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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.

How Can I Make Sure My Toddler Eats Healthy: Meal Ideas

If you need some inspiration to help you cook healthy and tasty food for your kids, try these meal ideas. 

They’re not suitable as first foods, but fine once your baby is used to eating a wide range of solid foods.

When preparing food for babies, don’t add salt, sugar or stock cubes directly to the food, or to the cooking water.

Breakfast ideas for babies and children

  • unsweetened porridge or cereal mixed with milk, topped with mashed ripe pear
  • wholewheat biscuit cereal with milk and unsweetened stewed fruit
  • toast fingers with mashed banana
  • toast fingers with a hard-boiled egg and slices of ripe peach
  • unsweetened stewed apple and breakfast cereal with plain, unsweetened yoghurt

Children’s lunch or tea ideas

  • cauliflower cheese with cooked pasta pieces
  • mashed pasta with broccoli and cheese
  • baked beans (reduced salt and sugar) with toast
  • scrambled egg with toast, chapatti or pitta bread
  • cottage cheese dip with pitta bread and cucumber and carrot sticks
  • plain fromage frais with stewed apple

Children’s dinners

  • mashed sweet potato with mashed chickpeas and cauliflower
  • shepherd’s pie (made with beef or lamb) with green vegetables
  • rice and mashed peas with courgette sticks
  • mashed cooked lentils with rice
  • minced chicken and vegetable casserole with mashed potato
  • mashed canned salmon with couscous and peas
  • fish poached in milk with potato, broccoli and carrot

Snacks for babies and toddlers

  • fresh fruit, such as small pieces of soft, ripe peeled pear or peach
  • canned fruit in fruit juice
  • rice pudding or porridge (with no added sugar or salt)
  • plain, unsweetened yoghurt
  • toast, pitta or chapatti fingers
  • unsalted and unsweetened rice cakes
  • plain bagels
  • small cubes of cheese

Getting your child to eat fruit and vegetables

Try these ways of increasing your child’s intake of fruit and vegetables:

  • Put their favourite vegetables or canned pineapple on top of pizza.
  • Give carrot sticks, slices of pepper and peeled apple as snacks.
  • Mix chopped or mashed vegetables with rice, mashed potatoes, meat sauces or dhal.
  • Chop prunes or dried apricots into cereal or plain, unsweetened yoghurt, or add them to a stew.
  • For a tasty dessert, try mixing fruit (fresh, canned or stewed) with plain, unsweetened yoghurt. You could also try tinned fruit in fruit juice, such as pears and peaches, or unsweetened stewed fruit, such as apples.

Your baby and cows’ milk

From six months, keep giving your child mum’s milk or formula milk, as well as introducing solid foods, but don’t give cows’ milk as a drink. Whole cows’ milk can be used in small amounts in cooking or mixed with foods from the age of six months. You can give it to your child as a drink from the age of one.

Semi-skimmed milk can be introduced at two years old, providing your child is eating a varied diet and growing well for their age. From five years, you can give your child 1% or skimmed milk to drink.

Further information

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From www.nhs.uk





Choosing a C-Section: What Is It and When Is It The Best Option?

A caesarean section, or C-section, is an operation to deliver your baby through a cut made in your tummy and womb.

The cut is usually made across your tummy, just below your bikini line.

A caesarean is a major operation that carries a number of risks, so it’s usually only done if it’s the safest option for you and your baby.

Around one in every four to five pregnant women in the UK has a caesarean.*

Why caesareans are carried out

A caesarean may be recommended as a planned (elective) procedure or done in an emergency if it’s thought a vaginal birth is too risky. They’re usually performed after the 38th week of pregnancy.

A caesarean may be carried out because:

  • your baby is in the breech position (feet first) and your doctor has been unable to turn them by applying gentle pressure to your tummy, or you would prefer they didn’t try this
  • you have a low-lying placenta  (placenta praevia)
  • you have pregnancy-related high blood pressure (pre-eclampsia)
  • you have certain infections, such as a first genital herpes infection occurring late in pregnancy or untreated HIV
  • your baby isn’t getting enough oxygen and nutrients – sometimes this may mean the baby needs to be delivered immediately
  • your labour isn’t progressing or there’s excessive vaginal bleeding

If there’s time to plan the procedure, your midwife or doctor will discuss the benefits and risks of a caesarean compared with a vaginal birth.

Asking for a caesarean

Some women choose to have a caesarean for non-medical reasons. If you ask your midwife or doctor for a caesarean when there aren’t medical reasons, they will explain the overall benefits and risks of a caesarean compared with a vaginal birth.

If you’re anxious about giving birth, you should be offered the chance to discuss your anxiety with a healthcare professional who can offer support during your pregnancy and labour.

If after discussion and support you still feel that a vaginal birth isn’t an acceptable option, you’re entitled to have a planned caesarean.

What happens during a caesarean

Most caesareans are carried out under spinal or epidural anaesthetic. This mean you’ll be awake, but the lower part of your body is numbed so you won’t feel any pain.

During the procedure:

  • a screen is placed across your body so you can’t see what’s being done – the doctors and nurses will let you know what’s happening
  • a cut about 10-20cm long will usually be made across your lower tummy and womb so your baby can be delivered
  • you may feel some tugging and pulling during the procedure
  • you and you birth partner will be able to see and hold your baby as soon as they’ve been delivered

The whole operation normally takes about 40-50 minutes.

Occasionally a general anaesthetic, where you’re asleep, may be used, particularly if the baby needs to be delivered more quickly.

Read more about how a caesarean is carried out.

Recovering from a caesarean

Recovering from a caesarean usually takes longer than recovering from a vaginal delivery. You might need to stay in hospital for three or four days, compared with one or two days for a vaginal birth.

You may experience some discomfort in your tummy for the first few days, and you’ll be offered painkillers to help with this.

When you go home, you’ll need to take things easy at first. You may need to avoid some activities such as driving for six weeks or so.

The wound in your tummy will eventually form a scar. This may be red and obvious at first, but it should fade with time and will often be hidden in your pubic hair.

Read more about recovering from a caesarean.

Risks of a caesarean

A caesarean is generally a very safe procedure, but like any type of surgery it carries a certain amount of risk.

It’s important to be aware of the possible complications, particularly if you’re considering having a caesarean for non-medical reasons.

Possible complications include:

  • infection of the wound or womb lining
  • blood clots
  • excessive bleeding
  • damage to nearby areas, such as the bladder or the tubes that connect the kidneys and bladder (ureter)
  • temporary breathing difficulties in your baby
  • accidentally cutting your baby when your womb is opened

Read more about the risks of a caesarean.

Future pregnancies after a caesarean

If you have a baby by caesarean, it doesn’t necessarily mean that any babies you have in the future will also have to be delivered this way.

Most women who have had a caesarean section can safely have a vaginal delivery for their next baby, known as vaginal birth after caesarean (VBAC).

However, you may need some extra monitoring during labour just to make sure everything is progressing well.

Some women may be advised to have another caesarean if they have another baby. This depends on whether a caesarean is still the safest option for them and their baby.

For more information, the Royal College of Obstetricians and Gynaecologists has a leaflet on birth options after previous caesarean section (PDF, 357kb).

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

*1 in 3 pregnant women in the U.S. has a caesarean

 





How to Reduce Your Baby’s Teething Pain

Teething can be distressing for some babies, but there are ways to make it easier for them.

Every baby is different, and you may have to try a few different things until you find something that works for your baby.

Teething rings

Teething rings give your baby something to chew safely. This may ease their discomfort and distract them from any pain.

Some teething rings can be cooled first in the fridge, which may help to soothe your baby’s gums. The instructions that come with the ring should tell you how long to chill it for. Never put a teething ring in the freezer, as it could damage your baby’s gums if it gets frozen.

Also, never tie a teething ring around your baby’s neck, as it may be a choking hazard.

Teething gels

Teething gels often contain a mild local anaesthetic, which helps to numb any pain or discomfort caused by teething. The gels may also contain antiseptic ingredients, which help to prevent infection in any sore or broken skin in your baby’s mouth.

Make sure you use a teething gel that’s specially designed for young children and not a general oral pain relief gel, as these aren’t suitable for children. Your pharmacist can advise you.

It’s best to talk to your pharmacist or GP before using a teething gel for babies under two months old.

If your baby is chewing

One of the signs that your baby is teething is that they start to chew on their fingers, toys or other objects they get hold of.

If your baby is six months or older, you can give them healthy things to chew on, such as raw fruit and vegetables. Pieces of apple or carrot are ideal. You could also try giving your baby a crust of bread or a breadstick. Always stay close when your baby is eating in case they choke.

Find out what to do if your baby starts choking.

It’s best to avoid rusks, because nearly all brands contain some sugar. Avoid any foods that contain lots of sugar, as this can cause tooth decay, even if your child only has a few teeth.

Paracetamol (*acetaminophen) and ibuprofen for teething

If your baby is in pain or has a mild raised temperature (less than 38C), you may want to give them a sugar-free painkilling medicine that is specifically for babies and young children. These contain a small dose of paracetamol or ibuprofen.

Children under 16 years old shouldn’t have aspirin.

Always follow the instructions that come with the medicine. If you’re not sure, speak to your GP (*doctor or pediatrician) or pharmacist.

Comforting a teething baby

Comforting or playing with your baby can distract them from any pain in their gums.

Preventing teething rashes

If teething is making your baby dribble more than usual, gently wiping their face often may help to prevent a rash.

Caring for your baby’s new teeth

You’ll need to register your baby with a dentist when their teeth start coming through – find a dentist near you.

Start brushing your baby’s teeth with fluoride toothpaste as soon as their first milk tooth breaks through.

For more advice, read about looking after your baby’s teeth.

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

Additional note:  Avoid benzocaine teething gels – there are plant-based natural teething gels that do not have the same drug safety concerns as noted by the US FDA:
https://www.fda.gov/Drugs/DrugSafety/ucm250024.htm

 

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From www.nhs.uk





How to Raise Healthy Vegetarian and Vegan Children

How Can I Raise A Healthy Vegetarian or Vegan Child?

If you’re bringing up your child on a diet without meat (vegetarian) or without any food from an animal (vegan), they’ll need two or three portions of vegetable proteins or nuts every day to make sure they get enough protein and iron.

Don’t give whole nuts to children under five years old as they could choke. Grind nuts finely or use a smooth nut butter.

Read Food allergies for important information about peanut allergy.

Weaning your vegetarian baby

The advice on introducing solids at about six months is the same for vegetarian babies as for non-vegetarian babies. However, as your child gets older, there’s a risk that a vegetarian or vegan diet may be low in iron and energy and too high in fibre.

You can make sure your child gets enough iron by giving them:

  • fortified breakfast cereal
  • dark green vegetables
  • bread
  • beans and lentils
  • dried fruit, such as apricots, figs and prunes

Vitamin C in fruit and vegetables helps the body to absorb iron, so include these at every mealtime.

You can help ensure that your child gets all the nutrients they need by giving them smaller and more frequent main meals, with one or two snacks in between, and making sure they eat a good variety of foods. You’ll also need to make sure they get enough calcium, vitamin B12 and vitamin D.

The Department of Health recommends that all children aged six months to five years are given vitamin supplements containing vitamins A, C and D every day.

It’s also recommended that babies who are being breastfed are given a daily vitamin D supplement from birth.

Babies who are having more than 500ml (about a pint) of infant formula a day shouldn’t be given vitamin supplements because formula is fortified with certain nutrients and no other supplementation is required.

Read more about vitamins for babies and toddlers.

Vegan diets for children

If you’re breastfeeding and you’re on a vegan diet, it’s important that you take a vitamin D supplement. You may also need extra vitamin B12.

Take care when giving children a vegan diet. Young children need a good variety of foods to provide the energy and vitamins they need for growth.

A vegan diet can be bulky and high in fibre. This can mean that children get full up before they’ve taken in enough calories. Because of this, they may need extra supplements. Ask a dietitian or doctor for advice before introducing your child to solids.

Energy

Young children need lots of energy to grow and develop. Give vegan children high-calorie foods, such as hummus, bananas and smooth nut and seed butters (such as tahini and cashew or peanut butter). They still need starchy foods. However, don’t give only wholegrain and wholemeal versions to children under five years old because they’re high in fibre. For extra energy, you could add vegetable oils or vegan fat spreads to foods.

Protein

Pulses and food made from pulses are a good source of protein for vegan children. Nut and seed butters also contain protein. Always use smooth versions for babies and children under five years old. Breastfeeding until your child is two or more, or giving them soya-based formula milk if they are vegan, will help ensure they get enough protein.

Ask your GP for advice before using soya-based formula.

Calcium

Fortified soya drinks often have added calcium. Some foods are also fortified with calcium, so check the label.

Vitamin B12

Fortified breakfast cereals and some yeast extracts contain vitamin B12. Your child may also need a supplement.

Omega-3 fatty acids

Some omega-3 fatty acids are found in certain vegetable oils, such as linseed, flaxseed, walnut and rapeseed oils. However, these are chemically different from the long chain omega-3 fatty acids found in oily fish. Evidence suggests that these short-chain fatty acids may not offer the same protection against heart disease as those found in oily fish.

Editor’s Note: from PedSafe Expert, Pediatrician Dr Joe:  The question “how can I raise a healthy vegetarian or vegan child is a challenging one”.  Technically speaking, UK and US recommendations for vitamin supplementations are fairly similar.  However, having read this article you’ll note that there is a significant responsibility passed onto the parents to know the exact content of every food in their childrens’ diets and look for any specific deficiencies based on all vitamins and minerals. This is a Herculean task as there is a plethora of information and disinformation out there that must be evaluated by parents.  Therefore I would ask parents to seriously consider their reasons for adopting a diet like this for their children, and to discuss all food choices and diet changes with their pediatrician to ensure their child is maintaining a proper nutritional balance.





How to Provide Care for Ill or Premature Babies

Neonatal care in hospital

Special care is sometimes provided on the ordinary postnatal ward and sometimes in a specialist newborn (neonatal) area. Having a baby in neonatal care is naturally worrying for parents and every effort should be made to ensure that you receive the information, communication and support that you need. Not all hospitals provide specialist neonatal services, so it may be necessary to transfer your baby to another hospital.

Why babies need special care

Babies can be admitted to neonatal services for a number of reasons:

  • they are born early – one baby in 13 (8 out of 100) is born early, and babies born before 34 weeks may need extra help with breathing, feeding and keeping warm
  • they are very small and have a low birthweight
  • they have an infection
  • their mother has diabetes
  • the delivery was very difficult or they have jaundice
  • they are waiting for, or recovering from, complex surgery

Contact with your baby

The environment of the unit may seem strange and confusing, especially if your baby is in an incubator or on a breathing machine. There may also be tubes and wires attached to their face and body. Ask the nurse to explain what everything is for and to show you how you can be involved in your baby’s care. Once your baby is stable, you will be able to hold him or her. The nurses will show you how to do this and your baby will benefit greatly from physical contact with you.

Feeding

To begin with, your baby may be too small or too sick to feed themselves. You may be asked to express some of your breast milk, which can be given to your baby through a tube. A fine tube is passed through his or her nose or mouth into the stomach. This won’t hurt them.

Breast milk has particular benefits, especially for sick or premature babies, as it is enriched with proteins (notably antibodies), fats and minerals. If your baby is unable to have your breast milk to begin with, it can be frozen and given to them when they are ready.

When you go home, you can express milk for the nurses to give while you are away. There is no need to worry about the quantity or quality of your milk. Some mothers find that providing breast milk makes them feel that they are doing something positive for their baby.

Find out about expressing your breast milk.

Incubators

Babies who are very small are nursed in incubators rather than cots, to keep them warm. You can still have a lot of contact with your baby. Some incubators have open tops, but if your baby’s incubator doesn’t you can put your hands through the holes in the side of the incubator to stroke and touch your baby.

When your baby is stable, the nurses will be able to help you take your baby out of the incubator and show you how to have skin-to-skin contact. You should carefully wash and thoroughly dry your hands before touching your baby. You can talk to your baby as well – this can help both of you.

The charity Bliss has information explaining the equipment on a neonatal unit.

Newborn babies with jaundice

Jaundice in newborn babies is common because their livers are immature. Severely jaundiced babies may be treated with phototherapy (light therapy). The baby is undressed and put under a very bright light, usually with a soft mask over their eyes. The special light helps to break down the chemical that causes jaundice. It may be possible for your baby to have phototherapy by your bed so that you don’t have to be separated.

This treatment may continue for several days, with breaks for feeds, before the jaundice clears up. In some cases, if the jaundice gets worse, an exchange transfusion of blood may be needed (some of your baby’s blood will be removed and replaced with blood from a donor). This is not common. Some babies have jaundice because of liver disease and need different treatment. A blood test that checks for liver disease is done before phototherapy is started.

Find out more about treatment for newborn jaundice.

Babies with jaundice after two weeks

Many babies are jaundiced for up to two weeks following birth. Jaundice can last up to three weeks in premature babies. It is more common in breastfed babies and does no harm. It is not a reason to stop breastfeeding.

It is important to see your doctor if your baby is still jaundiced after two weeks. You should see the doctor within a day or two. This is particularly important if your baby’s poo is chalky white. A blood test will distinguish between “breast milk jaundice”, which will go away by itself, or jaundice that may need urgent treatment.

Babies with disabilities

If your baby is disabled in some way, you will be coping with a lot of different feelings. You will also need to cope with the feelings of others, such as the baby’s father, your relations and friends as they come to terms with the fact that your baby has a disability.

More than anything else at this time, you will need to talk to people about how you feel, as well as about your baby’s health and future.

Your GP* (doctor), a neonatologist (doctor for newborn babies), paediatrician (children’s doctor) or your health visitor can all help you. You can also contact the hospital Patient Advice and Liaison Service (PALS)** or your social services department for information about local organisations that may be able to help. You can contact your social services department in the UK through your local authority (in the UK)**.

The organisations listed here can offer help and advice – many are self-help groups run by parents**:

Talking to other parents with similar experiences can often be the most effective help.

Worries and explanations

Hospital staff should explain what kind of treatment your baby is being given and why. If they don’t, ask them. It’s important that you understand what is happening so that you can work together to make sure that your baby gets the best possible care. Some treatments require your consent to go ahead and the doctors will discuss this with you.

It is natural to feel anxious if your baby needs special care. Talk over any fears or worries with the hospital staff. Hospitals often have their own counselling or support services, and a number of charities run support and advice services.

The consultant neonatologist or paediatrician should arrange to see you, but you can also ask for an appointment at any time if you wish. The hospital social worker may be able to help with practical issues such as travel costs or help with looking after children.

Read more information on serious conditions and special needs in children.

The charity Bliss has information and support for parents of babies being cared for in a neonatal unit. You can find out more at:

healthtalk.org has video interviews and articles on women talking about their experiences of having a baby in special care.

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

** Resources in the United States

  • US Hospitals typically offer similar Patient Liaison services – ask for Patient Relations or Patient Representatives
  • Social Services in the United States can provide information to help with costs and treatments
  • Children with Disabilities: UNICEF
  • Genetic Alliance is the US affiliate of Genetic Alliance UK
  • Note: several of the UK based organizations listed above like Bliss, Group B Strep Support, etc. have extensive websites offering detailed information that will be of assistance to parents worldwide.





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