Remi is 27 months old and lives in a bilingual household. He is an active toddler, likes to play with kids and is very social. But when he is in his play group, his mother notices that he hardly speaks a word while other kids of his age chatter away happily. Also sometimes he is aggressive and pushes or bites other kids. His mother is not very concerned about his speech delay, at least not as much as the onlookers. The reason she says is that Remi is well up to mark in all other areas of development, he is also improving in his speech ( he has started to say caa for car). She thinks that the delay is only because of his bilingual environment and is certain that he will catch up soon. Nevertheless she has decided to bring this issue up to the Paediatrician during his 'well baby' visit.
Does Remi have a speech delay?
If yes, what could be the cause?
Is the mother right in not being too concerned?
Does the child need intervention?
To understand and answer these questions, one need to know about the basics of speech and language development and the possible causes for delay.
Speech and Language:
Speech and language are two interlinked concepts that need to be understood before discussing about speech or language delay. Speech is the actual act of communicating by articulating verbal expression. In simple words, speech is the sound that comes out of our mouths. But language in the other hand is the knowledge of a symbol system that is used for communication, which includes understanding the meaning of words, ability to coin words and put them together to make meaningful sentences . Generally language delay is more serious than speech delay, but speech problems like stuttering can be equally frustrating.
Why is it important to recognise a delay in talking?
No other mile stone in a child's life brings so much change in parental relationship, as beginning to talk does. No more confusion, no more trying to figure out what the child needs, no more groping in the dark. Speech helps kids to express their needs precisely and parents to understand them.
Delay in talking concerns most parents and doctors and rightly so ,because speech delay has a significant impact on a child's personal , social and academic life and intervention at any age can help the children immensely and improve the outcome. Also many developmental problems can accompany speech delay , so early screening can help a lot in diagnosing them. Inability to communicate effectively can lead on to frustration and thechild may resort to physical aggression or bullying.
Normal speech development:
It is important to understand what is expected of the child in terms of speech and hearing , so as to be concerned if there is a deviance or delay. Speech development begins in the womb and most children develop at his or her own pace.
Birth to 3 months:
Cries,
startles at a loud sound,
Quietens and smiles when talked to,
soothened and pacified at gentle voice,
Cries, grunts and gurgles,
From around 2 months, cries differently for different reasons
smiles at your face.
Warning sign: No response to sound?
3 to 6 months:
intently looks at your face and coos when you talk,
vocalises excitement and displeasure,
Gurgles and babbles,
Notices musical or sound producing toys and pays attention to them.
Warning signs: Any of the above behaviour absent?
7 months to one year:
Turns and looks at the source of sound,
Enjoys playing pat-a-cake, peek-a-boo games,
Laughs and imitates a cough,
Responds to his name,
Understands commonly used words and names,
Begins to respond to requests like 'Give me' or ' Come here'.
Babbles- the babble is more of an imitation of normal speech,
Varies the pitch and uses different consonants during babble (m, p, b, g etc) .
Warning sign: Is babbling absent?
Is baby not responding to name, understand simple commands, shows interest in musical toys?
Does your child have recurrent ear infections?
1 to 2 years:
Jargon speech develops, the child appears to chat away in his own lingo,
At around this age, child begins to point at objects.
Words begin to appear , the acquisition of first few words of his vocabulary is often slow and they usually include nouns- names of persons and objects, and those needed to express their needs (more milk) ,
Make gestures that indicate his comprehension (puts phone to ear) ,
Makes sounds of familiar animals (cat – meow) ,
Starts speaking 1 or 2 words at around 1 year, increases to about 5 to 20 words at around 18 months while only 20% is understandable by strangers at this age. Says about 50 words at around 2 year of age, 60% of which is understood by strangers.
Some echolalia is present- the child repeats the words and sentences he hears.
Begins to say 2 words together,
Often generalises – all men are daddy or restricts - only family cat is a cat. Both these are normal stages in development of a child's speech.
Understands simple directions (Bring your shoes), questions like 'where is daddy?'. Asks many 'What is that ?' questions.
Enjoys and likes to dance to music.
Warning sign: Not a single word at 18 months?
Is child sociable and friendly or seem to be dwelling in his own world?
Does he use more gestures than words to indicate his needs?
2 to 3 years:
Sudden explosion of speech that begins at around 18 to 24 months continues with vocabulary increasing by leaps and bounds every day.
Speaks about 400 words, 75% of which is understood by strangers.
Starts using 'me' instead of name for self.
Echolalia diminishes.
Use sentences with two to three words or more.
By around 21/2 to 3 years, the child can have a conversation by putting together2 or 3 simple sentences by combining noun and verbs. Carries on conversation with self and dolls.
Uses plurals and past tense.
Understand prepositions (on the table, under the chair, next to the book etc), understands big/ little.
Likes to hear stories.
Names one or more colors by the beginning of 3rd year.
Warning sign: Does not follow instructions?
How many words does he speak?
No sentences yet?
Can not follow what he says most of the time?
After 3 years the child's language continues to develop in terms of complexity and logic.
3 to 4 years:
Child uses longer sentences, narrate incidents and tell stories,
Often understands time, color and number related concepts,
Ask many questions.
4 to 5 years:
Understands more complicated language,
Speaks well formed sentences.
These mile stones are general guidelines indicating a need to watch out when there is a delay. Children develop at their own pace and a child may still be developing normally even if he/ she does not meet every expected milestone at the corresponding age.
Why is my child not talking yet?
Before discussing the causes, it is important to determine if the child has a speech delay. Parents have the chance to observe their kid in different situations- alone, with parent, with friends or playmates and they are in the best position to recognise and report any delay. It is generally advised not to 'wait and watch' as it is noted that earlier the intervention, better is the outcome. So whenever there is a doubt, it is advisable to discuss with the Paediatrician as soon as possible.
The most common causes for speech and language delay are developmental language disorders, hearing loss or mental retardation.
Developmental language disorders:
Some children fail to speak at the expected age, but seem to have normal hearing, interpersonal relationships, articulation skills but have difficulty putting their ideas across in spoken words. Comprehension is usually normal, most kids can understand when they are signalled by gestures or what they are told , but some kids may also have a delay in receptive comprehension.
These children often use gestures to communicate their needs.With due intervention, these kids catch up with their peers by the time they enter school.
Some kids with such expressive language disorder have a constitutional delay in speech
(otherwise called maturational delay or late bloomers). As the name indicates, these kids develop normally but at a delayed pace. But this group of kids have an excellent prognosis, with all of them catching up with their peers at school age even without any intervention. It is difficult to differentiate this group from the earlier group who need intervention. Some factors like using plenty of gestures and attaining age appropriate receptive language development may help in differentiating the two groups. Nevertheless it is important to screen both groups as early as possible, since it is not always possible to differentiate them beforehand.
Mental retardation:
Language delay sometime accompanies a global developmental delay. It is associated with a delay in other fields of development.
Hearing impairment:
Intact hearing in early years is crucial for speech development. It is very important not to overlook hearing impairment just because the child responds to a loud noise (door bell) as hearing loss can occur over a range of frequencies. The cause of hearing loss can be repeated middle ear infections (leading to accumulation of fluid in the ear) or other causes that are unrelated to infections (like malformation of middle ear or neural hearing loss). Hence, it is critical to identify hearing impairment as early as possible.
Other less common causes of language delay:
Autism:: Most children with Autism have difficulty using language effectively. Persistent echolalia, poor attention duration, absence of eye contact, absence of gestures like pointing, inability to engage in interactive conversation can help in diagnosis.
Prematurity: can lead to delay in different areas including speech and language.
Psychosocial deprivation: Absence of a reliable primary care giver, poor stimulation, neglect can all lead to language delay.
Bilingualism:
Although statistically bilingual children start to talk a little later than their monolingual counterparts, the emergence of language skills in these children are still well within the normal range.
Selective mutism:
Children who have the ability to speak normally fail ( not refuse) to do so in certain social settings like school for more than 1 month. It can be very disabling for the child at school.The causes are not clear but supposed to be extreme shyness ,social anxiety and a genetic vulnerability. Previously selective mutism was thought to be due to poor adjustment and parental relationships but these assumptions are unproven. Some children are found to have additional disabilities.
Other causes of speech delay include Cerebral palsy, cleft palate, Developmental apraxia of speech, Receptive aphasia (where the child hears but does not listen), and intellectual disability.
Tongue tie, although per se does not cause a language delay , may cause speech problems.
What should I do if I think that my child has language delay?
Parents are often first to notice if a child has any problem with his language development or hearing.
As it is important to recognise speech or hearing problems as early as possible (even before the child starts talking), such concerns should be immediately discussed with the Paediatrician.
The Paediatrician will enquire about the child's functioning in other ares of development,the possibility of presence of risk factors ( prematurity, low birthweight, jaundice in newborn period etc) handedness, his school and family environment and if any other members in the family have similar problems.He then conducts a thorough physical examination and a detailed developmental assessment. Hearing assessment is also usually included .
Hearing evaluation helps to diagnose the type of hearing loss, the degree of hearing loss and if one or both ears are involved. There are various audiological procedures from which the audiologist selects the tests the child may have to be subjected to, depending on the child's age and the clinical scenario.
Management of a child with speech delay is individualised. The team includes his Paediatrician, audiologist, speech language pathologist (who is a health professional trained to evaluate and treat people with language and speech problems), psychologist, vocational therapist and social worker. The goal is to make the child understand what is spoken to him and to communicate his ideas effectively.
Treatment for children with hearing loss include placing tubes for middle ear effusions, using hearing aids , and employing other complex surgical procedures when required. These children are given speech therapy, auditory training and taught lip reading. Babies who are at risk for hearing loss, can be helped by subjecting them to frequent screening tests.
Speech language pathologists can help parents learn ways to encourage and enhance child's communicative skills, teach activities to improve their communication and when necessary teach them augmentative and alternative communication. Behaviour therapy can help children with selective mutism.
How can I help my child with language development?
Here are some tips to help your kid with his/her language development.
1.Start talking with your baby right from birth. Babies love to hear the sound of the language.
2.Move closely to your baby when you talk to him so he watch your eyes, face and lips.
3.Smile a lot and make eye contact with your baby. Talk with your baby as you give him bath, change diaper or carry him around.
4.Speak in Parentese -Parentese is the sing song tune that most people automatically use when talking to baby , often with exaggerated facial expressions, with short simple sentences which are repeated over and over again. It is found that 'Parentese' not only delights the babies but also help them acquire language skills. (Parentese is different from baby talk which uses meaningless words and sounds. Experts discourage parents from using baby talk to babies)
5.Encourage baby to localise sounds by ringing the rattle on either side and praising the baby when he turns.
6.Imitate your baby which encourages his vocalisation.
7.Play 'peek-a-boo' and 'pat-a-cake' with your baby.
8.Introduce your baby to variety of sounds like humming,buzzing, whistling and animal sounds.
9.Play music to your child, sing songs and encourage your kid to sing along.
10.Read age appropriate books to the kid. When young, read books with short sentences and simple illustrations. Babies enjoy reading picture books with parents.
11.Teach kids the concept of prepositions- in, out, over, under etc by using a box and small toys.
12.Teach him and encourage him to point and name body parts.
13.Talk a lot to your kid. Teach him the names of objects and persons. Ask him lot of questions. Encourage him to participate in simple conversation. Narrate stories and experiences.
Reinforce your conversations with plenty of gestures.
14.When your child begins to speak words, expand what he says (For example, if your kid points a car, explain him about the car, its color etc). This will help him learn more words.
15.When your kid starts asking questions, listen to him and patiently answer him.Wait for him to complete sentences, neither hurry him nor finish it for him.
16.Do not force your kid. Do not withhold objects and demand that he asks for it, to have it.
17.When your child makes mistakes, repeat the sentence with correct grammar.
18.Play with your child one to one. Talk about his toys and games.Watch his TV programmes with him and discuss the plot and story characters with him.
19.Encourage him to play with other kids who talk well and let him pick up words from them during play.
Stuttering:
Stuttering or stammering is an interuption of the flow of speech by repetition or prolongation of words, often accompanied by struggling behaviours like tremors of lips or eye blinking. Developmental stuttering occurs in young children who are yet to master the language.Children stutter when they are excited or when they are hurried to answer. Most kids outgrow their stuttering. Treatment is considered when the child has been stuttering for 3 to 6 months or display struggling behaviours.
Tips for the parents:
1. Do not react negatively when your child stutters.
2. Present a relaxed enironment at home.Do not be too demanding on the child's performance.
3. Talk about his stuttering problem in an accepting manner.
4. Talk a lot to your child and while talking maintain a relaxed tone.
5. Seek professional help if you find that stuttering is affecting his quality of life and inhibiting him socially.
Thursday, 18 December 2008
Tuesday, 9 December 2008
Childhood obesity.
Obesity is a serious medical epidemic that is affecting children and adolescents of current generation. These young people are much more at risk because extra pounds in kids are more detrimental to their health than gaining excess weight in adult life. Obese children and adolescentsare more likely to become obese as adults. Also earlier in lifea child gets obese, severe is his obesity during adult life. Obesity also makes them prone to cardiovascular diseases, high blood pressure, high cholesterol, type 2 diabetes, gall stones which were previously considered adult diseases.
Is my child obese?
BMI is the most practical measure to determine overweight and obesity (BMI is calculated from the weight and height of the child using standard formulae). Although BMI does not measure body fat, it is a reliable indicator. BMI for children are age and sex specific. Then the BMI is trnslated in to percentile using BMI for age growth charts for boys and girls. 85th to 95th percentile is considered overweight and obesity is being equal or more than 95th percentile.
You can calculate your kid's BMI and percentile here.
Why is my child overweight/obese?
By far, the most important cause of obesity is intake of calories that is consistently more than the energy spent.
Genetic factors:
It has long been recognised that obesity runs in families. Weight of the mother and obesity in parents and other family members are known risk factors. But recent and sudden increase in incidence of obesity in the current generation suggests that changes in nongenetic factors are more important.
Social factors:
Obesity is more common in low socioeconomic groups. Lack of time for cooking, lack of access to healthy food, ignorance about healthy food choice, lack of space and time for physical activity, food insecurity- all appear to contribute to this.
Behavioural factors:
Parenting behaviour that decides food habits of the family, feeding pattern of infants(breastfeeding), concern for a healthy life style, eating out, physical activity , having family meals - all go a long way in deciding child's food habit and likelihood for obesity. Stress in the family can cause some kids to overfeed as a coping strategy. High risk behaviours like smoking, alcohol use and early sex experimentation are associated with poor dietary and health attitudes.
Environmental factors :
The overall decline in physical activity over the generations combined with the availability of cheap, energy dense food and sweetened beverages can be singled out as a leading risk factor. The availability of gadgets that encourage children to watch tv or play video games rather than engage in play or physical activity, the sedentary life style where physical activity is not part of social life can cause kids to burn less energy . This when combined with a constant access to high calorie food predispose to obesity.
Some medical conditions like Cushing's disease, hypothyroidism and genetic disorders like Prader -Willi, Cohen's syndrome, Bardet-Biedl syndrome are known to be associated with obesity.
Why should I be concerned?
Obesity in kids have many immediate health consequences. Also as they are likely to grow in to obese adults they are prone to weight related health problems in adulthood.
Obese children are more likely to suffer from
1. High blood pressure.
2. High cholesterol.
3. Impaired glucose tolerance that predispose to Diabetes.
4. Breathing problems including Asthma.
5. Sleep problems including Sleep Apnoea which is involuntary stopping of breathing for few seconds during sleep.
6. Type 2 Diabetes- More commonly seen in obese kids and teens. Earlier onset may result in advanced complications like kidney problems and heart problems. occuring in early adulthood.
7. Obesity puts an enormous stress on the young skeletal system resulting in bone and joint problems.
8. Obese children attain puberty earlier than peers resulting in psychological issues. Menstrual irregularities are common in obese girls.
9. Liver complications.
10. Psychosocial complications: Obese kids and adolescents are often targets of bullying and social discrimination. Such social stigmatisation can put enormous stress on their young minds which can lead on to low self image. Low self esteem can hinder their social functioning and academic performance. Sometimes the negative images of obesity is so strong that teenagers often impose calorie restriction on themselves serious enough to cause pubertal delay and growth failure. For most children the emotional trauma often persists in to adulthood.
What can my family and I do to encourage healthy weight?
Remember that the goal is to reduce the rate of weight gain and allowing your child to grow in to the pounds that he/ she has accumlated. Children and adolescents must not be placed in a weight reduction diet without the advice or monitoring by a health care professional. Remember that obesity does not ocur overnight, it takes years of eating in excess of required energy to build up the extra weight. So the emphasis must be clearly on a healthy life style which includes making smart food choices and encouraging them to engage in appropriate amount of physical activity. It is important for parents and caregivers to be positive role models.
Tips for encouraging healthy food choices:
We must make sure that the energy provided by the child's diet is sufficient to support growth and development and to maintain desirable body weight. Choose a variety of foods to meet the recommended dietary allowances for all nutrients including iron and calcium for children and adolescents.
1. Use whole grain cereals and products instead of refined grain products.
2. Serve a variety of fruits and vegetables daily. Include seasonal as well as as exotic ones to improve variety.
3. Limit juice intake. Look for juices that has 100% juice and no added sugar.
4. Serve fat free or low fat milk and dairy products.
5. Include lean meat, poultry, fish , lentils and pulses as source of protein.
6. Aviod calorie rich, high fat, high sugar, salty or deep fried snacks. Avoid sweetened beverages.
Tips for healthy eating habits
Start in infancy:
1.Breastfeed exclusively for first 6 months and for atleast 12 months. Breastdfeeding is found to be protective against overweight in later childhood.
2. Delay introduction of juice and restict juice intake in young children.
3. Avoid overfeeding infants and young children. Left to themselves they are found to self regulate their caloric intake to meet their needs.
4. Introduce them to healthy food and keep offering them even if children refuse them initially. Avoid giving them foods that provide empty calories without any nutritional value.
Older kids:
1. Stock up your fridge and kitchen shelves with fresh vegetables, fruits , whole grain products and health snacks.
2. Avoid bringing home high calorie foods including sweetened beverages.
3. Learn to read food labels and identify healthy food choices. Make kids get actively involved in grocery shopping and in making such choices.
4. Downsize your portion levels reasonably to appropriate levels.
5. Encourage children to drink plenty of water.
6. Minimise eating out, particularly in fast food joints.
7. Actively involve children in cooking. Stick to healthy cooking- avoid using too much oil/fat and deep frying.
8. Make meal time a family time. Switch off TV while having meals.
9. Encourage kids to eat slowly, this gives time for brain to track sugar level and send satiety signals.
10. Use smaller plates and narrow, tall cups.
11. Never use food as reward or withold food as punishment.
12. Set an example by eating healthy foods and exercising to maintain normal weight.
13. If enough healthy choices are not available at school, offer healthy lunch and snacks for kids to take to school.
Improve physical activity:
Regular physical activity has many benefits other than weight management alone which includes reducing stress levels, improving social interaction, improving sleep, reducing blood pressure and strengthening muscles and bones.
1. Be active yourself. Kids tend to copy the adults in the family. Being active may stimulate and establish their interests in physical activity.
2. Do fun activities together as a family- Go for a walk, enjoy hiking, swimming, biking with the kids.
3. Do not make exercise as a chore. Insted make it enjoyable by letting children choose the activity or sports the are interested in.
4. If possible walk them to school instead of driving.
5.Include their peers in the activities.
6. Encourage toddlers to walk rather than pushing them around in strollers.
7. Encourage young kids to play games like jumping rope, playing hide and seek that makes them run about instead of sedentary play.
8. Encourage kids to join extra curricular activities and sports clubs at school. Offer help by taking them over and showing interest in their activities.
9.Emphasise on physical activty to the management and administrative staff of schools and child care centres.
Limit screen time:
1. Switch off the TV. Make an aggrement that the family has no more than 2 hours(or less) of TV viewing.
2. Do not watch TV during meal time.
3. Do not have TV in the bedroom (yours/ child's).
4. Watch programmes instead of watching TV. Recorded programmes also help you to fast forward commercials.
5. Try to avoid letting a toddler watch Tv alone. Watch with him and explain to him the difference between programmes and commercials.
6.Avoid video games or regulate the time they play video games. Encourage them to do yoga or exercycling while watching TV.
My child is overweight. How can I support him/her?
The role of parents are crucial in helping obese children to cope with their problems and help them reach and maintain their optimum weight. In addition to the above mentioned strategies,
1. Build your child's self esteem. Explore their field of interests and encourage them to put on their best performance.
2.Make them feel loved and appreciated.
3. Discuss with them about their health issues and interventions in a blame free, non judgemental manner.
4. Plan realistic goals and celebrate small successes.
5. Emphasise on the importance of healthy eating and phsical activity without focussing on the weight issue.
6. Avoid putting too much pressure on your kid regarding his weight issue.
7. Support them and work with them to cope with bullying, name calling and discrimination.
8. Learn to identify early symptoms of depression and deal with it promptly.
9. Be patient, be optimistic and stay positive.
Is my child obese?
BMI is the most practical measure to determine overweight and obesity (BMI is calculated from the weight and height of the child using standard formulae). Although BMI does not measure body fat, it is a reliable indicator. BMI for children are age and sex specific. Then the BMI is trnslated in to percentile using BMI for age growth charts for boys and girls. 85th to 95th percentile is considered overweight and obesity is being equal or more than 95th percentile.
You can calculate your kid's BMI and percentile here.
Why is my child overweight/obese?
By far, the most important cause of obesity is intake of calories that is consistently more than the energy spent.
Genetic factors:
It has long been recognised that obesity runs in families. Weight of the mother and obesity in parents and other family members are known risk factors. But recent and sudden increase in incidence of obesity in the current generation suggests that changes in nongenetic factors are more important.
Social factors:
Obesity is more common in low socioeconomic groups. Lack of time for cooking, lack of access to healthy food, ignorance about healthy food choice, lack of space and time for physical activity, food insecurity- all appear to contribute to this.
Behavioural factors:
Parenting behaviour that decides food habits of the family, feeding pattern of infants(breastfeeding), concern for a healthy life style, eating out, physical activity , having family meals - all go a long way in deciding child's food habit and likelihood for obesity. Stress in the family can cause some kids to overfeed as a coping strategy. High risk behaviours like smoking, alcohol use and early sex experimentation are associated with poor dietary and health attitudes.
Environmental factors :
The overall decline in physical activity over the generations combined with the availability of cheap, energy dense food and sweetened beverages can be singled out as a leading risk factor. The availability of gadgets that encourage children to watch tv or play video games rather than engage in play or physical activity, the sedentary life style where physical activity is not part of social life can cause kids to burn less energy . This when combined with a constant access to high calorie food predispose to obesity.
Some medical conditions like Cushing's disease, hypothyroidism and genetic disorders like Prader -Willi, Cohen's syndrome, Bardet-Biedl syndrome are known to be associated with obesity.
Why should I be concerned?
Obesity in kids have many immediate health consequences. Also as they are likely to grow in to obese adults they are prone to weight related health problems in adulthood.
Obese children are more likely to suffer from
1. High blood pressure.
2. High cholesterol.
3. Impaired glucose tolerance that predispose to Diabetes.
4. Breathing problems including Asthma.
5. Sleep problems including Sleep Apnoea which is involuntary stopping of breathing for few seconds during sleep.
6. Type 2 Diabetes- More commonly seen in obese kids and teens. Earlier onset may result in advanced complications like kidney problems and heart problems. occuring in early adulthood.
7. Obesity puts an enormous stress on the young skeletal system resulting in bone and joint problems.
8. Obese children attain puberty earlier than peers resulting in psychological issues. Menstrual irregularities are common in obese girls.
9. Liver complications.
10. Psychosocial complications: Obese kids and adolescents are often targets of bullying and social discrimination. Such social stigmatisation can put enormous stress on their young minds which can lead on to low self image. Low self esteem can hinder their social functioning and academic performance. Sometimes the negative images of obesity is so strong that teenagers often impose calorie restriction on themselves serious enough to cause pubertal delay and growth failure. For most children the emotional trauma often persists in to adulthood.
What can my family and I do to encourage healthy weight?
Remember that the goal is to reduce the rate of weight gain and allowing your child to grow in to the pounds that he/ she has accumlated. Children and adolescents must not be placed in a weight reduction diet without the advice or monitoring by a health care professional. Remember that obesity does not ocur overnight, it takes years of eating in excess of required energy to build up the extra weight. So the emphasis must be clearly on a healthy life style which includes making smart food choices and encouraging them to engage in appropriate amount of physical activity. It is important for parents and caregivers to be positive role models.
Tips for encouraging healthy food choices:
We must make sure that the energy provided by the child's diet is sufficient to support growth and development and to maintain desirable body weight. Choose a variety of foods to meet the recommended dietary allowances for all nutrients including iron and calcium for children and adolescents.
1. Use whole grain cereals and products instead of refined grain products.
2. Serve a variety of fruits and vegetables daily. Include seasonal as well as as exotic ones to improve variety.
3. Limit juice intake. Look for juices that has 100% juice and no added sugar.
4. Serve fat free or low fat milk and dairy products.
5. Include lean meat, poultry, fish , lentils and pulses as source of protein.
6. Aviod calorie rich, high fat, high sugar, salty or deep fried snacks. Avoid sweetened beverages.
Tips for healthy eating habits
Start in infancy:
1.Breastfeed exclusively for first 6 months and for atleast 12 months. Breastdfeeding is found to be protective against overweight in later childhood.
2. Delay introduction of juice and restict juice intake in young children.
3. Avoid overfeeding infants and young children. Left to themselves they are found to self regulate their caloric intake to meet their needs.
4. Introduce them to healthy food and keep offering them even if children refuse them initially. Avoid giving them foods that provide empty calories without any nutritional value.
Older kids:
1. Stock up your fridge and kitchen shelves with fresh vegetables, fruits , whole grain products and health snacks.
2. Avoid bringing home high calorie foods including sweetened beverages.
3. Learn to read food labels and identify healthy food choices. Make kids get actively involved in grocery shopping and in making such choices.
4. Downsize your portion levels reasonably to appropriate levels.
5. Encourage children to drink plenty of water.
6. Minimise eating out, particularly in fast food joints.
7. Actively involve children in cooking. Stick to healthy cooking- avoid using too much oil/fat and deep frying.
8. Make meal time a family time. Switch off TV while having meals.
9. Encourage kids to eat slowly, this gives time for brain to track sugar level and send satiety signals.
10. Use smaller plates and narrow, tall cups.
11. Never use food as reward or withold food as punishment.
12. Set an example by eating healthy foods and exercising to maintain normal weight.
13. If enough healthy choices are not available at school, offer healthy lunch and snacks for kids to take to school.
Improve physical activity:
Regular physical activity has many benefits other than weight management alone which includes reducing stress levels, improving social interaction, improving sleep, reducing blood pressure and strengthening muscles and bones.
1. Be active yourself. Kids tend to copy the adults in the family. Being active may stimulate and establish their interests in physical activity.
2. Do fun activities together as a family- Go for a walk, enjoy hiking, swimming, biking with the kids.
3. Do not make exercise as a chore. Insted make it enjoyable by letting children choose the activity or sports the are interested in.
4. If possible walk them to school instead of driving.
5.Include their peers in the activities.
6. Encourage toddlers to walk rather than pushing them around in strollers.
7. Encourage young kids to play games like jumping rope, playing hide and seek that makes them run about instead of sedentary play.
8. Encourage kids to join extra curricular activities and sports clubs at school. Offer help by taking them over and showing interest in their activities.
9.Emphasise on physical activty to the management and administrative staff of schools and child care centres.
Limit screen time:
1. Switch off the TV. Make an aggrement that the family has no more than 2 hours(or less) of TV viewing.
2. Do not watch TV during meal time.
3. Do not have TV in the bedroom (yours/ child's).
4. Watch programmes instead of watching TV. Recorded programmes also help you to fast forward commercials.
5. Try to avoid letting a toddler watch Tv alone. Watch with him and explain to him the difference between programmes and commercials.
6.Avoid video games or regulate the time they play video games. Encourage them to do yoga or exercycling while watching TV.
My child is overweight. How can I support him/her?
The role of parents are crucial in helping obese children to cope with their problems and help them reach and maintain their optimum weight. In addition to the above mentioned strategies,
1. Build your child's self esteem. Explore their field of interests and encourage them to put on their best performance.
2.Make them feel loved and appreciated.
3. Discuss with them about their health issues and interventions in a blame free, non judgemental manner.
4. Plan realistic goals and celebrate small successes.
5. Emphasise on the importance of healthy eating and phsical activity without focussing on the weight issue.
6. Avoid putting too much pressure on your kid regarding his weight issue.
7. Support them and work with them to cope with bullying, name calling and discrimination.
8. Learn to identify early symptoms of depression and deal with it promptly.
9. Be patient, be optimistic and stay positive.
10.Use the help and support of resources available.Consult your Paediatrician or dietician when in doubt.
Friday, 5 December 2008
Temper tantrums
You are on the much dreaded shopping trip with your 2 year old. When denied the bourbon he asked for he puts up the very familiar tantrum of lying down flat on the floor, flinging his arms and screaming at the top of his lungs. As people watch the drama, you wait for the earth to swallow you.
You are at a friends' place and having a nice chit chat. When it is time to leave, your kid refuses to oblige and runs around the house screaming and crying as you watch him red faced.
Are these scenes familiar? Probably yes, if you are a parent of a toddler. These are called temper tantrums.
Is it just my child?
Well, if it could be of any reassurance, temper tantrums are fairly common. As much as 80% of children in the age group of 18 months to 48 months throw tantrums and in about 20% of such children, it can happen almost daily. The extremely tantrum prone years are 18 months to 36 months and by age 4, they usually tail off.
What is a tantrum and why does it happen?
Temper tantrums are responses to triggering factors that take the form of physical and verbal outbursts (including crying, screaming, lying on the floor in public, running around, flinging of limbs, kicking, arching etc). Some kids can get aggressive, harm themselves and others, break things or hold their breath. These episodes are unintentional (they don't do it to annoy you nor do they enjoy it although some may enjoy the attention they get from it). The tantrums are influenced by the child's temperament (some kids throw more tantrums), their age and stage of development and the presence of stress factors in a kid's environment. A normal 2 year old is egocentric, does not understand the point of view of others, have a strong sense of independence, an intense desire to do things by themselves and to explore the environment, and a language development that is not sufficient enough to let them express their wants and feelings. All these feature's predispose them to tantrums.
Tantrums are provoked by these triggering factors:
1. Stress :Your child is more prone to a tantrum when he is tired, bored, sleepy or hungry. When there is stress in the family - financial or relationship issues, it may affect your child's temperament.
2. Frustration : Activities that are beyond the capacity of the child, which may include even normal day to day activities like tying his shoe laces by himself or toys that are beyond the motor development of a kid may provoke a tantrum.
3.Demands : A child may want to have his favourite snack, toy or activity right away and cannot reason out why he can't have it -right here and right now'. Such demands when unmet can provoke tantrums.
4.Attention seeking: For a kid even negative attention may be better than than no attention. Also a child may begin to enjoy the attention he gets during or following every tantrum.
5. Refusal: A child may not want want to do certain things- like brushing teeth, having a bath , wearing his overcoat . Insisting them to do that can begin a tantrum.
6.Rage tantrum: When emotionally overloaded your kid may get in to fits of rage or may even become disruptive like injuring themselves or others and damaging property.
What can I do to prevent a tantrum?
As temper tantrums are just a developmental phase in the life of a toddler which they eventually grow out of, it is reasonable to prevent them as much as possible.
1. Establish a routine and try to stick to it. This will avoid many situations that may surprise a child otherwise. For example, a regular evening bath followed by a cuddle and bed time story before sleep will not upset him, but asking him to go for bath/ bed at odd moments or when he is engrossed in playing might provoke a tantrum.
2. Avoid situations where the child gets hungry, tired or bored. Carry healthy snacks when you are going to be out for a long time. Take breaks in between shopping trips. When going on a long drive , take books , puzzles or toys with you that will keep them occupied.
3. Keep off toys that are beyond his capacity (Replace wooden blocks with magnetic bricks or 'fit in' type of blocks if your kid is interested in stacking but finds it impossible with the wooden blocks he has).
4. When he is in the 'do it yourself' mode, try offering him little help (I will help you put your legs in to the trousers, then you can pull them up all by yourself) and praise him lavishly when he completes the task.
5. Offer him choices as often as possible to indulge his self importance and independence.(Which shirt do you want to wear- the blue one or the red one?)
6. When you cannot accept no as an answer , do not ask a question.(Do not ask 'Do you want to have supper now?'. Instead declare that it is supper time for everyone).
7. Give him his well deserved attention as often and as long as necessary. For example if he is playing for a long time with his toys when you are working or doing your chores, don't wait long enough for him to come searching for you. Join him for a few minutes, play with him, appreciate him for playing by himself and then sneak back to what you were doing when he is too busy to notice.
8. Catch him doing something nice. When playing with other kids praise him lavishly when he shares his first toy with a friend. Praise him loudly that other kids may notice and probably you will not have to settle toy distribution disputes during the rest of the play session.
9.Choose your battles. When your kid asks for something that is reasonable or acceptable, give him what he asks. If he doesn't want to put on his overcoat , suggest that he can carry it with him and put it on if he feels cold. He most probably will want to put it on once you step in to the cold air.
10. Be reasonable. Sometimes it is worth to stop and ask yourself 'who is behaving like a child here?'. Be tolerant to childish pranks that are acceptable.
11. Signal your kid well before the end of an enjoyable activity.(You can watch TV for 10 more minutes, another 10 minutes at park before we leave )
12. Inform them beforehand when you are planning something out of routine.
13. Acknowledge their need to explore the environment. Empty your lower racks or fill them up with plastic bowls and keep your crystals out of reach, so your toddler can explore them without getting on your nerves. Childproof your home.
14. When the child is mastering his vocabulary, teach him words like hungry, tired, lonely, happy, sad that can help himself express him better.
15. When your child is at the verge of a temper tantrum, distract him (look at this funny picture) or surprise him out of it (wow, look at the flash lights on the police car).
16. Talk in a calm and compassionate voice and tell him that you can see that he is upset and offer him other choices that will comfort him(Can we go for a walk?)
17. Encourage him to use words when he asks for anything. Remind him that it will be easier for both of you if he uses words rather than whine/ cry/scream.
18. Keep a low stress level in the household. Do not argue in front of kids. Be cool and take it easy.
How do I handle my child's tantrum?
1. Keep calm. Do not panic (Easily said than done!).
2. Have an action plan ready. Being prepared can help you deal with it without losing your cool.
3. Never give in. Although buying the candy he asked seems to be the simplest solution, it will only perpetuate the problem. Be consistent , that goes a long way in disciplining the child.
4. Spanking or yelling at your kid will only make the situation worse. Learn to manage your temper as kids usually take parents as their role model.
5. If the tantrum is not going to harm the child or others, ignore it completely (although its difficult). Turn your back to him and continue to do what you were doing.
6. If the tantrum occurs in public, you may still ignore him and walk on . If you find that difficult take him to another place or your car (where there is no audience) and wait on it to pass off.
7. Give him a time out. Put him in a chair in a boring place(empty room or hallway) where you can assure his safety and tell him that you can talk it over when he calms down.
8. If he is having a rage tantrum, hold him for a couple of minutes (which is usually the time it lasts) so that he doesn't harm himself or others.
9. Do not get belittled by the onlookers or by the unsympathetic comment by others.
10. Do not judge your parenting skill because your child is having a tantrum.
11. Reassure yourself that by being consistent and cool you can tide over this. Most likely your child will grow out of it as he advances in his language and motor development. Also consider these episodes as opportunities where you are teaching your child to manage and handle stressful situations later in his life.
12. Most children are shaken and scared after a tantrum. Talk to your kid in a calm voice. Point to him the other ways that he could have handled the situation. Explain to him why his demands are unreasonable. Tell him that even though you disapprove his action you love him as a person and you are there for him always. Give him a big hug. But take care not to spoil him with too much attention and rewards after each episode, it can reinforce his behaviour.
Should I be concerned about my child's temper tantrums?
If the tantrums are severe enough are frequent enough to overwhelm you, you have to seek help from a health care provider. If you have to restrict your family's activities or you find yourself losing your self control during these episodes or your child frequently hurts himself and others or damages property, you need to get help from a professional.
Sometimes frequent and severe temper tantrums may have underlying causes like oppositional defiant disorder or ADHD (Attention deficit hyperactive disorder) that needs to be ruled out. When your child continues to have tantrums beyond the age of 5, they are most likely to have them through out their lives.
There are resources available to provide help, support and advise regarding parenting strategies and anger management if you need them. Remember that children have inherent personalities of their own and parenting can only influence that to a reasonable extent.
You are at a friends' place and having a nice chit chat. When it is time to leave, your kid refuses to oblige and runs around the house screaming and crying as you watch him red faced.
Are these scenes familiar? Probably yes, if you are a parent of a toddler. These are called temper tantrums.
Is it just my child?
Well, if it could be of any reassurance, temper tantrums are fairly common. As much as 80% of children in the age group of 18 months to 48 months throw tantrums and in about 20% of such children, it can happen almost daily. The extremely tantrum prone years are 18 months to 36 months and by age 4, they usually tail off.
What is a tantrum and why does it happen?
Temper tantrums are responses to triggering factors that take the form of physical and verbal outbursts (including crying, screaming, lying on the floor in public, running around, flinging of limbs, kicking, arching etc). Some kids can get aggressive, harm themselves and others, break things or hold their breath. These episodes are unintentional (they don't do it to annoy you nor do they enjoy it although some may enjoy the attention they get from it). The tantrums are influenced by the child's temperament (some kids throw more tantrums), their age and stage of development and the presence of stress factors in a kid's environment. A normal 2 year old is egocentric, does not understand the point of view of others, have a strong sense of independence, an intense desire to do things by themselves and to explore the environment, and a language development that is not sufficient enough to let them express their wants and feelings. All these feature's predispose them to tantrums.
Tantrums are provoked by these triggering factors:
1. Stress :Your child is more prone to a tantrum when he is tired, bored, sleepy or hungry. When there is stress in the family - financial or relationship issues, it may affect your child's temperament.
2. Frustration : Activities that are beyond the capacity of the child, which may include even normal day to day activities like tying his shoe laces by himself or toys that are beyond the motor development of a kid may provoke a tantrum.
3.Demands : A child may want to have his favourite snack, toy or activity right away and cannot reason out why he can't have it -right here and right now'. Such demands when unmet can provoke tantrums.
4.Attention seeking: For a kid even negative attention may be better than than no attention. Also a child may begin to enjoy the attention he gets during or following every tantrum.
5. Refusal: A child may not want want to do certain things- like brushing teeth, having a bath , wearing his overcoat . Insisting them to do that can begin a tantrum.
6.Rage tantrum: When emotionally overloaded your kid may get in to fits of rage or may even become disruptive like injuring themselves or others and damaging property.
What can I do to prevent a tantrum?
As temper tantrums are just a developmental phase in the life of a toddler which they eventually grow out of, it is reasonable to prevent them as much as possible.
1. Establish a routine and try to stick to it. This will avoid many situations that may surprise a child otherwise. For example, a regular evening bath followed by a cuddle and bed time story before sleep will not upset him, but asking him to go for bath/ bed at odd moments or when he is engrossed in playing might provoke a tantrum.
2. Avoid situations where the child gets hungry, tired or bored. Carry healthy snacks when you are going to be out for a long time. Take breaks in between shopping trips. When going on a long drive , take books , puzzles or toys with you that will keep them occupied.
3. Keep off toys that are beyond his capacity (Replace wooden blocks with magnetic bricks or 'fit in' type of blocks if your kid is interested in stacking but finds it impossible with the wooden blocks he has).
4. When he is in the 'do it yourself' mode, try offering him little help (I will help you put your legs in to the trousers, then you can pull them up all by yourself) and praise him lavishly when he completes the task.
5. Offer him choices as often as possible to indulge his self importance and independence.(Which shirt do you want to wear- the blue one or the red one?)
6. When you cannot accept no as an answer , do not ask a question.(Do not ask 'Do you want to have supper now?'. Instead declare that it is supper time for everyone).
7. Give him his well deserved attention as often and as long as necessary. For example if he is playing for a long time with his toys when you are working or doing your chores, don't wait long enough for him to come searching for you. Join him for a few minutes, play with him, appreciate him for playing by himself and then sneak back to what you were doing when he is too busy to notice.
8. Catch him doing something nice. When playing with other kids praise him lavishly when he shares his first toy with a friend. Praise him loudly that other kids may notice and probably you will not have to settle toy distribution disputes during the rest of the play session.
9.Choose your battles. When your kid asks for something that is reasonable or acceptable, give him what he asks. If he doesn't want to put on his overcoat , suggest that he can carry it with him and put it on if he feels cold. He most probably will want to put it on once you step in to the cold air.
10. Be reasonable. Sometimes it is worth to stop and ask yourself 'who is behaving like a child here?'. Be tolerant to childish pranks that are acceptable.
11. Signal your kid well before the end of an enjoyable activity.(You can watch TV for 10 more minutes, another 10 minutes at park before we leave )
12. Inform them beforehand when you are planning something out of routine.
13. Acknowledge their need to explore the environment. Empty your lower racks or fill them up with plastic bowls and keep your crystals out of reach, so your toddler can explore them without getting on your nerves. Childproof your home.
14. When the child is mastering his vocabulary, teach him words like hungry, tired, lonely, happy, sad that can help himself express him better.
15. When your child is at the verge of a temper tantrum, distract him (look at this funny picture) or surprise him out of it (wow, look at the flash lights on the police car).
16. Talk in a calm and compassionate voice and tell him that you can see that he is upset and offer him other choices that will comfort him(Can we go for a walk?)
17. Encourage him to use words when he asks for anything. Remind him that it will be easier for both of you if he uses words rather than whine/ cry/scream.
18. Keep a low stress level in the household. Do not argue in front of kids. Be cool and take it easy.
How do I handle my child's tantrum?
1. Keep calm. Do not panic (Easily said than done!).
2. Have an action plan ready. Being prepared can help you deal with it without losing your cool.
3. Never give in. Although buying the candy he asked seems to be the simplest solution, it will only perpetuate the problem. Be consistent , that goes a long way in disciplining the child.
4. Spanking or yelling at your kid will only make the situation worse. Learn to manage your temper as kids usually take parents as their role model.
5. If the tantrum is not going to harm the child or others, ignore it completely (although its difficult). Turn your back to him and continue to do what you were doing.
6. If the tantrum occurs in public, you may still ignore him and walk on . If you find that difficult take him to another place or your car (where there is no audience) and wait on it to pass off.
7. Give him a time out. Put him in a chair in a boring place(empty room or hallway) where you can assure his safety and tell him that you can talk it over when he calms down.
8. If he is having a rage tantrum, hold him for a couple of minutes (which is usually the time it lasts) so that he doesn't harm himself or others.
9. Do not get belittled by the onlookers or by the unsympathetic comment by others.
10. Do not judge your parenting skill because your child is having a tantrum.
11. Reassure yourself that by being consistent and cool you can tide over this. Most likely your child will grow out of it as he advances in his language and motor development. Also consider these episodes as opportunities where you are teaching your child to manage and handle stressful situations later in his life.
12. Most children are shaken and scared after a tantrum. Talk to your kid in a calm voice. Point to him the other ways that he could have handled the situation. Explain to him why his demands are unreasonable. Tell him that even though you disapprove his action you love him as a person and you are there for him always. Give him a big hug. But take care not to spoil him with too much attention and rewards after each episode, it can reinforce his behaviour.
Should I be concerned about my child's temper tantrums?
If the tantrums are severe enough are frequent enough to overwhelm you, you have to seek help from a health care provider. If you have to restrict your family's activities or you find yourself losing your self control during these episodes or your child frequently hurts himself and others or damages property, you need to get help from a professional.
Sometimes frequent and severe temper tantrums may have underlying causes like oppositional defiant disorder or ADHD (Attention deficit hyperactive disorder) that needs to be ruled out. When your child continues to have tantrums beyond the age of 5, they are most likely to have them through out their lives.
There are resources available to provide help, support and advise regarding parenting strategies and anger management if you need them. Remember that children have inherent personalities of their own and parenting can only influence that to a reasonable extent.
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