EARS

Ear infections are common in children because their eustachian tubes (the tubes that connect the middle ear to the throat) are short; thus, any throat infection can ascend quickly to the middle ear.

MIDDLE EAR INFECTION

Otitis media, or infection of the middle ear, is quite common in children and is associated with recurrent tonsillitis. In fact, one of the main reasons for removing tonsils (and adenoids) is chronic middle ear infections. Infections are caused by bacteria entering the middle ear from the nose and the throat via the eustachian tube. If middle ear infections are left untreated, they can result in permanent hearing loss. Recurrent middle ear infections are often linked with middle ear effusion.

Symptoms The most prominent symptoms are severe earache and loss of appetite. Your child may also have a fever or a discharge from the ear, and there may be some hearing loss. A toddler with a middle ear infection may be distressed and pull and rub the affected ear, which will be very red; in fact the whole side of his face may be inflamed.

Treatment The usual treatment is a course of antibiotics and pain-relieving medication. At home you should keep your child comfortable and cool and give lots of drinks as well as his medicines. An ear, nose, and throat specialist should treat repeated middle ear infections to avoid middle ear effusion. An operation to remove the tonsils may be recommended.

MIDDLE EAR EFFUSION

If your child has repeated infections of the middle ear or throat, or tonsillitis, the middle ear can gradually fill with jellylike fluid. Because the fluid cannot drain away through the eustachian tube, it becomes gluelike and impairs hearing because the sounds are not being transmitted across the middle ear to the inner ear, where they are actually heard. It’s important to deal with this condition promptly or your child could be slow to speak and learn.

Symptoms Middle ear effusion usually causes no pain, but partial hearing loss and a feeling of fullness deep in the ear may occur. A child with chronic middle ear effusion may sleep with his mouth open, snore, and speak with a nasal twang. If this condition is not treated it can cause permanent deafness, resulting in speech and learning problems.

Treatment After examining your child’s ear with an otoscope, a doctor may prescribe antibiotics to clear the infection and vasoconstrictor drugs to allow the fluid to drain. In severe or recurring cases of middle ear effusion, a minor operation may be necessary to insert a tiny plastic tube that drains the mucus through the eardrum, which quickly heals after a few days. The tubes quite often drop out of their own accord and rarely have to be reinserted, since all the fluid has drained.

A child who has tubes inserted should take precautions to avoid letting water into the ears, and should swim only if he is wearing snug-fitting earplugs.

THROAT

Throat infections such as tonsillitis and adenitis are rare in babies under one year. ‘They are more common in children who have just started school and are being exposed to a new range of bacteria.

SORE THROAT

An uncomfortable or painful throat is usually due to infection by a bacterium such as streptococcus, or a virus such as the cold or flu viruses.

Symptoms Your child may tell you that he has a sore throat, or you may notice that he finds it hard to swallow. Depress his tongue with a spoon handle and tell him to say “aaahhh” so that you can look down his throat for signs of inflammation or enlarged red tonsils.

Treatment Give lots of drinks, and puree your child’s food if he finds it difficult to swallow. Your doctor may prescribe an antibiotic if there is a bacterial infection or tonsillitis.

TONSILLITIS AND SWOLLEN ADENOIDS

The tonsils, situated on both sides of the back of the throat, prevent bacteria that invade the throat from entering the body by trapping and killing them. This can sometimes result in the tonsils themselves becoming swollen and infected. The adenoids, which are situated at the back of the nose, are nearly always affected at the same tIme.

Symptoms Your child will complain of a sore throat and may find swallowing difficult. On examination, the tonsils appear red and enlarged, possibly with yellow and white patches. He may have an elevated temperature, the glands in his neck may be swollen, and his breath might smell. If the adenoids are swollen, too, his speech may sound nasal.

Treatment Consult your doctor, who may take a throat swab and examine your child’s ears and glands. Bacterial tonsillitis is treated with appropriate antibiotics. Removal of the tonsils is considered after many severe recurrent attacks, or if the ears are badly affected too

Daytime naps As your child gets older you will find that she doesn’t necessarily want to sleep at nap time, but she still does need to rest. Try to make a routine out of nap time, whether your child sleeps or not by, say, playing some music or reading. You may find your child goes to sleep at nap time if you allow her to sleep in your bed as a special treat, or if you give her some idea of how long the nap time will be. One way of doing this is to put on her favorite tape and say that nap time isn’t over until the tape is finished.

FROM CRIB TO BED

When your child is strong enough and well coordinated enough to climb out of her crib and come into your room, it is time for her to start using a bed. Most children will be pleased and excited with their new bed, but if your child seems nervous, there are plenty of things you can do to help. The simplest thing is to let her take naps in the bed until she is ready to sleep in it at night. If you are worried that your child might fall out of the bed, you could use a bed guard on one or both sides.

PLEASANT BEDTIMES

From the age of three onward, your child may use delaying tactics in order to put off going to bed. The way you handle this situation really depends on how much energy you have at the end of the day, and what your previous bedtime routine has been.

If you’ve been looking after your child and managing the household tasks all day, you will need private time and may feel you can insist on her going to bed. On the other hand, if you have been out at work all day, you will want to see your child, so you may feel sympathetic to her pleas for your attention.

If you’ve always had quite a strict bedtime routine and your child suddenly departs from this, then it’s probably best for both of you if you firmly reinstitute the bedtime with loving fairness. If, however, you’ve always been flexible about bed times, then it’s probably best for your child’s happiness and peace of mind and your serenity to let her stay with you and make herself comfortable. She will be asleep in a few minutes if she has the reassurance of your presence in the room.

KEEPING BEDTIME PEACEFUL

I am convinced that bedtimes should be happy times, and with my own children I would do anything to keep them from going to bed unhappy. I was always prepared to make concessions to them at this time. I would do my utmost to prevent any crying, and where during the day I might admonish or punish a small misdemeanor, it would go unmarked at nighttime to make sure that my child didn’t go to sleep with the sound of an angry parent’s voice resounding in his ears.

If you have more than one child, let them enjoy their bedtimes in the same bedroom. Company is reassuring and seeing a sister or brother in pajamas at the same time as she is makes your child feel that bedtimes are just and fair, even if your older child is allowed to stay up slightly later. Until they get to an age where they need their privacy , it’s a good idea for them to share a bedroom.

Open the airway

Lay your child down on his back on a firm surface. Your child’s tongue may fall back on the rear of his throat when he is unconscious and on his hack. To move the tongue up and away from the throat, place two fingers under his l’hin and tilt his head back.

Give rescue breaths

Using your finger and thumb, pinch your child’s nostrils closed. Inhale, put your mouth over his mouth, making a complete seal, and breathe out until his chest rises. Remove your mouth and watch the chest fall. Give one breath every three seconds.

Check the pulse

After one minute of rescue breathing, check the pulse in your child’s neck . If there is no pulse, give CPR for one minute, then call an ambulance. If there is a pulse, continue rescue breathing and check the pulse every minute.

CARDIOPULMONARY RESUSCITATION FOR TODDLERS

If there is no pulse, give chest compressions with rescue breaths

Positioning the hand

Place your child on his back on a firm surface. Put the middle finger of one hand on the tip of the breastbone (the bone where the ribs meet in the middle), and the index finger above it. Put the heel! of your other hand so that it rests just above the index finger.

Give rescue breaths

After five compressions give one rescue breath. Don’t stop to take your child’s pulse unless he shows signs of reviving. Alternate five compressions in three seconds with one rescue breath. After one minute, call an ambulance, then continue.

Give chest compressions

Take your fingers away from the breastbone. Use the heel of the other hand to press down sharply to a depth of about 1inches (3 centimeters). Give five compressions in three seconds (time them by counting “one-and-two-and­three-and- four -and-five”).

CHOKING

If your child’s airway becomes partially or completely blocked he will choke and, if he’s unable to get enough oxygen into his lungs, may lose consciousness. To restore normal breathing, the blockage must be removed. You need to act promptly. Follow the steps outlined below to remove the obstruction. If, after following these steps, you are unable to clear the obstruction, You should call an ambulance immediately.

Get him to cough

Encourage your child to cough because this will help dislodge the obstruction.

Abdominal thrusts

Check inside his mouth for the blockage. If it is still there, make a fist and place this just below the rib cage, cover your fist with your other hand, and thrust firmly inward and upward. Continue the thrusts until the object is expelled, your child can breathe, or he loses consciousness. If this happens, immediately follow the four steps described in the box, right.

THE ABC OF RESUSCITATION

If your child stops breathing or loses consciousness, you must carry out the following checks in the order given:

A is for Airway Open the airway by lifting your child’s chin with two fingers, and tilting back his head slightly.

B is for Breathing /f your child shows no signs of breathing you will have to use rescue breaths to breathe for him.

C is for Circulation Check that your child has a pulse. If there is none, give CPR-chest compressions with rescue breaths .

UNCONSCIOUS

Lay your child on his back. Tilt his bead, lift his chin, and give rescue breaths . If they don’t go in, call an ambulance.

Straddling your child’, legs, place the heel of one hand above his navel and the other hand on top, and give five thrusts inward and upward.

Look in his mouth and remove any object using your finger.

Give rescue breaths again. If successful, continue giving breaths until your child starts breathing on his own or the ambulance arrives.

At the same time, it is equally unfair for your care team to assume that you will eventually decide on epidural analgesia and refuse to support you through unmediated labor. You need to be prepared to stand up for your self and your freedom to make an individual and guilt free choice.

Choosing Unmedicated Labor

If you feel strongly about avoiding medication during labor, it is important to plan carefully. Look for care providers and doulas who discuss pain relief in labor by asking you how you would like to handle your pain. Try to avoid care providers whose intense personal beliefs make them inflexible and likely to impose their beliefs on you. The most important things to consider when you choose pain medication are the effectiveness of pain relief balanced against the side effects for you and your baby. for information on having an epidural and other ways of managing pain in labor. The most important factors in the success of your plan are your own knowledge base and the support of your care team. Learn as much as you can about different labor positions for early labor and for pushing. Finally, choose to deliver your baby in a hospital or birthing center that supports unmedicated labor.

During your tour ask specific questions about labor positions the use of baths or showers for relaxation and pain relief, and the availability of labor aids such as birthing balls. Think about bringing different kinds of music, and remember to pack some snacks to keep up your strength and remain hydrated.

Movement Breathing And Relaxation Techniques

During labor, try different positions to see what feels right to you. Move around if you can between contractions, when you have a contraction, lean on a bean bag or against your partner. Some omen find that circling their hips or getting in to another position helps. Repetitive movements during labor can also be helpful. You may want to try rocking movements, arm movements, and hand squeezing. Some women find music during labor soothing, while others find it distracting and annoying. Concentrate on breathing slowly and deeply, but don’t get over zealous about sticking to particular breathing patterns, which can lead to hyperventilation. Vocalizing with grunts, moaning, or swearing can help manage pain. Don’t let hospital personnel try to guilt you in to keeping quiet during unmedicated labor.

Massage

Your birth partner can massage your back between contractions, and you may find this relaxes you. You might want to bring aromatherapy oils with you, if you find them soothing.

Water

Using a warm bath or shower during early labor is safe and does not increase the chances that you will develop an infection, whether or not your bag of water (amnioticsac) is already leaking. Bathing is relaxing, and increases satisfaction and a feeling of well being. Warm baths generally keep pain from getting worse for awhile (about half an hour in one study), but may not make much difference after this. There fore, bathing may have a short-term effect in decreasing labor pain and can be helpful in early labor, promoting relaxation between uterine contractions. Women who want a higher level of pain control may find bathing is only a temporary aid.

Support In Labor

Having good support during labor can make a difference in how well you manage to deal with labor pain. For example, some research suggests that using a doula as the primary labor coach (instead of a friend or partner) decreases the likelihood of having an epidural for pain relief or needing a cesarean delivery. A doula is an individual who is trained to help support or coach you during your labor or to support you after your baby is born.

Doulas vary widely in their levels of experience, their philosophies and their training. In some cases, doula services can be costly. If you want to use a doula, find one who is knowledgeable and flexible, and with whom you are personally comfortable. Since labor is an intense and intimate time, if you choose a doula you will want to spend some time and effort checking on qualifications and making sure that you are compatible. Rates charged by doulas vary widely.

Wearing contacts is also a very hygienic choice compared to regular glasses, which may collect germs and dirt if they are not regularly cleaned. If you’ve never used lenses before, you will also find that they are surprisingly cheap (especially if you compare with all the broken eyeglass frames you’re likely to encounter).

If you want to spend as much time and focus on your baby as possible, you probably want to get a pair of contact lenses that require very little care and cleaning. The most convenient ones are called disposable lenses, which you replace every morning. With these, there is no need for any cleaning solutions or maintenance, and you are also less likely to develop eye infections or irritated eyes, since you constantly have new, fresh lenses. If you are ready for less hassle with bulky glasses, just visit your local eye doctor to get your lenses properly fitted.

The Prenatal Core:

• How many members are there in the practice? What are their specialties?
• Will you have a primary provider, or will you see all members of the group during your pregnancy? Will this provider be of your own choosing and can you choose between a physician and midwife?

The Labor:

• Will your primary provider be your birth attendant or will you be cared for in labor by whomever in your group practice is on call that day?
• Can you choose between a physician and midwife to attend your birth?
• Will your physician or midwife meet you in the admitting area of the hospital or birthing center or will you be examined initially by a resident who will then contact your provider?
• Will you have a routine pubic shave (not shown to be effective in reducing infection rates)?
• Will you have a routine enema (not shown to be effective in stimulating or shortening labor and may have side effects)?
• Will you be allowed to walk around in labor (shown to help reduce the length of labor)?
• Who and how many people will be able to accompany you in labor?
• Will children (if you wish) be able to be present in labor?
• What is the provider’s rate of epidural anesthesia? The institution’s? What other pain relief measures does the provider generally utilize or recommend? If you have an epidural, will it be a low-dose, “walking” epidural?
• Can you bring your own pillows, clothes, food?
• Will you be able to eat/drink in labor?
• Will you routinely have intravenous (IV) tube feedings?
• Will you have routine continuous electronic fetal monitoring, intermittent electronic fetal monitoring, or intermittent monitoring of the fetal heart tones by fetoscope? Will the type of monitoring be determined by your risk status?
• What is the limit to how long each stage of labor will be able to go on, as long as progress is being made?
• What is the limit to how long you will be able to push as long as progress is being made?
• Will you be able to push in a variety of positions, such as knee­chest, side-lying, squatting, on the toilet?

The birth

• Will you be able to birth in the same-room as your labor?
• Will you be able to birth in a variety of positions, including squatting or side-lying, as you prefer at the time?
• Who and how many people will be able to be with you at the birth?
• Will children (if you wish) be able to be present for the birth? • Will your partner or other support person be able to cut the umbilical cord? Will he or she be able to put hands on the baby at the delivery?
• Is there a policy regarding audio or video taping of labor and/or birth should you want this option?
• What is the physician’s or midwife’s rate of episiotomy (should be very low as routine episiotomies have not been shown to be beneficial) ?
• What is the provider’s rate of cesarean birth? (This may be difficult to evaluate as it will depend on the type of practice the provider has; for example, if the provider is known as a “high­risk” physician, or is certified in the subspecialty of maternal and fetal medicine, other physicians may send women with serious problems to this physician, increasing her or his cesarean birth rate. in any case, it should be as low as possible. The Healthy People 2000 goals of the U.S. Public Health Department advised a cesarean birth rate of 15 percent by the year 2000. While this takes into consideration not only what is desirable, but what is possible, It can be used as a reasonable cut-off for a cesarean birth rate, even by a specialist in problem pregnancies.)
• Will your partner/support person(s) be able to accompany you if you have a forceps, vacuum, or cesarean birth?
• Will you be able to have epidural anesthesia for a cesarean birth, except in the situation of severe fetal distress requiring the fastest type of anesthesia available (most likely general anesthesia)?

The period after birth (postpartum)

• Will you be able to hold the baby immediately? Will the physician or midwife put the baby on your abdomen as soon as s/he is born?
• Will you be able to nurse immediately after birth?
• Will you ever need to be separated from the baby-i.e., will you have 24-hour rooming-in starting immediately?
• Will the baby’s physical examination be at your bedside or, if not, can you go to the newborn nursery for the examination?
• How many hours/days will you and the baby need to stay in the hospital/birthing center?
• Will you be able to stay in the hospital if the baby needs to re­main there longer than you do?
• What kind of emergency care is available should the baby need special care? Is this care on-site or via transfer? If transfer, what is the transfer system?
• Will the nurses give the baby formula if you do not have 24-hour rooming-in or will they wake you up to nurse?
• Does the hospital have a breast-feeding specialist or lactation consultant on staff?
• What, if any, type of classes for newborn and mother care are available postpartum?
• What are visiting policies postpartum-for your partner, other family members, friends, other children? Does having visitors mean the baby will have to go to he nursery?
• If your baby needs special care, is kangaroo care available ? What are visiting policies for the mother/father/others in the special care nursery (often called the NICU-Neonatal intensive Care Unit)? Can the parents participate in the newborn’s care in this nursery?