Caring for Your Baby and Young Child, Revised Edition: Birth to Age 5 - Softcover

Dr. Steven P. Shelov, M.D., M.S., F.A.A.P. is currently Professor of Pediatrics at Mount Sinai School of Medicine and Chairman of Pediatrics at Maimonides Medical Center and Lutheran Medical Center and Vice President of the Infants' and Childrens' Hospital of Brooklyn. He is the Editor-in-Chief of several of the parent publications for the AAP including Caring For Your Baby and Young Child, The First Year Of Life, and A Guide to Child Symptoms. Dr. Shelov pioneered and developed these series of books. In 2002, Dr. Shelov was presented with the Lifetime Achievement in Education Award by the American Academy of Pediatrics, its singular highest award for pediatric education.

Dr Robert Hannemann is a board certified pediatrician practicing part time at the Arnett Clinic in Lafayette, Indiana. He is Visiting Professor of Child Psychology, Biomedical Engineering, and Chemical Engineering at Purdue University, West Lafayette, Indiana where he is engaged in teaching and research. Dr Hannemann is Past President of the American Academy of Pediatrics.

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Preparing for a New Baby
Pregnancy is a time of anticipation, excitement, preparation, and, for many new parents, uncertainty. You dream of a baby who will be strong, healthy, and bright--and you make plans to provide her with everything she needs to grow and thrive. You probably also have fears and questions, especially if this is your first child, or if there have been problems with this or a previous pregnancy. What if something goes wrong during the course of your pregnancy, or what if labor and delivery are difficult? What if being a parent isn't everything you've always dreamed it would be? These are perfectly normal feelings and fears to have. Fortunately, most of these worries are needless. The nine months of pregnancy will give you time to have your questions answered, calm your fears, and prepare yourself for the realities of parenthood.

Some of these preparations should begin when you first learn you're pregnant. The best way to help your baby develop is to take good care of yourself, since medical attention and good nutrition will directly benefit your baby's health. Getting plenty of rest and exercising moderately will help you feel better and ease the physical stresses of pregnancy. Talk to your physician about prenatal vitamins, and avoid smoking and alcohol.

As pregnancy progresses, you're confronted with a long list of related decisions, from planning for the delivery to decorating the nursery. You probably have made many of these decisions already. Perhaps you've postponed some others because your baby doesn't yet seem "real" to you. However, the more actively you prepare for your baby's arrival, the more real that child will seem, and the faster your pregnancy will appear to pass.

Eventually it may seem as if your entire life revolves around this baby-to-be. This increasing preoccupation is perfectly normal and healthy and actually may help prepare you emotionally for the challenge of parenthood. After all, you'll be making decisions about your child for the next two decades--at least! Now is a perfect time to start.

Here are some guidelines to help you with the most important of these preparations.
GIVING YOUR BABY A HEALTHY START
Virtually everything you consume or inhale while pregnant will be passed through to the fetus. This process begins as soon as you conceive. In fact, the embryo is most vulnerable during the first two months, when the major body parts (arms, legs, hands, feet, liver, heart, genitalia, eyes, and brain) are just starting to form. Chemical substances such as those in cigarettes, alcohol, illegal drugs, and certain medications can interfere with the developmental process and with later development, and some can even cause congenital abnormalities.

Take smoking, for instance. If you smoke cigarettes during pregnancy, your baby's birthweight may be significantly decreased. Even inhaling smoke from the cigarettes of others (passive smoking) can affect your baby. Stay away from smoking areas and ask smokers not to light up around you. If you smoked before you got pregnant and still do, this is the time to stop--not just until you give birth, but forever. Children who grow up in a home where a parent smokes have more ear infections and more respiratory problems during infancy and early childhood. They get more sore throats, they cough and wheeze more and have a harder time getting over colds, and they are more prone to hoarseness. They also have been shown to be more likely to smoke themselves when they grow up.

There's just as much concern about alcohol consumption. Alcohol intake during pregnancy increases the risk for a condition called fetal alcohol syndrome (FAS), which is responsible for birth defects and below-average intelligence. A baby with fetal alcohol syndrome may have heart defects, malformed limbs (e.g., club foot), a curved spine, a small head, abnormal facial characteristics, small body size, and low birth weight. Fetal alcohol syndrome is also the leading cause of mental retardation in newborns. Alcohol consumption during pregnancy increases the likelihood of a miscarriage or preterm delivery, as well.
Where We Stand
Drinking alcohol during pregnancy is one of the leading preventable causes of birth defects, mental retardation, and other developmental disorders in newborns. There is no known safe amount of alcohol consumption during pregnancy. For that reason, the American Academy of Pediatrics recommends that women who are pregnant, or who are planning to become pregnant, abstain from drinking alcoholic beverages of any kind.
Although no one has determined exactly how much alcohol is too much for a pregnant woman, there is evidence that the more you drink, the greater the risk to the fetus. It is safest not to drink any alcoholic beverages during pregnancy.

You also should avoid all medications and supplements except those your physician has specifically recommended for use during pregnancy. This includes not only prescription drugs that you may have already been taking, but also nonprescription or over-the-counter products such as aspirin, cold medications, and antihistamines. Even vitamins can be dangerous if taken in high doses. (For example, excessive amounts of vitamin A have been known to cause congenital (existing from birth) abnormalities.) Consult with your physician before taking drugs or supplements of any kind during pregnancy, even those labeled "natural."

Your caffeine intake also should be limited while you are pregnant. While no adverse effects from minimal caffeine intake (one cup of caffeinated coffee per day) have yet been proven, recent studies suggest that consuming large amounts of caffeine during pregnancy might affect fetal growth. Caffeine also tends to keep adults awake and make them irritable, which can only make things less comfortable and restful for you.

Another cause of congenital abnormalities is illness during pregnancy. You should take precautions against these dangerous diseases:

German measles (rubella) can cause mental retardation, heart abnormalities, cataracts, and deafness. Fortunately, this illness now can be prevented by immunization, although you must not get immunized against rubella during pregnancy.

The majority of adult women are immune to German measles because they had the disease during childhood or already have been immunized against it. If you're not sure whether you're immune, ask your obstetrician to order a blood test for you. In the unlikely event that the test shows you're not immune, you must do your best to avoid sick children, especially during the first three months of your pregnancy. It is then recommended that you receive this immunization after giving birth to prevent this same concern in the future.
Where We Stand
The Academy message is clear--don't smoke when pregnant. Many studies now show that if a woman smokes during pregnancy, her child's birth weight and growth during the first year of life may be reduced. The range of indisputable effects runs from depressed breathing movements during fetal life to cancer, respiratory disorders, and heart disease in later years.

If you smoke, quit. If you can't quit, don't smoke around children (especially indoors or in the car). Children of parents who smoke have more respiratory infections, bronchitis, pneumonia, and reduced pulmonary function than children of nonsmokers. The Academy supports legislation that would prohibit smoking in public places frequented by children. The Academy also supports a ban on tobacco advertising, harsher warning labels on cigarette packages, and an increase in the cigarette excise tax. For more information, visit www.aap.org.
Chickenpox is particularly dangerous if contracted shortly before delivery. If you have not already had chickenpox, avoid anyone with the disease or anyone recently exposed to the disease. You also should receive the preventive vaccine when you are not pregnant.

Toxoplasmosis is primarily a danger for cat owners. This illness is caused by a parasitic infection common in cats, but it also is found in uncooked meat and fish. The infected animal excretes a form of the parasite in its stools, and people who come in contact with infected stools could become infected themselves.

If you own a cat, have it checked for toxoplasmosis before you become pregnant or as early as possible in your pregnancy. You can reduce the chances that your cat will contract toxoplasmosis by feeding it only commercially prepared cat food, which is processed in a way that destroys the parasites. Also, to decrease your own chances of being infected, have someone who is not pregnant clean the litter box daily. (The toxoplasmosis parasites cannot infect humans until forty-eight hours after the cat excretes them.) If you do clean the litter box or handle cat litter, make sure to wash your hands thoroughly afterward. As previously mentioned, toxoplasmosis also is found in uncooked meat and fish, so avoid eating uncooked or partially cooked meat or fish such as sushi, and practice good hand-washing techniques after handling uncooked meat products.
GETTING THE BEST PRENATAL CARE
Throughout your pregnancy, you should work closely with your obstetrician to make sure that you stay as healthy as possible. Regular doctor's visits up until the birth of your baby can significantly improve your likelihood of having a healthy newborn. During each doctor's visit, you will be weighed, your blood pressure will be checked, and the size of your uterus will be estimated to evaluate the size of your growing fetus.

Here are some areas that deserve attention during your pregnancy.
Nutrition
Follow your obstetrician's advice regarding your use of prenatal vitamins. As mentioned, you should only take vitamins in the doses recommended by your doctor. Perhaps more than any other single vitamin, make sure you have an adequate intake (generally, 400 micrograms a day) o...