Snoring

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Snoring is the sound of obstructive sleep apnea. It is a sound everyone is familiar with. Both children and adults snore. It is the sound produced by the forced flow of air through a reduced space and is caused by partial or complete airway closure. The term used to describe this is increased airway resistance. As everyone knows snoring varies throughout the night. It increases during dream sleep (REM) and causes sleep disruption not just for the person who cannot fall asleep due to the loud snoring (“Snoree”) but more importantly for the person who is snoring (“Snorer”). The results of this obstruction include an increased effort of breathing and secondary oxygen, carbon dioxide exchange abnormalities and subsequent physiologic changes.
Common risk factors for obstructive sleep apnea include adenoid and/or tonsil enlargement, obesity, craniofacial abnormalities, Down syndrome, neuromuscular disorders including cerebral palsy, and a family history of obstructive sleep apnea. The most common clinical signs include loud snoring, apnea and gasping sounds. Sleep is often restless with frequent moving, thrashing or awakening. Another common complaint is excessive sweating. For the younger child weight loss or poor weight gain are often seen. Due to the sleep disruption daytime sleepiness is common as is decreased cognitive performance at work or school and an increased incidence of bedwetting. Grades can decrease and frequent complaints include hyperactivity, distractibility and overall attention problems. Many of these children are diagnosed incorrectly as having an attention deficit disorder (ADHD).
The diagnosis is made by history and observation. A sleep study (Polysomnography) can be obtained to verify the diagnosis. In this study heart rate and breathing patterns are monitored in conjunction with the oxygen level in the blood.
Treatment depends on the cause. The most common cause is adenotonsillar enlargement. In this situation a tonsillectomy and adenoidectomy is required. If obesity is the issue then weight loss is needed and continuous positive airway pressure may be prescribed to alleviate symptoms while pursuing a weight management program. For neuromuscular and congenital causes intervention is specific to the cause. Chronic obstructive sleep apnea can lead to systemic and pulmonary hypertension which must be prevented.
If your child or teen snores seek help and advice. Snoring is never normal. If the snoring is associated with an acute illness patience may be the treatment of choice. If it is chronic then a thorough evaluation and subsequent intervention are required.

Generic Medication or Brand Name Medication – Is There a Difference?

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“Are generic drugs just as safe and effective?” This question is raised by most parents since out of pocket costs are almost always higher for brand-name medications. In addition, most doctors are required by insurance carriers to substitute a generic product for a brand-name product. Most parents prefer a generic medication due to the added cost of a brand-name drug. Generally, this substitution is both safe and reasonable. There are a few situations, however, when generic substitutions can cause adverse health effects. A few medications have a narrow therapeutic index (NTI) and substitution of a generic drug for a brand-name drug can cause a change in the blood level of the drug which can cause a worsening of a medical condition or new medical problems. This can be seen in medication used to treat depression, anxiety, seizures and for medications used for blood thinning or contraception. Specific drugs in this category include levothyroxine, warfarin, phenytoin and digoxin.

Approved generic drugs have demonstrated therapeutic equivalence. The Food and Drug Administration’s (FDA) Orange Book provides the latest information on generic approvals. A drug is considered bioequivalent if testing shows the drug has bioavailability properties that fall within the 80% to 125% range of the brand-name medication.
This substitution can also occur without the doctor being notified. Many health insurance plans request and allow pharmacists to substitute generic medication. Issues raised by this substitution relate to quality standards and safety controls for drug manufacture. Simple issues including a change in pill shape or color also add to the confusion and increase the potential for errors in pill administration.
Here are some helpful tips:
·         Ask the doctor or prescriber if it is safe to use a generic medication.
·         Ask if there is a difference between the brand-name medication and the generic medication.
·         Ask if your doctor would be able to monitor the generic medications effectiveness and increase the dose if more of the generic medication is needed due to a lower bioavailability.
·         Ask the pharmacist if a generic medication was substituted for a brand-name medication.
·         If you are being treated for one of the above described conditions be cautious.
Overall, the use of generic medications is safe and effective. Always discuss medication changes or medical issues that could be related to a medication change with both your doctor and your pharmacist.

Schedules and Elimination

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Every first time parent wonders how often their infant needs to be fed. Overall most infants thrive on feedings every 2-4 hours.  Frequent feedings every 2 hours will reduce the amount of time needed for a mother’s milk to come in. Studies show milk will come in a day earlier with an every two hour schedule rather than every 4 hours. The first 6 to 8 hours after delivery a mother may need to rest and allow the nursery staff to feed her infant due to the strenuous hours prior to delivery. Parents need to consider sending their infant to the nursery for the first 6-8 hours after delivery. This allows both parents to sleep. The nursery staff can bring the infant to the mother’s room for a feeding during this time for breast feeding and can feed the infant in the nursery if formula fed. Everyone must understand, the newborn feeding schedule should not exhaust the mother. Adequate sleep, nutrition and fluid intake are the first steps in maternal self-care.

Frequent nursing during the newborn period is associated with greater breastfeeding success as well as higher maternal prolactin levels which increases milk production and greater overall milk intake with greater infant weight gain by age 2 weeks.

Infants are born well hydrated. They have just completed one of if not the most turbulent day they will experience in their lives. Many are too tired to suck and others are slow to learn the latch and suck muscle routines. Breast milk does not come in for at least several days and during this time the colostrum production although important in terms of nutrients and immunity is low in terms of volume. Over half of all babies will lose at least 5% of their birthweight by day three after delivery. This weight loss is to be expected and infants are not stressed by this loss. If there is any sign of low blood sugar by history or exam, your infant will have sugar levels checked several times a day. This is done by pricking her heel for a small blood sample. If needed, early feedings with formula or breast milk will be given.

Many parents wonder if a feeding schedule should be used. Most grandparents were raised under the belief that scheduled feedings were best for infants. Interval feeding is no longer recommended. The American Academy of Pediatrics and the World Health
Organization do not support timed interval feeding schedules. The best approach
is to breastfeed an average of 8-12 times a day. If your infant is formula feeding the same advice is given. Feed frequently and watch for signs of hunger including rooting, restlessness, increased alertness or hand sucking and hand to mouth movements.

Feeding duration varies between infants. Try not to spend longer than 20 minutes for each feeding. Some infants eat faster than others. If your infant falls asleep during a feeding it is best to stop and restart when she shows signs of hunger. Feeding for extended periods will tire most infants and parents. A feeding schedule is a marathon and not a hundred yard dash.

The most important sign of adequate formula or breast milk intake is urine output and the character of the urine.  The urine color should be clear or pale yellow like dilute lemonade. Stool output is extremely variable and ranges from 1-2 times per day to 6-8 or more times per day. Breastfed infants frequently will have a bowel movement with each feeding. Formula fed infants tend to stool less frequently than breast fed infants. Breastfed infants may skip 1 or more days between bowel movements and show no signs of discomfort since the breast milk is absorbed so well by their digestive tract.
Formula fed infants who miss days usually will show some signs of gas and discomfort. The key is patience. No suppositories are needed and no medical intervention needs to be pursued as long as the infant is feeding well and overall doing well.  If your infant does not have a bowel movement in the first 24 hours of life she needs to be watched closely for any obstruction symptoms.

Stools in the first several days will be like black tar. They then change to transitional dark to yellow green seedy stools and eventually to wet mustard stools for breast fed infants. Formula fed infants have more formed yellow to brown stools. Breast milk stools are less odiferous than formula fed stools.  Infants who require soy formula due to milk protein or lactose sensitivity tend to have stools less frequently then infants fed regular
formula. Infants with lactose tolerance problems tend to have loose watery and at times explosive stools when given lactose containing formulas. Maternal diet will effect breast milk but rarely causes feeding and digestion problems for the infant. If specific food intake by the mother causes gastrointestinal issues for the infant then maternal diet adjustments should be made.

Temperament

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Each child is born with genetic predispositions for a specific behavioral style. Your child’s behavior style is described by her patterns of reactivity, regulation and flexibility. Reactivity describes how intense a response your child will show to a stimulus. Other components to reactivity include sensory sensitivity and overall motor activity level. Regulation describes outlook and how emotions are expressed.  Lastly, flexibility describes his ability to relate to change and transitions in terms of schedules, routines, rituals and social interactions. These patterns are commonly described as either happy, mellow or fussy babies. As a child grows older we describe more complex mood patterns as well as attention profiles, motor skill performance and sleep habits.

These genetic predispositions can be influenced by environmental stimuli, historical events and interpersonal relationships. The influence can either inhibit certain predispositions or accelerate and enhance patterns of response. The result is described as a layering of new circuitry within the brain. This circuitry allows new skills to develop. These new skills can reflect past genetic predispositions or not. The attention and stimulation you provide your infant and child will determine what response patterns are
expressed. Your responses may be positive or negative. Children respond to both. It is important you avoid negative or aversive responses. The greatest success is seen with a positive supportive focus based on love, safety and security. Without this support no alignment with or attachment to new patterns of behavior will occur.

One of the most important environmental stimuli is your own temperament. How you respond to your child depends not only on the sought after behavior but also on your own temperament. Take time to understand your own behavioral style. Examine your own mood patterns, attention span, flexibility and overall ability to control your own impulses even when you would prefer not to. It is this combination of temperaments that  determines the family environment which also provides a direct influence on behavior style.  In addition, your perception of your own parenting skills is strongly influenced by your child’s temperament and the family environment.

This reciprocal reaction between your temperament, your child’s temperament and the family environment are the prime determinants of the behavioral style your child will develop. Will he be agreeable, confident, happy, internally motivated and competent or will he be irritable, restless, unsettled, withdrawn, angry, easily frustrated overcautious, unpredictable and withdrawn. Your involvement in the development and support of these skill sets and new brain circuits is one of the most important duties of any parent. Your awareness of the complexity of these interactions allows you to influence your child to grow up with compassion and respect for himself and for others.

Self Regulation Profiles

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Your child is born with a genetically determined self regulation profile. Over the next five years of life she will express this profile. During these years you have the opportunity and responsibility to support her own . Many aspects of social, emotional and cognitive development are involved in self regulation. It is best described as an integration of emotion and cognition and results in the behaviors your child will express.

Self regulation includes a child’s ability to control their own impulses as well as the capacity to do somethig they would prefer not to do.  In order for her to do this effectively she must learn to recognize and understand her own feelings. This understanding will provide her with the skills she needs to manage her own emotions. This is the foundation of self regulation. Your child watches you. They learn more from what they see then what they hear. Your understanding and patterns of response effect their behavior. So, react wisely and choose the patterns you want to support while avoiding behaviors you do not want to see your child develop.

Many aspects of social, emotional and cognitive development are involved in self regulation. It is best described as an integration of emotion and cognition and results in the behaviors your child will express.

Self regulation develops over time and depends on your child’s developmental level. It is very important you understand developmental skills before you set your expectations about your child’s ability to self regulate. Infants rely on you for until six months or older. They have a limited ability to self regulate. They rely on you for food, comfort, sleep and social interaction. You must attend to their cues to understand their needs and wants. It is through this attention founded in love that attachment develops. This attachment provides the security your child needs to develop their own skills to self soothe and calm themselves. Toddlers have more skills and are learning how to connect their feelings and emotions to situations and events. They are newcomers to this skill and consequently their responses swing widely from happiness to sadness and tears to laughter. This self regulation growth is mirrored in their language development and as they grow older their language skills can be used to make their emotional outbursts and temper tantrums more manageable. By preschool your child will begin to understand the connection beween the feelings they have and the behaviors they express. This the crucial time for you to use shaping, modeling and emotional coaching techniques along with traditional limit setting to help them choose and implement self regulation strategies. Your involvement combined with realistic expectations and the anticipation of inappropriate behavior can help this time become less turbulent.

Choosing What is Best For Your Child

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When your child is born it is natural for you to feel vulnerable, fearful and anxious. You are concerned about doing the right thing, at the right time and in the right way. This concern is healthy and encourages you to obtain the best care possible for your new child. Concern becomes unhealthy and unhelpful, however, when it is replaced by fear and anxiety based on the concerns of others.  One of the skills you must rely on is the ability to gain control of your own experience.

As a parent you must learn to feel good about yourself and your child. You cannot rely on the expectations and feelings of others. To do so, causes you to loose your balance and in many ways encourages your fears to become real.  Everything in your life is responsive to you both in the way you think and the way you live your life. To allow negative thoughts to enter your life simply encourages them. Once negative thoughts are embedded in your mind they grow. Even though you mean well and only want to protect your child this fostering of negative thoughts actually causes you to loose control.

You and you alone have control over your life and your ability to inspire your child. It does not matter what others think or say about you or your child. Only your thoughts matter. Clean your mind of all negative anxiety and fear. Seek a contentment based on balance, understanding and acceptance. Trust your feelings about what is best for your child. Fill your mind with dreams, passions and inspirations about your child and by so doing you will prepare her to chase her own dreams.

Theses skills do not just happen.  They take time to grow. Give yourself time to develop the patience and understanding to deal with the negative thoughts of others. Such skills must be fostered and supported. The first step is a committment to this belief of self control. Experience will tell you and the way you live your life will show your child that each of you have control over your own futures. Certainly, unexplained and unwanted events will occur but most situations, events and opportunities are due to your thoughts, words and actions. In fact, most of the time you will be treated by others as you expect them to treat you. By finding, seeing and then listening to the positive harmony within your life and the life of your child you will understand life’s questions and answers are already within you and your child.

Death

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For every parent when their child is born thoughts of their child dying or becoming gravely ill or injured arise.This is common and expected.  As a parent you will find new emotions attached to words like meningitis, SIDS, autism, drowning, seat belts, car seats and immunizations. The need to address these negative thoughts is essential and has been discussed in previous blog entries.What should you do, however, when you are confronted by the death of a member of the family including a parent or a child? The answer to this question as with all others rests within you.

Although the departure of those you love may never be accepted it must be allowed. Death allows a person’s soul to be set free. The act of living allows each person to pursue the connection between mind and body, but, it is death that allows a person’s soul to be set free. This freedom is a freedom expected and long awaited since birth. Although the death of a child or teenager can can be understood through natural laws it
can only be accepted through the power of spirituality.

Souls are amazing. they are filled with equal parts patience and understanding mixed with a measure of joy and a touch of laughter. They never leave us no matter how much
we neglect them. They are social yet independent and never lonely. Their wisdom knows who and what we are. They listen even when not being listened to. Theirs is a world of questions more than answers and love unhindered by guilt or remorse. A world with no if ‘s or when but only now.

Your soul and the soul of your child are the keepers of understanding about all things eternal and those that are not. Ypur child’s soul is invisible save for its image reflected during acts of love and compassion. These glimpses are fleeting, yet their images are strong, narcotic and inspiring.  Living a life filled with compassion and forged from relationships is always at risk for pain and suffering. Yet, by living and dying each person, no matter what their age, is provided the opportunity of being and not just doing. For, a soul reveals itself most  and shines brightest in the eyes of your newborn and in the spirit and memories of the old and infirmed.

So do not Hide. Show no fear. Live life. Watch your child grow. Revel in every sound they ever utter or word they speak. watch their actions and reactions. Smile and shout about decisions whether right or wrong. Live a life without labels or bounds. Allow your child to live unencumbered by your fears, feelings and expectations. Empower yourself
and your child to make choices based on opportunity, love and compassion. There is no reason to fear illness and death. Each are part of life and will never touch your child’s soul. A child’s soul never sleeps. With unending patience it only watches and waits.

Parenting Principles

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The first question to ask yourself is whether you have a positive relationship with your child. Are your interactions positive or negative. If you have overall positive interactions then focus on continuing to provide uncritical and non-judgemental support and attention while praising good behaviors. In this way you will continue to foster cooperation and respect. If your interactions are increasingly negative then you must pursue strategies to rebuild a foundation of cooperation. Negative and punitive responses will not succeed.

Cooperation is enhanced through positive interactions with your child. This may occur randomly during day to day activities and also through established routines and expectations. These can be called creative parenting and schedule or event based parenting. Both types of parenting categories require a consistent approach based on clearly identified and communicated rules and expectations. Your child must be made the focus of your attention and you must encourage  your child by promoting your expectations. At the same time you must discourage inappropriate behaviors through the imposition of consequences. Behavioral consequences are especially important when safety issues are present. Even when punishment is used positive interactions are the goal.

The guiding principle is for you as parent to have the courage to deal with conflicts between you and your child every time challenging or contrary behaviors happen. You must be ready to seek cooperation by providing the discipline that is required.This is the fundamental principal of parenting.

Emotions Are Real

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When a child becomes upset and shows it in what they say or do parents are prone to pay too little or too much attention. By over responding you are actually supporting the duration and recurrence of the negative behavior. By paying too little attention to an emotion that seems insignificant to you your child will feel you are disavowing their feelings and often become frustrated. Frustration often leads to a progression negative behaviors that are compounded by a sense of grief, anger, insecurity, worry or hopelessness over not being able to have something your child really wants. Remember, young children are not capable of separating wants from true needs. This takes time and will only occur with training and personal development. This personal development occurs in relationships based on responsive and sensitive attention and attunement. Being aware and attuned to the wants and needs of your child in various situations will allow you to understand her emotions. Your child will only learn to accept
feelings as real if you treat her feelings as real. Any other response teaches them to dismiss, disavow or simply mirror emotions without learning how to recognize, respond and grow with them.

Simple techniques can help a child calm down. these include any activity that supports relaxation. Choose what is best for your child based on her interests and her age and skill sets. Some children respond to reading or singing a song. Others respond to physical activities including dancing or going for a walk. Others require a short nap or
massage. Your response is not only for support. It tells your child you recognize they are upset and you want to help them learn to manage and respond to their emotions. Once the initial response is made you can move on to more solution-based responses based on the situation that evoked the emotion. You can always give her a list of possible responses and allow her to choose the best one for her. If she comes up with inappropriate solutions explain why a new choice will be needed. The goal is to return to an appropriate activity where the ability to handle unhappiness and dissatisfaction are recalled but remain in the background and the normal activity of life is emphasized.

By spending time with your child every day you will have the opportunity to play and laugh together. Be attentive and responsive to them. Listen to what your child says and how she says it. Is she happy or sad; mad or glad; or angered or surprised.  Look for cues in her facial expression, body gestures, tone and pace of speech or any other verbal and non verbal cues. These experiences foster the sharing of emotions and are at the center of human relationships. Bonding and attachment during these periods provide the environment for the modeling of appropriate behavioral responses and expands the meaning of discipline from obedience to the modeling of behaviors that will last a lifetime.

Well Child Care 2 Months

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Feeding
At this age, your baby needs only breast milk or infant formula to grow healthy and strong. At this age most babies take about 4 to 5 ounces of formula every 3 to 4 hours. Although not mandatory, some mothers who breast feed also give their babies pumped breast milk or commercial formula that is put in a bottle. Avoid giving a supplement if this hinders breast feeding. This can allow your baby to learn another way to drink milk and other people can enjoy feeding your baby. Always hold your baby during feeding time. Then your baby learns that you are there to meet his needs. This is an important and special time. It is not time to start cereal or baby foods yet. Cereal can be started at 4 to 6 months of age.   Don’t forget: breast fed babies need a daily Vitamin D supplement such as Tri Vi Sol drops.
Development
Babies start to lift their heads briefly. They reach for things with their hands. They enjoy smiling faces and sometimes smile in return. Cooing sounds are in response to people speaking gentle, soothing words.
Sleep
Many babies wake up every 3 to 4 hours, while others sleep for longer periods during the night. Every baby is different. Feeding your baby a lot just before bedtime doesn’t have much to do with how long your baby will sleep.  This is a good time to move your baby out of your room and put him in his own room if one is available.
When babies spend almost all of their time on their back they sometimes get flattening of one side of their head.  This happens when an infant’s head is always turned to the same direction (either the right or left).  The weight of the baby’s head will actually flatten one side of the head more than the other and the head will look lopsided.  (It is important to understand that this does not affect brain function, only the shape of the head.) To prevent this:
1.) Give your infant plenty of tummy time every day.  Remember, that in order to be on his tummy, you baby MUST be with an adult and awake.
2.) Place your child in such a way that he looks to his left some times and to the right other times.  For example, this can be accomplished by putting your baby’s head at the opposite end of the crib on alternate days.
Tips to get your baby to sleep through the night:
1.) Place your baby in the crib when he’s drowsy but still awake.  Babies who fall asleep more independently often learn to sleep through the night more quickly.
2.) Never put your baby in bed with a bottle.
Reading and Electronic Media
Your baby will enjoy just hearing your voice. You can read aloud your favorite novel while feeding or cuddling with the baby. Never prop your baby in front of a television.
Safety Tips
Never leave your child alone, except in a crib.
Choking and Suffocation
·         Use a crib with slats not more than 2 and 3/8 inches apart.
·         Place your baby in bed on his back.
·         Use a mattress that fits the crib snugly.
·         Keep plastic bags, balloons, and baby powder out of reach.
Fires and Burns
·         Never eat, drink, or carry anything hot near the baby or while you are holding the baby.
·         Turn your water heater down to 120°F (50°C).
·         Install smoke detectors and carbon monoxide detectors.
·         Keep a fire extinguisher in or near the kitchen.
Falls
·         Never step away when the baby is on a high place, such as on a changing table.
·         Keep the crib sides up.
Car Safety
·         Never leave a child alone in a car.
·         Use an approved infant car safety seat and follow the instructions for proper use. If you aren’t sure how to install the seat in your car, contact a local fire department.
·         Parents should always wear seat belts.
·         Babies must ride in the back seat of the car.
Smoking
·         Infants who live in a house where someone smokes have more respiratory infections. Their symptoms are also more severe and last longer than those of children who live in a smoke-free home.
·         If you smoke, set a quit date and stop. Set a good example for your child. If you cannot quit, do NOT smoke in the house or near children.
Immunizations
Vaccines are now combined to reduce the total number of shots for your baby.
Babies cannot receive influenza vaccinations (also called flu vaccinations) until 6 months of age.  If your baby cannot be protected against the flu, make sure all family members and close contacts get flu vaccinations.
Your baby may run a fever and be irritable for about 1 day after getting shots. Your baby may also have some soreness, redness, and swelling where the shots were given.