Archive | February, 2014

Raising a Good Eater

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Raising a Good Eater

Posted on 28 February 2014 by Kristrun

stimulating-baby-indoorsMy children eat fruit and vegetables. They eat salad and sushi, spinach and seaweed. They eat curry and cabbage, kimchi and cauliflower. They eat pretty much anything. What’s more, they enjoy it. OK, some things more than others, but there is very little they will point blank refuse.

I’m not taking all the credit for this. I think I’ve been pretty lucky in so much as they genuinely enjoy food. I know this is not the case for many others. I would also like to point out that picky eating due to a disorder, such as that resulting from a child on the autistic spectrum, bears no resemblance to regular fussiness, and any healthy eating guidelines are not applicable in these cases.

I would like to share with you some things I have learned with my three children. Take what you fancy, and ignore what you don’t. What you are reading is based purely on my experience, nothing more. No research involved at all.

Make it tasty

Toddlers and children enjoy tasty food just as we do. I remember when my eldest was small and I was feeding her cold baby food from a jar. She was fussing and spluttering and spitting it out. I was staying with my sister in the UK at the time (jetlag and fussy eating – oh the joy) and she said to me “have you tried that stuff, Ailish? it’s revolting”. And so it was. My sister mushed up some vegetable stew with mashed potato, warmed it nicely and my daughter lapped it up. It simply had not occurred to me that a baby would have any preference when it came to how food tastes. How strange that seems now!

Don’t be afraid to cook with vegetable or chicken stock. Use a little butter. Add herbs, spices, garlic, ginger, a splash of soy sauce, a touch of chilli or curry powder. These are not adult flavours, they are just flavours. Go slow and easy and gently build up your child’s repertoire.

This may have worked a little too well for my youngest, who at age 9, adds tabasco to a worrying number of savoury dishes. What will he do for a chilli kick aged 20……?

Involve your child

The sooner you do this, the better. A baby can sit in a high chair or on the floor playing with a carrot, whilst the carrots are being chopped. Give a pan and a wooden spoon. Let them see, smell and touch whilst the food is being prepared. Before long, they can help to stir a pot or add the seasoning. A child who has had an active part in preparing a meal is far more likely to eat it. When they are old enough to appreciate it, take them to the market where they can see the food before it reaches our kitchen and allow them to make some choices. Shall we have chicken or fish? Potatoes or pasta? This involvement really does work and rather than presenting a finished meal out of nowhere with which the child feels no connection and therefore has little interest in, give them some insight, some input and a little control.

 

Use your fingers

Finger food is always a winner. I’m not one for terribly fussy food, and those images on the internet of children’s food as works of art on a plate give me hives. But various different foods, chopped smallish, always worked for us for a quick meal. Grapes cut in half, small cubes of cheese, carrot sticks….. this kind of thing generally appeals to most children. They can use their fingers to eat which is very important so that they learn about the different textures, and it is fun. Let your toddler make their own sandwich – give the bread, and the filling, and let them get on with it. A bit messy, but worth it. I used to also give my toddlers a blunt knife, a small tub of hummous or cream cheese and let them spread it onto crackers. An activity in itself! Filled a whole hour! Touching, feeling and dare I say it, playing with food, is very important to children so they learn it is nothing to fear. They are going to put it inside their mouths, which is a very personal thing, and they need to learn to trust. So let them explore it as much as possible.

Eat together

We all know this works. Children ultimately copy adults and eating is naturally a social time. Eating on your own is no fun, especially while feeling pressure to perform! Commonly in Hong Kong, Daddy is returning home late from work and Mummy would much rather eat a civilised dinner with him at 8.30pm, than feeding-time-at-the-zoo at 5.00pm (I don’t wish to generalise, but I know this to be true for a lot of families). This is perfectly understandable, who wouldn’t? But it is still important to sit down at the table with the children at meal times, maybe eat a few vegetables at the same time, talk and listen – make it comfortable and a time when they know they have your attention. A time to look forward to. It may be worth thinking about having your full meal at this earlier time once or twice during the week, and make a point of doing it all together at the weekend. And if it is impossible for either parent to be there, have your helper have dinner with the kids, rather than her only ‘feed’ the kids.

The chicken nugget trap

Try not to think in terms of kids’ food versus adult food. It’s all just food. Your kids are more likely to eat if you’re all eating the same thing and this is very possible once your child reaches the 12 month mark. You may need to adapt your child’s portion in some way (adding yoghurt to curry, taking a small portion out before adding chilli etc) but starting young with regular food will avoid them getting addicted to bland “kiddy” food and developing anxiety towards anything novel or with a strong flavour.

Back off

Nobody likes to be scrutinised while performing a task. Try taking the pressure off your little muncher. Offer the food, give a mouthful, and then take the focus off. Look to your own food, or chat to another child. You may just find they eat that broccoli when you are not watching them like a hawk. Especially if you are eating broccoli too!

Stay calm

Children pick up so easily on our mood. If you feel the tension rising as meal time is approaching, then so will they. Stay light hearted and strive towards making dinner time a time to enjoy. If they eat almost nothing, keep calm, smile, clear it away and try again tomorrow.

Firm but fair

I love food, and good food is important to me. So it was important that my children learned to love food too. Now, all children are naturally picky. I know some are pickier than others, but all children like to stick to what they know. This is normal. Encouraging new foods is a slow and gradual process, and it starts very early. My kids know they have to try something quite a few times before they are allowed not to like it. There are many things they have proclaimed they hated (no. 3 child is the best at this) and have ended up loving. Spinach fried in garlic. Roasted sweet potato. Beetroot. I could go on. So, don’t give up at the first hurdle. Offer tiny amounts of new things to try. However, I do respect them if they really cannot bear something after a valiant attempt. Child no. 1 doesn’t like celery. Child no. 2 doesn’t like pumpkin. Child no. 3 doesn’t like cream. And none of them will touch a mushroom.

For very small toddler munchkins, reasoning is not really an option, and so then I can see the value of “hiding” vegetables in food and there are many fabulous ways of doing this. But as they get older, this is, well…. quite boring, and I think they should have an idea of what they are eating.

Give some control

At meal times, in our house, there are certain things the children have little control over. They must come to the table at dinner time and they must try anything new. But, they can choose how much they eat. Taking this pressure off is sometimes enough to stop the battles.

Eating away from home

I cannot tell you the number of times I have had other people’s children at my house to eat and their Mums have been aghast when I tell them what we had for dinner. “Oh, but Johnny wouldn’t eat that.” Well, he did. Quite happily.

Children do all kinds of things differently when they are in different environments, away from familiar triggers and routines. So, don’t reject the restaurant, or the neighbour’s place for fear that your fussy eater will create a scene. They just might not.

Start small

A huge dish of food is a very intimidating thing to a small child. Offer small portions which they won’t feel threatened by. Better still, once they are old enough, let them serve themselves or choose how many carrots they want. This way, they are far more likely to be able finish it and you won’t be left with the “don’t waste food” argument. Personally, I never make my kids finish their food, but ask them to stop when their tummies feel full. Quite frankly, forcing food into a child does not seem better to me than putting it in the bin or feeding it to the dog. We just got our dog its preferred by dogs.

If they finish and ask for more, then great!

Eat local when travelling

I’m passionate about this. My children were born in Asia, and like most expat families, we have been fortunate to travel quite a bit. Travelling and food for our family go hand in hand. Memories of different places become entwined with the fabulous food we ate there. Pho in Vietnam. Nasi lemak in Malyasia. Chicken rice in Singapore. Hoppers and curry in Sri Lanka. Seafood in Australia. Pies in New Zealand (!!). Having good eaters really comes into its own when travelling. To be able to eat anywhere and try anything is such a joy in a foreign land. To have to trawl in search of spaghetti bolognese wherever one goes is tedious. And expensive.

Educate

Most kids like to eat junk. If we are being honest, most of us like to eat junk. In a few short years, you will have no control over what your child chooses to eat. All we can do is educate them about making healthy choices and why that is a good thing. My biggest bug-bear is sugary drinks, and it worries me when my children tell me how many cartons of iced tea, or cans of soda their school friends drink on any given day. If my kids choose not to do this, I will be happy.

Everything in moderation

I don’t believe in banning any foods; rather teach that some foods are for every day, and some are for special occasions. Party food is to be enjoyed at parties and life is too short not to eat chocolate and ice-cream.

 

I am well aware that some children have no interest in food and just view it as fuel, just as some adults do. I have a very dear brother-in-law who would be happy to see out the end of his days eating only cornflakes and chocolate. I am also willing to accept that I just struck lucky – both my husband and I enjoy good food, and therefore it may seem reasonable to assume that our children would be interested too. Be that as it may, but I am going to give myself a smidgen of credit; I put in the effort. My children are now 13, 11 and 9. My work is almost done. Start early and be confident.

Ailish Cotton

Mum of 3

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crying baby tongue

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Soothing a Crying Baby

Posted on 27 February 2014 by Kristrun

Keep calm skin to skin

Congratulations on the birth of your baby!

Your baby is an individual that you need to get know and unfortunately, he or she does not come with a manual. It can be exhausting and devastating when your baby is crying and you don’t know why or what to do. You may have already fed the baby, burped him and changed his nappy and still he isn’t settled. Why won’t he stop crying?

Remember your baby is new to this world and experiencing a lot of new things: now she needs to breath on her own, digest, pee and poo and is dependent on you for all of its needs. There are a few simple things that you can easily do that might sooth your baby and give her comfort.

Skin to skin contact is a great way to sooth your baby and can be easily given by both mom and dad. Skin to skin contact is the placing of your baby, unclothed (or nappy only) onto your chest, under a blanket or your clothing and it will usually be enough to calm your baby down. Even a hungry baby will be soothed when he can smell your skin and hear your heartbeat. In utero, your baby was used to hearing your heartbeat, so patting baby on the butt while giving skin to skin can calm her down quite quickly. Skin to skin also helps with digestion as well as giving a sense of security and feeling loved which is one of the basic needs of all babies.

Holding your baby and rocking him, bouncing, walking or dancing can also help to sooth. Remember that your baby has been rocked and walked to sleep whilst inside you and probably was quite awake and kicking when you were going to bed in the evenings and wanted to go to sleep!

While holding your baby, sing a song or talk in a calm voice. Your baby loves listening to your voice, he is used to it and it is something familiar. You won’t spoil your baby by holding her or attending to her needs.

The single most important thing for you to remember is to stay calm when your baby seems distressed because your baby is very in tune with your feelings and stress levels. So stay calm and your baby may follow suit.

Hafdis Runarsdottir

Annerley Midwife

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geobabyarticleantenatal

Antenatal Care In Hong Kong

Posted on 19 February 2014 by Kristrun

“This involvement of midwives is important because for a vast majority of women, pregnancy is not a medical condition, but is an geobabyarticleantenatalimportant life transition. A famous piece of research (Cochrane) has shown that, compared with women who were cared for under other models of care, women who received midwife-led models of care were less likely to be admitted to hospital during pregnancy, less likely to receive regional analgesics during labour and childbirth, and to have an episiotomy. In addition, women who received midwife-led models of care were also more likely to have spontaneous vaginal birth, to feel in control during labour and childbirth, and to initiate breastfeeding. And if that wasn’t enough: babies born to women who received midwife-led care were less likely to die before 24 weeks of pregnancy and were more likely to have a shorter length of hospital stay.

It makes us midwives look like angels; the truth is that most pregnancies are low-risk and midwives are more than capable of providing the necessary support, referring on only high-risk cases to doctors for some of the critical checkups. For low-risk mothers we can continue to monitor the mother’s health, but can also focus on providing the education and emotional support that helps mothers make the most of their pregnancy and early babycare – and hence the glowing figures….”

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Screen time and Toddlers

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Screen time and Toddlers

Posted on 07 February 2014 by Kristrun

Most of us are guilty of using Peppa Pig or Thomas the Tank Engine as a pseudo baby sitter. Or these fantastic apps that can keep little ones occupied for indefinite periods. I’m putting up my hand, here – I use screens in my house to buy peace and quiet, some quality time for me and often just that one email or a cup of coffee. I do it despite knowing that when I remove the screen, they will cry, there will be a fight and they will beg for “just one more”. It’s amazing how addictive this screen is to these little creatures and how difficult it can be to balance screen-time and non-screen-time. The very fact that this term “screen-time” has so quickly become a part of our vocabulary is alarming in itself.

How much screen time is safe?

Research has suggested that if you introduce the screen too early, language development may be affected. Some even say that the child can be six times more likely to develop speech problems. Teachers and early childhood educators know that a child’s vocabulary can vary greatly from one child to another, and that can often be linked directly to screen time versus oral interaction with real human beings. People ultimately do not learn language from a TV. Expression, emotion, tone, pitch, and the myriad of subtleties linked with any language comes from human interaction. I recommend less than 1 hour total screen time per day per child from the age of 1-5. None, or as little as possible, for babies younger than 12 months of age.

Screen time and Sleep

We know that screen time close to bedtime will affect sleep. The lights from the screens – especially screens that are kept very close to little faces will have an impact on their sleeping patterns. Try to balance the routine around bedtime so that watching anything on screen is kept as far from the actual sleeping time as possible. Easy way to do it is to use the screens to quiet things down, then switch off, play quietly, have dinner, then bath, read a book and go to sleep.

Screens and meals

As tempting as it may be, we all know it is not a good habit to allow children to be in front of the screen when having a meal. It can affect the amount of food they consume and their overall eating habits. They may eat like robots and completely out of balance with their appetite. Children want to copy everything adults do – including eating. If you have fussy eaters or children not interested in meal times, the best advice is to eat with your children or have your helper eat with them, if it is impossible for you to do so. This will help in making them interested and engaged during feeding times. Eating should be a social time, and it is never too early to instill this association.

Stick with what works

Some will argue that there are many educational apps and TV programs that can be very good for children. That may be right – there are certain programs that are very well designed and can stimulate and teach children all manner of things. But children learn far more from interaction with you, or others around them. Focus on labelling your surroundings – talk about size, shapes, colours, emotions, distances etc. Also focusing on stimulating their senses by allowing them to touch and feel their environment, and make an effort to have them exposed to soil, sand, grass, stones, pebbles – as many different environments as you can. This varying stimulus is so important to a baby’s development. Good old fashioned books, nursery rhymes and songs, always work. One of the biggest problems society will face in the future will be children who have severe problems socializing and they will be hiding behind their computer screens, unable to cope with the world around them in all its unpredictable, messy, disordered, wonderful glory. By focusing on communication, verbal interaction and stimulation, we will help build a foundation for life.

Bear all of this in mind whilst being realistic. Sometimes the screen is a lifesaver for everyone. When travelling with my children in the double buggy- the small screens makes us capable of doing these long haul flights with layovers. And when they are sick – it completely saves everything to have Peppa Pig with us to shorten the day. But let’s make it an exception, rather than a rule. A treat, rather than the norm. A conversation with Mummy or Daddy beats Peppa Pig, hands down, every time.

Kristrun Lind – Mother of two toddlers

B.Ed, M.Ed. (Iceland, HK), C.E.C.E. (HK)

kristrun@annerley.com.hk

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Childhood Fevers: Paracetamol and Ibuprofen

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Childhood Fevers: Paracetamol and Ibuprofen

Posted on 07 February 2014 by Kristrun

Remember that a fever is a symptom, not an illness in itself. It is the body’s way of creating an unfavourable environment for a viral or bacterial infection. Pathogens do not do well in elevated temperatures so it is a way of “fighting” the infection. So, if your child is not uncomfortable or in pain, it may be that you can leave the fever to do its work without intervention.

Relief can be given by keeping your child cool, removing clothing if necessary and making sure they stay well hydrated with sips of fluids. Do not wrap them up or use cold sponges.

However, if you are alarmed by an increasing high fever, or your child is in pain, you can give infant paracetamol or ibuprofen (although we do not recommend any medication under the age of three months). Always see a doctor if you are worried in any way or you suspect the fever is a symptom of a more serious illness. See here for more tips and advice on childhood fevers.

Infant Paracetamol can be used for pain relief and to help reduce temperatures. It comes in variety of forms including liquid medicine, chewable tablets and regular pills. It is sold widely without prescription as Calpol, Disprol, Medinol, Panadol and other brand names depending on the country of origin. Children’s version can be purchased sugar-free.

Be careful to check that your child is not getting paracetamol in other medicines (eg cold relief sachets) and always follow the instructions with regards to doseage. It is important to calculate this by weight of the child, not by age. There is no point in under-dosing (because they are “not very sick”) but great care must be taken not to over-dose.

Infant Ibuprofen can also be known as Nurofen, Brufen and Calprofen. Other brand names are also sold without a prescription – check with a pharmacist if you are unsure. Ibuprofen should not be given to babies under the age of three months or under 5kg unless prescribed by a doctor, and always follow instructions on the bottle for doseage.

Do not give both medications at the same time, and never give aspirin. However, it is possible to “stagger” dosing with both paracetamol and ibuprofen in some cases (such as a painful ear infection). Always check with a doctor for advice about this.

See here for more information on treating children with painkillers.

Conchita Amende.  Specialist community health nurse (health visitor UK).

 

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Common Childhood Illnesses and when to call a doctor

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Common Childhood Illnesses and when to call a doctor

Posted on 07 February 2014 by Kristrun

babyWithBluehat2All kids get sick. It’s a normal part of being a child, and as such, dealing with sickness is something all parents will come to face sooner or later. Of course we do our best to limit the risk of infection by maintaining good hygiene (hand washing being up there as most important) but the day will come when your child becomes ill with something or other. Some circumstances warrant a trip to the doctor or even the emergency room, others do not.

It’s important to remember that most children’s illnesses are viral, and hence anti-biotics are ineffective. In these cases, such as the common cold and coughs, we can treat the symptoms of the illness and strive to make our little ones feel comfortable, but a trip to the doctor is not always necessary. Bear in mind also that a viral infection can take up to 2 weeks to resolve. With a cold or flu-like virus, acute stage of feeling lousy will likely last 4 or 5 days (or more), but other symptoms, such as a lingering cough, can hang around for up to 2 weeks. This is ‘normal’.

Here’s a quick low down of some of the more common afflictions and what to do if your household is affected. Please remember that whatever the circumstances, you know your child best of all. If you feel that something is “not right”, then go and see a doctor and get it checked out.

Coughs and colds

It is normal for young children to get several colds per year and right now, it is affecting many families in Hong Kong. There are hundreds of different cold viruses and your baby has no immunity against any of them. Gradually, with time, they will get fewer as their immunity builds. Most colds get better in 5 to 7 days and there is usually no need to see a doctor. Some relief can be brought by treating the symptoms but do keep an eye on their general condition, as a cold can deteriorate into a chest or ear infection or worse.

Coughs

Children often cough when they have a cold because of mucus trickling down the back of the throat. Usually nothing to worry about if child is eating, drinking, breathing normally. When to see a doctor: wheezing, a bad cough that is not improving, a high fever, or breathlessness. These may be indicators of a chest infection which, if bacterial, may need antibiotics so see a doctor.

Sore throats

Often caused by viral illness such as colds or flu. Paracetamol or ibuprofen may be given to reduce pain. Most sore throats clear up on their own within a few days. When to see a doctor: prolonged symptoms (more than 4 days), high temperature and general unwellness, inability to swallow fluids or saliva.

Tonsilitis

Infection of the tonsils at the back of the mouth. Can be caused by bacteria but mostly viral. Symptoms include a sore throat, read swollen tonsils, pain and difficulty swallowing, fever, coughing and headache. Glands in the neck may also be swollen and there may be spots of pus on the tonsils. Most common between the ages of 5 and 15 and spread by coughing, sneezing or through touch. See doctor to check if bacterial (and therefore antibiotics may be advised). Treat symptoms using paracetamol, ibuprofen, throat lozenges or throat sprays (if age appropriate).

Slapped Cheek Syndrome

A viral disease which triggers mild cold-like symptoms, as well as one or two red cheeks. Rash elsewhere on the body can also develop and your child may experience joint pains. Most common between the ages of 2 and 14 years and no treatment (other than paracetamol) is necessary. It is difficult to prevent the spread of this virus as people are most infectious before symptoms appear.

Chickenpox

Most common in children under 10 years of age, infection is spread by inhaling droplets of the virus from the air, but can also be spread by direct contact with blister fluid. Incubation period is between 1 and 3 weeks and most infectious time is 1-2 days before rash appears. However, your child continues to be infectious until the blisters have crusted over. Symptoms start with general unwellness, maybe a rash and a slight fever. Spots will develop, which are red and become fluid-filled blisters within a day or two. They eventually dry into scabs, which will drop off. Scarring is not common, but can occur if they are badly infected.

Hand, Foot & Mouth Disease (HFMD)

A viral infection, for which there is no specific treatment and which normally clears up by itself after 7-10 days. Symptoms are blisters on feet, hands, inside the mouth and sometimes in the nappy area. You can help your child’s symptoms by: Encouraging them to rest and drink plenty of fluids (water and milk is ideal, but avoid acidic drinks such as orange juice or cola). Offering soft foods which are easier to chew and swallow. Pain relieving medication if very uncomfortable. HFMD is contagious so stay home until the blisters have dried.

Scarlet Fever

Highly contagious bacterial infection which starts with a throat or skin infection and leads to a fever, flushed face and wide-spread, pinkish-red rash. The rash feels rough, like sandpaper, and may be itchy. It is caught through contact with an infected person, or through contact with infected items, such as door handles. Most common in children between the ages of 4 and 8. See your doctor as antibiotics are needed within 10 days. If not treated, immune reactions can lead to complications such as kidney problems or rheumatic fever. Stay home, and away from others and do not share towels, clothes and bed-linen with others.

IMPORTANT

You know your child better than anyone else. Trust your instinct and if you feel something is “not right” or you are worried in any way, always seek help from a health professional.

If your child’s condition deteriorates rapidly, take them to a hospital straight away.

It is always better to be safe than sorry.

Here’s to a happy and health Year of the Horse!

Conchita Amende. Specialist community health nurse (health visitor UK).

 

 

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