Q: I'm not an expert in infant health and safety. How can I possibly answer/address every infant care and safety issue a mother has?

Transcription

1 Home Visitor Questions Related to Infant Health and Safety Q: I'm not an expert in infant health and safety. How can I possibly answer/address every infant care and safety issue a mother has? A: You are not expected to know everything! But, there is much you can do to help promote infant health and safety. You should provide caregivers with the most current infant health and safety information through current brochures, videos, and books--refer to the Resources link for specific sources on infant health and safety issues. Sharing stories, tips, and "lessons learned" from other families is also an effective way to educate caregivers on the most effective ways to care for their babies. Talk openly and sensitively to a parent when you suspect a health problem or safety concern. Use the Infant Health and Safety Assessment tips job aid and talk to your supervisor to evaluate the situation. Encourage caregivers to stay current on their well-baby visits and to use those visits to consult with a doctor or nurse at their clinic-they are experts in infant health and safety and can address concerns and problems thoroughly. Q: Won't a parent think I'm criticizing her if I question her ability to care for her baby? A: It depends on how you approach the situation. You first need to observe, ask, and then evaluate the parent's ability to care for her child and to keep him/her safe. If her actions, or inactions, hinder her child's health/safety, then use open-ended questions to get her to think about the ultimate consequences to her child. Sometimes parents simply don't think about the consequences of their actions, or inactions. It's also important that you maintain a respectful and nonjudgmental attitude toward parents. Focus on the parent's desire to be a good parent and do the right things with her child. Use this focus when telling and showing a parent some proven infant care techniques: techniques related to feeding, comforting, getting the baby to sleep, and for keeping a baby safe. Q: What if a parent doesn't seem interested in what I have to say/share with her? A: Parents have definite opinions and beliefs on how to care for their children. Although it might seem they are rejecting information, parents might just need to think about your ideas and suggestions for a while before they are ready to take action. Be patient and maintain a positive attitude. Use the Tell/Show/Watch approach to promote techniques and strategies a parent can use to care for her baby. Be sure to follow up with her to see if she is actually using the techniques. The parent may not be using the techniques because of something else going on. You may need to address the other issues before she can focus on the. If you still find that the parent doesn't seem interested, talk to your supervisor. She can help you think of ways to handle things differently.

2 Q: What if it's clear a child is in danger or at risk of illness/injury, but the parent doesn't agree or isn't concerned. What do I do? A: Talking proactively about common health and safety concerns is something you want to do regularly with your families during the first year of a baby's life. When you suspect the baby may be at risk for a health of safety concern, use the Tell/Show/Discuss/Follow up approach with the caregiver. Talk sensitively to the parent about her feelings in order to get her to the next step of accepting your advice/support and even seeking help from a doctor or mental health professional. If this still does not motivate the parent to take action, you will want to immediately discuss this with your supervisor, especially if you believe the baby may be at risk of Shaken Baby Syndrome, SIDS, or Failure to Thrive. You and your supervisor may even decide to schedule a joint home visit. Common Parent Questions related to Infant Health and Safety Feeding Questions: Q: A lot of people say that breastfeeding is best for my baby. But is it good for me, too? A: Breast milk is the ideal food for your baby. It has the nutrients he needs for his first six months of life. Breast milk helps protect your baby from many illnesses, and it's easily digested. Breastfeeding is good for you because it's convenient and economical. You can feed your baby anytime, anywhere. And you don't need to buy formula, bottles or nipples unless you plan to express milk and bottle-feed your baby now and then. Breastfeeding also helps your uterus return to its normal size faster. There may even be health benefits for you. Studies suggest that women who breastfeed may have a lower risk of developing specific types of cancer and hip fractures as they age. And breastfeeding mothers often talk about the special bond they feel with their babies. That's another wonderful benefit for you and your baby. Q: I have small breasts. Can I produce enough milk for my baby? A: When it comes to breastfeeding, size really doesn't matter. Whether you're a B or a double D, it's possible to make enough milk to feed your baby. Nature designed a perfect supply-and-demand system. The more your baby stimulates your breasts by sucking, the more milk you'll produce. So even if your baby is in a growth spurt and nursing more often, your body will "keep up." Remember, mothers of twins and even triplets can have enough milk supply to breastfeed successfully.

3 Q: My breastfed baby wants to nurse constantly. Where's the four-hour schedule? A:The three- or four-hour schedules you may have heard about usually refer to older babies. But your newborn's stomach is small. That's why many experts recommend feeding "on-demand." At first, your newborn may breastfeed every one to three hours, or eight to 12 times in a 24-hour period. If your newborn sleeps more than three hours between feedings, ask your baby's doctor about waking him to nurse. He needs the nourishment. And your breasts need the stimulation to continue to produce milk. Frequent feedings stimulate your breasts. Q: My nipples are so sore from breastfeeding my baby. What am I doing wrong? A: Your baby may not be "latching on" correctly. "Latching on" refers to the way your baby attaches her mouth to your breast. If she has latched on properly, she'll get a good flow of milk, and you won't get sore nipples. You can help your baby latch on by touching her lower lip to your nipple as she roots for your breast. She'll turn toward the side where she is touched. Then, when her mouth is open wide, lift your breast with one hand and pull your baby close to you. Her mouth should attach firmly onto your breast, not just your nipple. You may also try changing your position for nursing your baby. Or start nursing on the side that's the least sensitive for you. That way, your baby's strongest sucking happens before you switch to the more sensitive side. Q: Because I never know how much my breastfed baby is eating, how can I tell if he's getting enough? A: With bottle-feeding, you can see how much your baby eats. It's not as clear with breastfeeding. Still, there are ways to tell if your breastfed baby is getting enough to eat. He gains weight steadily. Your doctor will check this at your baby's well visits. He wets six or more diapers and has at least two bowel movements every 24 hours. He nurses at least eight times (and up to 12 times) every 24 hours during his first month. Your breasts feel softer and "empty" after nursing. Your baby swallows after sucking a few times during his feeding.

4 Q: Now that I'm home, I'm breastfeeding my son. But how can I keep breastfeeding when I go back to work? A: The breastfeeding/working schedule is completely possible with a little planning. Whether you go back to work full time or part time, you can develop a breastfeeding routine that works for you and your baby. Here's a schedule that many moms follow: Nurse early in the morning, right after your baby wakes up. Nurse again just before you leave for work. Pump your breast milk two or three times during the workday. Store it in a refrigerator and bring it home to feed your baby the next day. Have your childcare provider feed your baby the stored breast milk during the day. Nurse your baby as soon as you get home from work or pick him up from childcare. Nurse as much as you can during the evening to keep up your milk production. Q: I'm breastfeeding my baby but feel I need a break now and then. Is there a way I can breastfeed and formula-feed, too? A: Many women supplement their breastfeeding with formula now and then, or while they're at work. It's best to wait until your milk supply is established and your baby is comfortable with breastfeeding. A good time to start is when your baby's around six weeks old. Q: I've never been around any babies before now. I don't even know how to give him a bottle. Where do I start? A: Learning to feed a baby just takes a little time and practice. Start by making yourself calm and comfortable. Holding your baby on your lap with his head resting in the bend of your arm. Keep him in a semi-seated position, with his head slightly higher than his tummy. Tilt the bottle so that the nipple stays full. That way, your baby won't swallow air. Stroke the nipple against his lower lip or cheek. That should make him open his mouth. And remember to give your baby a chance to burp during and right after his feeding.

5 Q: What's the best way to burp my baby, and how often should I burp him? A:There are three good ways to burp your baby. You can hold him upright against your chest with his head over your shoulder, or you can sit him on your lap. Then pat or rub his back gently. It also works to lay him down with his tummy against your lap, supporting his head so it's higher than his chest and patting his back. As far as how often, burp a breastfed baby each time he switches breasts. Burp a bottle-fed baby after every two to three fluid ounces of formula. If your baby is fussy because he swallowed air, stop the feeding to burp him. The more he fusses, the more air he'll swallow and the more uncomfortable he'll be. So take a minute to calm him down, and let him burp before resuming the feeding. Newborns don't necessarily have to burp after every feeding. If your baby doesn't burp after a minute or two of encouragement, he probably doesn't have to. Q: How much formula should I feed my baby? A: Your newborn may drink as little as one fluid ounce or as much as three fluid ounces of formula at a feeding. In general, your baby will take in what he needs to meet his body's demands. So don't be too concerned about fixed amounts. Instead, feed him when he's hungry. He'll let you know when he's finished. If he doesn't eat as much at one feeding but seems satisfied, stop. Don't force him to finish if he's not interested. If he drinks a bottle and still acts hungry, he probably is. Offer him a little more during his next feeding. And add an additional ounce to his bottle and see what happens. Most babies do fine with three to four fluid ounces per feeding during the first month. And increase by an ounce at a time until they are drinking up to about six to eight fluid ounces. Q: I hear so much about the benefits of breastfeeding. But what about formula-feeding? A: Formula provides the nutrients your baby needs for his growth and development. Formula-feeding also allows Dad and other family members or friends to feed and bond with your baby, and for Mom to have a little break. In addition, some parents just feel more comfortable with formula-feeding. Q: How do I prepare my child for day care? A:The most important first step in preparing a child for going to day care is to ensure that you've selected a place that's right for her. For example, if your child gets easily overwhelmed when there's a lot going on around her, it would probably be best for her to be in a center where the classes are small, or in a family childcare setting. In general, it's best for young children to be in settings where caregivers adapt schedules to allow kids to eat and sleep based on their own daily rhythms, are sensitive and responsive to the individual needs of each child, welcome parent involvement, and provide you with information about your child on a daily basis.

6 When you feel comfortable about the care your child will be receiving, it's much easier to share that confidence and enthusiasm with your daughter. Once you've selected the best care for your child, there are some things you can do to get her off to a good start: Plan some brief and then incrementally longer separations so that she learns she can be safe and well cared for by loving adults other than you. This is especially important if your daughter hasn't spent much time with other caregivers during her first year. Take her to the childcare setting several times before her first day to help her become familiar with it. The unknown is often what's most scary. Let her explore the classroom and outside play area and interact with the caregivers and children. Read books with her about other children going to day care and dealing with separation. Play disappearing/reappearing games such as peekaboo and hide-and-seek to help her understand that while things and people may go away, they come back. Emphasize the message that "Mommy may go away, but Mommy always comes back." Make an audiotape of yourself reading stories and singing songs for your child to listen to at day care (if that's allowed) when she misses you. Or give her a picture of you and other family members-even the family pet-to look at when she's sad. Ask the caregivers if your daughter can keep these photos in her cubby or somewhere else that's easily accessible. If the day care allows, let your daughter bring a lovey-a blanket, doll, or stuffed animal-that gives her comfort and is a connection to home. On your child's first day, when it's time for you to leave her, don't linger or show worry. Children look to the trusted adults in their lives for cues on how to interpret situations. When we look and act worried and upset, our children naturally think there's something to be worried and upset about and are likely to have a harder time separating. Studies actually show that when parents say a brief, upbeat good-bye, their children stop crying and adjust more quickly. If you are really worried about how your child is faring without you, some day-care centers have observation rooms with one-way mirrors where you can watch for a few moments before leaving for work. Or give the day care a brief call, just to be reassured that she's doing fine. Most important: Don't be tempted to sneak out without saying good-bye, hoping that it will ease the transition. Your child experiences this as a breach of trust. Sneaking out also sends the message that you feel you're doing something wrong by leaving her. Instead, give her the clear message that she'll be fine, and that you look forward to seeing her when you come back. Finally, don't forget yourself in this transition. You're likely to experience a range of emotions related to separating from your child and sharing her care with others. Pay attention to your own feelings so that you can deal with them in a thoughtful way.

7 Q: Are there times when my baby can be on his or her stomach? A: Yes, place your baby on his or her stomach for "tummy time," when he or she is awake and someone is watching. When the baby is awake, tummy time is good because it helps your baby's neck and shoulder muscles get stronger. Q: Can my baby share a bed with his or her brother or sister? A: Bed-sharing with other children, including brothers and sisters, is unsafe for your baby. It increases the risk for SIDS as well as for suffocation. There have been reports of infants being suffocated from overlying by an adult, brother, sister, or other family member who was sharing a bed with an infant. Q: Will my baby get "flat spots" on his or her head from back sleeping? A: For the most part, flat spots on the back of the baby's head go away a few months after the baby learns to sit up. Tummy time, when your baby is awake, is one way to reduce flat spots. Another way is to change the direction you place your baby down to sleep. Doing this means the baby is not always sleeping on the same side of his or her head. If you think your baby has a more serious problem, talk to your doctor or nurse. Q: What about side sleeping? Is it safe? A: To keep your baby safest when he or she is sleeping, always use the back sleep position rather than the side position. Babies who sleep on their sides can roll onto their stomachs. A baby sleeping on his or her stomach is at greater risk of SIDS. Some infants may have health conditions that require them to sleep on their stomachs. If you are unsure about the best sleep position for your baby, be sure to talk to your doctor or nurse. Q: How should my baby ride in the car? A: The American Academy of Pediatrics (AAP) recommends that infants ride in the back seat in a rear facing child safety seat until they are at least one year old AND weigh at least 20 pounds. Infants weighing 20 pounds or more before one year of age should ride in a safety seat rated for heavier infants (some convertible seats are rated up to pounds rear-facing). Please remember to NEVER place a rear facing child safety seat in the front seat when a passenger air bag is present and never leave a child alone in a car, not even for a minute. Q: Why does my baby need regular health checkups (doctor's visits)? A: Infants, children and youth should get regular health checks-ups to make sure they are healthy. These routine check-ups are often called well-baby or well child exams. They are important in addition to "sick-child" visits, because they can find health problems early. Well-child visits also assure you that your child is growing and developing normally.