Practical Parenting

Let's Talk! Let's Talk! Let's Talk!

Hello all,

As adults, we do not realize the critical importance of talking with children and, as a result, we spend most of our time talking to children (e.g., telling them what to do). Having conversations with children helps them develop their vocabulary, it helps them learn the rules and conventions of our language, and it presents them with a great opportunity to ask questions and to learn many new things. In addition, by initiating conversations with children when they are young, they become comfortable talking to you and it becomes easier for them to talk to you when they are older about serious issues (e.g., bullying at school).

There are many simple ways to engage in conversations with young children. These conversations can be centered around books that you read together, events you attend, or even around a question the child may ask. You can also initiate conversations when you play with your children. For example, if your child is building with blocks, you can have a conversation about what the blocks represent and make up a story together about the structure the child may be building.

During the early years, children's language skills grow very quickly. They learn the words they hear and the words that are spoken to them. By the time children are three, they have a vocabulary of nearly 1,000 words. So how do you initiate conversations with your children? You may find the following tips helpful:

• Children love to ask questions. Build your conversations around these questions and ask your own.
• Talk about what your child is doing and what you're doing. Ask questions that extend their thinking such as, for example,"what kind of picture are you drawing?" or "what do you think will happen next in the story?" and "what is your favourite part of the story?"
• Practice taking turns in conversations.
• Read with your children. Involve them in the reading. If they are still too young to read, do a "picture walk" with them and have them tell the story looking at the pictures and using their own words.
• Continue to have conversations with your children in your first langauge. Research has shown than language skills transfer over when children learn another language.

Remember, it is largely through conversations with more experienced adults that children come to learn about the world outside their own personal experiences. So continue to have fun conversing with your children. As always, if you have any questions or comments, don't hesitate to share them with me.

Irritable bowel syndrome

Have you ever had these tummy aches ----that everyone has dismissed as a pain of convenience. My own mother always thought it was my most played excuse to stay out of school.

Finally after going through a series of tests and half a dozen doctors i finallly had a diagnosis-irritable bowel syndrome.

So what is irritable bowel syndrome and how common is it?

It is chronic disorder that can cause abdominal pain ,bloating and abnormal bowel movements. About 15-20% of school aged children . Children with irritable bowel syndrome complain of bloating,abnormal bowel movements. They complain of constipation alternating with diarrhea. The abdominal pain is diffuse, occurs any time of the day. It may be non -existent for weeks  and then on a warm sunny morn when you have the whole day planned out the pain may recur.

What causes IBS?

Although the exact cause is not known, It is postulated that some chemicals secreted by the intestines  or brain, may cause the intestine  to be more sensitive to triggers like stretching of the intestine .

How is it Diagnosed?

A careful history of how of the site onset and character of the pain may help distinguish it from more serious problems. It is also quite possible that the doctor may obtain some tests. The reason for these tests is to look for signs of any serious disease. These screening tests may initially include blood and stool tests. The results of screening tests often guide the doctor in deciding whether further tests are needed .Often times a referral to pediatric gastroentrologist shall be made.

If any of the tests come back abnormal-then definitely its not Irritable bowel syndrome . Further testing like endoscopies or imaging studies such as CT scans and upper Gi series may be required.

It is also recommended to watch out for these red flags:

Weight loss

diarrhea with blood

Joint pains and rashes

Pain that is not easily controled and is different form the usual

The primary care doctor needs to be informed. Depending upon the case a visit to the Emergency may also be necessary.

So does your child have IBS ?

Does your child have pain in the tummy that has been present for weeks-

• Gets relieved with defecation
• Is often associated with a change in the frequency of stool.
• Onset is associated with constipation alternating with diarrhea.

Other symptoms that may or not be present:

• Abnormal stool form
• Abnormal stool passage(straining,urgency or incomplete evacuation)
• Passage of mucus
• Bloating or feeling of abdominal distension

Treatment

Physicians know that stress and anxiety do not cause the problem. But they do aggravate it. So things that could be done and are under our control are:

• Establish a good relationship with a physician
• Eat more fiber
• Avoid fatty foods. Fatty foods may aggravate symptoms in children with IBS
• Medications: such s antispasmodics can temporarily relieve symptoms
• in cases where there is a tendency to be more constipated-laxatives may be used. Diarrhea may also be an issue that can be relived by the use of anti-diarrheal medications
• Reduce stress .Relaxation and behavioral techniques are always helpful.
• The most important thing is to understand your child and his needs.

What do i anticipate in the future?

Irritable bowel syndrome may have negative effects on the child’s physical and psychological state. The pain may interfere with school attendance, participation in sports and other extra-curricular activities. Infrequently, it may affect appetite and sleep

Fortunately, the diagnosis of functional abdominal pain has a good prognosis. Half of these children getting better on their own .

Please feel free to post your comments or ask any questions.

Ritu Walia

Spit ups

                                      My baby is a happy spitter

In our practice 50 percent of the mothers complain that their babies won't keep their formula down. They cry and most of the times are fussy. Most often these babies also have problems with adequate weight gain and various other problems that may get the parents worried. The spitting up or Gastro esophageal Reflux (GERD) GER occurs often in normal infants. Most infants with GER are happy and healthy even though they spit up or vomit. Spitting up tends to peak at 4 months and most infants stop spitting up by 12 months.                                                                                                 

When is it necessary to treat Gerd?

As long as the baby is gaining weight and is growing well, and has no other medical condition there is no need to treat this condition .However if if you see any of these following signs - It is important to involve your primary care provider.

·         If you see Vomiting associated with

            Blood

           Green or yellow fluid

            Poor weight gain

·         Inconsolable or Severe Crying and Irritability

·         Persistent Food Refusal

     Poor growth or failure to thrive 

·         Breathing Problems

       Difficulty breathing

      Repeat bouts of pneumonia

           Breathing stops

            Turning blue

            Chronic cough

           Wheezing

What tests may be ordered by you doctor?

Depending how severe the reflux is the following may be ordered:

1.  Test for a blood in stool

2. To look for anemia

3. Upper gi series-a type of x-ray to study the baby’s food pipe and the tummy.

4. Ph probe - A test to measure how often stomach contents wash up into the food pipe

However if the baby (0-24 months old) is gaining weight certain conservative measures can be employed;

Smaller frequent feedings should be given.

Frequent burping during feedings.

Avoid using an infant seat after feeds, this may encourage reflux

Changing the formula to a more basic form like nutramigen, allocare ,neocare.

Thickening of the feeds with rice cereal. Prior to this it is advisable to consult your primary care provider.

Role of Medications

If necessary medications may be provided. Two types of medications may be used one that reduces the stomach acid. Another type that shall prevent food from the stomach to go into the food pipe (esophagus). This again should be discussed with your primary care provider

Reflux may occur in older children and adolescents-which may at times require a more extensive work up. However this can also be modified with a conservative approach like

·         To have smaller more frequent meals.

·         Avoid eating 2-3 hrs prior to bed time.

·         Elevating the head of the bed to thirty degrees.

·         Avoiding choclate, carbonated drinks, spicy food and caffeine.

·         Avoiding large meals prior to exercising.

·         Loosing weight if over weight.

·         Avoid exposure to tobacco.

When do you get worried?

If any of the above mentioned worrisome signs are seen along with

·         Sensation of food coming to the back of your throat

·         Discomfort or pain in the stomach and chest

·         Swallowing problems such as

·         Pain while swallowing

·         Discomfort while swallowing

·         Sensation of food getting stuck in the chest

·         Breathing problems along with hoarseness of your voice

Diagnostic testing and treatment

Other than the above mentioned tests  An endoscopy may become necessary depending on the Patient. If the child has been taking acid suppression drugs for more than two months without any relief in the heart burn an upper endoscopy may be required. This allows the Doctor to look directly at the Childs food pie and stomach to check for any abnormality.

Generally acid suppressing drugs may be necessary if symptoms persist even after changes to the lifestyle are made.

Prior to making any of these life style changes it is important to discuss it with your primary care provider. Please feel free to post any comments or questions.

Ritu Walia

Reading = Learning

Hello all,
Reading is a fun activity that you can engage in with your child at any time of the day. It is a great way to spend some time together and to really get your child interested in reading.

When children are very young, you will be doing most of the reading and your children will enjoy listening to you. Remember to choose books from a variety of genres and topics. Choose books that have rhyming words in them (Dr. Seuss books are a good choice for this). My personal favourite authors include Robert Munsch and Eric Carle. Also, I always encourage parents to have their own library of books at home that children can choose from. Your local public library is also a great place to get books from. You may also consider speaking to the children's librarian to get some ideas of authors that children enjoy.

While reading is a good way to wrap up the day or to just have fun, there is a lot you can do to support your child's learning. The following are some basic strategies you can use when reading to your child:

1. Read the title of the book. Talk about why the title is important and emphasize that it sets the stage for the story that follows.

2. As you read each page of the story, go on a letter hunt with your child. Ask them to find the letter "a" or the letters that makes the "sh" sound.

3. Have the children predict what will happen next. Talk about whether the prediction was accurate or not. Emphasize that predictions need to be logical and that it is important to use information from the story (the context) and information they can draw from (their own experiences, knowledge, etc.) to make these predictions.

4. At the end of the story, have your child retell the story in his or her own words. Model how this is done for the child, and use words like "first," "next," "then," "after" to guide their retelling of the story.

By no means is this an exhaustive list of the kinds of things you can do when reading to your children, and this list is only meant to provide you with a general guideline to use when reading to your child. Be sure to talk to your child's teacher about what you can do at home to support your child's developing skill and interest in reading.

As always, if you have any questions or comments, please feel free to share them with me.  Until next time, keep reading!

Infant health and Nutrition

Hello! My name is Ritu Batra Walia. I am pursuing a career in pediatric gastroenterology. Pediatric gastroenterology specializes in the care of children with chronic abdominal pain, diarrhea, constipation, vomiting, bleeding from the GI tract, inflammatory bowel disease, liver diseases, diseases of the pancreas, poor weight gain and nutritional problems

With this blog I would like to discuss day to day complaints that drive a mother to the pediatrician’s office. I would be discussing issues on growth, nutrition and disorders related to digestive diseases.

I wonder how many mothers have complaints that their new born baby does not stop crying. The baby is miserable and is too fussy. This leads us to a discussion on infantile colic---.

What is infantile colic?

Colic is defined as crying and extreme irritability in infants. The fits of inconsolable crying tend to occur in the evening, but many infants do not follow a predictable pattern. The crying and fussiness can last for

hours at a stretch, followed by other periods when the baby acts and seems perfectly normal.

How common is infantile colic?

Colic is very common, affecting 1 in 4 newborns. The reason for the irritability is not totally clear but includes an immaturity of the baby’s nervous system, sleeping disruption, hypersensitivity to the environment and sensory overload. However it is important that the parents discuss this pattern with the pediatrician in order to rule out other causes that may need immediate medical attention.

What are the symptoms of infantile colic?

The baby will start crying at the top of their lungs, as if in apparent pain, turning red in the face, kicking the legs, arching, and passing gas. Sometimes, feedings will temporarily stop the screaming, only to resume when the nipple is taken or pushed away. Colicky infants continue to gain weight and grow normally.

Just remember a rule of threes:

Begins at three weeks of age

Lasts upto three hours

Occurs at least three days in a week

Lasts unto three months.

How do I treat my baby?

There is no specific treatment, Often; the baby’s formula is changed to one that is more basic. Some mothers will modify their own diet, removing gas forming foods or dairy products. If acid reflux is suspected, antacids can be tried and continued if they clearly help. In most cases massaging the baby’s tummy, swaddling or soothing music may help.

Above all the prognosis is very good and by three months of age the baby is more comfortable and this exhausting phase passes.

There is very conflicting data on over the counter medications. It is important to speak with your primary care provider prior to using any herbal or over the counter medications to your baby.

This is a tough phase for the parents. I am sure they loose allot of sleep during this time. It’s good to have some family support during this time.

As beautiful as mother hood may be ---it comes with a lot of sleepless nights, unconditonal love and sacrifice. These mothers also need some time for themselves and a little bit of tender love and care.

My next blog shall focus on something that we all suffer from----heart burn .Especially in infants.

Please feel free to share your questions and comments with me.

Reading Together

Reading is an activity that promotes the development of a large number of literacy skills in young children. When you make reading a part of your daily routine, children begin to develop an inherent interest in reading and they become motivated to learn how to read. In addition, they feel valued and enjoy spending this one-on-one time with you. While it may be difficult to find time to read to your child daily, many parents find that it helps to establish a set routine when it comes to reading. Most children enjoy being read to right before they get ready for bed, so if you are still struggling with incorporating reading into your child’s day, perhaps a part of the bedtime routine at your home can involve reading.

For most parents, choosing books that are appropriate for their young children becomes a challenge. As a rule of thumb, always choose books that are bright, colorful, and on topics that your children find interesting. If you are reading to children under the age of two, choose board books so that the children are able to turn the pages of these books on their own. If you have older children, choose from a variety of fiction and non-fiction books so that your children learn the distinction between “made up” stories and books that have “real information.” It is important to read a balance of fiction and non-fiction books because while the former are engaging and fun for children, the latter help them to learn new things about the world around them.

When your children are young and still unable to read independently, choose books that have a rich vocabulary and take the opportunity to explain the meaning of words to your children. Ask them to infer what any new words they come across may mean and discuss possible strategies that they can use to determine the most plausible definition of these words. For example, explain to the children that they can look at the picture or reread the sentence to determine the context for the word.

No matter where your children may be on the reading continuum, model the joys of reading. Whenever you have the opportunity, speak to your children about what you are reading, what you enjoy about reading, and what your favorite reading material is. Children are often eager to emulate their parents so that if they see that you are a regular reader, they will also choose to read regularly.

Finally, if your children have started school, work closely with their teacher to find out about the approaches that the teacher is using to teach literacy skills to your children. Ask the teacher about activities you can engage in with your children at home to support and enhance the learning that happens at school.

As always, please feel free to share your comments and questions with me. My next blog will continue this discussion on reading with children.

Reading to Children

Although children continue to develop reading skills throughout life, the early childhood years - from birth through age eight - are the most important period for literacy development.

Reading is a complex process and involves many skills. As a parent, there is much that you can do to support your children’s development of early reading skills, which are essentially the building blocks that will enable children to benefit from formal reading instruction and learn how to read independently and proficiently. Examples of some of these skills include vocabulary, knowledge of letter names, and phonemic awareness (i.e., the idea that words are composed of sounds).

Perhaps the most important activity that you can use to promote your children’s development of early reading skills is joint book reading. As a kindergarten teacher, I consistently stress to parents the importance of reading to their children on a regular basis because interactive reading activities strongly support children’s reading achievement and their interest in reading. Linguist Noam Chomsky (1972) emphasized that the most important activity that parents and educators can use to build children’s knowledge and skills that are required for reading is reading aloud to them.

In addition to developing these basic literacy skills, reading books with children motivates them to learn to read and it builds what teachers call their “schema.” A schema is essentially a repertoire of knowledge that becomes embedded in children’s long term memories and can be activated by key words or phrases, enabling children to relate new information to the information that they already have (i.e., their schema). Children adopt a series of schemata to understand the world. Consequently, when teachers want their students to comprehend what they are reading, they attempt to activate their schemata so that the children can connect what they are reading to information that they already have. Needless to say, it is critical to expose children to many books and to help them learn about themselves and the world around them.

Finally, the time that parents and children spend together during these joint book reading sessions are invaluable for children. Not only do they learn many important skills, but they also feel valued and enjoy spending this time with their parents.

Thank you for visiting this blog. Please feel free to share your questions and/or comments with me. My next blog will address specific strategies you can use when reading to your young children.

Happy reading!

Parents as Partners in Children's Learning

Welcome to practical parenting! My name is Keenjal Shah and I will be discussing issues related to early childhood education with you. I am extremely passionate about the early years and it is my goal to help you understand how to support your young children's learning and development.

The early years of education are a critical period for the establishment and development of skills, knowledge, and attitudes that are essential in providing the foundations for lifelong learning. The first six years of children’s lives are a time of unparalleled discovery when they learn about themselves and the world around them. Their personalities take shape as they begin to lay the foundation of knowledge so crucial in helping them have successful learning experiences at school.

Research has consistently shown that parents play a critical role in their children’s education. By becoming and remaining involved in your child’s learning and development, you have the unique opportunity to guide this learning and to really develop an understanding of your child’s specific learning strengths and needs. Developing a sense of how your children learn can enable you to facilitate and enhance this learning and, in so doing, sustain your child’s interest and motivation to learn. More importantly, when your children see that you are actively involved in their learning, they feel valued and the time you spend with them greatly enhances their learning experiences.

As a kindergarten teacher, I have realized that parents increasingly feel that the teacher is ultimately responsible for all that their children learn. While the role of the teacher is to ensure that your children acquire the skills they will need to thrive both in and out of school, your involvement will be instrumental in helping your child reinforce the learning that happens at school. This involvement should go beyond simply helping your children with homework and should involve, for example, regular communication with the school teacher, familiarizing yourself with the Ontario school curriculum, and participating on the school parent council. I encourage parents to have a say in what happens at the school and to become involved in initiatives at the school.

Unarguably, juggling family, work, and everything else life throws our way is a great challenge. The balancing act can sometimes become much too overwhelming and, inevitably, we end having to make difficult decisions about how we want to use our time. The idea that “24 hours is simply not enough” is a catch phrase and it has almost become an excuse to justify some of the things we have to give up. Despite how busy you may be, I encourage you to become involved and to stay involved in your child’s learning. This investment of time will pay dividends greater than you ever imagined.

Finally, take the time to show your children the beauty in our world. Take them to museums, the park, the movie theater, and your place of worship. Give them the rich experiences that they will forever remember and that will work to enhance their learning at school. As social scientist Dr. Bronfenbrenner explained, the “informal education that takes place in the family is not merely a pleasant prelude, but rather a powerful prerequisite for success in formal education from the primary grades onward” (Bronfenbrenner, 1991, p. 5).

My next blog will focus on engaging in shared book reading sessions with your children.  Please feel free to share your questions and/or comments with me.

Happy learning!