Thursday, February 12, 2009

Pre-School and Daycare Vaccines: Fomites and Kindergarten

I am graduating several kids from my pre-school this year to kindergarten. This is as big a move for the parents as it is for the kids. At one round-up, the gymnasium was filled with kids being "watched" so the parents could tour the facility without their little student in tow. As one parent commented on the experience, "I was worried about our child catching a cold in your small group".

Catching a cold, it turns out, is a natural part of the childhood experience. There are, however guidelines to keeping your child safe and the children around them - although your best efforts will be thwarted by the parents who, because of work obligations or because they simply do not care about the group, will bring a child with a fever. But what about the running nose, the cold, the winter crud that makes your child feel listless, less alert and just plain crummy?

A study was done on infants with the flu, a potentially deadly complications for kids this young. The researchers found that if you simply sit in the run with the sick child, you will not get the infection. If you touch what the child touched or cuddled the sick child, you would. In other words, your child's health in in the hands - their hands, the other kids hands and t o some degree, your hands as well.

In a daycare or preschool situation, providers spend a good deal of time making sure that hands are clean, toys and other objects stay away from the face, and that those toys and objects are regularly cleaned. But your child is only here Monday through Friday and those nasty germs, viruses and related bacteria are everywhere.

The term pediatricians often use is shedding viruses. This can occur before the child shows symptoms, during the child's illness and even after the fact. Because you cannot keep every child home the entire winter - pediatricians also suggest that missing school is far worse than the overall effect of the illness - unless they are really sick, you should consider their advice.

Children should be fully immunized against pertussis (whooping cough) and measles, for example, and the American Academy of Pediatrics recommends an annual flu shot for all children from 6 months to 18 years old. A child with a fever (or is vomiting) is another matter entirely. You may be tempted to load your child up with ibuprofen and drop them off, hoping for the best. But your provider or teacher knows your child better in many cases, than you do. If you do something like this, you will probably get a call.

Dr. Caroline Breese Hall, a professor of pediatrics and medicine at the University of Rochester has said, “Taking one child out of the school who sits next to your child is going to do little when your child goes into the lunchroom and there are secretions all over the table. You cannot focus on one sick child because there’s a world of much cleverer microbes.”

Wash, wash your hands and do it again. And be sure to teach your child the same sanitation. It can only help.

Monday, February 9, 2009

Potty Training: The Tips that come from Experience

It is so easy to get caught-up in the education of your child.  You teach them how to speak and act socially, you set boundaries and parameters for behavior, and you believe that your child is special among children, smart, bright, beautiful.  You want them to rush through childhood as get to the top of the class before the rest of the children are even reading Suess.  You begin eyeballing career paths and the schools that will get them there. 

But your child has other ideas.   And so do the schools that cater to these types of parents.  Your child must be potty trained, they insist and they do so for good reason.  They do not want to touch your child.  

These institutes of higher learning don't really do more for your child than the best in-home daycare/preschool can provide (small groups with individual attention, learning at a pace that suits the child not the curriculum, and most importantly, the ability to play with different age groups - at this stage, even six months difference in ages can mean a world of interesting social discoveries) but parents get hung up on the social pressures of their own peer groups.  It is understandable and forgivable.

So the race begins to push your child to potty train.  And as I have mentioned, your child has other ideas.  This process is not cookie-cutter by any stretch of the imagination.  It requires a child who interested - "Mom, I want to be changed" or "Dad, what are you doing in there" to waking up dry after a night's sleep.  These magic moments signal a readiness that is not bounded by a specific age.  But rather a specific nature.

Once this interest begins, it is best to not get too excited that your diaper days are numbered.  Kids are fickle and can be encouraged.  But once this turns into a battlefield, you will have many more problems than successes.

In an in-home preschool/daycare situation, the peer pressure of watching older kids line-up after snack/lunch/nap can begin the process.  The in-home teacher can offer assistance in the process.  But the bottom line: if you are not committed to the effort, your child will lapse, falter and you will be discouraged.

Here's the tips:

Once your child shows the interest - the child, not you - be prepared to look for a bathroom in every store you visit, every event you attend, and every house you visit.  Knowing where these are saves time, stress and energy.  Be prepared to abandon your cart, your lunch, your seat in order to get the child to the restroom as soon as possible.  That's the out-of-doors advice.

At home, over a relaxing weekend, put your child on the toilet every twenty minutes or so.  Leave them with a book or a toy but give them their privacy - at least enough so they think they are alone.  Keep checking back every few minutes asking about their progress.  If it is not happening, it won't - just then.  The time frame is arbitrary.  You will know how long your child can stay dry and use that as a baseline for their bladder and bowel control.

Third tip: rewards work.  Small ones like stickers or piggy banks can be something that works - for a while. You know your child best. But give them something really rewarding - like a piece of candy when they go, two for wiping up afterwards, three for a successful number two event, and you will find the process evolving a little more quicker.

Fourth tip: praise, praise and more praise.  Heaping it on makes your child feel like the center of attention and this should be standard for even the smallest of accomplishments.  But when it comes to potty training, nothing can be more important.

Do you need an insert, a potty chair or other device to make the process easier?  I don't think so.  You can accomplish the same feat without one.  Those products are more for the pushy parents who wants their child going on their schedule.

Fifth tip: Your child will forget she/he has to go.  This can be a traumatic moment in the process of developing responsibility.  If they simply were playing and failed to estimate the distance to the bathroom, explain to them why they need to stop what they are doing and how important it is to go like a big girl or boy.  And let them change their own wet clothing.  Help but they need to know that you didn't have the accident - they did and changing soiled clothing is not your problem.  

Sound harsh? You are building independence of thinking and action and the consequences of not thinking and failing to act cannot be mitigated by your accommodating the process by reassuring that it is okay, accidents will happen, and "here, let me help you".

Sixth tip: Once out of diapers, they are OUT OF DIAPERS for good.  There is no going back.  No partial diapers for your convenience.  No overnight protection.  Pull-ups are okay.  But there should never be any straddling of the lines in this process.  This is why we wait for the right moment and not the one of your choosing.

Seventh tip:  Number one is easy; number two however can be quite different and take a good deal longer to accomplish.  Potty training can take a weekend to explain and several months to successfully complete the process.  Perhaps longer.  

Is there an optimum age to begin?  By three they should have expressed an interest.  If not, you can begin the conversation.  If you child is a dreamy sort, engrossed in his own world of play and imagination, the process might take some extra effort.  If your child is the analytical type, mature (not just articulate and smart) and focused, the process might be much easier.

Know your child.  Do they like to sneak off to have a bowel  movement in a private space?  Note the time of day and begin sitting them on the potty more frequently around that time.  If your child wakes up dry, get them on the pot right away and encourage them to do it there.

Your child's age does have a small role in the success of your potty training efforts but by and large, it will be their interest, your patience and consistency and the support of everyone the child has contact with (daycare, preschool, relatives) to make the whole process work.

Probably the harshest reality of the process is the amount of control your child has over when and how well they do.  In many instances, this a parent's first encounter with you as support for another human being with a mind of their own!

Good luck.

Thursday, February 5, 2009

Kids and Sign Language

As you found out today, we have been working on American Sign Language. This is an important tool for kids to learn and because they have young minds, it is much easier for them to grasp basic commands.

So what is sign language?

Now is a good time to ask. According to the Linguistic Society of America, "During most of the 20th century, no one really knew. Not even Deaf people who used sign language in their daily lives knew what it was. Those who noticed that many thoughts are expressed differently in sign and in English assumed that sign was an ungrammatical form of English. Most Americans thought it was a way to express English words with signs—a substitute for speech. As the truth came to light in the second half of the 20th century, it surprised everyone."

Sign language is more than just a substitute for the acoustic version of speech that we are most familiar with, using instead a series of hand and body gestures along with facial expressions to convey the meaning of the "speaker's" intent. Wherever there are deaf people, sign languages develop. the substitute languages number in the hundreds with American Sign Language or ASL being the most recognized.

Juan Pablo Bonet is credited with the first formal instruction in sign language when he published the first manual on logopedia, a method to teach the deaf to communicate without words. His work first appeared in Madrid in 1620 titled Reducción de las letras y arte para enseñar a hablar a los mudos or "Reduction of letters and art for teaching mute people to speak". A century later, Charles-Michel de l'Épée formalized the alphabet and it has changed little since.

The question most hearing people first ask is: "Do the signs of American Sign Language (ASL) stand for English words?" the Linguistic Society offers this as way to explain: "A simple test is to find English words that have two different meanings. If ASL signs stand for English words, there would be a sign with the same two meanings as the English word. For example, the English word “right” has two meanings: one is the opposite of “wrong,” the other is the opposite of “left.” But there is no ASL sign with these two meanings. They are expressed by two different signs in ASL, just as they are expressed by two different words in French, Spanish, Russian, Japanese, and most other languages."

To help you work on this important language form with your child, who, when I first instructed them on the process found the act of making gestures great fun, I have added a few links here for you to work on as well. This helpful link is from Sprout

Another browser from the ASL shows in Quicktime clips a wide variety of words. In factthis ASL browser actually shows you almost the entire English language signed in video form.

If you have time with your child at a computer, Signing Time for Kids offers numerous games and instructions for both your child and you. Your child often finds the act of playing a game a useful form of instruction. Try this memory game

Tuesday, February 3, 2009

PreSchool Parenting: Make Mine Dirt

There is no doubt in my mind that you make every attempt to give your child as many advantages as humanly possible. You cook good food, bath them and make sure they get enough rest, engage them in activities to increase their brain power and instruct them on the social etiquette needed to help them grow into a good global citizen. But do you let them eat dirt?

Probably not. But what studies have discovered, a little dirt goes a long way in your efforts to grow a healthy child. Dirt!

According to Dr. Joel V. Weinstock, the director of gastroenterology and hepatology at Tufts Medical Center in Boston, your child's immune system “is like an unprogrammed computer. It needs instruction.” he doesn't discount the fact that efforts make the environment safe by cleaning up contaminated water and food have saved the lives of countless children, but, he also adds, these efforts have “also eliminated exposure to many organisms that are probably good for us.”

“Children raised in an ultraclean environment,” he added, “are not being exposed to organisms that help them develop appropriate immune regulatory circuits.”

The answer apparently is not just the dirt, but the worms who make the earth their habitat of choice. many places in the developed world have all but eliminated exposure to these creatures and the result is an increase in immune system disorders like multiple sclerosis, Type 1 diabetes, inflammatory bowel disease, asthma and allergies".

Dr. Ruebush, the “Why Dirt Is Good” author does not suggest we throw out the wash water but she does point out that “The typical human probably harbors some 90 trillion microbes. The very fact that you have so many microbes of so many different kinds is what keeps you healthy most of the time.”

Citing the overall health of children who grow up in a rural environment, exposed to dirt, animals and worms, Dr. David Elliott, a gastroenterologist and immunologist at the University of Iowa suggest we may be taking the whole cleanliness thing a bit too far. He suggests that “Children should be allowed to go barefoot in the dirt, play in the dirt, and not have to wash their hands when they come in to eat.”

Sure, we all practice post bathroom wash-ups and clean where we might, hands, tables, dishes. But a little grim can go a long way in helping your child grow up healthy - or at least healthier.