sit with little to no support. This typically occurs around 6 months of age.

As your baby begins to control his head and sit up, his larynx (voice box) lowers, his cheeks thin out, and his body becomes stronger and more mobile. All of this leads to the jaw stability and tongue movement required to eat purees from a spoon.

Speech

The body and mouth movements that develop with sitting and eating purees prepare your baby to babble. Your baby will begin to make lip sounds like “ba-ba” and “ma-ma”, and tongue sounds like“da-da”.

Extra Tip

To optimize oral motor development and encourage your baby to eat new things, try making your own pureed food. This will give the food more texture and different tastes, as store-bought purees tend to be very finely pureed and similar-tasting. We get it that this can be time consum-ing! As an alternative, try mashing up a banana or avocado and adding it to store-bought pu-rees.

Crawling = Soft Foods to Chew

Feeding

The left-right movements of crawling are also happening with your baby’s jaw, tongue and lips, so when he begins crawling he is ready for soft foods that he can bite and chew. Try pieces of cooked vegetables, soft fruits, or pasta. As a bonus, when you give your baby these foods on a tray or plate and encourage him to eat with his fingers, he is using his thumb and first fingers in what’s known as the pincer grasp. This fine motor skill will be crucial later on for skills like hold-ing utensils, crayons, and pencils.

Speech

The coordination and strength involved in biting and chewing help your baby make more com-plicated speech sounds. Babbling will now have different combinations of sounds (da-gee-da).

Extra Tip

Let your baby get messy! Imagine if someone was constantly wiping your face and hands with a wet cloth during a meal. You’d probably get turned off by the whole experience! Babies learn through curiosity, so we say let them smush food between their fingers, get it on their faces, and rub it around the tray or plate. This sends the message that eating is a pleasurable experience and encourages them to try different things.

Walking = Variety of Foods

Feeding

Walking brings in increased up-down, left-right, and side-to-side movements, which lead to a more controlled ability to bite and chew. Your baby can now begin to handle a variety of tex-tures, like harder vegetables, cubed fruits, cheese, and soft meats.

Speech

When your baby’s jaws, tongue and lips are coordinated enough for more complicated biting and chewing, more complex speech will emerge, like jargon (making sounds that imitate adult speech) and his first true words.

Extra Tip

Allow your baby to feed himself. At this stage he might become interested in using a utensil, but if not it’s okay to let him eat with his hands. It’s important for him to control both the amount of food he eats and how fast he eats it. We also encourage creative eating at this age; if he wants to scoop up food with a cracker instead of a spoon, or if he wants to use a spoon backwards, let him go for it! Babies that learn to feed themselves typically become better feeders for life.

In addition to following this approach, you can find a variety of exercises on the BabySparks app designed to help you introduce solid foods to your baby and encourage him to feed himself.


Integrated Children's Therapy is a pediatric speech and occupational therapy practice in Miami, FL. ICT provides individual and group therapy for speech, language, feeding and sensory-motor issues - all with a special emphasis on social communication development.

01 Nov

children-403582 960 720Have you heard? The American Academy of Pediatrics issued its 2016 recommendations about screen times for children. Their report makes it clear that there are long-term negative consequences for introducing screens too early or allowing kids to view them for too long. Screens includes electronic devices like smartphones, tablets, TVs, gaming consoles and other similar toys.

This group of over 64,000 pediatric professionals has reiterated its stance that entertainment screens should not be introduced before a child is 18 months old. After that, they recommend no more than one hour per day from 18 months to 5 years old, with parents actively watching with their young children to provide context.

Whoa, you say! That’s not possible – there are screens everywhere. Or, you might be thinking, I need to use screens to keep my young child quiet in public. We have all been there. This is not a guilt-inducing post – but a practical set of guidelines to help you navigate a challenging issue.


First Things First: Why Should You Care?

It’s just a little game or video time, right? Not so much. The pervasiveness of screens is increasing rapidly and, with it, research to determine the impact. For now, though, there is fairly universal agreement that too much screen time can lead to:

So that’s the bad news. Here’s the good news:

  1. It’s never too late to set guidelines for screen time. An easy option is to set a rule from the outset that screens are only for weekend use. Apple has come up with some handy tools to limit usage on iPad and iPhone that limit the need for you to be the enforcer.
  2. Just as screens and games have evolved in recent years, so too have non-electronic activities. For babies and toddlers, there are plenty of toys and books that can easily replace screens to keep kids engaged or distracted.
  3. When you are using screens, there are some apps that are better than others. Stay away from high-speed, action games and videos. Utilize games that require action/response from the toddler vs. those that are just for consuming fast imagery. Nursery rhyme apps, coloring apps, and letter drawing are some better choices.

Maureen O’Brien, PhD is a developmental psychologist, parenting coach and author of Advantage, Mom: 20 Lessons from a Parenting Pro, available at https://www.createspace.com/6024139 and Watch Me Grow: I’m One-Two-Three, available at http://amzn.to/1QtvyFlMore parenting tips and resources can be found on www.destinationparenting.com.

17 Oct

premieAccording to March of Dimes, approximately 1 in 10 babies are born prematurely in the US each year. Definitions are evolving, but premature babies are generally those born before 37 weeks gestation.
Most hospitals consider 24 week old fetuses viable, although some hospitals will treat them as young as 22 weeks. Delivering a baby at 24 weeks’ gestation is no guarantee of survival, but care in a Neonatal Intensive Care Units (NICU) can help increase the odds.

With every week that the fetus remains in utero, the higher the chance for thriving and surviving. By full-term all organ systems are mature and fully functioning, including the brain, lungs, heart, eyes, ears, bowel and muscles.

Fortunately, medical research and advances have increased the chances of survival in even the tiniest of babies. As a pediatric physical therapist, I have cared for these tiny “micro-preemies” from day one in the NICU and have had the pleasure of assisting many of them as they grow, thrive and become independent children.

With premature babies, their development may lag behind full-term babies in the earliest stages. That does not mean they will not catch up, but here are a few things to keep in mind to support your preemie.

Development in Premature vs. Full-Term Babies
When babies are born early, their systems have to continue development outside the protected environment of a mother’s womb. For this reason, there are several differences that should be taken into account when talking about the development of a premature baby, including:

1. Adjusted age vs. chronological age:
The adjusted age is calculated from the date a baby should have been born (the baby's due date). The chronological age is calculated from the actual birth date. Premature babies usually catch up with most developmental milestones by age two. Before this, and especially in the first year, they often develop in line with their adjusted age instead of their chronological (actual) age.

These differences may be demonstrated across many areas, including the timing of:

  • Gross motor skills (rolling over, crawling, walking)
  • Fine motor skills (pincer grasp, clapping)
  • Social skills (e.g., eye contact, smiling)
  • Speech (making vowel and consonant sounds)

Keep in Mind: The timing of their development milestones will most likely be aligned with their adjusted age, instead of their chronological age; so a baby that was born 2 months early will likely hit milestone ranges 2 months later than their age calculated on a calendar.

2. Muscle tone:
Premature babies often have less muscle bulk and tone than full-term babies. Their muscles are loose and floppy or sometimes described as "hypotonic." As newborns, this makes it harder for them to stay in a flexed position and may delay development of their motor skills. Full-term babies are able to keep themselves in a nicely flexed position with arms and legs tucked up (in the fetal position). I often explain to families that this is the result of their preemie babies having had a shorter “workout program” than a full-term infant. They did not get to push and kick against resistance the same time frame leading to lower muscle tone and overall body weakness. Because of this, it is strongly recommended for premature babies to be followed up by field specialists such as pediatric physical therapists. They can help them catch up and strengthen the right muscle groups to accelerate progress.

Keep in Mind: Preemies often need the support of specialists to help them overcome some of their limitations; talk to your doctor early to start getting them the help they need.

3. Brain development:
The brains of premature babies also had less time to develop, often resulting in lower gray matter volume and neural connectivity at birth. These differences can have implications in timing and quality of cognitive and social development.

premiebrain

For this reason, sleep is extremely important in the case of these little ones. It allows their brain and body to grow. Premature infants have two sleep states: active sleep and quiet sleep. Their brain is creating new pathways and perfecting wiring during these sleep cycles:

• Light sleep (also called active sleep or REM sleep) -
When a baby is in a light sleep, they will move around quite a bit and make some noise. You may even see the baby’s eyes open and rolling back into their head. Don’t worry, this is completely normal. They will spend most of their time in light sleep. As they grow older and stronger, they will begin to have more full cycles of light and deep sleep.
• Deep sleep (also called quiet sleep or non-REM sleep) -
This deep sleep is a baby's most restful stage of sleep. Most preemies will have very little deep sleep until they are closer to term in age.

Keep in Mind: Sleep is critical for all babies, but especially so for premature infants. Make sure you have a cozy environment for them and factor quiet sleep into your plans. Many babies are happy to sleep in strollers or on the go – for younger preemies, try to give them some consistent sleep in their beds.

With patience and attention, your premature baby will make their unique developmental journey step by step. Understanding their differences is the first step to your child’s wonderful journey ahead!

Editor's Note: When your premature baby is ready to start doing BabySparks activities, the app will automatically use their adjusted age to provide recommended activities. We do not recommend any premature baby doing development activities until a gestational age of at least 36 weeks.


Morgan Bryant, PT, DPT has a doctorate in physical therapy, practice owner of Matrix Rehab, LLC visit www.matrixrehab.net, wife and mother of 2.

01 Oct

2016-10-1 object permanenceWhen babies reach around 4 months of age, they have a cognitive growth spurt. Skills appear that form the foundation of a new, more advanced way of thinking. One of the concepts that emerges around this age is what developmental psychologists call ‘object permanence.’

A simple way to understand object permanence is to imagine a magic trick where the magician puts a ball in his hand, covers it with a handkerchief, waves his hand over the handkerchief, and ‘voila’, the ball is gone. Except we know that it really isn’t. And we wonder what happened to it. We have all these thoughts because we know that even though we can't see it, the ball continues to exist, whereas for a young baby that hasn't developed this understanding, it is as if the ball no longer exists.

How does object permanence develop?
As with most complex concepts, object permanence develops gradually through various stages. It can usually be first observed around 4 or 5 months when babies realize that partially hidden objects are still there in their entirety (to see this in action, cover part of a stuffed animal with a blanket and watch the child reach for it). At around 8 months babies are able to recover objects that have been completely hidden if the item was hidden while they were looking. By the age of one, they even look for objects that were hidden while they were looking away, but might still only look for them in the last place where they saw them.

There is no clear consensus in the scientific community about the exact moment when object permanence emerges. Based on various experiments Swiss psychologist Jean Piaget, who first studied it, believed that it was around the age of 8 months. More recently, scientists have devised methods to more accurately estimate the onset - combining a baby's bodily and facial reactions with brain wave patterns measured via an EEG. Increasingly, their belief is that it emerges around the age of 4 months. To see what some of these experiments typically look like, click here.

A stepping-stone to other critical development milestones
To develop an understanding of object permanence babies must first be able to form mental representations of objects (they can picture a ball in their head vs. just seeing it in front of them). As their ability to understand object permanence grows, they exercise their ability to develop and manipulate these mental representations and vice versa. This link is very important as it makes it easier to understand how object permanence is related to subsequent critical development milestones, for example:

  • Working memory: object permanence is considered a method to evaluate working memory in early stages. It is easy to see the connection between the ability to form and use mental representations of objects and their last seen location, and working memory. Working memory is a core executive function and its capacity is often considered a strong predictor of cognitive abilities at a later age.
  • Separation anxiety: for babies to display this behavior, which usually peaks between months 9 and 18, they need to realize that Mom or Dad still exist when out of their sight. The link is very direct. This is the reason that, even though many parents struggle with separation anxiety, it is good to remember that not only it is perfectly normal, but also a sign of healthy cognitive and social-emotional development.
  • Symbolic thought: as children's understanding of object permanence and their ability to manipulate mental representations improve, symbolic thought gradually emerges. At around 18-20 months, it can be observed during play time, as they use an empty plastic bottle of water to represent a rocket or a wood block to represent a car. Later, they will also use symbolic thought to come up with the solution to a simple problem without having to use trial and error, as they have done until this stage.

The list continues, which is the reason that understanding this concept is such an important event in a child's overall early development. It opens a door to reaching other milestones for which this concept is a prerequisite and moves your child's understanding of how the world works significantly forward. Your child will develop this skill over time. You can support its development through simple games like peek-a-boo and hide-and-seek, or by doing some other of your Babysparks activities specifically designed for this purpose. Once again, your baby’s play time is doubling as learning time!


Maureen O’Brien, PhD is a developmental psychologist, parenting coach and author of Advantage, Mom: 20 Lessons from a Parenting Pro, available at https://www.createspace.com/6024139 and Watch Me Grow: I’m One-Two-Three, available at http://amzn.to/1QtvyFlMore parenting tips and resources can be found on www.destinationparenting.com.