Growing Up

· Your Growing Child
· Your Child's Development
· A Healthy Baby Needs Primary Care
· What to expect in each medical visit and questions for the Doctor or Nurse
· Common Concerns
· Keeping Your Child Healthy At School

Your Growing Child

Each baby has his or her own personality. Watch, listen, hold, talk and play with your baby. Pay attention. Parents and children teach each other.

When a child's needs are met, he will develop a sense of trust. A child must feel safe in his world to feel secure. A child who feels safe will learn and grow by trying new things. Your child's doctor or nurse can always help you with questions about your growing child.

Your Child's Development

If you have concerns about your baby's development, talk to your doctor or nurse. You can also call the Early Intervention (E.I.) Program. E.I. is a statewide program for children from birth to age 3. They can help evaluate your child's development. These services are provided at no cost to you.

Children may be eligible for Early Intervention services who:

· Were born premature
· Show feeding, vision, or hearing problems
· Have difficulty sitting, standing, walking, talking
· Have difficulty doing things for themselves
· Show behavior or attention problems
· May be at risk because of where they live
· Were born with a disability or health condition that affects development

Early Intervention helps parents understand their child's developmental needs and teaches them ways to help their child grow. In addition to evaluations, services include:

· Home visits
· Parent-child groups
· Parent support groups
· Group and individual sessions to meet educational goals
· Toddler groups
· Parent education
· Referrals

E.I. services are provided by a team which has: speech, physical, occupational and family therapists; nurses; social workers; and teachers. The team works with the family to determine what type of help is needed and to put together a plan for your child. To find out about the E.I. program nearest you, call 1-800-905-8437.

If your child is over three years old and you have concerns, talk with your doctor. You can ask your local school department to evaluate your child for special education services. The school department should make sure your child gets the services he needs.

A Healthy Baby Needs Primary Care

Primary care is the regular health care your child gets from a doctor or nurse. A well-child visit is a regular visit to a doctor or nurse when your child is healthy. Well-child visits help to keep your child healthy by preventing problems or treating them right away. When your child is as healthy as he can be, you will both be able to do the things you want.

What is a primary care provider?
Your primary care provider may be a:

· Pediatrician - a doctor who cares for children and adolescents
· Family Physician - a doctor who cares for people of all ages
· Nurse Practitioner - a nurse who cares for children or whole families
· Physician Assistant - a provider who cares for children or whole families

Your primary care provider will:

· Provide regular check-ups, immunizations, and test
· Follow your child's growth and development
· Give you suggestions for keeping your child healthy
· Treat your child when he is sick
· Refer you to specialists, benefits or services

Talking With Your Child's Primary Care Provider.

You know your child better than anyone else. Your child's doctor or nurse needs your help to give your child the best care. It is your provider's job to listen to your concerns and to answer your questions. It is your job to speak up for your child.

If you want more information, ask your provider. No question is silly or dumb. If you do not understand something, ask your provider to explain it to you. Your child's doctor or nurse will not know that you have a question unless you ask it. It can be helpful to write down questions ahead of time. Some doctors have a special call-in time each day to answer questions.

Information about your family may help your doctor or nurse care for your child. He or she will keep this information confidential. Tell your provider about:

· Your health
· Your family's health
· Concerns about:
   1. Discipline and behavior
   2. Drug and alcohol use
   3. Physical, emotional and sexual abuse
   4. Stress, separation, loss, or trauma
· Any visits to hospitals, emergency rooms or other doctors
· Anything else you feel is important.

Family Health History

It may be important to tell your baby's doctor or nurse about your family's health. If you have an adopted or foster child, you may not have this information. Write down as much as you get from the adoption agency or birth parents.

List the family members (parents, brothers and sisters, grandparents, aunts, and uncles) who have had any of the following:

Other conditions you may want to talk about with your child's doctor or nurse include mental illness, smoking, alcohol and drug use.

Recommended Schedule for Well-Child Visits

In the first year of life, your child should have a well-child check-up at 1-2 weeks, 2, 4, 6, 9 months and one year. After that, take your child at 15 and 18 months, and once a year from 2-21. Your doctor or insurance plan may recommend a different schedule.

Immunizations are part of many well-child visits. By age 2, your child should be immunized against these diseases:

· Diphtheria
· Haemophilus influenzae type B (Hib)
· Hepatitis B
· Measles
· Mumps
· Pertussis
· Polio
· Rubella
· Tetanus
· Varicella (chickenpox)

Always remember to bring your baby's immunization record!

What to expect at each visit to the doctor:

Common Concerns:

Crying

Crying is one way babies communicate. All babies cry-some cry more than others. It is common for babies to have a fussy time in the evening. Babies often cry the most around six weeks old. If your baby seems to be in pain, call your doctor or nurse. Never shake your baby.

Holding your baby will not spoil her. Your baby will learn that someone cares about her. The following things may help calm your baby.
· Cuddle, comfort, or rock her
· Talk and sing to your baby
· Feed her
· Burp your baby
· Carry her in a baby carrier-the kind you wear
· Change her diaper
· Take her for a ride in the stroller or car
· Walk with your baby
· Play soothing music

It is normal to feel stressed when a baby is crying. Know when you are beginning to feel anxious. Have some ideas planned for when this happens.

Coping with crying

Most of the time holding your baby or speaking to him will comfort him. If nothing works and you start to feel out of control - take a break. Even if it means leaving the baby to cry for a few minutes. Put the baby in a safe place, like the crib, and go to another room. Put on some music, turn on the television, or take a shower. Check your baby every five minutes. For help at any time, call the Parental Stress Line at 1-800-632-8188.

Shaking a baby will NOT stop the crying. Babies' brains are very fragile. Shaking can cause brain damage, blindness and death. Whatever you do, never hit or shake your baby.

If your baby cries a lot, try to get help from friends and family. Ask them to watch the baby while you take a break. You can ask your baby's doctor or nurse about crying. They will have other helpful ideas. Do not feel guilty about asking for help. You and your baby will be glad you did.

Your baby will cry less as he gets older - it will not last forever.

What kinds of toys are good for a baby?

Many low-cost toys and household objects will be fun for your baby. She may enjoy:

· Brightly colored mobiles or pictures placed out of reach
· Soft, light, sturdy rattles
· Cloth or vinyl picture books
· A mirror that cannot break
· Washable dolls and stuffed animals without loose parts

Babies like to put everything in their mouths. It is very easy for a baby to choke on small things. Do not let your baby have a rubber balloon. Balloons are the toys that babies choke on the most. The shiny (mylar) balloons are okay.

To find out if a toy is too small:

Drop it into an empty toilet paper tube.
If it is small enough to fall through the tube, it could cause choking.
Do not let your baby play with any toys that are too small.

Warning about baby walkers

Baby walkers can be dangerous. Every year almost 30,000 children get hurt in baby walkers. Many injuries are caused by babies falling down the stairs or tipping over. Baby walkers do not help a child learn to walk. In fact, they may even slow down walking, because the walker does the work, instead of the child. Think about using a seat that looks like a walker, but has no wheels. Your baby can stand, bounce, look around and stay safe.

Walkers are not recommended, but if you use a walker make sure to:

· Never leave your baby by himself in a walker
· Block off stairways and close doors
· Keep the walker away from uneven floor or carpet edges
· Never use a walker in rooms with hanging appliance cords, ovens, ironing boards, space heaters or fireplaces.

Childproofing - making sure your home is safe

1. Cover all electrical outlets
2. Keep all cords, sharp knives and scissors out of reach
3. Put safety latches or locks on all cabinets and drawers with dangerous things, such as cleaning products, alcohol and drugs, medicines and vitamins, and make-up
4. Make sure your home is lead-free.
5. Put gates on all stairways.
6. Keep doors to the bathroom, other stairs, and outside closed tightly.
7. Make sure the hot water temperature in your home is under 120 F.
8. Make sure there is nothing that she can pull down, such as tablecloths, pots, electrical cords.
9. Keep all rubber balloons, small and sharp toys, and plastic bags away from your baby.
10. Put the number for the Poison Control Center, 1-800-682-9211, next to your phone.
11. Keep a bottle of Syrup of Ipecac in your medicine chest. Only use this if the Poison Control Center or your doctor or nurse tell you to.
12. If you own a gun, keep it unloaded and locked up. Lock up bullets in a separate place.
13. Install window guards at all windows above the first floor.

When you take your child to other places, they may not be childproof. You will need to watch her extra carefully. To keep your child safe:

· Make sure your child is in a safe space.
· Make sure a trusted adult is always with your child

Helping your baby learn words

Your baby will start saying simple words such as "mama· and "dada". In time, she will point and name people and things. Then she will say two or more words together. These are her first sentences. The two most important things are:

Talk to your baby
Read to your baby

· When she says a word or sound, repeat it back to her.
· When sounds happen around the house, talk about them. "I hear the telephone ringing."
· Tell her what you are doing. "I am buckling your safety belt."
· Use picture books and magazines. Tell stories or point out people doing everyday things. "The family is eating pizza."
· Ask questions. "Do you want more apricots?"
· When she points to something, encourage her to say the word. "Do you want the cookie of the cup?· Repeat the word as you give it to her.
· Avoid baby talk.
· It is okay to use two languages in your home. Babies do not get confused.

Growing Independence

As your toddler grows, he will want to try lots of things for himself. This is a necessary part of growing up. He is excited about the world. He wants to find out all about it.

As a parent, your job is to make safe places for him to explore. Imagine how he feels - happy when things go his way, unhappy when they do not. Give him a chance to do things for himself. Let him make his own mistakes. This is the way he will learn. You can offer to show him how to do it or to help.

When you need him to do something, give yourself plenty of time. Toddlers go at their own pace.

· Prepare him to finish what he is doing. Tell him: "It will be time for your bath in a few minutes.· Remind him again.
· Give him simple choices when possible. "You can wash your hands in the bathroom or in the kitchen."
· Do not ask questions that can give answers you do not want. "Will you clean up your toys now?"

There will be times when children cannot do what they want to do. These times might turn into temper tantrums - a toddler's way to show frustration or anger.

How do I know if my child is ready for Toilet Training?

Sooner or later your child will be ready to use the potty or toilet. You cannot make him ready. Your job is to watch for signs that it might be the right time. Being ready means several things. Your child may be ready when he or she:

· Stays dry for at least 2 hours at a time, or wakes up dry after naps
· Follows simple directions
· Has bowel movements that come at about the same time each day
· Lets you know by words or sounds that he is about to have a bowel movement
· Is uncomfortable in dirty diapers
· Can pull his pants on and off
· Shows an interest

Toilet training is something your child will do when he is ready. Talk with your doctor or nurse for help. There are also books and videos for you and your child to look at. Be sure that your child learns to wash his hands after using the toilet.

Toilet training can be slow. Problems come when parents feel that training is not
happening fast enough. Let the child set the pace. Be patient.

Make-Believe

A new kind of thinking develops in most three-year olds - imagination. Play gives many chances to use imagination. Your child can pretend to be a parent, a bear or a baby. She can imagine that a shoe is a car, a telephone, or a bottle. Pretend play allows a child to become what she cannot be in real life. Pretend play helps learning.

Your child may have an imaginary friend. This friend can do the things a child dreams about. Imaginary friends are common. Do not be concerned. Respect your child's privacy. Imaginary friends give your child a safe way to try out who she wants to be.

An active imagination is healthy, even when it includes changing the truth. A make-believe story might begin as a way for your child to feel safe. Your child is trying to take care of things the best way she knows how. Try to understand what is happening and respect her feelings. If you react harshly, your child could become fearful.

Helping your child feel good about himself

Self-esteem or self-image means how we feel about ourselves. It is important for your child to feel that he is loved and wanted. Children with high self-esteem often:

· Do better in school
· Cooperate well with others
· Know how to show their emotions
· Form friendships more easily
· Make healthier decisions

Getting ready for school

Before your child starts school, most learning happens during play. Being ready for school is more than knowing letters and numbers. Children need to feel secure at school and being with others.

· Encourage her to do lots of different things
· Give her chances to be away from you
· Encourage her to dress and use the bathroom herself
· Let her take care of her own things
· Teach basic safety rules such as crossing streets, riding buses, and playing safely
· Encourage her to say what she needs and wants
· Give her chances to play with others, take turns and share toys
· Let her do things on her own
· Encourage her to finish tasks

All children are different - even children from the same family. School is a place for your child to keep growing - at her own pace. If she feels good about herself and with others, she will learn.

Physical Activity

Children love moving around. Exercise will help shape your child's body and his sense of self. It gives your child coordination and balance, strength, speed, flexibility, and an awareness of himself in space. If he is part of a group, he will learn cooperation and responsibility for others.

As your child gets older, he may become more social, more coordinated and better able to follow rules. He may want to take lessons or join organized sports. Dancing classes, biking and hiking groups, or neighborhood basketball can all offer him a chance to develop physically.

Some children prefer group activities such as soccer, basketball or baseball. Others like individual ones such as tennis, dance, gymnastics or swimming. Your child may try several activities before he finds the one he most enjoys. It may not be the activity he is best at or the one you imagined for him. Having fun is what counts.

Keeping your Child Healthy at School

The school nurse is a partner in keeping your child healthy and ready to learn. It is important for the school to have information about your child's health.

You will need to give the following to the school:

1. A record of a physical examination no more than six months before school starts. Your doctor or nurse can give you a written record of the exam to give to the school. Or, you can get a copy of the Massachusetts School Health Record form from the school nurse and ask your provider to fill it out.

2. A record of your child's immunizations - you can use the Massachusetts Lifetime Immunization Record, if it is up-to-date.

3. Proof that your child has been tested for lead poisoning.

4. Your telephone numbers, the numbers of another person to contact in case of an emergency, the name of your child's doctor or nurse, and the name of your health insurance plan.

5. If your doctor or nurse thinks that your child might be at risk for Tuberculosis (TB), a test will be done to check for TB. These results will be reported to the school nurse.

If your child has a special health condition, it is important to meet with the school nurse before your child enters school. Together you can develop a health care plan for your child. This way your child's health needs can be taken care of during the school day.

There are special procedures if your child needs medicine or treatments at school. The school nurse cannot give your child any medicines or treatments without your consent and a doctor's order.

If your child seems to be having trouble in school, talk to your child's teacher and doctor or nurse. There are many things that can be done to help your child. Your family, the school and your doctor or nurse can work together to make the best plan for your child.

Growing Up Healthy was adapted with permission from the Massachusetts Department of Public Health, Bureau of Family and Community Health, Division of Maternal, Child and Family Health. Growing Up Healthy (Creciendo Sano in a Spanish adaptation) was originally developed with support from the Maternal and Child Bureau, Health Resources and Services Administration, US Department of Health and Human Services. We would like to acknowledge Gail Ballester and Steve Shuman, the Managing Editors from the Massachusetts Department of Public Health, and the many Massachusetts contributors and reviewers.