Caring for Your Baby and Young Child, Revised Edition : Birth to Age 5

by AMERICAN ACADEMY OF PEDIATRICS

• ISBN13: 9780553382907
• ISBN10: 055338290X
• Edition: 4th
• Format: Trade Paper
• Copyright: 2004-06-01
• Publisher: Bantam

Summary

The organization that represents the nation's finest pediatricians and the most advanced research and practice in the field of child health answers all your medical and parenting questions. Here is sound, reassuring advice on child rearing that covers everything from preparing for childbirth to toilet training to nurturing your child's self-esteem. Here, too, is an indispensable guide to recognizing and solving common childhood health problems, plus detailed instructions for coping with emergency medical situations. Comprehensive, accurate, and doctor-approved,Caring for Your Baby and Young Childprovides the very latest state-of-the-art information, including: Basic care from infancy through age five Guidelines and milestones for physical, emotional, social, and cognitive growth A complete health encyclopedia covering injuries, illnesses, congenital diseases, and other disabilities Guidelines for prenatal and newborn care with sections on maternal nutrition, exercise, and screening tests during pregnancy An in-depth guide to breastfeeding, including its benefits, techniques, and challenges A complete guide for immunizations and updated information on vaccine safety A guide for choosing child care programs and car safety seats Ways to reduce your child's exposure to environmental hazards, such as tobacco smoke New sections on grandparents, stay-at-home dads, computers and the Internet, and much more Caring for Your Baby and Young Childis an essential child care resource for all parents who want to provide the very best for their childrenand the one guide pediatricians routinely recommend and parents can safely trust.

Author Biography

Dr. Steven P. Shelov, M.D., M.S., F.A.A.P. is currently Professor of Pediatrics at Mount Sinai School of Medicine and Chairman of Pediatrics at Maimonides Medical Center and Lutheran Medical Center and Vice President of the Infants' and Childrens' Hospital of Brooklyn. He is the Editor-in-Chief of several of the parent publications for the AAP including <b>Caring For Your Baby and Young Child</b>, <b>The First Year Of Life</b>, and <b>A Guide to Child Symptoms</b>. Dr. Shelov pioneered and developed these series of books. In 2002, Dr. Shelov was presented with the Lifetime Achievement in Education Award by the American Academy of Pediatrics, its singular highest award for pediatric education. <br><br>Dr Robert Hannemann is a board certified pediatrician practicing part time at the Arnett Clinic in Lafayette, Indiana. He is Visiting Professor of Child Psychology, Biomedical Engineering, and Chemical Engineering at Purdue University, West Lafayette, Indiana where he is engaged in teaching and research. Dr Hannemann is Past President of the American Academy of Pediatrics.

Table of Contents

Resources from the American Academy of Pediatrics	xviii
Foreword	xix
Introduction: The Gifts of Parenthood	xxi
Your Child's Gifts to You	xxii
The Gifts You Give Your Child	xxiii
How to Make Giving a Part of Your Daily Family Life	xxv
PART I
1 Preparing for a New Baby	3	(26)
Giving Your Baby a Healthy Start	4	(3)
Getting the Best Prenatal Care	7	(1)
Nutrition	7	(1)
Eating for Two	7	(1)
Exercise	7	(1)
Tests During Pregnancy	8	(1)
Choosing a Pediatrician	8	(3)
Training of Pediatricians	8	(1)
How to Find a Pediatrician	9	(2)
Issues to Discuss with Your Pediatrician	11	(6)
When Should the Baby Leave the Hospital?	12	(1)
Should the Baby Be Circumcised?	13	(2)
Should I Breastfeed or Bottle Feed?	15	(1)
Should I Store My Newborn's Cord Blood?	16	(1)
Preparing Your Home and Family for the Baby's Arrival	17	(12)
Choosing a Layette	17	(2)
Buying Furniture and Baby Equipment	19	(4)
Preparing Your Other Children for the Baby's Arrival	23	(2)
Preparing Yourself for Delivery	25	(2)
Preparing the Father for Delivery	27	(2)
2 Birth and the First Moments After	29	(12)
Routine Vaginal Delivery	30	(1)
Delivery by Cesarean Section	31	(2)
Delivery Room Procedures Following a Normal Vaginal Birth	33	(1)
Procedures Following Premature Birth	34	(5)
Leaving the Delivery Area	39	(1)
Newborn Screening Tests	40	(1)
Reflecting on Your Baby's Arrival	40	(1)
3 Basic Infant Care	41	(38)
Day to Day	42	(24)
Responding to Your Baby's Cries	42	(3)
Helping Your Baby Sleep	45	(1)
Positioning for Sleep	45	(7)
Diapers	52	(2)
Urination	54	(2)
Bowel Movements	56	(1)
Bathing	57	(3)
Skin and Nail Care	60	(4)
Clothing	64	(2)
Your Baby's Basic Health Care	66	(13)
Taking a Rectal Temperature	66	(5)
Visiting the Pediatrician	71	(1)
Immunizations	72	(7)
4 Feeding Your Baby: Breast and Bottle	79	(42)
Advantages and Disadvantages of Breastfeeding	81	(1)
Breastfeeding Your Baby	82	(24)
Developing the Right Attitude	82	(1)
Getting Started: Preparing the Breasts for Lactation	83	(2)
Letting Down and Latching On	85	(3)
The First Feeding	88	(3)
When Your Milk Comes In	91	(2)
How Often and How Long?	93	(3)
How Do You Know If Your Baby Is Getting Enough?	96	(1)
What About Bottles?	97	(1)
Milk Expression and Storage	98	(3)
Mothers' Possible Nursing
Problems and Questions	101	(5)
Advantages and Disadvantages of Bottle-Feeding	106	(1)
Bottle-Feeding Your Baby	106	(8)
Why Formula Instead of Cow's Milk?	107	(1)
Choosing a Formula	107	(3)
Preparing, Sterilizing, and Storing Formula	110	(2)
The Feeding Process	112	(1)
Amount and Schedule of Formula Feedings	113	(1)
Supplementation for Breastfed and Bottle-fed Infants	114	(3)
Vitamin Supplements	114	(1)
Iron Supplements	115	(1)
Water and Juice	115	(2)
Fluoride Supplements	117	(1)
Burping, Hiccups, and Spitting Up	117	(4)
Burping	117	(2)
Hiccups	119	(1)
Spitting Up	119	(2)
5 Your Baby's First Days	121	(22)
Your Newborn's First Days	122	(12)
How Your Newborn Looks	122	(4)
Your Baby's Birth Weight and Measurements	126	(5)
How Your Newborn Behaves	131	(1)
Going Home	132	(2)
Parenting Issues	134	(4)
Mother's Feelings	134	(2)
Father's Feelings	136	(1)
Sibling's Feelings	137	(1)
Health Watch	138	(4)
Abdominal Distension	138	(1)
Birth Injuries	138	(1)
Blue Baby	139	(1)
Coughing	139	(1)
Excessive Crying	139	(1)
Forceps Marks	139	(1)
Jaundice	139	(1)
Lethargy and Sleepiness	140	(1)
Respiratory Distress	141	(1)
Umbilical Cord	141	(1)
Umbilical Granuloma	141	(1)
Umbilical Hernia	141	(1)
Your Newborn's First Physical Exams	142	(1)
Blood Tests	142	(1)
6 The First Month	143	(34)
Growth and Development	143	(17)
Physical Appearance and Growth	143	(2)
Reflexes	145	(2)
States of Consciousness	147	(4)
Colic	151	(2)
The First Smile	153	(1)
Movement	153	(1)
Vision	154	(2)
Hearing	156	(1)
Smell and Touch	157	(1)
Temperament	158	(2)
Basic Care	160	(6)
Feeding and Nutrition	160	(1)
Carrying Your Baby	161	(1)
Pacifiers	162	(1)
Going Outside	162	(1)
Finding Temporary Child Care Help	163	(2)
Traveling with Your Baby	165	(1)
The Family	166	(5)
A Special Message to Mothers	166	(1)
A Special Message to Fathers	167	(1)
A Special Message to Grandparents	168	(2)
Siblings	170	(1)
Health Watch	171	(4)
Breathing Difficulties	171	(1)
Diarrhea	171	(1)
Excessive Sleepiness	171	(1)
Eye Infections	171	(1)
Fever	172	(1)
Floppiness	172	(1)
Hearing	172	(2)
Jaundice	174	(1)
Jitters	174	(1)
Rashes and Infections	174	(1)
Thrush	174	(1)
Vision	174	(1)
Vomiting	175	(1)
Weight Gain	175	(1)
Safety Check	175	(2)
7 Age One Month Through Three Months	177	(24)
Growth and Development	178	(10)
Physical Appearance and Growth	178	(1)
Movement	179	(3)
Vision	182	(2)
Hearing and Making Sounds	184	(2)
Emotional and Social Development	186	(2)
Basic Care	188	(6)
Feeding	188	(1)
Sleeping	189	(3)
Siblings	192	(2)
Health Watch	194	(5)
Diarrhea	194	(1)
Ear Infections	195	(1)
Eye Infections	196	(1)
Gastroesophageal Reflex	196	(1)
Rashes and Skin Conditions	197	(1)
Respiratory Syncytial Virus (RSV) Infections	197	(1)
Upper Respiratory Infections (URI)	198	(1)
Immunization Alert	199	(1)
Safety Check	199	(2)
8 Age Four Months Through Seven Months	201	(30)
Growth and Development	203	(11)
Physical Appearance and Growth	203	(1)
Movement	203	(3)
Vision	206	(2)
Language Development	208	(1)
Cognitive Development	209	(2)
Emotional Development	211	(3)
Basic Care	214	(9)
Introducing Solid Foods	214	(4)
Dietary Supplements	218	(1)
Weaning from Breast to Bottle	218	(1)
Sleeping	219	(2)
Teething	221	(1)
Swings and Playpens	221	(2)
Behavior	223	(4)
Discipline	223	(4)
Siblings	227	(1)
Health Watch	227	(1)
Immunization Alert	228	(2)
Safety Check	230	(1)
9 Age Eight Months Through Twelve Months	231	(34)
Growth and Development	232	(19)
Physical Appearance and Growth	232	(1)
Movement	233	(5)
Hand and Finger Skills	238	(1)
Language Development	239	(2)
Cognitive Development	241	(3)
Brain Development	244	(2)
Emotional Development	246	(5)
Basic Care	251	(8)
Feeding	251	(3)
Weaning to a Cup	254	(4)
Sleeping	258	(1)
Behavior	259	(4)
Discipline	259	(2)
Siblings	261	(1)
Grandparents	262	(1)
Immunization Alert	263	(1)
Safety Check	263	(2)
10 The Second Year	265	(36)
Growth and Development	266	(12)
Physical Appearance and Growth	266	(1)
Movement	267	(1)
Hand and Finger Skills	268	(2)
Language Development	270	(2)
Cognitive Development	272	(1)
Social Development	273	(3)
Emotional Development	276	(2)
Basic Care	278	(11)
Feeding and Nutrition	278	(10)
Getting Ready for Toilet Training	288	(1)
Sleeping	288	(1)
Behavior	289	(7)
Discipline	289	(3)
Coping with Temper Tantrums	292	(3)
Family Relationships	295	(1)
Immunization Alert	296	(1)
Safety Check	297	(4)
11 Age Two to Three Years	301	(38)
Growth and Development	302	(14)
Physical Appearance and Growth	302	(1)
Movement	303	(2)
Hand and Finger Skills	305	(1)
Language Development	306	(1)
Cognitive Development	307	(2)
Social Development	309	(2)
Emotional Development	311	(5)
Basic Care	316	(18)
Feeding and Nutrition	316	(2)
Teething and Dental Hygiene	318	(3)
Toilet Training	321	(2)
Sleeping	323	(2)
Discipline	325	(1)
Preparing for School	325	(9)
Family Relationships	334	(2)
A New Baby	334	(1)
Hero Worship	334	(2)
Visit to the Pediatrician	336	(1)
Immunization Alert	336	(1)
Safety Check	337	(2)
12 Age Three to Five Years	339	(50)
Growth and Development	340	(1)
Physical Appearance and Growth	340	(1)
Age Three to Four Years	341	(15)
Movement	341	(2)
Hand and Finger Skills	343	(2)
Language Development	345	(3)
Cognitive Development	348	(2)
Social Development	350	(3)
Emotional Development	353	(3)
Age Four to Five Years	356	(12)
Movement	358	(1)
Hand and Finger Skills	358	(2)
Language Development	360	(2)
Cognitive Development	362	(2)
Social Development	364	(2)
Emotional Development	366	(2)
Basic Care	368	(18)
Feeding and Nutrition	368	(4)
Beyond Toilet Training	372	(1)
Bed-wetting	373	(1)
Sleeping	374	(3)
Discipline	377	(2)
Preparing for Kindergarten	379	(3)
Traveling with Your Preschooler	382	(4)
Visit to the Pediatrician	386	(1)
Immunization Alert	387	(1)
Safety Check	388	(1)
13 Part-time Care for Your Child	389	(34)
What to Look for in a Caregiver: Guidelines for the Toddler and Preschool Child	390	(1)
Choices in Part-time Care	391	(8)
In Home Care	392	(2)
Family Child Care	394	(3)
Child Care Centers	397	(2)
Making a Final Selection	399	(8)
Building a Relationship with Your Child's Caregivers	407	(3)
Resolving Conflicts that Arise over Your Child's Care	410	(1)
What to Do When Your Child Is Sick	411	(2)
Controlling Infectious Diseases in Child Care Programs	413	(4)
Colds and Flu	414	(1)
Cytomegalovirus (CMV) Infection	414	(1)
Diarrheal Diseases	415	(1)
Eye and Skin Infections	415	(1)
Hepatitis	415	(2)
HIV (AIDS Virus) and Hepatitis B	417	(1)
Preventing and Dealing with Injuries in Child Care Programs	417	(3)
Part-time Care for Children with Special Needs	420	(3)
14 Keeping Your Child Safe	423	(50)
Why Children Get Injured	424	(6)
Safety Inside Your Home	430	(10)
Room to Room	430	(1)
Nursery	430	(5)
Kitchen	435	(1)
Bathroom	436	(1)
Garage and Basement	436	(1)
All Rooms	437	(3)
Baby Equipment	440	(7)
High Chairs	440	(1)
Infant Seats	441	(1)
Playpens	442	(2)
Walkers	444	(1)
Pacifiers	444	(1)
Toy Boxes and Toy Chests	445	(1)
Toys	445	(2)
Safety Outside the Home	447	(22)
Car Safety Seats	447	(1)
Choosing a Car Safety Seat	448	(2)
Types of Car Safety Seats	450	(3)
Installing a Car Safety Seat	453	(4)
Use of the Car Safety Seat	457	(1)
Air Bag Safety	458	(1)
What Parents Can Do	459	(1)
Pedestrian Safety	460	(1)
Baby Carriers Backpacks and Front Packs	460	(1)
Strollers and Baby Carriages	461	(1)
Shopping Cart Safety	462	(1)
Bicycles and Tricycles	462	(2)
Playgrounds	464	(1)
Your Backyard	465	(1)
Water Safety	466	(2)
Safety Around Animals	468	(1)
Preventing Kidnapping and Abduction	469	(4)
PART II
15 Emergencies	473	(24)
Bites	475	(1)
Burns	476	(2)
Cardiopulmonary Resuscitation (CPR) and Mouth-to-Mouth Resuscitation	478	(3)
Choking	481	(4)
Cuts and Scrapes	485	(2)
Drowning	487	(1)
Electric Shock	488	(1)
Fingertip Injuries	489	(1)
Fractures/Broken Bones	490	(1)
Head Injury/Concussion	491	(2)
Poisoning	493	(4)
16 Abdominal/ Gastrointestinal Tract	497	(28)
Abdominal Pain	497	(3)
Appendicitis	500	(2)
Celiac Disease	502	(1)
Constipation	503	(2)
Diarrhea	505	(4)
Food Poisoning	509	(3)
Hepatitis	512	(2)
Hydrocele (Communicating Hydrocele, Infant Hernia)	514	(1)
Inguinal Hernia	515	(1)
Malabsorption	516	(1)
Milk Allergy	517	(2)
Pinworms	519	(1)
Reye Syndrome	520	(2)
Vomiting	522	(3)
17 Behavior	525	(18)
Anger, Aggression, and Biting	525	(2)
Computers and the Internet	527	(2)
Coping with Disasters and Terrorism	529	(2)
Hyperactivity and the Distractible Child	531	(2)
Television	533	(5)
Temper Tantrums	538	(3)
Thumb and Finger Sucking	541	(1)
Tics	542	(1)
18 Chest and Lungs	543	(16)
Asthma	543	(3)
Bronchiolitis	546	(2)
Cough	548	(2)
Croup	550	(1)
Flu/Influenza	551	(2)
Pneumonia	553	(2)
Tuberculosis	555	(2)
Whooping Cough (Pertussis)	557	(2)
19 Developmental Disabilities	559	(16)
Cerebral Palsy	560	(3)
Congenital Abnormalities	563	(6)
Hearing Loss	569	(3)
Mental Retardation	572	(3)
20 Ears, Nose, and Throat	575	(24)
Allergic Rhinitis	575	(2)
Colds/Upper Respiratory Infection	577	(3)
Middle Ear Infections	580	(5)
Epiglottitis	585	(1)
Herpes Simplex	586	(1)
Nosebleeds	587	(2)
Sore Throat (Strep Throat, Tonsillitis)	589	(1)
Swimmer's Ear (External Otitis)	590	(2)
Swollen Glands	592	(3)
Tonsils and Adenoid	595	(4)
21 Eyes	599	(10)
Vision Difficulties Requiring Corrective Lenses	602	(1)
Strabismus	602	(1)
Amblyopia	603	(1)
Eye Infections	604	(1)
Eyelid Problems	604	(1)
Tear (or Lacrimal) Production Problems	605	(1)
Cataracts	606	(1)
Glaucoma	606	(1)
Eye Injuries	607	(2)
22 Family Issues	609	(24)
Adoption	609	(1)
Child Abuse and Neglect	610	(4)
Divorce	614	(3)
Grief Reactions	617	(3)
One- and Two-Child Families	620	(1)
Sibling Rivalry	621	(2)
Single-Parent Families	623	(1)
Smaller Extended Families	624	(1)
Stepfamilies	625	(2)
Twins	627	(2)
Working Mothers	629	(2)
Stay-at-Home Fathers	631	(2)
23 Fever	633	(8)
24 Genitourinary Tract	641	(12)
Blood in the Urine (Hematuria)	641	(2)
Proteinuria	643	(1)
Hypospadias	643	(1)
Undescended Testicles (Cryptorchidism)	644	(1)
Urethral Valves	645	(1)
Labial Adhesions	646	(1)
Meatal Stenosis	647	(1)
Urinary Tract Infections	647	(2)
Wetting Problems or Enuresis	649	(4)
25 Head, Neck, and Nervous System	653	(12)
Autism	653	(2)
Meningitis	655	(2)
Motion Sickness	657	(1)
Mumps	658	(2)
Seizures, Convulsions, and Epilepsy	660	(1)
Sinusitis	661	(1)
Wryneck (Torticollis)	662	(3)
26 Heart	665	(8)
Arrhythmias	665	(2)
Heart Murmur	667	(1)
Hypertension/High Blood Pressure	668	(3)
Kawasaki Disease	671	(2)
27 Immunizations	673	(6)
Side Effects	674	(1)
Children Who Should Not Receive Certain Vaccines	675	(4)
28 Musculoskeletal Problems	679	(10)
Arthritis	679	(4)
Bowlegs and Knock-Knees	683	(1)
Elbow Injuries	683	(1)
Flat Feet/Fallen Arches	684	(1)
Limp	685	(1)
Pigeon Toes (Intoeing)	686	(1)
Sprains	687	(2)
29 Skin	689	(24)
Birthmarks and Hemangiomas	689	(2)
Chickenpox	691	(1)
Cradle Cap and Seborrheic Dermatitis	692	(1)
Eczema (Atopic Dermatitis and Contact Dermatitis)	693	(2)
Fifth Disease (Erythema Infectiosum)	695	(1)
Hair Loss (Alopecia)	696	(1)
Head Lice	696	(2)
Hives	698	(1)
Impetigo	699	(1)
Insect Bites and Stings	700	(2)
Measles	702	(2)
Poison Ivy, Poison Oak, Poison Sumac	704	(1)
Ringworm	705	(1)
Roseola Infantum	705	(1)
Rubella (German Measles)	706	(1)
Scabies	707	(1)
Scarlet Fever	708	(1)
Sunburn	709	(1)
Warts	710	(1)
West Nile Virus	711	(2)
30 Chronic Conditions and Diseases	713	(14)
Coping with Chronic (Long-Term) Health Problems	713	(2)
Anemia	715	(3)
Cystic Fibrosis	718	(1)
Diabetes Mellitus	719	(3)
Failure to Thrive	722	(1)
HIV Infection and AIDS	723	(4)
31 The Environment and Your Child	727	(8)
Asbestos	727	(1)
Carbon Monoxide	728	(1)
Drinking Water	728	(2)
Lead Poisoning	730	(2)
Outdoor Air Pollution	732	(1)
Radon	732	(1)
Second-Hand Smoke	733	(2)
Index	735

Excerpts

1

Preparing for a New Baby



Pregnancy is a time of anticipation, excitement, preparation, and, for many new parents, uncertainty. You dream of a baby who will be strong, healthy, and bright--and you make plans to provide her with everything she needs to grow and thrive. You probably also have fears and questions, especially if this is your first child, or if there have been problems with this or a previous pregnancy. What if something goes wrong during the course of your pregnancy, or what if labor and delivery are difficult? What if being a parent isn't everything you've always dreamed it would be? These are perfectly normal feelings and fears to have. Fortunately, most of these worries are needless. The nine months of pregnancy will give you time to have your questions answered, calm your fears, and prepare yourself for the realities of parenthood.

Some of these preparations should begin when you first learn you're pregnant. The best way to help your baby develop is to take good care of yourself, since medical attention and good nutrition will directly benefit your baby's health. Getting plenty of rest and exercising moderately will help you feel better and ease the physical stresses of pregnancy. Talk to your physician about prenatal vitamins, and avoid smoking and alcohol.

As pregnancy progresses, you're confronted with a long list of related decisions, from planning for the delivery to decorating the nursery. You probably have made many of these decisions already. Perhaps you've postponed some others because your baby doesn't yet seem "real" to you. However, the more actively you prepare for your baby's arrival, the more real that child will seem, and the faster your pregnancy will appear to pass.

Eventually it may seem as if your entire life revolves around this baby-to-be. This increasing preoccupation is perfectly normal and healthy and actually may help prepare you emotionally for the challenge of parenthood. After all, you'll be making decisions about your child for the next two decades--at least! Now is a perfect time to start.

Here are some guidelines to help you with the most important of these preparations.



GIVING YOUR BABY A HEALTHY START



Virtually everything you consume or inhale while pregnant will be passed through to the fetus. This process begins as soon as you conceive. In fact, the embryo is most vulnerable during the first two months, when the major body parts (arms, legs, hands, feet, liver, heart, genitalia, eyes, and brain) are just starting to form. Chemical substances such as those in cigarettes, alcohol, illegal drugs, and certain medications can interfere with the developmental process and with later development, and some can even cause congenital abnormalities.

Take smoking, for instance. If you smoke cigarettes during pregnancy, your baby's birthweight may be significantly decreased. Even inhaling smoke from the cigarettes of others (passive smoking) can affect your baby. Stay away from smoking areas and ask smokers not to light up around you. If you smoked before you got pregnant and still do, this is the time to stop--not just until you give birth, but forever. Children who grow up in a home where a parent smokes have more ear infections and more respiratory problems during infancy and early childhood. They get more sore throats, they cough and wheeze more and have a harder time getting over colds, and they are more prone to hoarseness. They also have been shown to be more likely to smoke themselves when they grow up.

There's just as much concern about alcohol consumption. Alcohol intake during pregnancy increases the risk for a condition called fetal alcohol syndrome (FAS), which is responsible for birth defects and below-average intelligence. A baby with fetal alcohol syndrome may have heart defects, malformed limbs (e.g., club foot), a curved spine, a small head, abnormal facial characteristics, small body size, and low birth weight. Fetal alcohol syndrome is also the leading cause of mental retardation in newborns. Alcohol consumption during pregnancy increases the likelihood of a miscarriage or preterm delivery, as well.



Where We Stand



Drinking alcohol during pregnancy is one of the leading preventable causes of birth defects, mental retardation, and other developmental disorders in newborns. There is no known safe amount of alcohol consumption during pregnancy. For that reason, the American Academy of Pediatrics recommends that women who are pregnant, or who are planning to become pregnant, abstain from drinking alcoholic beverages of any kind.



Although no one has determined exactly how much alcohol is too much for a pregnant woman, there is evidence that the more you drink, the greater the risk to the fetus. It is safest not to drink any alcoholic beverages during pregnancy.

You also should avoid all medications and supplements except those your physician has specifically recommended for use during pregnancy. This includes not only prescription drugs that you may have already been taking, but also nonprescription or over-the-counter products such as aspirin, cold medications, and antihistamines. Even vitamins can be dangerous if taken in high doses. (For example, excessive amounts of vitamin A have been known to cause congenital (existing from birth) abnormalities.) Consult with your physician before taking drugs or supplements of any kind during pregnancy, even those labeled "natural."

Your caffeine intake also should be limited while you are pregnant. While no adverse effects from minimal caffeine intake (one cup of caffeinated coffee per day) have yet been proven, recent studies suggest that consuming large amounts of caffeine during pregnancy might affect fetal growth. Caffeine also tends to keep adults awake and make them irritable, which can only make things less comfortable and restful for you.

Another cause of congenital abnormalities is illness during pregnancy. You should take precautions against these dangerous diseases:

German measles (rubella) can cause mental retardation, heart abnormalities, cataracts, and deafness. Fortunately, this illness now can be prevented by immunization, although you must not get immunized against rubella during pregnancy.

The majority of adult women are immune to German measles because they had the disease during childhood or already have been immunized against it. If you're not sure whether you're immune, ask your obstetrician to order a blood test for you. In the unlikely event that the test shows you're not immune, you must do your best to avoid sick children, especially during the first three months of your pregnancy. It is then recommended that you receive this immunization after giving birth to prevent this same concern in the future.



Where We Stand



The Academy message is clear--don't smoke when pregnant. Many studies now show that if a woman smokes during pregnancy, her child's birth weight and growth during the first year of life may be reduced. The range of indisputable effects runs from depressed breathing movements during fetal life to cancer, respiratory disorders, and heart disease in later years.

If you smoke, quit. If you can't quit, don't smoke around children (especially indoors or in the car). Children of parents who smoke have more respiratory infections, bronchitis, pneumonia, and reduced pulmonary function than children of nonsmokers. The Academy supports legislation that would prohibit smoking in public places frequented by children. The Academy also supports a ban on tobacco advertising, harsher warning labels on cigarette packages, and an increase in the cigarette excise tax. For more information, visit www.aap.org.



Chickenpox is particularly dangerous if contracted shortly before delivery. If you have not already had chickenpox, avoid anyone with the disease or anyone recently exposed to the disease. You also should receive the preventive vaccine when you are not pregnant.

Toxoplasmosis is primarily a danger for cat owners. This illness is caused by a parasitic infection common in cats, but it also is found in uncooked meat and fish. The infected animal excretes a form of the parasite in its stools, and people who come in contact with infected stools could become infected themselves.

If you own a cat, have it checked for toxoplasmosis before you become pregnant or as early as possible in your pregnancy. You can reduce the chances that your cat will contract toxoplasmosis by feeding it only commercially prepared cat food, which is processed in a way that destroys the parasites. Also, to decrease your own chances of being infected, have someone who is not pregnant clean the litter box daily. (The toxoplasmosis parasites cannot infect humans until forty-eight hours after the cat excretes them.) If you do clean the litter box or handle cat litter, make sure to wash your hands thoroughly afterward. As previously mentioned, toxoplasmosis also is found in uncooked meat and fish, so avoid eating uncooked or partially cooked meat or fish such as sushi, and practice good hand-washing techniques after handling uncooked meat products.



GETTING THE BEST PRENATAL CARE



Throughout your pregnancy, you should work closely with your obstetrician to make sure that you stay as healthy as possible. Regular doctor's visits up until the birth of your baby can significantly improve your likelihood of having a healthy newborn. During each doctor's visit, you will be weighed, your blood pressure will be checked, and the size of your uterus will be estimated to evaluate the size of your growing fetus.

Here are some areas that deserve attention during your pregnancy.



Nutrition



Follow your obstetrician's advice regarding your use of prenatal vitamins. As mentioned, you should only take vitamins in the doses recommended by your doctor. Perhaps more than any other single vitamin, make sure you have an adequate intake (generally, 400 micrograms a day) of folic acid, a B vitamin that can reduce the risk of certain birth defects, such as spina bifida. Your obstetrician may recommend a daily prenatal vitamin pill, which includes not only folic acid and other vitamins, but also iron, calcium, and other minerals. Make sure your doctor knows about any other supplements you may be taking, including herbal remedies.



Eating for Two



When it comes to your diet, do some planning to ensure that you're consuming balanced meals. Make sure that they contain protein, carbohydrates, fats, vitamins, and minerals. This is no time for fad or low-calorie dieting. In fact, as a general rule, you need to consume about 300 more calories per day than you did before you became pregnant. You need these extra calories and nutrients so your baby can grow normally.



Exercise



Physical activity is just as important when you're pregnant as at any other time of life. Discuss a fitness program (including any video fitness tapes you may be interested in) with your doctor. Particularly if you haven't been exercising regularly, she may suggest a moderate walking or swimming regimen. Don't overdo it. Take it particularly slowly during the first few workouts--even just five to ten minutes a day is beneficial and a good place to start. Drink plenty of water while working out, and avoid activity with jumping or jarring movements.



Tests During Pregnancy



Even when your pregnancy is progressing normally, your obstetrician may recommend some of the following tests.

An ultrasound exam is one of the most common tests given to pregnant women. It monitors your fetus's growth and the well-being of his internal organs by taking sonograms (images made from sound waves) of him.

A nonstress test monitors the fetus's heart rate. In this test, a belt is positioned around your abdomen to measure the fetus's heart rate.

A contraction stress test is another means of checking the fetus's heart rate, but this time it is measured and recorded in response to mild contractions of the uterus that are induced during the test.

Other tests may be recommended, depending on your own physical health and personal and family history. For example, particularly for women with a family history of genetic problems or for those who are age thirty-five or older, your obstetrician may advise tests that can detect genetic disorders. The most common genetic tests are amniocentesis and chorionic villus sampling.



CHOOSING A PEDIATRICIAN



Every pediatrician is committed to helping parents raise healthy children with the greatest possible ease, comfort, pleasure, and success. However, different pediatricians have different approaches, so you may want to interview several before selecting the one who best suits your family's particular preferences and needs. Conduct these visits before the baby arrives, so the pediatrician you choose can give your newborn her very first exam.

Here are some considerations to help you make your choice.



Training of Pediatricians



Pediatricians are graduates of four-year medical schools with three additional years of residency training solely in pediatrics. Under supervised conditions, the pediatrician-in-training acquires the knowledge and skills necessary to treat a broad range of conditions, from the mildest childhood illnesses to the most serious diseases.

With the completion of residency training, the pediatrician is eligible to take a written examination given by the American Board of Pediatrics. Once she passes this examination, a certificate is issued, which you probably will see hanging on the pediatrician's office wall. If you see the initials "FAAP" after a pediatrician's name, it means he has passed his board exam and is now a Full Fellow of the American Academy of Pediatrics. Only board-certified pediatricians can add the designation "FAAP" after their name, which means they have reached the highest status of membership in this professional organization.

Following their residency, some pediatricians elect an additional one to three years of training in a subspecialty, such as neonatology (the care of sick and premature newborns) or pediatric cardiology (the diagnosis and treatment of heart problems in children). These pediatric subspecialists generally are called on to consult with general pediatricians when a patient develops uncommon or special problems. If a subspecialist is ever needed to treat your child, your regular pediatrician will help you find the right one for your child's problem.



How to Find a Pediatrician



The best place to start looking for a pediatrician is by asking other parents you know and trust. They are likely to know you, your style, and your needs. You also should consider asking your obstetrician for advice. She will know local pediatricians who are competent and respected within the medical community. If you're new to the community, you may decide to contact a nearby hospital, medical school, or county medical society for a list of local pediatricians. If you are a member of a managed care plan, you probably will be required to choose a pediatrician from among their approved network of doctors. (For more information about managed care, see "Managed Care Plans: Getting Good Care for Your Child" on pages XX-XX).

Once you have the names of several pediatricians you wish to consider, start by contacting and arranging a personal interview with each of them during the final months of your pregnancy. Many pediatricians are happy to fit such preliminary interviews into their busy schedules. Before meeting with the pediatrician, his office staff should be able to answer some of your more basic questions:

Is the pediatrician accepting new patients with my insurance or managed care plan?

What are the office hours?

What is the best time to call with routine questions?

How does the office handle billing and insurance claims? Is payment due at the time of the visit?

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Excerpted from Caring for Your Baby and Young Child: Birth to Age 5 by American Academy of Pediatrics Staff
All rights reserved by the original copyright owners. Excerpts are provided for display purposes only and may not be reproduced, reprinted or distributed without the written permission of the publisher.