Blog

Sucking is an important milestone for any baby and it starts to develop as early as the twentieth week of pregnancy, while the baby is still in the comfort of the womb7. Sucking is important in the development of feeding7, organising behaviour (improved alertness) as well as speech and language development. Sensitivity around the mouth area develops in the womb from as early as 8 weeks gestation (weeks pregnant). This is one of the first systems to develop and indicate the importance of the mouth in survival. The baby can suck from 24 – 28 weeks and coordinate her suck-swallow and breathing pattern from 28 weeks gestation1,2. When born preterm, the baby may struggle with the coordination of suck-swallow and breathe and this may lead to choking when feeding is started too soon. In order to support the development of sucking and preserve the sucking reflex in the preterm baby, it is important to provide the baby with a appropriate sucking opportunities, which may include suckling on the mothers breast (or an expressed breast in the case of a tiny baby), sucking on her own thumb, hand, or lips or sucking on a pacifier7. For preterm babies younger than 32 weeks gestation a pacifier should be selected that is similar to her thumb, since this it what she would be sucking on when still in the womb, but for a full term baby you can look for a pacifier that is similar to mom’s nipple3, 7. The general guidelines for a pacifier is that it should be shaped cylindrical in order to enable tongue-cupping. (this is the tongue forming a groove in the middle of the tongue in which the pacifier will be placed4). When baby then feeds, she will be using the same technique, and this enable her to move the milk from the front to the back of the mouth (via the groove) and prevent her from spilling. Furthermore, the pacifier nipple should have a small bolus on the end to stimulate the soft palate and also the feeling part of the brain (the limbic system)7. This in turn stimulate the release of endorphin's or “feeling good hormones” which calms the baby. The optimal length of the nipple can be determined when putting your finger into the baby’s mouth and allowing her to suck on it5, 7. Mark the position on your finger where her lips close and when you take your finger out you will be able to see how long the nipple should ideally be. The mother’s nipple lengthen and shorten continuously during a feed and the pacifier cannot do the same. Care should therefore be taken to select the optimal length, since a nipple that is too long may cause an overactive gag reflex and a nipple that is too short and flat may cause the baby to push the nipple out of her mouth and may also hinder the development of certain sounds and feeding7. Sucking also has a direct effect on language development. The pacifier should furthermore have a big, soft mouth shield to stimulate and wake up all the nerve endings around the mouth and help with lip closure. The pacifier should preferably be a single unit that has no parts that may come apart and cause choking7. Finally the pacifier should have a handle which the baby can hang on to, since this will support the hands-to-mouth and mid-line positioning. Hands-to-mouth (or face) is a method the baby use to self-soothe and mid-line positioning is used for self-regulation, but also for supporting integration of left and right brain functions. Cylinder shaped nipples to support tongue cupping (similar to thumb or mom’s nipple) Small bolus at end of nipple to stimulate limbic system of brain Optimal nipple length to reach ridge between soft and hard palate Big, soft mouth shield to stimulate nerve endings around the mouth “Handle” on shield to provide for hand-to-mouth and grasping. When painful procedures, such as immunizations need to be performed the baby can be provided with a pacifier or mom’s breast two minutes before the procedure and additional sweet tasting substances such as mother’s milk or sucrose can be given two minutes before the procedure6. The taste system develops very early in pregnancy and is an important sense that is used to block painful stimuli and help the baby to return to a state of balance as soon as possible and with using as little energy as possible. Research has shown that all different kinds of pacifiers has a similar outcome on orthodontic development of the child at five years of age, but by not using a cylindrical shaped nipple or teat, she may experience problems with feeding and language. Breastfeeding are however still superior to bottles teats and pacifiers when you want to ensure the best orthodontic development for your little one. Your baby should also be offered a pacifier when she is crying and struggling to settle, but she should not be using a pacifier after 14 months of age. However, if she does not want to take a pacifier, no need to worry. Only allow her to suck on your breast, since this will support the best mouth development. When your breast is not available mom or dad’s finger will be a great replacement. Providing your baby with a pacifier to suck on when you put her to bed, will also lower her risk for dying of cot death. What about pacifiers in a Baby Friendly environment? Baby Friendly is an initiative that was developed for moms with healthy pregnancies, healthy vaginal births and healthy babies who are not separated from mom after birth. If you do not fit all of these criteria, then your baby may need some support with sucking and if the baby is in the neonatal intensive care unit and does not suck for a period of time, she may loose the suckling reflex. Sucking confusion is also only seen when the incorrect kind of pacifier are offered, but by following the guidelines above and only using a pacifier when really needed (preferably only starting after 3 weeks), you will not have a problem with nipple confusion due to the use of a pacifier. Sucking is important, since it supports normal development, self-soothing and let the baby feel good. In preterm babies it also prepare the babies for feeding per mouth and help them to feed better, grow better and even balance blood sugar levels. by Wema Lubbe REFERENCES 1. Breastfeeding and Human Lactation. Riordan, 2005:83, 85 2. Uys, KJ. 2000. Oral Feeding Skills of Preterm Infants. Master’s Dissertation in Communication Pathology. University of Pretoria. 3. Prematurity – Adjusting your dream. 2008. Lubbe W. Little Steps, Pretoria. 4. Wolf, LS & Glass, RP. 1991. Feeding and Swallowing Disorders in Infancy: Assessment and Management. Tuscon, Arizona: Therapy Skill Builders. 5. Wilson-Clay B, Hoover K. 2008. The Breastfeeding Atlas. Lactnews Pr, 206p. 6. Stevens B, Yamada J, Ohlsson A. Sucrose for analgesia in newborn infants undergoing painful procedures (Cochrane Review). In: The Cochrane Library, Issue 3, 2004. Chichester, UK: John Wiley & Sons, Ltd. 7. Engebretson, JC, Wardell, DW. 1996. Development of a Pacifier for Low-Birth-Weight Infant’s Nonnutritive Sucking. JOGNN. August. 26(6), 660-664

It is empowering for parents to have an idea of what play activities they can incorporate into their daily routines to interact with their baby. Activities that stimulate their vision, hearing, touch and movement, all help them make sense of their world and move towards it. It is important to spend time watching what your baby is doing and what he/she takes an interest in, and then repeating it, providing more of the same. It is in our daily interactions with a loving, consistent caregiver that baby receives the most valuable input. Nurturing daily routines of feeding, bathing, dressing and nappy changing, provide wonderful opportunities for playful interaction. Finding time to be with your babies, to watch them, and to have fun together, is the key to stimulating their development. Remember, YOU are your baby’s first and most important play-mate and play-object. Baby clinics, family or friend groups, and mother-baby workshops are also very beneficial in our learning as parents. Groups give support and sharing as well as help parents understand their babies’ behaviours, stages of development and what activities are best for stimulating sensory and motor development. Here is a guideline of your baby’s development in the first year of life. Having an idea of what your baby is beginning to learn at each stage, gives you an idea of what you can do to encourage their newly emerging skills. At this stage babies are becoming really clever, as they begin to organise all the information from people and the environment, and make logical connections between things. They are learning new concepts daily, and ways to solve problems. They begin to understand what they see, hear, touch and feel and the world really does take on meaning. Becoming mobile means they can go and explore and discover for themselves. This provides a greater variety of new experiences that enhance learning and confidence. There is a growing desire for independence and babies need to be given this space to practice separating from and returning to their caregiver. Sitting balance improves and babies learn to move in and out of sitting. They start to get around by crawling, pulling to stand and walking while holding onto furniture. By the end of this stage, they may be able to stand alone, walk with one hand held or take a few steps on their own. Play is the most important thing at this stage in a baby’s life. They enjoy repetition, and like to practice things over and over again. Babies learn to point, poke and pick up small objects with a refined pincer grip. Taking things out of containers and putting them back in, and putting things together become strong favourites. As they learn to let go with control, they begin to stack blocks or place rings on a stick. They use two hands together to pass objects from hand to hand and clap hands. Babies begin to understand simple requests and take turns interacting with you, which makes games such fun. They respond to requests such as ‘Wave bye-bye’, or ‘Give it to me’. They begin to communicate by gestures and pointing, developing their own jargon and word approximations, and start to imitate sounds. At the end of this stage, they may say one or two words with meaning e.g. ‘Mama’ or ‘Dada’. Babies become capable of sharing feelings and can express love, disappointment, fear, anger and frustration. Object Permanence is well developed and babies are confident in searching for hidden objects. Having the ability to move to find a hidden toy provides much entertainment and a sense of self. This is a time for exploration and self-discovery. Babies develop a growing independence and a sense of what they are capable of in order to make an impact of the world. They are beginning of problem solve together with others to achieve a goal. Kate Bailey, Occupational Therapist

It is empowering for parents to have an idea of what play activities they can incorporate into their daily routines to interact with their baby. Activities that stimulate their vision, hearing, touch and movement, all help them make sense of their world and move towards it. It is important to spend time watching what your baby is doing and what he/she takes an interest in, and then repeating it, providing more of the same. It is in our daily interactions with a loving, consistent caregiver that baby receives the most valuable input. Nurturing daily routines of feeding, bathing, dressing and nappy changing, provide wonderful opportunities for playful interaction. Finding time to be with your babies, to watch them, and to have fun together, is the key to stimulating their development. Remember, YOU are your baby’s first and most important play-mate and play-object. Baby clinics, family or friend groups, and mother-baby workshops are also very beneficial in our learning as parents. Groups give support and sharing as well as help parents understand their babies’ behaviours, stages of development and what activities are best for stimulating sensory and motor development. Here is a guideline of your baby’s development in the first year of life. Having an idea of what your baby is beginning to learn at each stage, gives you an idea of what you can do to encourage their newly emerging skills. At this stage, there is an increased sense of confidence and purposefulness and babies can become quite expressive. This is an important step in their ability to communicate their intent and develop their sense of self. Parents need to provide their babies with the opportunity for discovery. This is the best way of teaching. Active learning is the key at this time, and babies need to be given the lead in play and exploration. During this stage, babies manage a stable sitting position, which frees arms and hands to reach more accurately and manipulate objects. They are discovering the effect they have on ‘things’. They learn to shake, bang, pull, twist, turn and poke at objects. Two hands start working together as they bang objects together and start passing objects from hand to hand. Finger movements are starting to develop as they begin to use a thumb and index (pincer) grip to pick up small things. Motor control develops as babies learn to roll, and at the end of this stage perhaps even crawl and pull up on furniture, this means new sensory experiences and different perspectives on their world. It also leads to greater independence. Cognitive abilities develop rapidly and babies show an increased interest in objects. Object Permanence begins, which helps babies understand that objects continue to exist even when they cannot be observed. This helps them accept their parents being out of sight for a while. Language means more to them, as words start to take on meaning. Their receptive speech develops first and they may respond to simple commands such as ‘Come here’, or ‘Where is Dad?’ and distinguish tone of voice. Babies babble with repetitive sounds such as ‘gaga, baba, dada’. They become expressive and can shout for attention. Babies are becoming more purposeful in their communication. They develop a unique one to one relationship where a give and take relationship develops. Parents should follow their babies interests and reinforce the importance of what they are doing. This helps build self-esteem and confidence. Babies begin to enjoy social interactions, which is important for their confidence and well-being. Babies of the same age tend to regard one another with interest, exploring each other by poking, pulling or pushing. They are very interested in the responses they get, learning the concept of ‘cause and effect’. Personalities are developing and babies are becoming social human beings. Outings increase a sense of belonging and help babies learn to react to new situations and people. Kate Bailey, Occupational Therapist

It is empowering for parents to have an idea of what play activities they can incorporate into their daily routines to interact with their baby. Activities that stimulate their vision, hearing, touch and movement, all help them make sense of their world and move towards it. It is important to spend time watching what your baby is doing and what he/she takes an interest in, and then repeating it, providing more of the same. It is in our daily interactions with a loving, consistent caregiver that baby receives the most valuable input. Nurturing daily routines of feeding, bathing, dressing and nappy changing, provide wonderful opportunities for playful interaction. Finding time to be with your babies, to watch them, and to have fun together, is the key to stimulating their development. Remember, YOU are your baby’s first and most important play-mate and play-object. Baby clinics, family or friend groups, and mother-baby workshops are also very beneficial in our learning as parents. Groups give support and sharing as well as help parents understand their babies’ behaviours, stages of development and what activities are best for stimulating sensory and motor development. Here is a guideline of your baby’s development in the first year of life. Having an idea of what your baby is beginning to learn at each stage, gives you an idea of what you can do to encourage their newly emerging skills. Babies are learning to adapt to the new world and organise all the sensory information around them. This is a time of ‘settling in’ as they learn to regulate. Parents and babies learn about one another and parents learn to become familiar with their babies rhythms and signals. At this early age, newborn babies need to sleep, feed, be held, cuddled and talked to. Parents should always respond to their baby’s needs, as this is a time of bonding, developing trust and getting to know one another. Babies learn to focus, maintain eye contact and become very interested in the human face. Right from birth babies are able to mimic facial expressions and this is the beginning of social behaviour. Babies respond to sound from birth. They begin to recognise their caregiver’s voice and can be consoled by the sound of her voice. At 3 months, they begin to turn their heads to the direction of sound. By being touched and by exploring their world through touching, babies become aware of their bodies and how their bodies move. Deep pressure touch is particularly important at this stage to support baby to regulate/calm. Babies are sensitive to movement right from birth. Rhythmical movement and carrying are soothing and comforting for babies. When awake, babies are moving in random wide range movements. As they learn to control their bodies, they bring their hands together in the middle. Babies are learning head control, by lifting their heads up when on their tummies and by holding their heads in the middle when lying on their backs. At 3 months, improved head control can be seen when holding a baby in supported sitting. Parents need to realise that they can over stimulate their babies at this young age. They should be sensitive to their babies needs and read their signals. When a baby looks or turns away, appears fretful or cries, give baby some time and space to regain a calm state. Kate Bailey, Occupational Therapist

What is normal, what is not? Parenting is a mammoth task, and brings with it a lot of uncertainty as to what is actually within the norm, and what may need more urgent attention. I shall therefore attempt to sketch a picture of what is considered normal, with initial focus on the first few months of life, which are particularly panic-provoking! This includes a few words on the dreaded “C-word”…Colic. I shall then go through system by system what may go wrong and when to seek help. As a paediatric allergist, I have a particular interest in allergy prevention strategies, hence shall attempt to dispel a few myths and iron out some truths about what we can do to reduce allergies in the offspring. What is normal in the first few months? The first few months of parenthood are particularly tough as you take full responsibility for a precious but needy little baby, and have to function on minimal sleep. My advice: accept all the help you can, don’t set your expectations too high, and don’t expect your baby to fit into a mould! This is “survival time” for all- the enjoyment of parenthood will come! For the first 3-4 months babies’ brains and tummies are still very immature. This time has been dubbed the “fourth trimester.” The baby is not yet able to manipulate you hence it is not really possible to “spoil” a baby during this time. However, routines can be established from an early age and it is useful to try have a baby in some kind of a routine of sleep, feeding and play by 12 weeks or so if possible. The predictability of a routine helps you as well as other caregivers as well as your baby. Remember to be flexible and especially adaptable at times of travel, sickness and immunisations when the routine may be disturbed for a while. The first few months are vital for establishing a bond with your baby and a relationship of trust- the baby needs to know that “warmth and food and cuddles will come my way when I need them.” Remember that it is normal for a baby to cry as it is its only way of communicating. Crying increases from an average of about 1 hour a day at birth to 2-3 hours a day at 6 weeks, then slowly decreases again to about 1-2 hours a day at 3 months. Remember this “crying curve” when you are tearing your hair out at 6 weeks post birth! Gripes and Groans in the first few months The immature gut during the first 3-4 months means that most babies have gripes and groans to varying degrees. “Colic” by definition is excessive crying of more than 3 hours a day, more than 3 days a week, typically from 2-3 weeks until 3-4 months of age. Truly colicky babies by definition are thriving and usually have a pattern of an unsettled period, typically (but not always) in the early evening, when they cry inconsolably and may draw their legs up in discomfort. Although the specific cause of colic is rather mysterious, the general feeling is that it may be caused by an immature gut and immature nervous system (oversensitivity). Colic does not cause long term harm or distress to the baby. Simple measures such as winding the baby carefully, holding them upright with gentle pressure on the tummy, movement, driving, “white noise”, wind drops and probiotic drops may be useful. More potent colic mixtures can be sedating hence should be used sparingly only for “crisis” times once or twice a day after discussion with your clinic sister or doctor. Individual colic “medications” do not have a great success rate, and each one may work in only about a third of patients. Therefore, if they do not make a difference after a week or 2, stop them. Time is the great healer for colic, but this is hard to accept when you have a little baba crying 24/7! Some cases of excessive crying and discomfort may be caused by reflux of acid and milk into the throat, lactose intolerance and cow’s milk protein allergy. Please discuss concerns of with your clinic sister and doctor, especially if there is excessive vomiting, constant crying, inadequate weight gain, severe nappy rash, or chestiness. On that note, most babies vomit as they have an immature valve at the top of their stomachs which lets milk go up again. This is normal. Vomiting, in fact, only peaks at 4 months. However, if the vomiting seems excessively painful, the baby back-arches a lot, refuses to lie on the back, and is extremely miserable after feeds or fusses excessively during feeds, reflux “disease” should be considered and discussed with your healthcare practitioner. Stools During the first few days of life the baby passes meconium, which is a black or dark green stool of “marmite” consistency. After a few days, stools change. Breastfeeding stools are normally mustard yellow with white “seeds” of curdled milk. Breastfed babies have a wide variety of stooling habits. In the first few weeks they tend to pass stool after most feeds. After a few weeks they settle into a pattern which is widely variable: from 7-8 stools per day to one stool per week- this is all within normal limits. Babies on predominantly formula feeds should ideally pass stool at least once a day. Babies often groan and strain and become red in the face when they are passing stools- this is normal unless accompanied by painful crying. If you are concerned about constipation- (if stools are infrequent or unusually hard or painful to pass) please consult your doctor. Sleep Sleep is always an issue in families with young kids. We won’t go into detail here as every child and family is so different. Don’t expect miracles before 6 months- the young baby is programmed to require night feeds which can be normal until 8-9 months of age. Thereafter, demanding a milk feed is usually not a nutritional issue but a comfort “prop” to help them fall asleep again. Teaching a child to self soothe is an important tool to impart on your young one and can be done from about 4 months of age. They may need a comforter such as a special blanket, soft toy or dummy (or a combination of these) to help them fall asleep. Babies are generally reasonably easy for the first 10 days or so then may become more difficult as colic and wind sets in. Their sleep requirements are high (about 16 hours a day in total for the first few weeks), gradually settling into a pattern of approximately 3 naps per day by 3 months of age. If possible, some naps should be more than 40 minutes long to provide restoring sleep. At night time they will continue to wake 3-4 hourly for feeds for the first few weeks; by 3 months there is often a longer “stretch” of sleep during the night of 5-6 hours. Remember that the safest sleep position for your baby is on the back. The “back to sleep” campaign in the UK has seen the rate of cot deaths halve over only a few years. If the family is really not coping with the interrupted nights, or if there is a sudden change in sleep pattern, it is worth having the child looked at to make sure there is not a physical ailment disrupting the sleep. The routine and feeding pattern should be examined to make sure the daytime sleep and feed requirements are being met. There are a variety of forms of sleep training available, from controlled checking to gentle gradual separation techniques- please discuss with your clinic sister or doctor before embarking on these. If a child is unwell or going through a stage of separation anxiety, it is not a good time to sleep train. Remember that “this too shall pass” and that most children- even the worst initial sleepers- sleep very well by the age of 5 or 6 years. Feeds Initial feeds should be 3-4 hourly during the day, and on demand at night. Some babies only manage 2 hours in between feeds initially- this should stretch once they are able to drink more at one time. Breastfeeding is ideal for babies for several reasons including cost, convenience, allergy prevention and to boost their immune systems. The clinic sisters have vast experience with breastfeeding, please consult them for advice if you are battling. However, not all mothers manage to breast feeds or have insufficient milk- nothing to feel guilty about. There is a vast choice of formula milks and the approximate volume that a baby needs for the first few months is 150 mL milk per kg per day (divide this volume into the number of feeds per day). For example, a 4 kg baby on formula milk who feeds 3 hourly needs approximately 150 x 4= 600 mL per day; ie approximately 75 mL per feed every 3 hours. (8 feeds per day) Some babies need less milk, some need more- the best way to judge is by their weight gain. For this reason we plot babies’ weights on the growth chart regularly to make sure they are not falling off the growth curve. Babies lose weight during the first few days of life- loss of up to 10% of their birth weight is normal. The baby should regain its birth weight by 2 weeks of age. After that, for the first 3 months or so weight gain should be between 150-350 grams per week. After 3 months it slows down somewhat. Solids can be introduced any time from 4 months (17 weeks) onwards. Throughout the first year of life milk is the most important component of the infant’s diet, and even on 3 solids meals a day, during the first year the infant requires at least 450-600 ml milk per 24 hours. After the age of one, milk can be cut down gradually to 300-500 mL per day- overfeeding with milk after a year of age will interfere with an appetite for solids and may lead to problems such as anaemia. From about 14 months or so many toddlers notoriously go through a fussy eating stage-their growth curve naturally slows down and the world around them is SO much more interesting than food! It is therefore important to try and introduce a great variety of foods to the toddler before the fussy stage begins. Developmental Milestones Every baby develops at a slightly different pace, but generally the sequence of development is similar. Stimulation of a baby’s development will be covered by my colleagues. As soon as the baby starts fussing and seems fed up, stop with the stimulating process so that they can calm down in preparation for the next nap. Below are basic milestones typical at different ages. Remember each child develops at a different pace, and individual babies may be advanced in a certain area e.g, grabbing and mouthing yet a bit slower in other areas e.g. sitting/crawling. If your child is lagging behind significantly please consult the paediatrician: the sooner delays are picked up, the quicker we can intervene to find a diagnosis and treatment. Developmental milestones Age Gross Motor Skills Fine Motor Skills Hearing and Language Development Visual Development Personal/Social Birth Very little head control Hands are closed and grasp reflex present Startles to loud noises -Eyes close in response to bright light -Best distance of vision is about 30 cm away -Black and white vision Cries 6 weeks Moderate amount of head control -Can make tight fists -Places hands in mouth -Responds to sounds by calming, startling or crying -Starts making cooing sounds May follow slow moving objects through 90 degrees Begins to smile in response to familiar face or voice 3 months -Very little head lag -Can lift upper body and head when lying on tummy -Leg kicking and stretching -Standing reflex develops (pushes down on a surface with legs when held up) -Hands held loosely -Inspects hands and grasps objects that are place within hands -Can bring hands together -Recognises and responds to parents -Coos and gurgles -Blows bubbles Follows objects moving up to 180 degrees in the field of vision -Smiles spontaneously -Develops facial expressions to show basic emotions -Recognises mother’s face and scent 6 months -Supports head well -Can support upper body with hands when lying on stomach -Sits with support -Can roll over -Reaches for and grasps objects -Places objects in mouth -Transfers objects from hand to hand -Responds vocally when spoken to -Uses sounds such as squealing or laughter to express emotions -Uses repetitive monosyllabic sounds like bababa Can move eyes in all directions Recognises toys 9 months -Sits without support -Crawls on stomach and then on hands and knees -Starts to pull body into a standing position -Can pick up, shake and drop small objects -Grasps food and places in mouth -Holds a bottle Begins to point Starts imitating sounds -Stranger anxiety- Knows and trusts a limited number of caregivers -Recognises own name 12 months -Cruises around furniture -Starts to walk (walking may take up to 18 months) -Begins to throw objects -Good pincer grip -Holds 2 objects and bangs together -Still mouths a lot -Speaks 2-3 words -Makes sounds at toys Picks up tiny things from the ground -Searches for hidden or fallen toys (0bject permanence) -Waves goodbye, - points -Shakes head 15 months -Walks steadily -Starts to climb Stacks 2- 3 blocks Speaks 3-4 words -Has temper tantrums when frustrated -Becomes attached to a soft toy or other object 18 months -Walks steadily. -Runs -throws ball underhand -kicks -Scribbles -Stacks 3-4 blocks -Speaks 6-8 words -May have some 2 word phrases As above -Starts to use fork and spoon -“reads” picture books on his own 24 months -Runs -Jumps with 2 feet -Walks down stairs one foot at a time -stacks 6 blocks -scribbles -may still use both left and right hands to draw -Names at least 6 body parts -Uses 2-3 word sentences -Half of speech understandable -Starts to learn some colours Adult visual acuity -Asks “why?” -Begins to show interest in playing with other children but finds it difficult to share. Play is often in parallel -Helps with dressing -Uses fork and spoon 30 months -Jumps easily -Balances on one foot for a few seconds -Walks down stairs with alternating legs -Draws vertical line and circle -Pencil grip starts to develop -Handedness becomes evidence -Able to name some colours and shapes -2-4 word sentences -Able to recite name -Able to brush teeth with assistance -Washes and dries own hands 36 months -Hops on one leg -Rides a tricycle -Copies a circle -Shows definite handedness -3-4 word sentences -Able to follow 2-3 word commands -Starts to play with other children -can name a friend -Able to help with dressing Dr Claudia Gray, Paediatrician and Allergologist, Vincent Pallotti Hospital and Red Cross Children’s Hospital, Cape Town

As parents, we have one thing in common - we want to do the best for our new baby. Have you ever wondered what it really means to do the best for your baby? The concept of “Early Stimulation” can be an overwhelming expectation for those doing their best just to survive and adapt to the demands of parenthood. We often get too caught up in what we or other people think and expect. We replace playfulness with responsibility and that burden can take the joy out of our interactions with our precious babies. Yes, research does show that enriching experiences, particularly in the first 3 years of life, produce a multitude of nerve connections in the brain. What expands the brains wiring is the flood of sensory and motor experiences the baby receives right from birth, for example, being smiled at, watching a mobile, listening to Mom or Dad’s voice, being lovingly touched, cuddled and played with, all sends out electrical impulses that builds and refines the brains circuitry. This points strongly to the importance of hands-on parenting, finding time to touch, cuddle, talk to and provide babies with pleasurable play experiences. It is empowering for parents to have an idea of what play activities they can incorporate into their daily routines to interact with their baby. Activities that stimulate their vision, hearing, touch and movement,all help them make sense of their world and move towards it. It is important to spend time watching what your baby is doing and what he/she takes an interest in, and then repeating it, providing more of the same. It is in our daily interactions with a loving, consistent caregiver that baby receives the most valuable input. Daily routines of feeding, bathing, dressing and nappy changing, provide wonderful opportunities for playful interaction. Baby clinics, family or friend groups, and mother-baby workshops are also very beneficial in our learning as parents. Groups give support and sharing and help parents understand their babies’ behaviours, stages of development and what activities are best for stimulating sensory and motor development. When talking about stimulation, however, we as parents should keep in mind that ‘the more the better’ is not necessarily true. We as parents need to learn to ‘read’ our babies readiness and responses and become ‘tuned in’ to our babies’ needs. Your baby should be ready for interaction to truly benefit from stimulation. When calm and alert, your baby is receptive and will benefit most from your playful times together. Younger babies spend shorter periods in this optimal state, whereas, older babies can progressively tolerate more stimulation for longer periods of time. It is immensely powerful when parents feel the thrill of being able to calm their baby, and hold a space for interaction and positive emotion. From this platform, your baby is able to view the world with curiosity from which exploration and learning emerges. Each child has a unique sensory processing style, an individual way of perceiving and thus experiencing their world. We need to recognize our babies’ individual differences and how they process their sensory world. Some babies are more sensitive. For these parents, it is not so easy to do just anything, any time, any how. These babies become easily overwhelmed and can become anxious in new environments and with new people. They need extra assistance from an empathetic adult who is available to assist them to regulate and thus regain an organised state. Assisting your child obtain a calm state, creates trust and a sense of security that forms a base from which the child can follow his/her natural curiosity and begin to explore the environment and experience new social interactions. Babies experience their world through their senses. Therefore understanding how they respond to sensory input, helps you understand them better. Being aware of the sensory environment and the effect it has on your baby, helps you adapt the sensory input to suit your baby. Are the lights too bright, is there too much noise, too many people, is there too much movement for my baby, is she tired of being touched and passed around, have we had too busy a day? Remember that each baby has his or her own tolerance level to stimulation. Stimulating your baby is about tuning in to their individual needs, and responding to their readiness to engage with you and with the world around them. Giving the “just right”type and intensity of stimulation when your baby is ready, is important for your bonding and for their emotional and intellectual development. Stimulation is also about providing playful, loving interactions during every day activities, watching what they are enjoying and providing more of the same. Finding time to be with your babies, to watch them and to have fun together, is the key to stimulating their development. This surely must be the best we can do for our babies. By Kate Bailey, mother of three, Occupational Therapist and designer of the Moms and Babes program.

Your baby is developing fast during the first few months. You can ensure optimal development by playing with your baby. Surprisingly, the best toy is you, the parent of the baby! During pregnancy all the senses of the baby develops and the baby can use these at birth. The baby can hear and recognize the mother’s voice as well as her heart beat and other sounds of her digestive system. The baby can suck, swallow and breathe as well as perform some movements. However, the sense of vision can only develop after birth. The baby’s visual cortex in the brain develops rapidly in the first few months after birth. This is the time when it grows, expands and makes sense of the visual world. The objects that babies are most interested in are human faces. The intensity of the baby’s stare when you breastfeed or when you hold the baby close to your face is a clear sign of the interest in the human face. Your baby is making visual images of your face in his or her brain. This image is associated with your voice. It is also associated with feelings of being comforted, of being warm and of being fed. Your baby is building an image of you. The first attachment is formed. As the baby grows and develops, the play that you have with your baby, not using toys but using your voice, your facial expressions, your sense of touch will be one of the most important games that you can provide to encourage not only a healthy physical development but to build the bridges between you and your child for a strong emotional bond and a healthy relationship. How do you play without toys? Make eye contact Meet the baby’s physical needs Hold, carry, rock, sing, talk and in general have your baby with you, in your arms, in a sling or within hearing distance when the baby is awake Talk and sing when you change nappies and when you bath and dress your baby, make these chores happy times and use it to build a strong emotional bond Play games where you move or rock the baby in different positions, look out for changes in head position which will trigger the development of the vestibular-proprioceptive system and pave the way towards a good posture and effective movement skills Massage your baby using different oils, fragrances and even textures (make sure it is safe to use and what the effect of fragrances can be on your baby, before the time) Thus, no need to buy the expensive toys and equipment in the shops – use yourself and ensure the best emotional attachment with your child. A mother who suffers from illness and/or postnatal depression generally finds it difficult to do the above. It can also be challenging when the baby is ill and the mother is tired and sleep deprived. Please do your best to play these games at least twice a day, even for a short period of time. A young unsettled baby cannot be “spoilt”, thus if your instinct is to comfort your baby by rocking the baby or by allowing the baby to sleep on your stomach for periods of time, do this as it will be beneficial for you and for the baby. You can consider sleep patterns and be concerned about diet once both of you have rested and are healthy. Happy playing time! -------------------------------------------------------------------------------------------------------------------------- Marga Grey is the author of Sensible Stimulation. She is an occupational therapist who practised in South Africa for almost 30 years, working mainly with children and their families. She presented many workshops to parents, teachers and therapists and through her work realised the importance of the first three years as a foundation for development. This was also her field of study for a Master’s Degree from Wits University. She currently lives in Queensland, Australia where she works at the university.

At birth your little bundle is physically and emotionally completely dependent on you, but during their first year you will soon see their personality taking shape. From the moment they’re born, babies are completely dependent on the people around them. And not just to feed, soothe, burp and change them, but also to instil and develop feelings of trust and security. These are achieved through establishing a daily routine, with some degree of flexibility, and it’s essential for babies to have their needs met in a caring and affectionate way. Because infants have an innate ability to respond to human faces and voices, your baby will be able to pick up on the tone of your voice from a very early age. In fact, research shows that the connections between your baby’s brain cells develop more rapidly, and are reinforced more effectively, when you use a positive emotional tone when interacting with them. It’s also interesting to know that, at first, your little darling won’t really be able to distinguish between themselves and you. It’s only as they grow that they start to realise that you’re actually two separate individuals. Just be aware though that this realisation typically leads to separation anxiety. It will take a while before your baby understands ‘object permanence’ and they will worry that you’ve disappeared if they lose sight of you! They may also develop stranger anxiety and become upset when they see people they don’t recognise. During this first year, your little one will slowly start to realise that they have an influence on their environment. They’ll most likely discover this by accident at first. Such as when they inadvertently kick the mobile above their cot and watch in sheer astonishment as it moves! But, with time, their behaviour will become increasingly more ‘goal directed’ and they’ll really enjoy seeing the effect they have on the objects and people around them. And, just so you know, this is also an imperative early step in ensuring your baby develops good self-esteem. Your baby’s relationship with you will play a major role in developing their personality. And it’ll set the stage for how they relate to others later in life. It’s truly amazing to see your tiny tot’s unique personality start to emerge, influenced by their own inborn temperament and the nature of your family and culture. By Anel Annandale, a Mysmartkid expert and Occupational Therapist

During the first year of their life, your little one won’t be able to identify or name any shapes yet. However, there are certain activities you can do with them to expose them to various shapes so they become aware of these. Make sure your sweetie pie has a variety of toys of different shapes to play with. When playing with these, say for example: “The ball is a round circle and this block is a square.” Make your baby aware of different shapes as often as possible. Place specific shape toys, like balls, wooden blocks of different shapes and foam blocks, in a container. Unpack these with your munchkin while giving the name of each shape as you do. Hang mobiles or pictures with different shapes in your baby’s room, play area, above their changing station or on their car seat. Name the different shapes for them when you see them looking at or playing with these. Let your baby sit on your lap while you page through a book with different shapes. Be sure to name the shapes by saying: “The sun is a yellow circle. They live in a big square house.” By Susanne Hugo, a Mysmartkid expert and Occupational Therapist