Tips on Baby Basics

  • Be attuned and responsive to the needs of your infant by watching, touching and listening.
  • Always provide love, attention and affection to your infant.
  • Breastfeeding through one year of age is always best. Longer is better.
  • Breast feed your new infant every 1-2 hours until your milk comes in.
  • If your infant is urinating 6 times a day and the urine is clear and copious your infant is not dehydrated.
  • A double electric breast pump that is adjustable provides speed and efficiency benefits.
  • Breast milk can be kept in the fridge for four days and in the freezer for 3-6 months.
  • Always thaw breast milk overnight in the fridge or by immersing in tepid water.
  • Keep visitors to a minimum during the first few weeks of life.
  • Safety at home, in the car and out of the home is very important.
  • Dress your infant in layers to help with temperature regulation.
  • Always follow the “Back to Sleep” rules to decrease your infant’s risk of SIDS.
  • The use of a lubricant such as petroleum jelly in the diaper area after every diaper change prevents diaper rashes.
  • Consider giving your infant a soft full body massage with olive oil, coconut or Neutrogena bath oil twice a day to prevent skin dryness.
  • Infants startle due to sudden noises or an unexpected touch or body movement. This is normal.
  • Infants under 6 months of age cannot be spoiled.
  • The use of a body carrier helps both mother and baby.
  • Co-sleeping does have risks associated with it.
  • The best ways to calm a baby include walking or swaying, sucking on a finger or pacifier, upper body swaddling and making sushing sounds.
  • Watch a You Tube video about how to swaddle your infant. Leave the legs loosely wrapped but supported. This helps to prevent hip problems.
  • Infants who swallow excess air often feed less well
  • Three burping positions are the throne and shoulder positions, the belly flop on lap position and the walking strut with baby facing away.
  • Diaper changing stations need proper safety, set-up and hygiene.
  • Chewing, rubbing, cold and rare pain medications are the best ways to decrease teething pain.
  • Avoid cereal and pureed baby food before 4-6 months of age.
  • Never leave an infant alone in a tub and always check the water temperature.
  • Baths 1-2 times a week are often enough.
  • Tummy time can become fun time but it often takes practice and patience.
  • Always look for snooze clues such as eye rubbing and cranky behavior.
  • Sleep schedules are often irregular through 4-6 months of age.
  • After 4-6 months most infants benefit from scheduled naps twice a day.

Grandparent Boundaries

Grandparent wisdom and advice can benefit your child.  By the year 2030 30% of the US population will be over age 65.  Although many things have changed since grandparents raised children many things have not.  Grandparents can be the best models, mentors and memory keepers for a family. They can also be intrusive, rash and judgmental. Every parent must recognize the perils of this generation gap while at the same time understanding the wisdom and experience grandparents provide.

Whether you are a parent or a grandparent your goal is to keep your child safe.  It is important for parents and grandparents to avoid confrontations that can lead to resentment. Advice from grandparents often feels judgmental. Grandparents must be cautious not to intrude or interfere in the decisions their children make about raising their own child. Many times useful information is presented in ways that cause friction and wounds that are difficult to heal.

Parents must take the time to explain to their parents why they want things done differently in the past. Choose your battles carefully and focus on what is important rather than engaging in a battle for control. By explaining why you want something done differently you will be better able to engage your parents in a dialog concerning the care of their grandchild. This dialog will allow you to address the concerns of the grandparent rather than just telling them what you want done. Always seek middle ground and compromise on minor issues. On important issues always focus on the health and safety of your child and stand firm about the boundaries you set and the decisions you make.

Parents and grandparents must both learn how to suppress their egos. Many Grandparents view parents as children rather than as adults worthy of respect and parents view parenting advice from grandparents as intrusive and interfering. A parental “it is now my turn” mentality leads to discord and inevitable differences in opinion and prevents the development of reciprocal respect.

Parents must be flexible and at the same time set clear boundaries concerning the care of their child.  Grandparents must find the balance between sharing their experience and wisdom while not interfering and avoiding rash judgment and hostility. When parents and grandparents recognize each has a unique perspective to share the value of personal opinions increases.

Some things that need to be discussed include safety issues, discipline and technology. Smoke avoidance is very important. Infants and children of all ages should not be exposed to tobacco smoke. When placed in a crib a “back to sleep” position should always be used. Infants must not be overdressed since overheating increases the risk for sudden infant death syndrome (SIDS). The crib should be free of all toys and bumper pads are not needed. The mattress should be firm and there should be no loose cords that could lead to entanglement and strangulation. Baby powder and fragrances should be avoided and breastfeeding is best.  Supplemental food should not be introduced until 6 months of age. A rear facing car seat is best until age 2 years and a bedtime bottle should be avoided. Infants under 6 months of age cannot be spoiled. If an infant under this age is crying a cry it out (CIO) approach is not appropriate.

Eating patterns have also changed. Portions should be small and never encourage children to clean their plate if they are no longer hungry. A better response is to decrease future portions.  For discipline positive redirection and antecedent management have replaced negative punishment. Finally technology is moving forward rapidly. Technology is now imbedded within the lives of children. The focus should be on setting healthy boundaries concerning the use of technology rather than on avoidance and negative comments about the hazards and dangers of technology.

A Simple Word

Why is it so hard to say, ”No?”

I picked up my afternoon schedule and nodded yes. My secretary had just asked me if she could add two patients into my afternoon schedule.  Every slot on the day planner was filled, and I wondered how I was going to find time to fit everyone in. I tossed the schedule on the desk as the phone rang. “Dr. Barber your first patient is ready.” Head down, I took a deep breath in and walked out of my office.

Life is an emotional winter storm, chaotic and overfilled with promises and responsibilities. Minutes, hours and days are consumed by endless duties, lists and negative emotions. Parents are overwhelmed by fatigue and limited by time and opportunity. As responsibilities grow hopeful dreams fade, and parents stop living. Frozen and overwhelmed by shame, guilt, anger and fear parents silently accept the next demand, the next responsibility and the next chore.

Your brain is a wonderful instrument. Billions of synapses allow you to debate, disrupt, judge and detail what needs to get done. The brain drives us all to act or not to act, to think or not to think and to perform or not to perform. It becomes the storyteller of acceptance and excuses and the enforcer against saying the word “No.”

Excuses allow parents to say no when the brain is overpowered by inadequacy and negative emotions. Each of us is hardwired not to say “No.”  We want to be powerful and well-liked. We want to be change agents and competent models.  Responding with an excuse rather than the word “No” justifies rather than explains and shrouds us with avoidance rather than acceptance and communication. Excuses are a passive and protective stall tactic that bury our emotions and allow us to hide from and avoid our own feelings.  They harm us physically and emotionally and must be replaced with truth.

The best way do this is to recognize, understand and respond to your own needs and take control of your life by using the word “No.”  This word must be practiced and cultivated. It empowers both the speaker and the listener and allows you to disengage while encouraging the speaker to seek and find another solution. “No” informs the listener you are willing to give up control and makes the listener the agent of change. This heartfelt , mindful and trust filled act informs the listener that you do not have the desire or ability to take on one more task or responsibility and are confident that they do have the ability to find their own solution.

This act of saying “No” is the foundation of self-care. Self-care creates prosperity for all and increases your generosity and future ability to give. It eliminates the need to make excuses for self-neglect and supports responsibility for your own needs. Self-care enriches two-way communication and provides the energy to live an inspirational life filled with love, passion and good health.

Until my quadruple bypass 12 years ago I was an expert excuse-maker.  I always said “Yes” without pause or hesitation looking out and never in. Blind to self-neglect, stress and fatigue I was lost in a storm buried deep within my heart.  That day I woke up. You can too. It starts with a simple word.

Sibling Rivalry for the School-Aged Child

School-aged children must learn how to name and accept conflicting feelings about a sibling. These children must learn that they will need to cross many small streams during their lives, but they must always be aware that even a small stream after a heavy rain can become perilous to cross. By being aware of this danger most severe sibling rivalry issues can be avoided.

Learning how to recognize, understand and respond to jealousy and competition allows the school-aged child to learn how to build positive and supportive relationships. Learning how to name conflicting feelings is the first step to head off sibling rivalry. By responding to these feelings the older child is also preventing emotions from developing into unconscious drives that result in unhealthy and even risky behaviors. Unconscious drives can easily evolve into destructive behaviors such as tattling, physical or verbal aggressive behavior or the destruction of personal property.

The goal of every parent is to build lifelong positive and supportive relationships between all of their children. By being fair, not having favorites and not comparing children parents are setting a strong positive example of behaviors they support and endorse. This is done by focusing on individuality and not equality. By learning how to give and share in a non-judgmental and accepting fashion, children will be ready and able to reach out not only to sibs but also to others they meet and desire to develop positive relationships with.

Parents must paint a realistic picture of both the fun and less than fun aspects of having a new infant in the family. Infants are fussy, cry often, require constant attention and even require “smelly” diaper changes. By starting early and preparing the school-aged child for the work ahead you are more likely to find a partner in this endeavor rather than an adversary.

Parents who do not set a positive example run the risk of accelerating negative rivalry issues and supporting the evolution of negative behaviors. Parental responses must focus on being fair and never comparing children. There can be no favorites and unconditional love and support must be provided daily if your child is to have a secure sense of security. Weekly family meetings where the importance of love, unity, trust and positive self-worth are discussed can also be very helpful. It is essential all participants understand that everyone is entitled to an opinion and no one has the right to change or control the behavior of another. Parents must learn how to listen during these meetings, acknowledge the feelings of participants, sum up the situation and then support the development of a dialog between the participants. This is done by asking for solutions rather than providing solutions. Criticism must be avoided and positive behaviors supported.

The aim of a parent is to focus on prevention of rivalry rather than directing blame on a specific behavior or child. By learning how to arbitrate rather than judge parents are less likely to be drawn into a conflict where there is no right or wrong. This also prevents alienation and supports the ability of every child to resolve conflicts in a respectful fashion.

Sibling Rivalry for Preschoolers & Toddlers

In this age group the arrival of a new baby is often accompanied by jealousy and competition for affection and attention. Toddlers and preschoolers often respond with behavior and mood changes to replace what they perceive as lost attention. This is why it is very important for parents to prepare children for the arrival of a new infant who will require parental attention which previously was directed elsewhere.

Most of these issues can be prevented by taking the time to provide love, attention, affection and a sense of security for the displaced child. A secure attachment engenders trust and eliminates the fear of loss which drives many of the behavior problems that accompany sibling rivalry for the younger child.

It is also important schedules, routines and rituals be continued. Mealtime and bedtime routines should not be changed. Toddler and preschool aged children depend on these routines to anchor their daily schedule. In addition, bedtime and playtime rituals such as story time, bath time, meal time, going on walks and various playtime activities must be continued.  Your child is looking to your behavior as a sign that he or she is still loved and important. By continuing prior behaviors you can prevent sibling rivalry from evolving into negative behavior.

The arrival of a new infant in the household is a perfect time to support the older child’s independence. By giving your toddler the freedom and encouragement to explore the world you will soften the anxiety and potential sense of loss that a new infant can symbolize. It is also a time when your toddler can learn how to respect others. Toddlers and preschoolers both need to learn they should not try to control the behavior of another. When a toddler does not respect a parent or a sibling, future behavior issues are certain to follow. It is also important to encourage and help direct your preschooler to name these competitive and jealous feelings and by praising and rewarding his or her strengths you will encourage the development of good feelings which can replace bad feelings.

For the preschooler a new sibling provides the added opportunity to feel deserved and approved of. By focusing on the individuality and unique strengths of the older child you will be supporting and acknowledging the importance of a positive and supportive relationship between you both. It is important you are always fair and never compare children.  Beware of words or actions that can be interpreted by the older child as showing the new arrival to the family is your favorite. Allow your love to show you have no favorites.

The Breadbox

Why are memories so powerful?

“Joey, would you get some bread out of the breadbox?” “Sure, Mom,” I answered as I walked over to the counter and twisted the black knob. The breadbox was the size of a small microwave. I twisted the knob on the stainless steel front panel and reached in and pulled out two slices and remembered a trip to the bakery yesterday. “Mrs. Barber, what can I get you today?” The woman behind the counter asked. “A loaf of pumpernickel,” my mom answered.  The baker looked through the glass counter at me and asked, “Can I give Joey slice?”  My mom smiled and nodded her head. I reached my hand towards the top of the glass counter. “Thank-you,” I mumbled as I bit into the warm, fragrant and chewy bread. It was a taste and smell I will never forget.

In the next decade hundreds of thousands of people will die every year due to the ingestion of too much sugar, salt and fat. Yet, the real killer is not the food of today but the memories of tomorrow.

Every child has three lives: a life at home, a life at school and a life at work or play.  In the past the food we ate was dependent on cost, location and the season. Fresh, vegetable-based and regionally-available foods were at the center of our menu. Food did not come prepared, packaged or processed.  Limited choice and availability strengthened our resolve. A loaf of bread, saltines and graham crackers have now been replaced with an endless media parade of fast food restaurants, carbohydrates and snacks. There were no sugar or flavor additives and a pinch of salt was enough. We ate less, worked harder to prepare our food, and we were healthier.

My generation might be the last generation to rely on breadboxes, a well-stocked pantry, baking and family-owned corner restaurants. We remember family recipes, family meals, the smell of dinner cooking, aprons and lively discussions around a dishwasher-less  sink filled with pots and pans.

Yes, times have changed. The economy, a lack of opportunity, fatigue and our drive to possess has drained from many parents the ability to recognize the importance of healthy food. We make choices based on time and efficiency rather than good health.  We are conditioned to hear and see how food can make us feel good rather than keep us alive. Our tastes have been brainwashed. Food has become an escape and often an unhealthy reward rather than a lifestyle.

In the past we walked to the store and now we drive. Corner stores, bakeries and butcher shops have disappeared. In their place grocery chains with altars of processed, frozen and ready to eat sliced, diced and pre-packed or prepared foods have appeared.  Aisle placement is now both an art and science used to influence you on what to buy for you and your child. Plastic has replaced paper and the microwave has become the oven of today.

The bill for these choices we are influenced to make is coming due.  Corporate chefs have become taste conditioners. Healthy foods have disappeared under the guise of convenience. Our bodies and our taste buds are jaded by fat, sugar and salt at the expense of our health, our children’s health and the health of our children’s children. Labeling is an illusion and misrepresentation controls you. Food choice has been hijacked and the cost is your good health.

I remember the days before corporate America controlled the food that we eat. We learned how to cook meals and choose ingredients. We relied on heritage, seasonal availability and taste rather than what we saw or heard in the media. Stop this epidemic now. No fancy or expensive medicine is needed. Sit down with your child and talk about food. Make sure your child knows how to cook ten basic meals. Start this discussion at an early age. Teach by your words and example about the importance of a fresh, non-processed, healthy diet centered around vegetables, fruit, whole grains, vegetable protein and lean meats. Talk about the dangers of milk enriched with sugar and how cheese is a hidden source of unhealthy saturated fat. Make every meal an event your child will remember just as I remembered that trip to the bakery.

Today, parents have more challenges and temptations compared to parents of prior generations. The choice, however, is simple. Give in and allow these pirates to control how long you and your child will live or take control and choose a diet that supports a long and healthy life for you, your child and your grandchildren. The choice is yours.

Skin to Skin Contact After Delivery

Much has been written about the importance of the first hour following delivery. Your infant encounters a new and previously unseen world. Sounds begin to take on new meanings and basic processes we take for granted such as breathing and eating begin. It is a time of heightened perception for both parent and infant. It is a time when every parent must be both a soldier and an ambassador as their child encounters and enter a potentially hostile world.  Parents provide comfort and safety to the new infant.

Following delivery your infant experiences major physiologic changes that can cause imbalances in the respiratory, circulatory and metabolic systems. Your infant can become cold and glucose levels can drop. It is also a time when your infant is at increased risk for infection.  To help deal with this turbulence hospitals and professionals have enacted and supported policies to make this transition safe and loving.

Your first act as a parent should be to provide skin to skin contact with your infant. Studies have shown such contact provides physiologic stability for your infant.  Benefits include improved blood oxygenation and glucose levels and reduced stress hormone levels in your infant. Basic body functions including temperature regulation, respiratory pattern and blood pressure also improve. Your infant will cry less and more easily enter a quiet alert state.

Additional benefits include a fostering of a secure attachment between you and your baby. Skin to skin contact increases the release of maternal hormones that induce and encourage attachment between mother and baby.  One of these hormones is oxytocin which has been shown to increase relaxation, facial recognition and maternal to child attraction. Such behaviors are essential for the care and protection of your infant.  In this critical post delivery period these behaviors have been associated with an increase in touching, holding and positive speaking behaviors between mother and child as distant as 1 year following delivery.

In addition to attachment the skin to skin contact prevents the risk of stress induced by separation. Your infant has never been separated from you. It is well known that infants are able to sense physical separation from their mother. Harm from separation has been seen in animals. We must assume newborns are at risk for similar negative physiologic and brain affects.  In addition, recent brain research supports the importance of early attachment for normal brain growth in terms of both myelination and synaptic development. Specific parts of our brain involved with our emotional responses are especially sensitive and reliant on both activation and modulation during this critical period.  These effects impact our learning, memory and our sympathetic nervous system.  Holding, carrying and caressing during the newborn period and infancy fosters and supports brain growth and the development of self regulation in your infant.

A final benefit of skin to skin contact is the fostering of breastfeeding. This type of contact initiates a cascade of events that results in successful breastfeeding. Skin to skin contact is the first step in a progression of stages that result in familiarization of the infant with the mother’s nipple which is then followed by self -attaching and eventual suckling. Sleep then follows soon thereafter.  Early stages include crying, relaxation, awakening, increased activity and resting and crawling.

Skin to skin contact on the mother’s chest allows the infant to be closely monitored by both mother and staff. The infant should be positioned so the face and nares are visible and the infant’s color, skin perfusion and respiratory patterns can be followed closely.

Nursery routines such as weighing and bathing that interrupt skin to skin contact should be avoided. All nursery and post-partum activity should be directed to the immediate needs of the mother and infant. Actions that can be delayed until after the first breastfeeding include vitamin K injection, body measurements and eye ointment prophylaxis. Usually a hat is not required when mother and child are skin to skin and a diaper is often not needed except after a cesarean section.  The cord can be initially clamped away from the infant so the clamp does not pinch the baby and mother during skin to skin contact. The cord can be re-clamped and trimmed at the first bath. The first bath should be delayed until at least 8-12 hours following delivery.

Pacifier Advice

Pacifiers do not harm an infant but there are some risks to pacifier use. Never loop a pacifier around an infant’s neck. This can lead to strangulation. Self-made pacifiers may be dangerous due to the risk of choking if part of the pacifier breaks off. There should be small ventilation holes at the base of a pacifier and make sure the pacifier is the right size for your infant.  A BPA (Bisphenol A) free pacifier is also a good idea. The pacifier should be dishwasher safe and buy several so they can be washed in the dishwasher or washed frequently with hot soapy water and allowed to air dry.

Pacifiers can help soothe an infant. Many infants benefit from sucking and infants who use a pacifier have a decreased risk of SIDS. Pacifiers are also helpful on airplane flights where middle ear pressure can cause pain for many infants. They also help many infants fall asleep easier.

Pacifiers should not be used on a hungry infant to delay feeding and it is best to avoid having the pacifier become a “lovey” or a transitional object. By fading the use of a pacifier at about 12 months the transition off a pacifier is often easier. Delaying elimination of the pacifier beyond 18 months of age often makes the transition off a pacifier much more difficult.

Children who continue to use a pacifier beyond age two may change the alignment of their teeth. This can lead to future dental problems. The older your child is the more difficult it is to transition away from the pacifier. Many children use the pacifier as a sleep cue or as a transitional support. This dependence often causes sleep consequences such as frequent interval waking that are difficult to manage. Never pressure your child to stop using a pacifier. Pressure and punishment are not helpful. By relying on praise and distraction most parents are able to substitute an acceptable and less risky transitional support.

Deciding whether to use a pacifier is a great opportunity for you to learn how to recognize, understand and respond to your infant or child’s cues.  Infants who soothe and self settle easily without using a pacifier often do not need a pacifier. Infants who suck on their own hands and fingers are able to rely on these natural pacifiers in the same way as infants who suck on the little finger of a parent.

Infants who are breastfed should not be given a pacifier for at least several weeks after delivery. This allows maternal milk production to increase and supports the development of a strong physical attachment between mother and child.

The Hungry Child

How can you help a hungry child?

I sat wide eyed and speechless as I watched the video while a friend and co-worker of mine narrated the video and the still pictures. The pictures and video were taken at a small orphanage in Liberia called Fatima Cottage. This orphanage houses 64 children and is run by an eighty-eight year old woman who has the heart of an earthly saint.  Children sat at several long tables in a dirt floored room. The room was filled with smiles and songs sung by wiggling children with sparkling eyes. It was then that I heard her words, “One of the six tables in the room will not receive food today because there is not enough food to feed all the children in the orphanage.”  As my heart dropped and my eyes widened I said to myself, “How can that be?”  I watched silently as the children who did not receive food continued to sing.

A tidal wave called obesity is here. Whether or not you are overweight it will shape your future.  We all have heard about the importance of a balanced diet that is low in fat and high in fruits and vegetables and energy rich whole-grain foods. Our portions are too large, our reasons to overeat are too numerous, our stress is too high and our bombardment with unhealthy food eating patterns and food choices are too many. We live in a country where the largest fast food company, McDonalds, spends nearly $1,000,000,000 dollars a year on advertising. We know it is time to change our approach to food yet education does not seem to work. New roadblocks to good health appear as soon as old roadblocks are removed.  We hear a never ending stream of information that trumpets the importance of improved access to healthy food, active lifestyles, as well as the avoidance of empty calories from junk and fast food.  We hear about the perils of snacking and sugar-added beverages and the invasiveness of modern day technology and electronic devices that eliminate our interest and the need to be physically active.  Children and parents become detached from a sense of purpose that each of us can relate to. It is this lack of purpose that haunts and defeats us in our daily pursuit of good health.

Children must be given the opportunity to choose compassion, altruism and respect over distraction and the pursuit of personal satisfaction.  Although we over-eat for many mindless or purposeful reasons including avoidance and comfort the fact is we continue to overeat. If we are to survive this tidal wave of unhealthy behavior and stress we must pivot, acknowledge our goal of a healthy life for every man, woman and child on this earth and adapt and alter our response to this problem.  We must stop killing ourselves while allowing so many in our world to go hungry or starve.

What can you do? Stop this disconnect between food and survival for your child. Teach your child what food actually means. How food allows not only each of us but everyone to survive. Lead in your actions and words.  Show your child how to become a steward for others and for themselves. With your help your child will stop seeing the world as a scary self-centered place where one’s own desires trump those of another. This awakening will show your child how the care of others leads to both healthy self-care and an inner happiness born from a certainty that is within each of us.

Reach out to your faith, family and friends and join an organization that is dealing with the hunger and starvation in our world.  Allow yourself and your child to be engaged in the fight to understand and defeat hunger. This battle will not be short or easy but it can be won. Your actions will change how you and your child eat.  Reframe your understanding of what you eat, why you eat and when you eat. Don’t walk away from that table of children singing ever louder hoping to silence their hunger.  Your efforts can change your life and the life of your child and lives of hungry children throughout the world. Start today. Bring your love and commitment to this battle to live healthy and defeat hunger.  You are your child’s greatest teacher.  Act now, before it is too late.

Obsessive Compulsive Disorder (OCD)

Obsessive Compulsive Disorder (OCD) is highly variable in terms of symptoms. The obsession is the thought and the compulsion is the behavior.  Although some OCD patterns are common such as touching, counting and repeating, obsessive and compulsive behaviors can be very unique. When a behavior causes social, emotional, educational or occupational dysfunction then therapy and intervention are necessary.  In most cases OCD can be treated successfully.

The first step in treatment is identification and finding a professional who is willing and able to help you find a successful treatment regimen. The most common treatments include behavior therapy or medication.  Choose a physician or a mental health professional you feel comfortable with.  Your ability to engage with the therapist really does matter.  Ask for a no charge “get to know” visit where you can meet the therapist for a few minutes to talk about the type of care you are seeking. If you begin seeing a therapist and there is not a therapeutic reciprocal alliance then ask for a referral to another therapist. Engagement does matter.

Cognitive Behavior Therapy (CBT) is the most common type of behavior therapy used in OCD.  The goal of CBT is to identify and confront fears in order to reduce anxiety through exposure and response prevention exercises without progression to the compulsive behavior. Obsessions that cause the least anxiety are dealt with first and then each obsession is pursued in a serial fashion progressing up to the most anxiety associated obsession.

Medication can also be used to decrease the intensity of OCD symptoms. Medication is often used in conjunction with CBT to reduce anxiety and improve patient compliance and success.  The most common medication is an antidepressant such as Anafranil, Prozac, Paxil or Zoloft.

Support groups, exercise, calming activities such as meditation and yoga and other strategies such as guided positive imagery and progressive relaxation techniques can also be helpful.