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

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


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Caring for Your Baby and Young Child: Birth to Age 5 by Steven P. Shelov


From the most respected organization on child health comes this essential resource for all parents who want to provide the very best care for their children. Here is the one guide pediatricians routinely recommend and parents can safely trust, covering everything from preparing for childbirth to toilet training to nurturing your child’s self-esteem. Whether it’s resolving common childhood health problems or detailed instructions for coping with emergency medical situations, Caring for Your Baby and Young Child has everything you need.

•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 secondhand smoke
• Sections on grandparents, building resilience, media, and multiples
• New chapters on sleep and on allergies—including food allergies
•New content on prebiotics and probiotics, organic foods, and other healthy lifestyle topics
•And much more

Product Details

ISBN-13: 9780553386301
Publisher: Random House Publishing Group
Publication date: 10/13/2009
Edition description: Original
Pages: 928
Product dimensions: 7.30(w) x 9.10(h) x 2.00(d)

About the Author

Steven P. Shelov, MD, MS, FAAP, is a Professor of Pediatrics at Mount Sinai School of Medicine, Chairman of Pediatrics at Maimonides Medical Center and Lutheran Medical Center, and Vice President of the Infants' and Childrens' Hospital of Brooklyn. In 2002 Dr. Shelov was presented with the Lifetime Achievement in Education Award by the American Academy of Pediatrics. Tanya Remer Altmann, MD, FAAP, editor-in-chief of The Wonder Years, is a board-certified pediatrician in private practice and clinical instructor at Mattel Children's Hospital at the University of California, Los Angeles.

Read an Excerpt

Introduction: The Gifts of Parenthood

YOUR CHILD IS THE GREATEST GIFT you will ever receive. From the moment you first hold this miracle of life in your arms, your world will be broader and richer. You will experience a flood of feelings, some of wonder and joy and others of confusion and of being overwhelmed and wondering whether you can ever measure up to the needs of your new baby. These are feelings you could barely imagine before—feelings that no one can truly experience without having a child.

 Even describing them can be difficult because the bond between parent and child is so intensely personal. Why do tears come to your eyes the first time your baby smiles or reaches for you? Why are you so proud of her first words? Why does your heart suddenly start to pound the first time you watch her stumble and fall? The answer lies in the unique two- way giving relationship between you and your child.

Your Child’s Gifts to You 

Although simple, your child’s gifts to you are powerful enough to change your life positively.

 UNQUALIFIED LOVE. From birth, you are the center of your child’s universe. He gives you his love without question and without demand. As he gets older, he will show this love in countless ways, from showering you with his first smiles to giving you his handmade Valentines. His love is filled with admiration, affection, loyalty, and an intense desire to please you. 

ABSOLUTE TRUST. Your child believes in you. In her eyes, you are strong, capable, powerful, and wise. Over time, she will demonstrate this trust by relaxing when you are near, coming to you with problems, and proudly pointing you out to others. Sometimes she also will lean on you for protection from things that frighten her, including her own sensitivities. For example, in your presence she may try out new skills that she would never dare to try alone or with a stranger. She trusts you to keep her safe. 

THE THRILL OF DISCOVERY. Having a child gives you a unique chance to rediscover the pleasure and excitement of childhood. Although you cannot relive your life through your child, you can share in his delight as he explores the world. In the process, you probably will discover abilities and talents you never dreamed you possessed. Feelings of empathy mixed with growing selfawareness will help shape your ability to play and interact with your growing child. Discovering things together, whether they are new skills or words or ways to overcome obstacles, will add to your experience and confidence as a parent and will better prepare you for new challenges that you never even envisioned. 

Your Child’s Gifts to You 

THE HEIGHTS OF EMOTION. Through your child, you will experience new heights of joy, love, pride, and excitement. You probably also will experience anxiety, anger, and frustration. For all those delicious moments when you hold your baby close and feel her loving arms around your neck, there are bound to be times when you feel you cannot communicate. The extremes sometimes become sharper as your child gets older and seeks to establish her independence. 

The same child who at three dances across the room with you may at four have a rebellious and active period that surprises you. The extremes are not contradictions, but simply a reality of growing up. For you as a parent, the challenge is to accept and appreciate all the feelings with which your child expresses himself and arouses in you, and to use them in giving him steady guidance. 

The Gifts You Give Your Child 

As his parent, you have many vital gifts to offer your child in return. Some are subtle, but all are very powerful. Giving them will make you a good parent. Receiving them will help your child become a healthy, happy, capable individual. 

UNCONDITIONAL LOVE. Love lies at the core of your relationship with your child. It needs to flow freely in both directions. Just as she loves you without question, you must give her your love and acceptance absolutely. Your love shouldn’t depend on the way she looks or behaves. It shouldn’t be used as a reward or withheld as a threat. Your love for your child is constant and indisputable, and it’s up to you to convey that, especially when she misbehaves and needs to have limits set or behavior corrected. Love must be held separate and above any fleeting feelings of anger or frustration over her conduct. Never confuse the actions with the child. The more secure she feels in your love, the more self- assurance she will have as she grows up. 

SELF- ESTEEM. One of your most important gifts as a parent is to help your child develop self- esteem. It’s not an easy or quick process. Self- respect, confidence, and belief in oneself, which are the building blocks of self- esteem, take years to become firmly established. Your child needs your steady support and encouragement to discover his strengths. He needs you to believe in him as he learns to believe in himself. Loving him, spending time with him, listening to him, and praising his accomplishments are all part of this process. On other occasions, helping him modify his troubling behaviors in ways that aren’t punitive or hurtful, but constructive, is just as important to building a firm self- esteem. If he is confident of your love, admiration, and respect, it will be easier for him to develop the solid self- esteem he needs to grow up happy and emotionally healthy. 

VALUES AND TRADITIONS. Regardless of whether you actively try to pass on your values and beliefs to your child, she is bound to absorb some of them just by living with you. She’ll notice how disciplined you are in your work, how deeply you hold your beliefs, and whether you practice what you preach. She’ll participate in family rituals and traditions and think about their significance. You can’t expect or demand that your child subscribe to all your opinions, but you can present your beliefs honestly, clearly, and thoughtfully, in keeping with the child’s age and maturity level. Give her guidance and encouragement, not only commands. Encourage questions and discussions, when age and language permit, instead of trying to force your values on your child. If your beliefs are well reasoned and if you are true to them, she probably will adopt many of them. If there are inconsistencies in your actions—something we all live with— often your child will make that clear to you, either subtly by his behavior or, when he is older, more directly by disagreeing with you. The road to developing values is not straight and unerring. It demands flexibility built on firm foundations. Self- awareness, a willingness to listen to your child and change when appropriate, and, above all, a demonstration of your commitment to traditions will best serve your relationship with your child. While the choice of values and principles ultimately will be hers to make, she depends on you to give her the foundation through your thoughts, shared ideas, and, most of all, your actions and deeds. 

JOY IN LIFE. Your baby doesn’t need to be taught to be joyful, but he does need your encouragement and support to let his natural enthusiasm fly free. The more joyful you are, particularly when you are with him, the more delightful life will seem to him and the more eagerly he will embrace it. When he hears music, he’ll dance. When the sun shines, he’ll turn his face skyward. When he feels happy, he’ll laugh. This exuberance often is expressed through his being attentive and curious, willing to explore new places and things, and eager to take in the world around him and incorporate the new images, objects, and people into his own growing experience. Remember, different babies have different temperaments—some are more apparently exuberant than others, some are more noisily rambunctious, some are more playful, some are more reserved and quiet. Still others are more even- keeled, mixtures of the two extremes. But all babies demonstrate their joy in life in their own ways, and you as the parent will discover what those ways are and will nurture your child’s joy. 

GOOD HEALTH. Your child’s health depends significantly on the care and guidance you offer her during these early years. You begin during pregnancy by taking good care of yourself and by arranging for obstetric and pediatric care. By taking your child to the doctor regularly for checkups and consultations, keeping her safe from injuries, providing a nutritious diet, and encouraging exercise throughout childhood, you help protect and strengthen her body. You’ll also need to maintain good health habits yourself, while avoiding unhealthy ones, such as smoking, excessive drinking, drug use, and lack of adequate physical activity. In this way, you’ll give your child a healthy example to follow as she grows up. 

SECURE SURROUNDINGS. You naturally want to give your child a safe, comfortable home. This means more than a warm place to sleep and a collection of toys. As important as it is to provide shelter that is physically safe and secure, it is even more important to create a home that is emotionally secure with a minimum of stress and a maximum of consistency and love. Your child can sense problems between other family members and may be very troubled by them, so it’s important that all family problems, even minor conflicts, be dealt with directly and resolved as quickly as possible through cooperation. This may entail seeking advice, but remember, your family’s well- being helps maintain an environment that promotes your child’s development and will allow him to achieve his potential. The family’s dealing effectively with conflicts or differences ultimately will help him feel secure in his ability to manage conflicts and disagreements and will provide him with a positive example for resolving his own challenges. 

SKILLS AND ABILITIES. As your child grows up, she’ll spend most of her time developing and polishing a variety of skills and abilities in all areas of her life. You should help her as much as possible by encouraging her and providing the equipment and instruction she needs. Books, magazines, play groups, and preschool will quickly take on a central role as your toddler becomes a preschooler. But it’s important not to forget some of the most important learning tools: Your child will learn best when she feels secure, confident, and loved; she will learn best when information is presented in a way that she will respond to positively. Some information is best presented through play—the language of children. Young children learn a tremendous amount through play, especially when with parents or playmates. Other information is best learned or incorporated through actual experience. This may mean learning through exposure to diverse places, people, activities, and experiences. Other things are learned through stories, picture books, magazines, and activity books. Still other things are learned by watching—sometimes just watching you, sometimes watching other children or adults. Preschool experiences also promote socialization. If you enjoy learning and making discovery fun for your child, she soon will recognize that achievement can be a source of personal satisfaction as well as a way to please you. The secret is to give her the opportunities and let her learn as best fits her style and at her own rate.

How to Make Giving a Part of Your Daily Family Life 

The back- and- forth sharing of these gifts between you and your child will foster your relationship and nurture your child’s development. Much like learning a new dance, working out the actual steps in giving is not always going to be easy. But it will happen with time and patience, and with your own commitment to strengthen the parent- child relationship. 

Giving your child the guidance and support that he needs to grow up healthy involves all the skills of parenthood: nurturing, guiding, protecting, sharing, and serving as an example or model. Like other skills, these must be learned and perfected through practice. Some will be easier for you than others. Some will seem easier on certain days than on others. These variations are a normal part of raising a child, but they do make the job challenging. The following suggestions will help you make the most of your natural parenting skills so you can give your child the best possible start. 

ENJOY YOUR CHILD AS AN INDIVIDUAL. Recognize that your child is unique—different from everyone else—and appreciate her special qualities. Discover her special needs and strengths, her moods and vulnerabilities, and especially her sense of humor, which starts to show itself early in infancy. Let her show you the joy of play. The more you enjoy your child and appreciate her individuality, the more successful you’ll be in helping her develop a sense of trust, security, and self- esteem. You’ll also have a lot more fun being a parent! 

EDUCATE YOURSELF. You probably know much more than you think you do about being a parent. You spent years observing your own parents and other families. Perhaps you’ve cared for other children. And you have many instinctive responses that will help make you a giving parent. In other times, this probably would have been all the preparation you needed to raise a child. However, our society is extremely complex and is constantly changing. In order to guide their children in this new world, parents often benefit from some extra education. Talk to your pediatrician and other parents, and ask questions. Get to know other families with children the same age, and watch how these parents raise their children (for example, when are they protective and when do they let go, and how much responsibility do they expect of their children at various ages?). Also, read about issues and problems that affect your family. Contact your local religious organizations, school systems and PTAs, child care programs, parent education classes, and other groups that specialize in childrelated concerns. Often these groups serve as networks for concerned and interested parents. These networks will help you feel more comfortable and secure when issues seem puzzling or frustrating. 

As you gather advice, sift through it for information that is right for you and your child. Much of what you receive will be very valuable, but not all of it. Because child rearing is such a personal process, there is bound to be disagreement. You are not obligated to believe everything you hear or read. In fact, one of the purposes of educating yourself is to protect your child from advice that does not fit your family. The more you know, the better equipped you’ll be to decide what works best for your family. 

BE A GOOD EXAMPLE. One of the ways your child shows her love for you is by imitating you. This is also one of the ways she learns how to behave, develop new skills, and take care of herself. From her earliest moments, she watches you closely and patterns her own behavior and beliefs after yours. Your examples become permanent images, which will shape her attitudes and actions for the rest of her life. Setting a good example for your child means being responsible, loving, and consistent not only with her but with all members of the family. Show your affection and nurture your relationships. If your child sees her parents communicating openly, cooperating, and sharing household responsibilities, she’ll bring these skills to her own future relationships. 

Setting good examples also means taking care of yourself. As an eager, wellmeaning parent, it’s easy to concentrate so hard on your family that you lose sight of your own needs. That’s a big mistake. Your child depends on you to be physically and emotionally healthy, and she looks to you to show her how to keep herself healthy. By taking care of yourself, you demonstrate your selfesteem, which is important for both you and your child. Getting a sitter and resting when you’re overtired or ill teaches your child that you respect yourself and your needs. Setting aside time and energy for your own work or hobbies teaches your child that you value certain skills and interests and are willing to pursue them. By giving yourself some personal time (at least once a week), the easier it will be for you and your child to develop your own identities. That needs to occur as she grows older. She also will benefit from getting to know other trusted grown- ups by having them babysit, and at times involving your entire family in group activities with other families. Ultimately she will pattern some of her own habits after yours, so the healthier and happier you keep yourself, the better it will be for both of you. 

You can set an example in still another important area, too, and that’s in demonstrating tolerance and acceptance in an increasingly multicultural society. As the United States has become a melting pot of nationalities and cultures, it is more important than ever to teach tolerance to your child when relating to people of other racial, ethnic, and religious groups and alternate lifestyles. Make an effort to help your child understand and even celebrate diversity. No boy or girl is born prejudiced, but it can be learned at a very young age. By four years old, children are aware of differences among people. The way you relate to people in your life will provide a foundation for how your child will treat her peers and others throughout her childhood and adulthood. Let your child know that there are many similarities among people and make an effort to dispel stereotypes that she is exposed to, replacing them with the belief that all people deserve to be respected and valued. 

SHOW YOUR LOVE. Giving love means more than just saying “I love you.” Your child can’t understand what the words mean unless you also treat him with love. Be spontaneous, relaxed, and affectionate with him. Give him plenty of physical contact through hugging, kissing, rocking, and playing. Take the time to talk, sing, and read with him every day. Listen and watch as he responds to you. By paying attention and freely showing your affection, you make him feel special and secure and lay a firm foundation for his self- esteem. 

COMMUNICATE HONESTLY AND OPENLY. One of the most important skills you teach your child is communication. The lessons begin when she is a tiny baby gazing into your eyes and listening to your soothing voice. They continue as she watches and listens to you talking with other members of the family and, later, as you help her sort out her concerns, problems, and confusions. She needs you to be understanding, patient, honest, and clear with her. Good communication within a family is not always easy. It can be especially difficult when both parents are working, overextended, or under a great deal of stress, or when one person is depressed, ill, or angry. Preventing a communications breakdown requires commitment, cooperation among family members, and a willingness to recognize problems as they arise. Express your own feelings, and encourage your child to be equally open with you. Look for changes in her behavior— such as frequent or constant crying, irritability, sleep problems, or appetite loss—that may signal sadness, fear, frustration, or worry, and show her that you’re aware of and understand these emotions. Ask questions, listen to the responses, and offer constructive suggestions. 

Listen to yourself, as well, and consider what you say to your child before the words leave your mouth. It’s sometimes easy to make harsh, even cruel, statements in anger or frustration that you don’t really mean but that your child may never forget. Thoughtless comments or jokes that seem incidental to you may be hurtful to your child. Phrases like “That’s a dumb question” or “Don’t bother me” make your child feel worthless and unwanted and may seriously damage her self- esteem. If you constantly criticize or put her off, she also may back away from you. Instead of looking to you for guidance, she may hesitate to ask questions and may mistrust your advice. Like everyone else, children need encouragement to ask questions and speak their minds. The more sensitive, attentive, and honest you are, the more comfortable she’ll feel being honest with you. 

SPEND TIME TOGETHER. You cannot give your child all that he needs if you only spend a few minutes a day with him. In order to know you and feel confident of your love, he has to spend a great deal of time with you, both physically and emotionally. Spending this time together is possible even if you have outside commitments. You can work full- time and still spend some intimate time with your child every day. The important thing is that it be time devoted just to him, meeting his needs and your needs together. Is there any fixed amount? No one can really say. One hour of quality time is worth more than a day of being in the same house but in different rooms. You can be at home full- time and never give him the undivided attention he requires. It’s up to you to shape your schedule and direct your attention so that you meet his needs. 

It may help to set aside a specific block of time for your child each day and devote it to activities he enjoys. Also make an effort to include him in all family activities—meal preparation, mealtimes, and so forth. Use these times to talk about each other’s problems (do be attentive, however, to overburdening your child with adult problems; kids don’t need to shoulder your anxieties), personal concerns, and the day’s events. 

If you’re a working parent, your attentiveness to your child when you’re together will help ensure that he is well adjusted and well loved. If your child is well taken care of when you’re at work, he will thrive regardless of your hours spent away on the job. 

NURTURE GROWTH AND CHANGE. When your child is a newborn, it may be difficult for you to imagine her ever growing up, and yet your main purpose as a parent is to encourage, guide, and support her growth. She depends on you to provide the food, protection, and health care her body needs to grow properly, as well as the guidance her mind and spirit need to make her a healthy, mature individual. Instead of resisting change in your child, your job is to welcome and nurture it. 

Guiding your child’s growth involves a significant amount of discipline, both for you and for your child. As she becomes increasingly independent, she needs rules and guidelines to help her find what she can do and grow from there. You need to provide this framework for her, establishing rules that are appropriate for each stage of development and adjusting them as your child changes so they encourage growth instead of stifling it. 

Confusion and conflict do not help your child to mature. Consistency does. Make sure that everyone who cares for her understands and agrees on the way she is being raised and the rules she’s expected to follow. Establish policies for all her care providers to observe when she misbehaves, and adjust these policies along with the rules as she becomes more responsible. 

You also should create an environment that encourages the healthy brain development of your child. His world—including where he lives and plays and whom he interacts with—will affect how his brain grows. Your child’s environment and experiences need to be nurtured constantly, with warm and loving care providers who give him the freedom to explore and learn safely. (Throughout this book, you’ll find guidelines on ensuring the optimal development of your child’s brain.) 

MINIMIZE FRUSTRATIONS AND MAXIMIZE SUCCESS. One of the ways your child develops self- esteem is by succeeding. The process starts in the crib with his very first attempts to communicate and use his body. If he achieves his goals and receives approval, he soon begins to feel good about himself and eager to take on greater challenges. If, instead, he’s prevented from succeeding and his efforts are ignored, eventually he may become so discouraged that he quits trying and either withdraws or becomes angry and even more frustrated. 

As a parent, you must try to expose your child to challenges that will help him discover his abilities and achieve successes while simultaneously preventing him from encountering obstacles or tasks likely to lead to too great a series of frustrations and defeats. This does not mean doing his work for him or keeping him from tasks you know will challenge him. Success is meaningless unless it involves a certain amount of struggle. However, too much frustration in the face of challenges that really are beyond your child’s current abilities can be self- defeating and perpetuate a negative self- image. The key is to moderate the challenges so they’re within your child’s reach while asking him to stretch a bit. For example, try to have toys that are appropriate for his age level, neither too basic for him nor too difficult for him to handle. See if you can find a variety of playmates, some older and some younger. Invite your child to help you around the house and have him do chores as he gets older, but don’t expect more of him than he realistically can manage. 

As you raise your child, it’s easy to get carried away by your hopes and dreams for him. You naturally want him to have the best education, all possible opportunities, and eventually a successful career and lifestyle. But be careful not to confuse your own wishes with his choices. In our highly competitive society, a great deal of pressure is placed on children to perform. Some preschools have entrance requirements. In some professions and sports, children are considered out of the running if they haven’t begun training by age ten. In this atmosphere, the popularity of programs that promise to turn “ordinary babies” into “super babies” is understandable. Many well- meaning parents want desperately to give their children a head start on lifetime success. Unfortunately, this is rarely in the children’s best interests. In fact, there is a lack of evidence that these rigorous, early- training programs can actually produce “super babies.” Achieving a balanced, moderate approach is the key to meeting expectations and avoiding frustration and disappointment for both you and your child. 

Children who are pressured to perform early in life do not learn better or achieve higher skills over the long run than do other children. On the contrary, the effects of psychological and emotional pressures may be so negative that the child develops learning or behavioral problems. If a child is truly gifted, he might be able to handle the early- learning barrage and develop normally, but most gifted children require less pressure, not more. If their parents push them, they may feel overloaded and become anxious. If they don’t live up to their parents’ expectations, they may feel like failures and worry that they’ll lose their parents’ love. This kind of chronic stress and so- called “adverse childhood experiences” (see page xxxiii) can even have a negative impact on brain development and keep children from reaching their own innate potential. 

Your child needs understanding, security, and opportunity geared to his own special gifts, needs, and developmental timetable. These things cannot be packaged in a program and they don’t guarantee the future, but they will make him a success on his own terms. 

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