Parenting Tips

2006-08-15T19:38:00.000-07:00

Neonatal (Newborn) Jaundice

- Dr Yeo Kin Lian Paediatrician & Neonatologist,
Gleneagles Medical Centre

Jaundice in newborn babies is common and is often not a serious medical problem. However, severe jaundice may lead to cerebral palsy, deafness and mental retardation. Fortunately, these complications are rare with the availability of effective treatment for babies who develop significant jaundice, and with close follow-up checks after discharge from the hospital.

In talking to parents, the same questions are often asked about jaundice.

1. Does my baby have jaundice ?
This is one of the commonest questions asked by parents who have a newborn baby. Jaundice usually appears on the third day of life and tends to peak around the fifth day. Therefore, when babies are discharged on the third day, the doctor should review them a few days later. It is not advisable to delay the follow-up check by more than a week.

2. What is jaundice ?
Jaundice is a yellowish discolouration of the skin caused by excessive bilirubin in the body. Bilirubin is a substance formed by the breakdown of red blood cells , and the liver gets rid of the bilirubin pigment via the stool. In newborn babies however, more bilirubin is produced compared to the amount excreted, resulting in the accumulation of bilirubin in the blood.

Although we can tell that a baby is jaundiced by looking at the skin, a blood test may be necessary to decide if treatment is required.

3. Will my baby develop jaundice ?
Jaundice is more frequent in Chinese babies as compared to Caucasian babies. It is also common in babies who are born premature, have blood groups that are incompatible with their mothers', suffer from excessive bruising, or those with G6PD (a type of enzyme normally present in red blood cells) deficiency.

It is not possible to predict which baby will develop jaundice. Therefore, it is important for the doctor to see the baby a few days after discharge.

4. How can I tell if my baby has Jaundice ?
Very often, parents look at their baby's eyes for jaundice. However, it is difficult to tell if a baby is jaundiced by looking at the eyes because the baby's eyes are often closed. Jaundice first appears around the nose and face, and progresses downwards to the rest of the body as it worsens.

5. What are the symtoms of jaundice ?
"The baby looks yellow !" That is the most obvious and only symtom in almost all babies. They usually feed well and appear normal in behaviour.

6. What can I do to orevent jaundice ?
Regular feeding with formula or breast milk helps with the excretion of jaundice in the stools. Water or glucose feeds does not help in reducing jaundice.

7. Is there any food I should avoid ? Can I continue breastfeeding ?
In general, there is no need to restrict the diet of nursing mothers. It is better to avoid herbal preparations. To be safe, you should seek the advice of a doctor or lactation consultant for possible side effects of prescribed medications. It is not necessary to stop breastfeeding in mild or moderate jaundice.

8. Is jaundice dangerous ? Is treatment of jaundice really necessary ?
Jaundice is dangerous at extremely high levels. Bilirubin (jaundice) is toxic to nerve cells in the developing brain. It can cause cerebral palsy.deafness, and mental retardation. Yes, treatment of jaundice is necessary to prevent it from reaching dangerously high levels.

9. How is jaundice treated ? Can it be prevented with medicine ? Does fluorescent lights and sunlight help ?
Phototherapy (light treatment) is safe and effective. The baby has to be monitored closely during the treatment. Eye shields are used to protect the baby's eyes during treatment. Blood exchange transfusion is only performed if the jaundice is very severe amd is not responding to phototherapy.

Medication to prevent jaundice exists, but it is not available for routine treatment yet.

Normal flurorescent lights at home is not effective treatment and there is no scientific proof to show that sunlight is effective in the treatment of jaundice.

10. Will the jaundice recur ?
The short answer is no. In most babies, jaundice resolves after 1 or 2 weeks and does not recur. Breastfed babies may have jandice that can persist for up to 10 weeks.

All babies need follow-up medical checks untils the jaundice resolves. Persistent jaundice may be a sign of hepatitis or liver disease. Pale or beige coloured stools are abnormal and must be reviewed by the doctor as soon as possible.

And there you have it - all you ever want to know about jaundice !

2006-08-07T04:22:00.000-07:00

Umbilical cord blood - He's ready for his new life..
Are you ready to safeguard it ?

Cord Blood Cryopreservation saves lives. The stem cells in a newborn's umbilical cord have been used in lifesaving treatments for many diseases. Cord blood is a rich source of stem cells. These stem cells will develop into mature blood and immune cells and potentially into cells of other organs.

You've only got one chance at it. Cord Blood can only be collected from the newborn's umbilical cord at the time of birth. So DON't Miss THIS OPPORTUNITY of a lifetime.

FAQ :

Q : What is Umbilical cord blood ?
A : Umbilical cord blood represents the blood that remains within the placenta and can be drawn out from a vein in the cord attached to the placenta. The Placenta and its attached section of cord are normally thrown away following the birth of your child.

Q : What is stored umbilical cord blood used for ?
A : Umbilical cord blood is a rich source of blood stem cells. These cells have been proven for use in the treatment of blood related cancers and other blood or immune system related diseases. Transplantation for the treatment of other cancers or diseases is possible and currently may be in clinical trial.
Transplanting these cord blood cells, within either context, offers hope of cure for many patients with various life-threatening diseases.

Q : Is transplantation the only use for cord blood stem cells ?
A : Transplantation protocols for blood diseases and disorders are currently the main clinically proven use of cells from cord blood. Research clinician and Scientists are currently exploring the use of freshly isolated cord blood cells for repair of damaged organs or for protocols in various cell therapies.

Q : When is the cord blood collected ?
A : The cord blood is collected immediately after the delivery of your baby. The cord blood is collected after the umbilical cord is clamped and cut between the mother and baby. The blood is collected from the umbilicus vein from the section of cord that remains attached to the placenta, not attached to your baby. Therefore , blood is not taken from your baby. The collection process will not change your labour experience in any way. The safety of the birthing process, your privacy and that of your baby are of great importance.

Conclusion : I would urge all would-be parents to consider the option of preserving their umbilical cord blood upon the birth of their child. In the case if they do not want to go this path or do not want to pay for the service, they could choose to donate it for free. Of course the service is dependent on the country you resides in.. but in Singapore, it will not cost you anything to donate to the SCBB (Singapore Cord Blood Bank). And yes, information about you is kept confidential at the SCBB..Your baby's cord blood unit is identified by a unique number, NEVER by name. - YOU Could help to SAVE the LIFE of a Child or an Adult !

2006-07-24T23:56:00.000-07:00

Looney Tunes images

Some of my fondest childhood memories revolve around Looney Tunes images. Bugs Bunny was a staple in our home. My brother and I spent countless hours watching Bugs Bunny, Daffy Duck and Elmer Fudd along with the other crazy cartoon characters. We were entertained by these characters for years and years and I find it very difficult to believe that the cartoons are no longer being aired.

The cartoons (my brother and I refer to them as Bus Bunny cartoons) are no longer aired on television. There are updated Looney Tunes images that are presented with new storylines but they are not nearly as good as the originals.

This tragic turn of cartoon events is due to concerns about political correctness and concerns about violence on television. The edited Looney Tunes images are better than nothing but even these cut versions are scarcely seen on television today. I find this to be detrimental to the development of my child’s cartoon appreciation skills.

The thing that I loved about the Bugs Bunny cartoons was the detail in the artwork. The background scenes were meticulous and had details that are lacking in today’s cartoons. The Looney Tunes images were far more professional than the flat characters and empty backgrounds presented to us today.

The music was another great feature of the older cartoons. I was introduced to classical music through Bugs Bunny. Not only were the Looney Tunes images of superior quality, the music was as well. Mozart was a regularly featured composer on many of the episodes that we watched every Saturday morning.

One episode won an award for its amazing attention to detail. The character in the cartoon was playing the piano. The artists drew the character’s hands to replicate an actual piano player’s as he struck the keys. This Looney Tunes image is not socially unacceptable nor is it violent. It is also never aired on television anymore.

I guess that I will rely on downloading Looney Tunes images from the computer to teach my kid about what I watched while I was growing up. I guess that I will have to pull the fond stories and tales out of my mind to share with my child.

Saturday mornings will never be the same without the classic cartoon entertainment. It has been years since I have seen one of these cartoons but the Looney Tunes images remain strong in my memory.

2006-07-24T23:45:00.000-07:00

Do you need a toy chest ?

Children’s toys can create a lot of bothersome clutter. With housing prices skyrocketing throughout the world, families are turning to smaller housing for affordability. Keeping the clutter of toys to a minimum is important.

If you do not own a toy chest, also called a toy box, you may want to invest in one. Toys can be neatly stored away in a toy chest at night or when company is over.

A typical toy chest is a simple wooden box that contains a bottom, four sides, and then a hinged or sliding top. A toy chest can be plain or very ornate. Depending on where you want it to be while determine the type you’ll want to invest in. If it’s going to be sitting in a corner out of sight an inexpensive version will certainly suffice.

I own a coffee table that has a tabletop that flips up and turns into a bench with a hidden toy box underneath. This coffee table has held my children’s Lego’s for years. While the toys are readily available for after school play, the toy chest appears to be little more than a coffee table when company is over. This type of toy chest can make any busy mother’s day a little less stressful.

Teaching a youngster to keep a room tidy can be much easier when a toy chest is involved. Many children respond extremely well to games. Putting toys into a toy chest can turn the most tedious of childhood chores into a fun experience. Softer toys can be used in a game of toy chest basketball, while harder toys can become a race to see who can pick up and put away toys the fastest. Instead of battling with your children, you can turn picking up into a fun activity.

My own children helped pick up when they were young. They loved competing against each other while seeing who could pick up his or her half of the toys the fastest. The helped me out immensely, while they loved the fact that the game made picking up fun. It is a huge help for mom when children do not mind doing their share of the toys. My only problem is that I never did the same thing with laundry.

Utilizing this form of storage contain can also help with bedroom messes. Many children’s toys contain small pieces that do not come in a box. Using a toy box or toy chest makes it easy to store these smaller objects while still keeping them accessible for active children. Toy boxes are handy items that every home should have!

2006-07-24T23:22:00.000-07:00

Newborn Baby Gifts

Shopping for newborn baby gifts can be a nerve-wracking experience. There are no creatures as indecisive and moody as new babies, except for their parents. So when getting new baby gifts, you really should play it safe. Don't try to get subtle things for newborn baby gifts, but get something that the parents will deffinitely really appreciate. Unfortunately, it is hard to predict what newborn baby gifts will go over best because babies are so indecisive, and their parents will like it if the kids find them entertaining. So you should try to find a new baby gift that you as a baby would have liked, or if you have had the chance to meet the baby, try to figure our what would fit that baby best.

Of course the best, or at least the most popular newborn baby gifts are the expensive and complicated bright plastic electronic ones, big and clunky with lots of loud noises and electric lights. You can pay anything from 20 dollars to 200 dollars for these newborn baby gifts, but there is a good chance that the baby will like them, even if the noises of the beeping and squaking speakers sometimes drive the parents crazy. They are also great gifts to develop a baby's skills and coordination. The babies can push different buttons to make different sounds, or to hear different words, and sometimes can even fit different objects into different shaped holes to develop spatial reasoning.

Other great newborn baby gifts are stuffed animals. New baby gift stuffed animals are really great for infants, and will last for a considerable amount of time, because the baby will come to treasure its stuffed animals for years. Stuffed animal newborn baby gifts can be depended on to soothe the baby and be an affectionate, if somewhat chewed on and drooled over companion. Of course, clothing always makes a good newborn baby gift as well. New babies are notoriously messy creatures, and creatures which one strives mightily to dress up in the most adorable of attire. Therefore, a new baby needs a considerable amount of clothing which is warm, comfortable, and easy for the parents to put on and to take off. This is why if you buy clothing for newborn baby gifts the parents will inevitable meet it with their thanks and gratitude, giving you ample reason to feel proud of your gift.

2006-07-05T03:50:00.000-07:00

Hand Foot & Mouth Disease

A miserable child who has lost of appetite,

perhaps the child has hand-foot-mouth disease......

What is Hand Foot & Mouth Disease ?

Hand-foot-mouth disease (HFMD) is caused by the Coxsackie virus and Enterovirus 71. The throat and tonsils develop small ulcers while the hands, feet, and diaper area are affected by a rash with characteristic vesicles (very small blisters). This is usually a mild illness with the rash healing in 5 to 7 days.

Who Gets It ?

HFMD is spread from person to person by direct contact with the nasal discharge, saliva, faeces and fluid from the rash of an infected person. A person is most contagious during the first week of the illness. This disease is most common among young children, particularly those aged less than 5 years. Adults can get it, but this is much less common.

What are the Symptoms ?

Children with HFMD disease usually start to feel crummy 3 to 7 days after they are expsed. Often, the first thing parents notice is their children's decreased appetite. Children may also have a fever, headache and a sore throat. A day or two later, many children develop sores ion the mouth. They begin as small red spots on the tongue, gums, or mucous membranes. They may blister or form ulcers.

A skin rash may also develop over a day or two, with flat or raised red spots. The spots are often found on the palms and soles. Also , it is common to have the rash on the buttocks. Often, the red spots will form tender blisters. The rash does not itch.

Treatment

There is no specific treatment for the infection other than symptomatic relief of symptoms. Treatment with antibiotics do not help with HFMD. Acetaminophen can be used to treat fever. Aspirin should not be used in viral illness in children under age 12 years. Salt water mouth rinses may be soothing. Ensure an adequate fluid intake because swallowing may be painful.

Prevention

Children should be kept away from crowded public places (such as schools, preschools, play groups, markets and public transport) if they show signs of infection. Family members and schools are advised to maintain high standards of personal and environmental hygiene to minimize the risk of HFMD. We should adopt the following good practice :

Wash hands with soap before eating and after going to the toilet;
Cover mouth and nose when coughing or sneezing;
Maintain good air circulation;
Clean thoroughly toys or applicances which are contaminated by nasal or oral secretions;
Do not share eating utensils

Advice For Parents

Children should be kept away from crowded public places (schools, preschools, play groups, markets, swimming pools, public transport etc.) If they show signs of infection.

Parents are advised to consult a doctor early if their child has symptoms of HFMD. They should also be alert to any change oin their child's normal behaviour, e.g. irritation and sleepiness. Should they refuse to eat or drink, have persistent vomiting or drowsiness, parents should bring their child immediately to hospital.

Children suffering from HFMD should not attend childcare centres, kindergartens or schools. They should :

Stay at home and avoid contact with other children until they have recovered;
Not swim until 6 weeks after the onset of illness;
Remain away from school until their fever has subsided and they must be certified free from HFMD infection by a registered medical practitioner prior to returning to school.

2006-07-05T02:35:00.000-07:00

Childhood Depression

Childhood depression is a very real but sometimes elusive illness that affects the young today. We take a look at what it actually means and how unity and support in the family can help fight its hold over a child.

At the recently concluded Asia Pacific Suicide Prevention Convention 2006, we learnt a few startling facts about children and suicide. For example, in a worldwide survey, 7.3% to 38% of the children surveyed demonstrated suicide ideation, which is the idea of wanting to kill themselves. In Singapore, close to 4.7% of children entertain this morbid thought. While the figure may be alarming, there is no need to panic as it is actually not uncommon to think about suicide.

Ask anyone in the street if he had thought about suicide before and the answer will most probably be a `yes'. Thinking about something as serious as killing oneself and actually doing it are two different matters. Out of all childhood suicides, approximately 23.5% are associated with mental illness such as depression, schizophrenia and others. Seeing the numbers and understanding that depression is one of the key causes that drive our young to suicide. It is time we understand a little more about this elusive illness called "Childhood Depression".

The Definition of Childhood Depression

In a 2004 article published by the American Academy of Child and Adolescent Psychiatry http://www.aacap.org/publications/factsfam/depressd.htm , childhood depression is defined as "an illness when the feelings of depression persist and interfere with a child or adolescent's ability to function."

Feelings of depression are represented in the forms of mood, physical, mental and behavioural changes in a child. Dr Ken Ung, Senior Consultant Child, Adolescent & Adult Psychiatrist & Psychotherapist at Adam Road Hospital describes the signs of childhood depression as persistent "irritability or loss of interest, loss of appetite and weight, poor sleep , lethargy, headache, stomach pain, loss of concentration, preoccupation with self-harm or suicide, refusal to go to school, increased temper tantrums and antisocial behaviours such as smoking, drinking and running away from home. Any combination of these changes that lasts for more than two weeks could spell a child falling into depression and warrants a closer look.

Many of the symtoms listed are actually applicable to both adults and children but there are telling differences. Age, in a non-categorical way, does make a difference in the presentation of depressive behaviour. "We don't tend to categorize (childhood depression) in terms of age groups," says Dr Ung, " but we can generally say that adolescent depression tends to look more like adult type depression , whereas, childhood depression can be more `a typical' perhaps manifesting in bodily pains and behaviour changes. The closer the age of a child to adulthood - the more we can expect to see an adult-type depression.

Types of childhood depression

There is no clear categorization of childhood depression. According to Dr Ung, "Typing depression is notoriously difficult and fashions come and go. We now tend to type it according to severity i.e. mild, moderate and severe. Sometimes, we use the term `reactive' depression to denote the type that is due to a reaction to some stress (such as the sudden passing of a loved one). Although very rare in children, `psychotic' depression refers to the presence of psychotic symptoms, which are symptoms that show that the person has lost touch with reality, i.e. hearing voices, believing irrational, bizarre or incredible thoughts."

Another childhood psychiatry expert, Dr Sharon Chan of Sharon Chan Child Guidance Clinic, who has been practicing child psychiatry since 1988 concurs, "I am not sure that there is such a categorization (of childhood depression).. because the entity is still controversial, it follows adult depression patterns (sic) - chronic, single episode or recurrent, adjustment disorder, bipolar etc."

Bipolar disorder, also known as manic-depression, is a type of mood disorder marked by extreme changes in mood, energy levels and behaviour. Symptoms can begin in early childhood but more typically emerge in adolescence or adulthood. Children with bipolar disorder usually alternate rapidly between extremely high moods (mania) and low moods (depression). These rapid mood shifts can produce irritability with periods of wellness between episodes, or the young person may feel both extremes at the same time. Parents who have children with the disorder often describe them as unpredictable, alternating between aggressive or silly and withdrawn.

Stages of childhood depression

According to a Harvard Medical School Publication, " The picture changes with age. Up to age three, the signs (of childhood depression) may include feeding problems, tantrums, and lack of playfulness and emotional expressiveness. AT ages 3-5, depressed children may be accident-prone and subject to phobias. Even before age 5, they may show signs of self-reproach by apologizing unnecessarily for minor mistakes and transgressions like spilling food or forgetting to put clothes away. Children of early school age (6-8) sometimes show depression with vague physical complaints and aggressive behavior. They may cling to their parents and avoid new people and challenges. At ages 9-12, some common symptoms are morbid thoughts and lying awake worrying about schoolwork. By then, children have enough intellectual capacity and social understanding to think about reasons for their depression , and they may blame themselves for disappointing their parents."

When asked for his opinion on this analysis, Dr Ung says, " I think that this is a good guide by and large. Nevertheless, this is merely a guide and should not ne taken as set in stone. For example, a 12 year old boy may show signs of depression by aggressive behaviour and phusical complaints."

For Dr Chan, "Depression before the age of six is very rare. In fact, I do not think that there is general agreement that it exists. In a young child, the common emotional condition is anxiety, not so much depression. From six years onwards, I would agree with the given description."

Children under stress, who experience loss , or who have attention , learning , conduct or anxiety disorders are at a higher risk for depression. Depression also tends to run in families.

Lena's experience

Lena (not her real name) is a 17 year-old student who recently suffered a relapse and fell into depression once more. Lena has been troubled by depression since the age of 12. Once again, she has no appetite for food, is feeling listless and confused, lost alot of weight and is isolating herself from others.

Lena's mother, 49 year old clerical staff Sonia (not her real name), recounts her daughter's experience with depression, " It all started after Lena's father passed away. At first , nothing seemed wrong. SHe was very sad but she did not shed a tear at his funeral. It was a year after that she started to miss him badly. This was compounded by being bullied in school and stressed by schoolwork. Always a quiet child, Lena became even more withdrawn. She had trouble sleeping, would cry for no reason, refused to eat and talked about hurting herself."

Seeing her daughter's condition, Sonia brought Lena to a Polyclinic which referred them to a psychiatrist at a hospital. Lena was given antidepressants and started having regular therapy sessions with psychiatrists and counsellors. She tried to follow their advice of not thinking negatively, to focus on developing her interests and to make a timetable for each day. Everyday was a struggle but she managed to recover with time.

"She said she liked the counselling sessions where she could talk to someone about her feelings and problems." say Sonia of Lena's reaction to treatment. "Slowly, she got better to the point that she was more cheerful and could laugh and giggle like a normal young girl. She even enrolled in yoga classes that helped her gained fitness and to relax."

For Sonia, being supportive of Lena through the down times and being sensitive to her needs are her priorities. "I told her that her health is more important than studies. When I'm at work, I try to call her and talk to her whenever I can. She will tell me things like, " Mummy, I'm useless and I don't know what to do," and I will try to encourage her to look on the bright side, not to think too much..etc.. I have to try to give her lots of love, my full support and attention."

Treatment

What most doctors agree on is that medication should not be used unnecessarily on children and that when used, it should be accompanied with the right counselling and therapy. " It's interesting that recent studies have not been able to prove that antidepressants work in children. This could be because children are not mini adults and what works for adults may not work for kids," says Dr Ung.

There is also little research of how antidepressants work on children and prescription drugs may increase the risk of self-harm for some vulnerable ones. However, Dr Ung adds, "To keep a perspective on things, the increase of antidepressants prescriptions is small, probably around 2% in affected children given inactive medications (placebos) to about 4% of those on active medication."

Counselling, it seems , plays the key role in helping children recover from depression. "A good counsellor will try to get information from parents, child and school and will try his or her best to co-ordinate the counselling to incorporate all these parties. Cognitive-behavioural therapy is one of the commonest forms of counselling techniques used nowadays - it seeks to change the negative thoughts of the child to more realistic and positive ones and also t help the child make action/behavioural changes that will help lift the mood," adds the psychiatrist.

Cyber Help
With the computer-savvy generation of today, some children or teens may choose to express their thoughts and feelings in cyber space. http://www.depnet.com is a community website launced in March to provide information and counselling services for depression. A `diary' services allows members to post daily updates on their mental and emotional experiences while a `letterbox' service provides them with an opportunity to ask questions to a panel of experts. Most importantly, a service like this seeks to educate the public on the existence of depression and encourage those who are depressed to seek help. Following examples, depressed children may be inspired by a strong sense of community to step out of a possible state of isolation. Adults too, can visit to gather more information and advice before deciding how best to seek help.

Understanding is Key.

"Sometimes, depressed children are mistakenly labelled as lazy, stubborn or difficult," says Dr Chan. This is largely due to a lack of knowledge and understanding on the adults' part. Children, unlike adults are dependent on their families and guardians to identify their troubles and seek help.

Dr Ung adds," One common misconception is that the child is mad. This is totally not so. Another is that the child is `weak'. Some famous people who are strong of character and have suffered depression include Abraham Lincoln. Another misconception is that it is incurable or that the child is `bad'. Depression is a very treatable condition and the change of behaviour from depression should not be mistaken for `badness'.

2006-07-05T01:58:00.000-07:00

Are You Ready For Another Baby ?

According to some studies, a gap between births of 18 to 23 months has the highest chance of ensuring the healthiest possible outcomes for both mother and babies. Many experts agree that women should space pregnancies at least 18 months apart, so that their bodies would have had sufficient time to make a full recovery from the last birth. This is especially true for moms who have had a previous cesarean or other uterine surgery.

Having said that, when it comes to family planning and birth spacing, there is really no `rule of thumb'. Some women will be enthusiastically planning for another child while they still have one or more children in diapers. Others may not even want to think about those long nine months of pregnancy until their youngest child is at least ready for kindergarten.

One thing is for sure - as much as having a baby is a big change, going from your first to your second(or more) can be an even bigger challenge. What should you consider if you're trying to decide whether you're ready for another new addition to your family ?

First of all, it is important to consider your won needs, wishes and capabilities. Does the thought of having another baby fill you with delight or trepidation ? Are you being indirectly `pressured' to have another child, because you're coming close to the end of that `optimal fertility' age, or because you think your child really ought to have a playmate ?

You'll also need to think about your energy level, and whether you will realistically be able to cope with the physical demands of an increased workload. Can you count on any help from your spouse, relatives or friends, not just during the pregnancy, but also after the birth ? Are you mentally prepared to make sacrifices, because having more than one child really doesn't leave you with much personal or social time ?

Another crucial factor is your relationship with your spouse. Does your partner feel about the same way as you do about having another baby ? If not, you should really work the ground and go through the issues befire you make a firm decision as to whether a new baby is a good idea. Remember, two-way communication is vital in a marriage and most `projects' work best when both partners are on the same side of the fence.

Some couples believe that having a baby can help to bring them together, but unfortunately, more often than not, the opposite is true. If you're already facing problems in your marriage, a squalling newborn is unlikely to provide a solution, and may even increase the existent level of tension in your relationship.

Don't forget your child or children when you are contemplating another pregnancy. It is an inevitable fact that once a second child is born, parents will no longer be able to spend as much time with either child as they spent with their first, so be ready to grapple with those pangs of guilt !

Before the age of three, most children will not accept with any measure of grace the notion of sharing their parents, space and belongings. If you have a toddler at home, be prepared for the child to react to a new sibling by displaying jealous or muischievous behaviour. Temper tantrums and exhibitions of sibling rivalry are very likely in the pipeline, so it's really advisable for your to psyche yourself up for some colourful displays of emotion if your decide to go ahead with your plan to introduce a sibling.

Emotions and states of mind aside, you must take a realistic look at your physical surroundings and your financial health. Is your current home big enough to house another little being ? Don't forget that while a newborn can spend its first few months in a cot, sooner or later, you need to address the question of shared versus separate rooms for your kids.

If having a baby means having to move to a larger home, your finances will obviously enter the equation. Though your initial 'capital outlay' will not be as great as when you had your first child, due to the fact that you can often recycle baby clothing and equipment, you will need to seriously consider parallel expenses for clothing, entertainment and education as your children mature.

There's no denying that the cost of raising kids can be pretty hefty. If having another child is going to cause you to live out the next ten years of your life on a shoestring budget, postponing the "baby plan" until your bank account is looking healthier may be the practical way to go.

Ready, Steady, Go !!!

So you've take the time to weigh all the factors mentioned, and decided that you're all set for that new arrival. What's next ? Well, if you have a young child at home, one of the first of many practical things you will need to consider is your decrease in mobility and energy level in the later stages of pregnancy. Make sure that you have or will have some form of help at hand, and plan in advance for your older child to be constructively occupied while you go about with your bulging belly.

As you enter your eighth month of pregnancy, start preparing your child for the imminent arrival of the baby. If you begin too soon, your child may grow impatient ion the process of waiting for the "event" - nine months is a long time to a young child~ Books are a wonderful way of introducing the concept of a new baby to toddlers, and there are plenty of good books for kids on the subject.

As much as a new baby is going to be big change for all family members, it may affect the existing child the most. Reassure your child continually that the amount of love he is receiving is not going to decrease with the arrival of another little creature. WHen you are buying items in preparation for the birth, don't neglect to throw in a inexpensive gift for your first child, just to remind him that he is by no means forgotten.

If you are planning to move to a bigger residence, it is recommended that you make this transition before you even start trying for a baby, as you most certainly do not want to be faced with the propect of moving when you are heavily pregnant ! Even if you decide to stay in your current home, bear in mind that 'new demarcation lines' will have to be drawn up.

It's never too early to pre-designate an area in the house as a special place or private territory belonging to the first child. This will become your older child's 'sanctuary' in which to feel secure when his privacy is invaded (and it will be). It's also a good idea to set aside a common area, and to encourage your child to identify a few toys as 'shareable' ones. Consequently, his 'private property' can be safely stored within his reach but out of the grasp of smaller and (arguably) stickier fingers.

2006-07-05T01:00:00.000-07:00

7 Baffling Things Toddlers Do

Every parent of a toddler will come across bewildering behaviours exhibited by their tiny tot for which no adult explanation can account for. For instance, why do toddlers love taking off all their clothes, often at strange moments and stranger places ? Or why do they insist on the same food at mealtimes, only to turn their noses up at the tried-at-tested recipe one fine day out of the blue ?

Even if parents cannot fathom the logic behind the actions, toddlers almost always have a perfectly good reason for behaving the way they do. Experts advise parents not to be overly concerned about these unusual behaviours, because most of them are perfectly normal, and usually (and thankfully!) short-lived.

Conundrum 1. My toddler is frightened of the most ordinary things.

Many kids have some `understandable' fears such as fear of the dark, of imaginary monsters, or of loud noises such as thunder. HOwever, some kids are scared of the most commonplace objects - for instance, 5-year-old Su used to be absolutely terrified of brooms.

"We were mystified by her phobia, until Su became old enough to talk about it," said her mother, Anna. Apparently, the bristles on brooms reminded Su of the hair of a scary witch she once saw in a television drama. Fortunately, Su grew out of her fear by the time she was 4. Her parents' advice ? "Don't dismiss or get angry at your child's fears, even if they seem irrational to you. Plenty of reassurance and patience works far better than annoyance or frustration.

Conundrum 2. My toddler starts screaming for me whenever I talk on the phone.

Everytime Susan picks up her mobile phone to make or answer a call, her 18-month-old toddler, Brian, ambles over as fast as he can, clings on to her leg and starts whining for her attention. " He could be perfectly happy playing with his toys, but when that phone is pressed to my ear, he starts making his loud protests," laments Susan.

One simple reason why this can happen is that young kids hate being interrupted in the middle of a game, or some other fun activity, that they are engaged in with the parents in question. Another explanation is that they have no concept of time - "I'll be done in a few minutes!" does nothing to reassure them. The solution? Keep a box of items that can divert your kid's attention , and buy you a few minutes' peace, within easy reach when you need to use the phone.

Conundrum 3. My toddler is frightened of the most ordinary things.

Three-year-old Bill loves to get back to basics by progressively shedding every single item of clothng he has on in the course of just one morning. "He hates any kind of clothing," concludes his mother, May. "I even have to use scotch tape to secure the pull-up diapers which he wears at bedtime !"

Well, look at it from your kid's point of view. If he is feeling the heat, what's the quickest way and most obvious way of getting comfortable ? Sometimes, it's also the fact that they relish in their recent found abilities to strip bare - it's fun,and the looks on their parent's faces are even more amusing. Rather than get all bothered over it, let your child have his way - it'll be something you'll all laugh over when he grows out if this phase.

Conundrum 4. My toddler is frightened of the most ordinary things.

When 2-year-old Mandy started to display a fondness for cheese, her mother Fiona was delighted. She stocked up on all types of cheese - slices, sticks, cubes and so on. Imagine her chagrin when her capricious daughter's tastes suddenly changed ! "The cheese was left untouched and I had to throw it all out," sighed Fiona.

These culinary U-turns can be triggered by changes in appetite or mood. Toddlers are notoriously fussy eaters and what tastes great one day may just foul the next. Another possibility is that they are exercising their newly discovered sense of control, and are trying to push the boundaries by attempting to put their tiny feet down. Your best bet is to stay calm and casually reintroduce the food in a month's time. Chances are, it might find its way back on your kid's list of `favourites'.

Conundrum 5. My toddler is fascinated with toilets.

Toilets obsession is by no means unusual among toddlers. Try seeing it from their point of view - here is a wonderful and magical contraption that can whisk away their emissions with just a flush ! Naturally, kids wonder where all the much goes, and some take the further step of actively and physically examining the loo - any loo - in an attempt to find the answer. - No matter how embarrassed you may be when your child heads straight for the washroom wherever you visit, don't try to shoo him off with deadly threats. The best way is to spend an hour or so being his partner in crime - show him how the toilet works, and explain how each mechanism has its purpose. Don't be mortified - no kid has ever spent his childhood staring down a toilet chute without getting bored at some stage.

Conundrum 6. My toddler says or does the same thing over and over and over.

Every morning for the past month, my three-year-old son asks me as i head out the door, "Mommy, where are you going ? " The best part is, he makes this same query at least 15 times before I manage to get going, even though the answer - "Going to work, babe!" - is always and invariably the same.

Sometimes, it's just another one of their ingenious delay tactics. Other times, it's due to the fact that your kids simply love to keep you talking - the subject matter isn't of the least importance. Repetition could also stern from a child's love of routine; rituals reassure them greatly.

You can always try to steer your child in an entirely fresh direction, by introducing a new topic, or a different activity. However, do be warned that this may just motivate him to start a new line of repetitive questions, or a new game that he will want to play with you - 50 times over.

Conundrum 7. My toddler suddenly becomes shy with people he knows well.

Mike visits his grandparents on a monthly basis, something which he has done since he was a wee baby. When he arrives, Granny eagerly stretches out her arms and calls out a warm welcome, but he refuses to approach her, choosing instead to hide behind his mother's skirt. What's the reason for these sudden `shy' episodes ?

"I try to remember that toddlers don't view time as we do, and a month is a long period in the life of a child," say Mike's mother, Ling. "I encourage my parents to take it slowly, and not to overwhelm him - a warm-up session usually helps in getting him to start play with the `strangers' again. " As a child matures, his memory and sense of time improves, and these `shy' incidences will gradually lessen.