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Video: How to Introduce Your Child to Sleeping in a Bed

In this brief video, NHS Health Visitor, Sara, discusses how to approach moving your young child from a cot (*crib) to a bed and gives some tips for success.

Editor’s Note: Video Highlights

  • child-moving-to-a-bedThere are no hard-and-fast rules for when to move your baby from a cot (*crib) to a bed – do it when it feels comfortable for your child and for you
  • From 18 months, you might find that your child is too big for a cot or is trying to climb out – that’s the time to move them into a bed
  • For some children, moving from a cot to a bed is really exciting and they accept it really well
  • For other children, they might feel a bit stressed about the change – so you might need to choose a calm time in their life
    • Challenging times for moving from a cot to a bed can be if you’re moving house, if you’ve gone back to work or if your child is not feeling well
  • You may need to move your child to a bed if you have another baby on the way – if so, do it about six to eight weeks before your new baby is born, to help keep your child from being unsettled with too much change
  • Once sleeping in a bed, your child might get up in the night and wander around, so be sure to childproof their room
    • Put a stair gate across the door
    • Check their room for any electrical appliances or wires they could trip over, any small toys or objects they can get hold of or any cord blinds that they could get tangled in
    • You might also want to put barrier next to the bed or put cushions on the floor in case they fall out
  • If your child doesn’t like the bed initially and they want to protest, just stay calm, reassure them, give them a cuddle, but put them back in the bed
    • You might find that you have to do it a few times, but if you’re consistent, they’ll soon get used to being in the bed
  • When your child has slept in the bed, or had some naps in the bed, praise them because it can make a big difference to their confidence and they’ll feel much more willing to sleep in the bed if you praise them for what they’ve done

Editor’s Note: *clarification provided for our US readers.

 





When and How to Treat a Fever: a Pediatrician’s Perspective

I have posted in the past about fever and many of the myths surrounding it (Kids Will Get Sick: 5 Facts a Pediatrician Wants You To Know).  In this post I would like to deal with the causes, nature of fever, benefits of fever, and some “treatments”.  It is one of the most common reasons people bring their children to the Emergency room and probably among the least significant reasons for doing so.

Fever is a symptom of an illness such as cough, runny nose, headache, and many others and, except for the discomfort of the associated symptoms (chills, achiness, drowsiness, etc.) fever, in and of itself, does not need to be treated.  As far as what is the definition of fever, it depends on the age of your child or infant. Just about any fever in an infant less than 3 months of age is considered to be significant for the purpose of evaluation.  As your baby/child gets older the level of fever at which the concern rises does so with the height of the fever and the associated symptoms.  Beyond the immediate newborn period (up to age 3 months) fever (or better termed higher than normal body temperature) is generally considered to be over 100.4 to 100.5 Fahrenheit.

Fever is part of the immune reaction that your body goes through to identify the offending agent and muster the resources to fight off that agent.  Some studies have shown that the presence of fever helps your body fight off the disease in a more rapid and efficient way.  As such, it is easy to see that in fighting off an illness, the reduction of that fever for its own sake is not necessarily the best thing to do.  As I mentioned in my last post about fever, if your child is very uncomfortable due to the presence of fever, it certainly is reasonable to give a medicine such as Tylenol or Advil, but not just because the fever is there.

In an effort to reduce fever by worried parents many methods have been tried; such as placing a child in a cold bath or sponging with cold water, even to go as far as placing ice packs in supposedly strategic places.  This would seem logical at first blush but in fact, human beings have a very good method of warming a cold body, and that is shivering, wherein the muscles go into a hypermetabolic state producing heat by metabolic processes.  It is possible to place someone with a fever in a cold bath and have him or her come out with a higher temperature than before the bath.  So the reasonable approach to comfortably lower a fever is to undress a child with fever but not enough to stimulate chills or shivering, place your child in a warm (skin temperature) bath of only a few inches of water and sponge off your child frequently allowing for natural evaporative processes to cool the skin.  Offer your child plenty of cool fluids that will do some cooling from within as well as keeping him/her well hydrated- fever will cause extra fluid loss through sweating and the hypermetabolic state.  Do not wrap your child in blankets just to “sweat the fever out” as doing this may also inadvertently raise fever, and increase fluid loss and discomfort- certainly covering the child enough to relieve chills and shivering is appropriate for comfort.

In trying to determine whether someone who runs a lower than “normal” natural body temperature is running a fever, just use the reading you get with the thermometer as the difference between a normal temperature and one that “runs low” is very small and would not be significant medically.  Furthermore body temperatures vary throughout the 24 hour day in the same person- so when that “normally low” body temperature was taken becomes important.

So you can almost expect fever to accompany any illness of an infectious nature whether mild or severe.  Keep calm, it is not the fever that is important, but the appearance, behavior and the presence of certain other symptoms that your Doctor with be most interested in when you call his office.

How to Boost Your Child’s Bones for Lifelong Health

Children’s bones keep growing throughout childhood. They grow fastest of all very early in life and when children go through puberty.

The bones keep getting denser until they reach what’s known as “peak bone mass”. This usually happens between the ages of 18 and 25.

boost-your-childs-bone-healthThe denser your child’s bones are at the time of peak bone mass, the greater their reserves of bone to protect against the fragile bone disease osteoporosis later in life.

“The reserve of bone you establish during childhood and the teenage years is with you through early adulthood,” explains Dr Paul Arundel, a consultant in paediatric metabolic bone disease at Sheffield Children’s Hospital. “We all start to lose bone mass later in life. If you are starting from a low baseline you are more likely to develop osteoporosis sooner.”

The good news is that you can protect your child’s bone health with some simple lifestyle measures.

Your Child’s Bone-friendly Diet

Building strong bones in childhood requires a range of vitamins and minerals. A healthy, balanced diet will provide this. That means a diet that includes:

  • fruit and vegetables – at least five portions every day (but no more than one 150ml – *about 5 oz – glass of fruit juice)
  • carbohydrates – such as potatoes, pasta, rice and bread (preferably wholegrain)
  • protein – such as meat, fish, eggs, beans, nuts and seeds
  • dairy products – such as milk, cheese and yoghurts

There are a couple of nutrients that are particularly important for building strong healthy bones.

Calcium for Healthy Bones

Our bodies contain about 1kg (*about 2.2 lbs) of calcium. About 99% of this is found in our bones and teeth – it’s what makes them strong and hard. Most of this calcium is laid down during childhood and the teenage years.

Calcium is particularly vital during puberty when the bones grow quicker than at any other time. Puberty takes place over a number of years, typically sometime between 11 to 15 for girls and 12 to 16 for boys.

The recommended calcium intake for children and young people aged from 11 to 18 is 800-1,000mg compared with 700mg for adults. But research shows that, on average, children and young people in this age group don’t get enough.

“Teens need more calcium because they’re growing,” says Dr Arundel. “People don’t think about bone health in teenagers as much as they do with toddlers, but teenagers are growing a lot more.”

Foods that contain lots of calcium include dairy foods such as milk, cheese and yoghurt, but also tinned sardines (with the bones in), green, leafy vegetables (but not spinach), peas, dried figs, nuts, seeds and anything that’s fortified with calcium, including some soya milks.

Vitamin D for Kids’ Bone Health

Vitamin D is important for bones because it helps our bodies to absorb calcium.

Our main source of vitamin D is sunlight. Vitamin D is made by our skin when it’s exposed to sunlight during the summer months (late March/April to the end of September).

There are only a few foods that are a good source of vitamin D. These include oily fish, eggs and foods that have been fortified with vitamin D, such as fat spreads and some breakfast cereals. Read Food for strong bones.

To ensure they get enough vitamin D, the following groups should take daily vitamin D supplements, to make sure they get enough (*US recommendations are similar – click here):

  • All babies from birth to one year of age (including breastfed babies and formula fed babies who have less than 500ml a day of infant formula)
  • All children aged one to four years old

Everyone over the age of five years is advised to consider taking a daily supplement containing 10 micrograms (mcg) of vitamin D.

But most people aged five years and above will probably get enough vitamin D from sunlight in the summer (late March/early April to the end of September), so you might choose not to take a vitamin D supplement during these months.

It’s important never to let your child’s skin go red or start to burn. Babies under six months should never go in direct sunlight. Find out how to get vitamin D from sunlight safely.

Find out more about who should take vitamin D supplements and how much to take.

If you receive benefits, you may be eligible for free Healthy Start vitamins, which contain vitamin D. Your health visitor can tell you more, or you can visit the Healthy Start website.

Bone-strengthening Exercises for Children

Daily physical activity is important for children’s health and development, including their bone health.

Try not to let your child be sedentary for long periods. You can do this by reducing the amount of time they spend sitting down, for example, watching TV or playing video games.

Children under five who aren’t yet walking should be encouraged to play actively on the floor. Children who can walk on their own should be physically active daily for at least 180 minutes (three hours) spread throughout the day. This should include some bone-strengthening activities, such as climbing and jumping.

Children aged five to 18 need at least 60 minutes (one hour) of physical activity every day, which should include moderate-intensity activity, such as cycling and playground games.

To strengthen muscles and bones, vigorous-intensity activities should be included at least three times a week. This could be swinging on playground equipment, sports such as gymnastics or tennis, or hopping and skipping.

See 10 ways to get active with your kids.

Eating Disorders and Bone Health

Eating disorders affect people of all ages, both male and female. But girls and women are more likely to be affected and anorexia most commonly develops in the teenage years.

The bones are still growing and strengthening at this time and eating disorders like anorexia can affect their development. Low body weight can lower oestrogen levels, which may reduce bone density. Poor nutrition and reduced muscle strength caused by eating disorders can also lower bone density.

If your teenage child has anorexia or another eating disorder, it’s important to seek medical advice about their bone health.

Editor’s Note: *clarification provided for our US readers.





Study: Can Music Help Premature Babies Sleep and Feed?

music-and-premature-babies“Playing music to premature babies ‘helps them sleep and improves their breathing’,” is the headline in the Daily Mail about research into the effects of ‘music therapy’ on premature babies.

While positive effects were found, it is still unclear whether this will lead to tangible health improvements.

The researchers in this study speculate that being born premature could be traumatic (from an acoustic perspective) for two reasons:

  • The baby is prematurely separated from the sound of the mother’s heartbeat and the sounds they were accustomed to in the womb
  • The baby is ‘plunged’ into the noisy environment of a neo-natal intensive care unit

Researchers wanted to see whether exposing premature babies to more comforting sounds could help compensate for these proposed sources of trauma.

They investigated three types of live music therapy, administered with the help of a certified music therapist:

  • A lullaby or any other song chosen by the parent that was modified to be like a lullaby, preferably sung by a parent
  • An instrument designed to replicate womb sounds
  • An instrument that sounded like a heartbeat

The researchers found that the therapies were associated with slowing of infants’ heartbeats, calmer breathing, and improved feeding and sleep patterns. The therapies were also associated with decreased stress levels in the parents.

It is unclear whether music therapy does improve premature babies’ health outcomes. For example, if infants receiving music therapy are able to leave hospital earlier or have better long-term health outcomes.

Where did the story come from?

The study was carried out by researchers from the Beth Israel Medical Centre, New York and was funded by the Heather on Earth Music Foundation, a non-profit organisation that provides funding for music therapy programmes in children’s hospitals.

The study was published in the peer-reviewed journal Pediatrics. This article was open access, meaning that it can be accessed for free in full from the journal’s website.

This research was well-covered by the Daily Mail. The paper also contains an aside (presumably included in an accompanying press release) that one parent chose to sing a ‘lullabied’ version of Marvin Gaye’s soul classic ‘I Heard It Through the Grapevine’ and another chose 70’s funk standard ‘Pick up the Pieces’ by Average White Band.

What kind of research was this?

This was a randomised crossover trial that aimed to determine whether three different live music interventions in premature infants could affect:

  • Physiological functions, such as heart and respiratory rates, oxygen saturation levels and activity levels
  • Developmental function such as sleep patterns, feeding behaviour and weight gain

The three interventions administered with the help of a certified music therapist were:

  • A lullaby, either Twinkle, Twinkle Little Star or any other song chosen by the parent which was modified to be like a lullaby, preferably sung by a parent
  • An ‘ocean disc’ musical instrument, which is a round disc containing metal beads that aims to replicate womb sounds
  • A ‘gato box’, a 2- or 4-tone wooden box or drum that is played with the fingers to provide a rhythm in a manner that simulates the heartbeat sound that the baby would hear in the womb

The ocean disc and the gato box were played live and were coordinated to the infant’s breath rate. All infants received each of the three possible treatments (lullaby, gato box, ocean disc) as well as a control where no sound stimulation was given.

A randomised crossover trial is similar to a randomised control trial, but after a participant has received one treatment they are swapped over to another treatment arm, meaning that all participants received all three treatments and the control.

The trial design does have the disadvantage that the benefits obtained from one treatment might still be present when a second treatment is tested.

What did the research involve?

The researchers recruited 272 premature infants aged at least 32 weeks old with respiratory distress syndrome, clinical sepsis and/or small size for gestational age in neonatal intensive care units.

The infants received each of the three possible treatments (lullaby, gato box or ocean disc) or no explicit sound stimulation (to act as a control).

Each treatment was given twice during the two-week trial (three treatments per week). The day each treatment was given and the time of day (morning or afternoon) was randomised. If the infant received an intervention in the morning, the control was given in the afternoon and vice versa. The interventions were delivered by music therapists in conjunction with parents.

Heart rate, oxygen saturation, respiratory rate and activity level were measured at one-minute intervals during the 10-minute phase before the intervention, the 10-minute phase during, and the 10-minute phase after the intervention.

The researchers also analysed the infants’ vital signs, feeding behaviours, and sleep patterns daily during the two-week period.

In addition, self-perceived stress levels in parents of infants in neonatal intensive care were assessed before and after the two-week trial.

What were the basic results?

Activity Level

The percentage of ‘quiet-alert time’ (one of several states of alertness ascribed to newborns) increased during a lullaby. After the lullaby, it decreased.

Heart Rate

All three interventions showed a significant effect over time (before, during, after) on heart rate. Heart rate decreased the most during the lullaby and gato box interventions, and after the ocean disc treatment.

Respiratory Rate

The ocean disc also decreased the number of inspirations per minute during and after the treatment.

Developmental Behaviours

Use of the ocean disc was associated with increased ‘positive sleep patterns’ and ‘sucking pattern behaviour’ increased after the gato box treatment.

Parental Stress

The music interventions were also associated with a decrease in parents’ perception of stress.

How did the researchers interpret the results?

The researchers conclude that the live sounds and lullabies applied by a certified music therapist can influence cardiac and respiratory function, may improve feeding behaviours and sucking patterns, and may increase prolonged periods of quiet-alert states. These interventions also decrease the stress felt by parents of premature infants.

Conclusion

This research has found that live music therapies may slow infants’ heartbeats, calm their breathing, improve sucking behaviour important for feeding, improve sleep patterns and promote states of quiet alertness.

Different interventions led to different patterns of improvement, but all three types of musical therapy appeared to have a positive effect on the infant. The therapies also seemed to help the parents of premature infants feel less stressed.

Although this research is interesting, it is still unclear whether music therapy can lead to tangible health improvements, for example, the researchers did not measure whether infants receiving music therapy were able to leave hospital earlier or had better long-term health outcomes.

There are also practical considerations in that access to musical therapists is likely to be limited.

Despite these limitations, the study seems to provide a degree of evidence that the deep-seated human instinct to sing lullabies to your baby does them good.

For more information, read Getting your baby to sleep

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Summary

“Playing music to premature babies ‘helps them sleep and improves their breathing'” is the headline in the Daily Mail about research into the effects of ‘music therapy’ on premature babies. While positive effects were found, it is still unclear.

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Study: Snoring When Pregnant Linked to Low Birth Weight Babies

Snoring while pregnant is linked to smaller babies,” reports The Daily Telegraph. There is also evidence that snoring can lead to an increased risk of a baby having to be delivered by caesarean section.

This news is based on the results of a US cohort study that questioned a group of women during their last trimester of pregnancy (weeks 29 and over).

The researchers asked whether the women “habitually” snored (snoring three to four nights per week or nearly every night), and then followed up their birth outcomes. It found that self-reported “habitual” snoring, in particular snoring before and during pregnancy, was associated with increased likelihood of having a baby small for gestational age. There was also an increased likelihood of caesarean delivery.

The researchers adjusted for a number of factors that could be responsible for any association seen (confounders), such as mother’s age. However, this study cannot show that snoring directly caused the poorer delivery outcomes, as there could be other confounding health or lifestyle factors that were not adjusted for.

snoring when pregnantThe researchers speculate that snoring leads to increased levels of inflammation which could affect the placenta leading to low birthweight. But this hypothesis needs further investigation.

Overall, pregnant women who snore should not be overly concerned by this research that snoring is going to have a harmful effect on their baby. What is important though, is for pregnant women to be able to get adequate rest.

Though, as the researchers suggest, it may be useful for health professionals to ask about snoring symptoms, and if appropriate, recommend treatments.

Why do people snore?

Snoring is caused by the vibration of the soft tissue in the head and neck as a person breathes in.

The vibration can be amplified by a number of risk factors, leading to louder snoring. The factors include:

  • Obesity
  • Smoking
  • Drinking alcohol before going to sleep

Read more about the causes of snoring.

Where did the story come from?

The study was carried out by researchers from the University of Michigan, US. It was funded by the Gene and Tubie Gilmore Fund for Sleep Research, the University of Michigan Institute for Clinical and Health Research and the US National Heart, Lung and Blood Institute.

The study was published in the peer-reviewed journal Sleep.

The results of the study were accurately reported in the media.

What kind of research was this?

This was a cohort study. It aimed to examine the impact of maternal snoring during pregnancy on key delivery outcomes.

These outcomes included mode of delivery (vaginal or via caesarean section) and birth centile. Birth centiles are a method of comparing birthweight to the rest of the population. For example, if birth centile was below the 10th centile, this means that for every 100 infants less than 10 have lower birthweights. In this study, centiles were customised to take into account factors including maternal height, weight, and ethnicity and the infant’s gender and gestational age at birth.

A cohort study is the ideal study design to investigate this question. However, while the researchers adjusted for a number of factors that could be responsible for any association seen (confounders), this study cannot show that snoring caused poorer delivery outcomes. There could be other confounders that were not adjusted for.

What did the research involve?

The researchers recruited 1,673 pregnant women in their third trimester of pregnancy (this study included those of 28 weeks’ gestation or more) who attended antenatal clinics within the University of Michigan.

The women were asked whether they habitually snored or whether they had stopped breathing or gasped for air at night. Habitual snoring was defined as snoring either “three to four times per week” or “almost every day”. If women reported habitual snoring, they were asked when they started snoring. If women snored both before and during pregnancy, their snoring was classified as chronic. If snoring only started during pregnancy, the snoring was classified as pregnancy-onset snoring.

Delivery outcomes were obtained from medical records. The primary study outcomes were birth centile, mode of delivery (vaginal or caesarean section), cord blood gases (which helps determine whether the baby has been deprived of oxygen) and newborn transfer (whether the baby had to go into intensive care).

The researchers looked at whether snoring was associated with poorer delivery outcomes. The researchers tried to control their analyses for important potential confounders, such as mother’s age, body mass index (BMI)pre-eclampsia, number of previous pregnancies and maternal smoking.

What were the basic results?

Of the 1,673 women, 35% reported habitual snoring (26% who had started snoring in pregnancy, and 9% who were “chronic” snorers).

Chronic snoring was associated with:

  • Having a small for gestational age baby (birthweight less than the 10th birth centile) (odds ratio [OR] 1.65, 95% confidence interval [CI] 1.02 to 2.66).
  • Having a caesarean section (planned, not emergency) (OR 2.25, 95% CO 1.22 to 4.18)

Pregnancy onset snoring was associated with:

  • Having an emergency caesarean delivery (OR 1.68, 95% CO 1.22 to 2.30)

How did the researchers interpret the results?

The researchers concluded that: “Maternal snoring during pregnancy is a risk factor for adverse delivery outcomes including caesarean delivery and small-for-gestational age. Screening pregnant women for symptoms of SDB [sleep disorders breathing] may provide an early opportunity to identify women at risk of poor delivery outcomes.”

Conclusion

This large cohort study has found that self-reported snoring during the last trimester of pregnancy – and in particular chronic snoring – is associated with having a small for gestational age baby as well as a caesarean delivery.

A cohort study is the ideal study design to investigate this question, and the researchers have attempted to adjust for a number of important potential confounding factors that could be responsible for any association seen, such as maternal age, BMI and smoking status.

However, this study cannot show that snoring directly caused the poorer delivery outcomes, as there could be other health or lifestyle factors not adjusted for that are involved in the relationship.

In addition, in this study snoring was self-reported. It is possible that other women snored who were not aware of it (though the vast majority of women had bed partners, and only 2% of partners complained about snoring when women reported not snoring).

This study cannot tell us whether, if there is a direct link between snoring and poor delivery outcomes, by what biological mechanism this may be.

The researchers speculate that snoring leads to increase levels of inflammation which could affect the placenta leading to low birthweight. But this hypothesis needs further investigation.

Overall, pregnant women who snore should not be overly concerned by this research that this is going to have a harmful effect on their baby.

The research does raise the possibility that it may be helpful for health professionals to ask whether an expectant mother is a snoring, and if so, offer advice or treatment.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Summary

“Snoring while pregnant is linked to smaller babies,” reports The Daily Telegraph. There is also evidence that snoring can lead to an increased risk of a baby having to be delivered by caesarean section.

Links to Headlines

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Babies Should Get Peanuts Early to Cut Allergy Risk

New guidelines issued yesterday by experts from the US National Institutes of Health (NIH) recommend introducing peanut-containing foods to babies as early as possible as a way to lower their risk of developing a peanut allergy.

The recommendations reverse previous advice to add peanuts later, but are driven by new scientific research that showed early introduction of peanuts could cut allergy development by 81%. The guidelines are tailored for a child’s risk for peanut allergy, as follows:

  • babies should get peanuts earlyInfants at HIGH risk for peanut allergy (have severe eczema, egg allergy or both)
    • Add peanut-containing foods as early as 4 to 6 months
    • Consult with health care provider prior to adding peanuts – specialized testing may be needed
  • Infants with mild or moderate eczema
    • Add peanut-containing foods around 6 months
  • Infants without eczema or any food allergy
    • Add peanuts to infant diet as appropriate/desired
  • IN ALL CASES, start babies on other solids before adding peanut-containing foods

If you have specific questions or concerns about introducing your child to peanuts, speak to your pediatrician or family doctor.

 

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