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How to Plan Activities That Keep Babies & Toddlers On The Move

Ways to get your baby moving

  • Lay your baby down on their back so they can kick their legs.
  • Pulling, pushing, grasping and playing with other people are great ways to practise different kinds of movements.
  • Once your baby has started crawling, let them crawl around the floor, but make sure it’s safe first – see our crawling safety checklist.
  • Playing outdoors helps your baby learn about their surroundings.
  • You can take your baby swimming from a very young age – there’s no need to wait until they’ve been vaccinated.

See Start4Life for more activity tips for babies.

Why tummy time is important

Tummy time helps to build the muscles your baby needs for sitting and crawling. You can start doing tummy time from birth by lying your baby on your chest – but only do this when you’re wide awake and unlikely to fall asleep.

Little and often is best to begin with. Gradually increase the amount of time you do this day by day. Then, when your baby is ready, try doing tummy time on the floor. If your baby has difficulty lifting their head, you can roll up a towel and put it under their armpits. Put some toys nearby for them to reach out to.

Only do tummy time when your baby is awake and alert, and you’re there to keep an eye on them.

Baby bouncers, walkers and seats

It’s important that your baby doesn’t spend too much time in:

  • baby walkers or bouncers – these encourage babies to stand on their tiptoes and can delay walking if your baby uses them a lot
  • baby carriers and seats – long periods in reclining carriers or seats, or seats that prop your baby in a sitting position, can delay your baby’s ability to sit up on their own

If you do use a baby walker, bouncer or seat, it’s best to use them for no more than 20 minutes at a time.

Physical activity for toddlers

Once your child is walking, they should be physically active for at least 180 minutes (three hours) a day, spread throughout the day.

  • Let your toddler walk with you rather than always using the buggy.
  • Toddlers and young children love going to the park, where they can climb and swing or just run around.
  • Toys your child can pick up and move around will help improve their co-ordination and develop the muscles in their arms and hands.
  • Involve your toddler in household tasks like unpacking shopping, tidying or sorting washing.
  • Teach your child songs with actions and encourage them to dance to music.

Watching TV or using a tablet for long periods – or being strapped into a buggy, car seat or highchair – isn’t good for young children.

If you need to make a long car journey, consider taking a break and getting your child out of their seat for a bit.

See physical activity guidelines for children under five.

Enjoy being active together

It’s good to join in with your child’s active play when you can. Have fun showing them how to do new things like running and hopping. Being active together shows your child that activity is enjoyable.

You’re a role model for your child so stay active yourself and try to meet the physical activity guidelines for adults.

There may be activities for parents and children at your local leisure centre or Sure Start Children’s Centre.

Activity for young children with a disability

All babies and young children need to be active, including children with a long-term condition or disability, unless their health professionals give you different advice.

Just like other children, they will enjoy being active and it will help their development. You may need to adapt some activities to suit your child.

Scope has ideas for games all children can play, and the Contact a Family advice service** offers information on caring for a disabled child (in the UK).

Coping with a very active toddler

It can be exhausting keeping up with a toddler who is always on the go. It may help if you:

  • keep to a daily routine – routine can help if your child is restless or difficult; it can also help you stay calm and cope with the strain
  • dedicate time to your child – make sure there are times each day when you give them your full attention
  • avoid difficult situations – for example, keep shopping trips short
  • try to go out every day – go to a park, playground or other safe, open space where your child can run around and use up energy
  • set small goals – help your child to sit still and concentrate for a very short time, perhaps on a book or new toy, then gradually build it up

Does my child have attention deficit and hyperactivity disorder (ADHD)?

At times you may wonder if your non-stop toddler has ADHD. But only about 2% of children in the UK have ADHD**. It’s more likely that your child is just a healthy, energetic toddler.

If you’re worried about how active your child is, talk to your health visitor (*nurse specialist/midwife) or GP (*physician).

Learn more about ADHD or visit ADDISS: National Attention Deficit Disorder Information and Support Service.

Editor’s Note:  

* Clarification Provided for our U.S. Readers

** US Reference Information:

  • The American Psychiatric Association (APA) says that 5 percent of American children have ADHD. But the Centers for Disease Control and Prevention (CDC) puts the number at more than double that. The CDC says that 11 percent of American children, ages 4 to 17, had the attention disorder as of 2011.
  • UNICEF-USA is a charity that helps to protect US children and support children with disabilities

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My Twins are Behind in Talking…How Can I Help?

On average, twins are about six months behind single babies in their language development.

Twins may be slower to pick up speech and language skills because:

  • twins tend to receive less attention in shorter bursts than single babies
  • parents often speak to one twin while looking at the other, but children need eye contact to help their language development
  • twins tend to spend more time with each other, so they pick up each other’s speech rather than that of adults and older children around them
  • twins have less time to practise speech as they compete to get themselves heard
  • sometimes one twin may answer for the other

Don’t worry if your twins seem to be slow to speak. Just try to make sure they have plenty of time to talk and express themselves.

Talking to twin babies

Nappy changes can be a good opportunity to give twins one-on-one attention. You could bathe each baby separately to give you time to chat with them individually.

You can also:

  • turn off the TV and radio for at least 30 minutes each day, so your babies can listen to the noises around them with no distractions
  • listen to your babies and respond to them as they experiment with different sounds
  • try to play and read books with your babies individually; make time to talk to your babies individually each day, using their name and making eye contact
  • encourage older siblings, friends and family to talk to your babies one to one

Read more about how to encourage language skills in children.

Twins & Multiple Births Association (Tamba) has information about twins and language. Tamba also has a free (in the UK) telephone helpline. Twinline** is open every day from 10am to 1pm and 7pm to 10pm on 0800 138 0509.

Talk to your GP (*doctor) or health visitor if you’re concerned about your children’s language skills.

Editor’s Note:  

* Clarification Provided for our U.S. Readers

** Resources Outside the UK:

  • Multiples of America: US non-profit providing information, research studies and clubs throughout the U.S. for multiple birth families (and families-to-be)

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How To Manage Atopic Eczema – An Itchy, Scaly Children’s Rash

Atopic eczema (atopic dermatitis) is the most common form of eczema, a condition that causes the skin to become itchy, red, dry and cracked.

Atopic eczema is more common in children, often developing before their first birthday. 

However, it may also develop for the first time in adults. It’s usually a long-term (chronic) condition, although it can improve significantly, or even clear completely, in some children as they get older.

Symptoms of atopic eczema

Atopic eczema causes the skin to become itchy, dry, cracked, sore and red. Some people only have small patches of dry skin, but others may experience widespread red, inflamed skin all over the body.

Although atopic eczema can affect any part of the body, it most often affects the hands, insides of the elbows, backs of the knees and the face and scalp in children.

People with atopic eczema usually have periods when symptoms are less noticeable, as well as periods when symptoms become more severe (flare-ups).

Read about the symptoms of atopic eczema

When to seek medical advice

See your GP (*physician) if you have symptoms of atopic eczema. They’ll usually be able to diagnose atopic eczema by looking at your skin and asking questions such as:

  • whether the rash is itchy and where it appears
  • when the symptoms first began
  • whether it comes and goes over time
  • whether there’s a history of atopic eczema in your family
  • whether you have any other conditions, such as allergies or asthma
  • whether something in your diet or lifestyle may be contributing to your symptoms

Typically, to be diagnosed with atopic eczema you should have had an itchy skin condition in the last 12 months and three or more of the following:

  • visibly irritated red skin in the creases of your skin – such as the insides of your elbows or behind your knees (or on the cheeks, outsides of elbows, or fronts of the knees in children aged 18 months or under) at the time of examination by a health professional
  • a history of skin irritation occurring in the same areas mentioned above
  • generally dry skin in the last 12 months
  • a history of asthma or hay fever – children under four must have an immediate relative, such as a parent, brother or sister, who has one of these conditions
  • the condition started before the age of two (this does not apply to children under the age of four)

Causes of atopic eczema

The exact cause of atopic eczema is unknown, but it’s clear it is not down to one single thing. Atopic eczema often occurs in people who get allergies – “atopic” means sensitivity to allergens.

It can run in families, and often develops alongside other conditions, such as asthma and hay fever.

The symptoms of atopic eczema often have certain triggers, such as soaps, detergents, stress and the weather. Sometimes food allergies can play a part, especially in young children with severe eczema.

You may be asked to keep a food diary to try to determine whether a specific food makes your symptoms worse. Allergy tests aren’t usually needed, although they’re sometimes helpful in identifying whether a food allergy may be triggering symptoms.

Read about the causes of atopic eczema.

Treating atopic eczema

Treatment for atopic eczema can help to relieve the symptoms and many cases improve over time.

However, there’s currently no cure and severe eczema often has a significant impact on daily life, which may be difficult to cope with physically and mentally. There’s also an increased risk of skin infections.

Many different treatments can be used to control symptoms and manage eczema, including:

  • self care techniques, such as reducing scratching and avoiding triggers
  • emollients (moisturising treatments) – used on a daily basis for dry skin
  • topical corticosteroids – used to reduce swelling, redness and itching during flare-ups

Read about treating atopic eczema and complications of atopic eczema.

Other types of eczema

Eczema is the name for a group of skin conditions that cause dry, irritated skin. Other types of eczema include:

  • discoid eczema – a type of eczema that occurs in circular or oval patches on the skin
  • contact dermatitis – a type of eczema that occurs when the body comes into contact with a particular substance
  • varicose eczema – a type of eczema that most often affects the lower legs and is caused by problems with the flow of blood through the leg veins
  • seborrhoeic eczema – a type of eczema where red, scaly patches develop on the sides of the nose, eyebrows, ears and scalp
  • dyshidrotic eczema (pompholyx) – a type of eczema that causes tiny blisters to erupt across the palms of the hands

Editor’s Note:  

* Clarification Provided for our U.S. Readers

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Study: Bath Oils for Childhood Eczema Provide No Medical Benefit

“Bath oils used to help treat eczema in children offer no meaningful benefit as part of their care, a trial has found,” reports BBC News.

Childhood eczema, also known as atopic eczema, is a common condition that causes redness and soreness of the skin. Treatments include using moisturisers (emollients), which have been shown to work, and using emollients as soap substitutes in the bath or shower.

However, until now, there has been little evidence for a third type of treatment: adding emollient additives to baths.

In the first big study of its kind, researchers found commonly prescribed emollient bath additives – designed to be added to bathwater and leave a thin layer over the skin – made little difference to children’s eczema symptoms.

The study, carried out in England and Wales, involved 483 children aged 1 to 11 years. Half were randomly assigned to use bath additives regularly for a year – in addition to their usual treatments, including standard leave-on emollients – while the other half did not use them.

The results showed that bath additives made too small a difference to symptoms to be considered clinically important.

Find out more about treating childhood eczema.

Where did the story come from?

The study was commissioned by the UK National Institute for Health Research as part of a programme to investigate which treatments are effective and provide value for money, and carried out by researchers from Cardiff University, the University of Bristol, the University of Southampton and the University of Nottingham.

It was published in the peer-reviewed British Medical Journal and is free to read online.

The UK media reports were generally accurate and balanced.

What kind of research was this?

This was a randomised controlled trial, which is often the best way to investigate whether a treatment works.

To make results more accurate, many trials like this use a dummy treatment (placebo) so that patients don’t know if they are receiving the real treatment. However, in this case, the researchers decided they could not make a convincing placebo for emollient bath additives so did not include one in the study.

What did the research involve?

Researchers used records from 96 general practices in Wales, south England and west England to identify children diagnosed with eczema. The children’s parents or carers were then contacted and invited to take part.

After screening, half the children were prescribed bath emollient additives for a year and the other half were asked not to use them. Most of the experimental group were prescribed Oilatum, Balneum or Aveeno bath products.

All children continued their usual eczema treatments, which included using emollients as creams and soap substitutes, and using steroid creams where needed.

Parents or carers recorded children’s eczema symptoms – weekly for the first 16 weeks and then monthly for a year – using the standard patient oriented eczema measure (POEM). In children, this is usually assessed on how severe parents or guardians think a child’s eczema is.

POEM gives a score of 0 to 28, with 0 to 7 being no or mild eczema, 8 to 16 moderate eczema and 17 to 28 severe eczema. A drop of 3 points on the scale is considered enough to represent a clinically meaningful improvement in symptoms.

The parents or carers also recorded how often the children bathed and how often they used the bath emollient additives.

The researchers compared symptom scores for the 2 groups, adjusting for eczema severity at the start of the study, use of steroid creams and soap substitutes, and ethnic group.

What were the basic results?

The average symptom score at the start of the study was 9.5 in the bath-additives group and 10.1 in the no-bath-additives group, meaning most children had moderate eczema.

Over 16 weeks, the average symptom score was:

  • 7.5 in the bath-additives group
  • 8.4 in the no-bath-additives group

After controlling for confounding factors, such as use of other eczema medication, the average symptom score was 0.41 points lower in the bath-additives group (95% confidence interval [CI]-2.7 to +1.10). This was not a statistically significant difference and was well below the 3-point difference considered to be clinically important.

The researchers also looked at subgroups to see if any particular group of children were more likely to benefit from the bath additives. While they did find some effect for children under 5 years old, it still did not reach the 3-point threshold.

They did find a possibly clinically meaningful benefit for children who bathed 5 times or more a week (2.27-point improvement, 95% CI 0.63 to 3.91), but this analysis was based on fewer children, making it less reliable.

How did the researchers interpret the results?

The researchers said the trial “provides strong evidence that emollient bath additives provide minimal or no additional benefit beyond standard eczema care in the management of eczema in children”.

Conclusion

The study shows that bath emollient additives may not be a useful part of eczema care for children.

But it’s important to be clear this does not apply to the use of leave-on emollient creams and lotions, or to the use of emollients instead of soap. There’s evidence that leave-on emollient creams work, and doctors agree using emollients instead of soap is helpful.

This study’s results only apply to emollient products added to the bathwater. If you’re not sure of the difference, speak to a pharmacist or your GP.

If your child has been prescribed bath emollient additives and is happy with them, there’s no reason to stop using them. The study found no increased risk of side effects – such as slipping in the bath, soreness or redness – among children who used them.

However, they may not make much difference to your child’s eczema, and it’s possible the NHS may decide to recommend that doctors stop prescribing these products in future.

The study was well conducted but had a few limitations, the main one being that, unusually for research of this type, there was no placebo. Placebos are normally included to control for the placebo effect – where people tend to feel better if they are taking a treatment because they expect it to work.

However, in this case, people that did receive the bath additives did not report symptoms significantly different from those not using the additives, which suggests the placebo effect did not have much influence in this study.

The study looked at lots of subgroups among the 483 children to see if any showed different results. However, this increases the likelihood that some of the results are due to chance.

We therefore cannot put too much stock in the finding that children bathing 5 times or more a week may get some benefit from emollient bath additives, as this analysis included just 143 children.

If your child isn’t responding well to a particular treatment for eczema, there are other treatments that may be more effective. Find out more about treating childhood eczema.

Analysis by Bazian
Edited by NHS Choices

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Why Your Newborn Should Have a Blood Screening Test

Every baby is offered newborn blood spot screening, also known as the heel prick test, ideally when they’re 5 days old.

Newborn blood spot screening involves taking a blood sample to find out if your baby has one of 9 rare but serious health conditions.

Most babies won’t have any of these conditions but, for the few who do, the benefits of screening are enormous.

Early treatment can improve their health, and prevent severe disability or even death.

What does the blood spot test involve?

When your baby is 5 days old, a health professional will prick their heel and collect 4 drops of blood on a special card.

You can ease any distress for your baby by cuddling and feeding them, and making sure they’re warm and comfortable.

Occasionally, the sample may need to be taken when your baby is 6, 7 or 8 days old.

Sometimes a second blood spot sample is needed. The reason for this will be explained to you. It doesn’t necessarily mean there’s something wrong with your baby.

The test doesn’t carry any known risks for your baby.

Which conditions is the blood spot test for?

The blood spot test screens for the following 9 rare but serious conditions.

If you, your partner or a family member already has one of these conditions (or a family history of it), tell your health professional straight away.

Sickle cell disease

About 1 in 2,000 babies born in the UK** has sickle cell disease. This is a serious inherited blood disease.

Sickle cell disease affects haemoglobin, the iron-rich protein in red blood cells that carries oxygen around the body.

Babies who have this condition will need specialist care throughout their lives.

People with sickle cell disease can have attacks of severe pain and get serious, life-threatening infections. They’re usually anaemic because their blood cells have difficulty carrying oxygen.

The blood spot screening test means that babies with sickle cell disease can receive early treatment to help them live healthier lives. This may include vaccinations and antibiotics to prevent serious illnesses.

Pregnant women are also routinely tested for sickle cell disease early in pregnancy.

Read more about sickle cell disease, or download leaflets for parents whose child has sickle cell disease.

Cystic fibrosis

About 1 in 2,500 babies born in the UK** has cystic fibrosis. This inherited condition affects the digestion and lungs.

Babies with cystic fibrosis may not gain weight well and are prone to chest infections.

Babies with the condition can be treated early with a high-energy diet, medicines and physiotherapy.

Although children with cystic fibrosis may still become very ill, early treatment can help them live longer, healthier lives.

Read more about cystic fibrosis, or download a leaflet for parents whose baby has suspected cystic fibrosis.

Congenital hypothyroidism

About 1 in 3,000 babies born in the UK** has congenital hypothyroidism. Babies with congenital hypothyroidism don’t have enough of the hormone thyroxine.

Without thyroxine, babies don’t grow properly and can develop learning disabilities.

Babies who have the condition can be treated early with thyroxine tablets, and this allows them to develop normally.

See more information about congenital hypothyroidism (CHT).

Inherited metabolic diseases

It’s important to let your health professional know if you have a family history of a metabolic disease (a disease that affects your metabolism).

Babies are screened for 6 inherited metabolic diseases. These are:

About 1 in 10,000 babies born in the UK** has PKU or MCADD. The other conditions are rarer, occurring in 1 in 100,000 to 150,000 babies.

Without treatment, babies with inherited metabolic diseases can become suddenly and seriously ill. The diseases all have different symptoms.

Depending on which one affects your baby, the condition may be life threatening or cause severe developmental problems.

They can all be treated with a carefully managed diet and, in some cases, medicines as well.

Does my baby have to have the blood spot test?

It’s not compulsory, but it’s recommended because it could save your baby’s life.

You can choose to have screening for sickle cell disease, cystic fibrosis or congenital hypothyroidism individually, but you can only choose to have screening for all 6 inherited metabolic diseases or none at all.

If you don’t want your baby to be screened for any of these conditions, discuss it with your midwife.

You should be given information about the blood spot test and the diseases it screens for in advance so you can make an informed decision for your baby.

If you change your mind, babies can be screened up to the age of 12 months for all the conditions except cystic fibrosis. Cystic fibrosis can only be screened for up to 8 weeks of age.

If you have any concerns about the tests, speak to your midwife, health visitor or GP.

When will we get the results?

You should receive the results either by letter or from a health professional by the time your baby is 6 to 8 weeks old.

The results should be recorded in your baby’s personal child health record (red book)(*health records). It’s important to keep this safe and take it with you to all your baby’s appointments.

If you haven’t received your baby’s results, speak to your health visitor or GP(*physician).

You’ll be contacted sooner if your baby screens positive. This means they’re more likely to have one of the conditions tested for.

You’ll be contacted:

  • the day the result is available, or the next working day, if your baby is thought to have congenital hypothyroidism (CHT) – you’ll be given an appointment to see a specialist
  • before your baby’s 4 weeks old if they’re thought to have cystic fibrosis
  • before your baby’s 6 weeks old if they’re thought to have sickle cell disease

Screening for cystic fibrosis finds some babies who may be genetic carriers of the condition. These babies may need further testing.

Screening for sickle cell disease also finds babies who are carriers of this or other red blood cell diseases.

Carriers are healthy, although they can experience problems in situations where their bodies aren’t getting much oxygen – for example, if they’re having an anaesthetic.

Parents of babies who are found to be carriers should be told by the time they’re 6 to 8 weeks old.

Read more about what being a carrier means.

What do the results mean?

Most babies will have a normal result, which means it’s unlikely that they have any of the conditions.

A small number of babies will screen positive for one of the conditions. This doesn’t mean they have the condition, but they’re more likely to have it. They’ll be referred to a specialist for more tests.

It’s important to know that screening isn’t 100% certain. A baby with a negative screening result may later turn out to have the disease screened for. This is known as a false negative.

Babies with a positive result sometimes turn out not to have the disease – what’s known as a false positive.

Occasionally, other medical conditions are picked up by blood spot test screening. For example, babies with beta thalassaemia major, a serious blood disease, will usually be detected. These babies also need to be referred for early treatment.

More information

Editor’s Notes:

*Clarification provided for our US readers

** Resources outside the U.K.

  • For the individual state test conditions and screening programs in the US visit here.
  • For more information on newborn blood screening visit the CDC bulletin here

 

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Do You Know What Vitamins & Supplements Your Little One Needs?

The average healthy American child probably does not need much of anything to supplement their diet and the emphasis should be placed on offering a healthy diet in moderation of all portions of that diet to include fats and carbohydrates (sugar). Most regular vitamins we all hear about are needed in very small doses that are easily supplied by a varied North American diet. Having said that, there are certain groups of children who definitely need supplementation; to mention just a few, certain chronically ill children, certain children from third world countries suffering from starvation or emotional deprivation, or severely abused children in this country who have been subjected to the worst possible environmental deprivations.

The Academy of Pediatrics recommends the following for other special groups:

  1. Since another recommendation is to limit sun exposure in children in order to prevent later skin cancers, and this restriction can lower amount of vitamin D normally produced in sunlight, and therefore, a supplement of 400 IU of vitamin D is recommended based on sun exposure (or lack thereof). For exclusively breast fed babies, 400 IU of vitamin D daily is recommended early after delivery. For those babies drinking 32 ounces of formula a day no vitamin D supplement is recommended since all American formulas have the correct supplement of this vitamin.  Whole milk also has correct vitamin D supplement but whole milk not recommended for children over 12 months of age. Check with your baby’s Doctor about the need for this vitamin.  Similar recommendations are made for calcium and phosphorus intake.
  2. Babies who are full term and have no problems have probably received enough iron from their mothers during the last month of pregnancy to last the first 3- 4 months so an exclusively breastfed baby should begin Iron supplementation beginning at age four. Iron in breast milk is only partially absorbed. Preterm and developmentally disabled children are also at higher risk for Iron deficiency while formula fed infants will receive the proper amount of iron as long as they continue formula. Fortunately, it is common place for Pediatricians to check a blood count as an indication of iron status at age 9- 10 months and again at around 15 months and if anemia is found iron can be added to the diet. The bottom line again is to check with your Doctor for the need and amount of iron needed for your infant and child.
  3. Large amounts of certain vitamins such as A, C, D and K has never been shown to provide any beneficial effects in normal healthy North American children and can be toxic– this is not a case of “if a little is good a lot is better”- often times this is not the best policy for anything.
  4. As far as other vitamins (such as A & B) are concerned, I stick with my original paragraph that most healthy children eating a fairly well rounded diet over all, (not day to day) does not need any extra vitamin supplement at.

Homeopathic supplements for children are very popular now but there are no adequate recommendations for amount used and frequency for children and therefore should be used with caution; further knowledge and research is needed.

Other complementary medical treatments have no definite guidelines for use in children, but certain children may benefit from their use.

Always involve your child’s Doctor when considering going beyond the established guidelines in your children.

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