How does a baby grow? Quite contrary to the fears of nervous parents who scan weight and height charts for signs that all is well, usually in a pattern that’s normal for him or her.
A baby’s future height and weight are to a great extent preprogrammed at conception.
And assuming prenatal conditions are adequate, and neither love nor nutrition is lacking after birth, most babies will eventually realize that genetic potential.
The programming for height is based primarily on the midpoint between the father’s height and the mother’s. Studies show that, in general, boys seem to grow up to be somewhat taller than this midpoint, girls somewhat shorter.
Weight also seems to be preprogrammed, to a certain extent. A baby is usually born with the genes to be slim, stocky, or a happy medium. But the eating habits learned in infancy and fostered throughout childhood can help to fulfill this destiny or defeat it.
Growth charts, like the one in the Ready Reference section in the back of this book, shouldn’t become a source of anxiety for parents—it’s too easy to misread or misinterpret them. But they are useful in telling parents and doctors when a baby’s growth is departing from the norm, and when an evaluation, taking into account parental size, nutritional status, and general health, is necessary. Since growth often comes in spurts during the first year, one measurement that seems to show too little growth or too much may not be significant. It
should, however, be viewed as a red flag. A two-month halt to weight gain may indicate only that baby is slowing down because he or she is genetically destined to be small (particularly if growth in the height department is also easing off), but it can also indicate that baby is being underfed or is ill. A weight gain that is double what is normal during the same two months (if it is not accompanied by a similar jump in height) may just be baby’s way of catching up if birth-weight was low or weight gain has been slow so far, but it can also be a sign that baby is just plain eating too much.
There are, however, a few reasons for thinness that do need remedying. A major one is
underfeeding. If a baby’s weight curve keeps dropping off for a couple of months, and if the loss isn’t compensated for by a jump the following month, the doctor often will consider the possibility that the child is not getting enough to eat. If you’re breastfeeding and this is the case, the tips on page 165 should help get baby gaining again. If you’re bottle feeding, you can try, with the doctor’s approval, diluting the formula a little less. Either way, supplementing with solids once the doctor green-lights them can help fill baby out.
Don’t underfeed intentionally. Some parents, eager to get their babies started on the path toward a future of slimness and good health, limit calories and fat in infancy. This is a very dangerous
practice, since infants need both for normal growth and development. You can start them on the road to good eating habits without depriving them of the nourishment they need now.
Be sure, too, that your baby isn’t one who is either so sleepy or so busy that he forgets to demand his meals regularly. Between three and four months old, an infant should be eating at least every four hours during the day (usually at least five feedings), though he may sleep through the night without waking to eat. Some breastfed babies may still be taking more feedings, but fewer feedings could mean your baby isn’t eating enough. If your baby’s the kind who doesn’t make a fuss when he’s not fed, take the initiative yourself and offer meals to him more often—even if it means cutting short a daytime nap or interrupting a fascinating encounter with his crib gym.
Rarely, a baby’s poor weight gain is related to the inability to absorb certain nutrients, a metabolic rate that is out of kilter, or an infectious or chronic disease (in which case you would probably notice other symptoms). Such illness, of course, requires prompt medical attention.
HEART MURMUR
“The doctor says my baby has a heart murmur but that it doesn’t mean anything. Still, it’s scary.”
Any time the word heart is part of a diagnosis, it’s scary. After all, the heart is the organ that sustains life; any possibility of a defect is frightening, particularly to the parents of an infant whose life is just beginning. But in the case of a heart murmur, there is, in the vast majority of cases, really nothing to worry about.
When the doctor tells you your baby has a heart murmur, it means that on examination, abnormal heart sounds, caused by the turbulence of the flow of blood through the heart, are heard. The doctor can often tell just what kind of abnormality is responsible for the murmur by the loudness of the sounds (from barely audible to almost loud enough to drown out normal heart sounds), by their location, and by the type of sound—blowing or rumble, musical or vibratory—for example.
Most of the time, as is likely in your baby’s case, the murmur is the result of irregularities in the shape of the heart as it grows. This kind of murmur is called “innocent” or “functional,” and can usually be diagnosed by the baby’s doctor by simple office examination with a stethoscope. No further tests or treatments or limitations of activities are necessary. More than half of all children have an innocent murmur sometime during their lives, and it is likely to come and go throughout
childhood. But the existence of the murmur will be noted on your baby’s record so other doctors who examine him at a later date will know it has always existed. Very often, when the heart is fully grown (or sometimes earlier), the murmur will disappear.
If you’re worried no matter what anyone says, you can ask your baby’s doctor to tell you exactly what type of murmur your baby has and whether or not it can be expected to cause any problems, now or in the future, and to explain just why you have nothing to worry about. If the answers aren’t
reassuring enough, ask for a referral to a pediatric cardiologist for consultation.
BLACK STOOL
“My daughter’s last diaper was filled with a black stool. Could she be having a digestive problem?”
More likely she’s been having an iron supplement. In some children, the reaction between the normal bacteria of the gastrointestinal tract and the iron sulfate in a supplement causes the stool to turn dark brown, greenish, or black. There’s no medical significance in this change, and no need to be
concerned by it since studies show that small amounts of iron don’t increase digestive discomfort or fussiness. On the other hand, for most babies an iron supplement isn’t recommended (breastfed infants get enough iron from breast milk; bottle-fed babies get enough from iron-fortified formula; fortified cereal provides iron later). So unless your baby’s doctor has prescribed one, you should discontinue dosing baby. If your baby has black stools and isn’t taking a supplement, check with her doctor.
BABY MASSAGE
“I’ve heard that massage is good for babies. Should I massage my son?”
Massage is no longer for adults only. For some years it’s been known that premature newborns do better with therapeutic massage—they grow faster, sleep and breathe better, and are more alert. Now
it appears that massage also benefits healthy infants—and healthy children, as well.
There are a number of reasons why you should consider laying the hands on your baby. We know that being held, hugged, and kissed by a parent helps a baby thrive and enhances parent-child bonding.
But the therapeutic touch of massage may do that and even more, possibly strengthening the immune system; improving muscle development; stimulating growth; easing colic, teething pain, and tummy troubles; promoting better sleep patterns; stimulating the circulatory and respiratory systems; and decreasing stress hormones (yes, babies have those too). And a loving touch (whether in the form of massage or just a lot of hugging and holding) has also been shown to decrease aggressive tendencies in children. What’s more, baby’s not the only one who stands to benefit; massaging an infant is
actually relaxing for parents, too—and has been found to relieve symptoms of postpartum depression.
If you’d like to learn how to rub your baby, get a book or video, or take a class with a massage therapist familiar with baby massage. Or try these tips:
Pick a time that’s relaxing for you. The massage won’t have the desired effect if the phone’s
ringing, dinner’s burning on the stove, and you have two loads of laundry going. Choose a time when you’re unhurried and unlikely to be interrupted, and take the phone off the hook or turn off the ringer and let voice mail take a message (a ringing phone—even one answered by machine—is distracting).
Pick a time that’s relaxing for baby. Don’t massage baby when he’s hungry or full. Right after a bath is a perfect time, when baby has already started to relax (unless he hates the bath and it leaves him riled). Before playtime is another possibility, since babies have been shown to be more focused and attentive after a massage.
Set a relaxing scene. The room you select for the massage should be quiet and warm, at least 75°F (since baby will be undressed except for a diaper). Dim the lights to reduce stimulation and enhance relaxation, and add soft music if you like. You can sit on the floor or bed, and lay baby on your lap or between your open legs; use a towel, blanket, or a pillow covered by a towel or blanket under baby.
Lubricate, if you like. You can give your baby a dry rub, or use a little baby oil, vegetable oil, or baby lotion (but not on baby’s head). Warm the oil or lotion a little between your hands before you start rubbing.
Experiment with techniques. In general, babies prefer a gentle touch—but not so light that it’s ticklish. Here are a few ideas to get you started:
Gently place both of your hands on either side of your baby’s head and hold for a few seconds.
Then stroke the sides of his face, continuing down the sides of his body to his toes.
Make tiny circles on baby’s head with your fingers. Smooth baby’s forehead by gently pressing both hands from center outward.
Stroke baby’s chest from center outward.
Stroke baby’s tummy from top to bottom using the outer edge of one hand, then the other, in a circular motion. Then, let your fingers do the walking across your baby’s tummy.
Gently roll baby’s arms and legs between your hands or use firmer, deep strokes to “milk” baby’s arms and legs. Open those curled-up hands and massage those little fingers.
Rub baby’s legs up and down, alternating hands. When you get down to the feet, massage them, uncurling and stroking baby’s toes.
Turn baby on his tummy, and stroke his back from side to side, then up and down.
While you work, talk or sing softly. Always keep one hand on baby.
Take your cues from baby. He will tell you whether you’re rubbing him the right way or not. He’ll also tell you when to keep rubbing, and when it’s time to end the massage session.
EXERCISE
“I’ve heard a lot about the importance of exercising your baby. Is it really necessary for me to take my little girl to an exercise class?”
Americans tend to be extremists. Either they’re totally sedentary, getting all their exercise by turning on the TV and reaching for a beer, or they embark on an overly rigorous jogging program that lands them injured in the sports specialist’s office within a week. And either they confine their babies to a stationary life in high chairs, strollers, and play yards, or they rush out and enroll them in exercise classes the moment they can lift their heads, in hopes of creating a fit-for-life infant athlete.
But extremism in the pursuit of good health tends to be ineffective, and is usually doomed to failure. Moderation is a much better goal to aim for, in your lifestyle and your baby’s. So instead of ignoring your baby’s physical development or pushing her beyond her abilities, take the following steps to start her on the road to fitness:
Stimulate body as well as mind. Many parents make an effort to teach their children intellectual matter from the cradle but figure the physical will take care of itself. And, for the most part, it will—
but paying a little extra attention to it will remind both you and your baby of its importance. Try to spend some part of your playtime with your baby in physical activity. At this stage, it may be nothing more than pulling her to a sitting position (or a standing one, when she’s ready), gently raising her hands over her head, “bicycling” her legs by bending her knees up to meet her elbows in a rhythmic way, or holding her up in the air with your hands around her middle, making her flex her arms and legs.
Make the physical fun. You want her to feel good about her body and about physical activity, so be sure she enjoys these little sessions—and certainly don’t be serious about them yourself. Talk or sing to her and tell her what you’re doing. She’ll come to identify little rhythmic ditties (such as “Exercise, exercise, how I love my exercise”) with the fun of physical activity.
Don’t fence her in. A baby who’s always strapped safely into a stroller or an infant seat or snuggled into a baby carrier, without opportunity for physical explorations, is well on her way to becoming a sedentary—and a physically unfit—child. Even an infant who’s too little to crawl can benefit from the freedom to move that a blanket on the floor or the center of a large bed (with constant supervision, of course) can offer. On their backs in such a position, many three- and four-month-olds will spend great stretches of time attempting to turn over (help them practice by slowly turning them over and back again). On their bellies, many will inch around, exploring with their hands and mouths, pushing their bottoms up in the air, raising their heads and shoulders. All of this activity naturally exercises tiny
arms and legs—and is impossible to duplicate in a confined space.
Keep it informal. Exercise classes or taped programs for infants are not necessary for good physical development, and if they’re the wrong kind or are used in the wrong way, they can be detrimental.
Babies, given the opportunity, naturally get all the exercise they need. That said, such activities can be fun for both of you—an opportunity to play and interact with other parents and other babies, and to try things you might not be able to try at home. If you do choose to take your baby to an exercise
program, check the program first for the following:
Do teachers have good credentials? Is it safe? Ask your baby’s doctor for an evaluation before you sign up. Also observe. Any program that encourages exercises that jostle or shake babies is a dangerous one (see page 272). Beware, too, of classes that are high-pressure, rather than fun, encouraging competition instead of individual growth.
Do babies seem to be having fun? If an infant isn’t smiling or laughing while exercising, she isn’t enjoying it. Beware especially if the babies seem confused or frightened, or pressured to do things that make them uncomfortable.
Is there plenty of age-appropriate equipment for your baby to play with—for instance, at this age, brightly colored mats, inclines to creep up, balls to roll, toys to shake?
Are babies given plenty of opportunity for free play—explorations made on their own and with you? Most of the class should be devoted to this, rather than structured group activities.
Is music an integral part of the program? Babies like music and rhythmic activities, such as rocking and singing, and the two go together well in an exercise program.
Let baby set her pace. Pushing a baby to exercise, or to do anything else she isn’t ready for or in the mood for, can set up very negative attitudes. Begin exercise with your baby only when she seems receptive, and stop when she tells you, by her indifference or fussiness, that she’s had enough.
Keep her energized. Good nutrition is as important to your baby’s good physical development as exercise. Once solids are introduced (with the doctor’s permission, of course), start her on the First- Year Diet (see page 316) so that she has the energy needed for fun and games and the nutrients for optimal development.
Don’t be an unfit parent. Teach by example; the family that exercises together stays fit together. If your child grows up watching you walking half a mile to the market instead of driving, doing daily aerobics in front of the TV instead of munching chips, swimming laps in the pool instead of
sunbathing alongside it, she’s more likely to enter adulthood with good feelings about fitness that she can pass on to her own offspring.
What It’s Important to Know: PLAYTHINGS FOR BABY
Walking into a toy store is like walking into a carnival in full swing. With every aisle vying for attention with its selection of eye-catching wares, bombarding the senses and sensibilities with an endless array of colorful boxes and displays, it’s hard to know where to start. And though such trips
can bring out the child in any adult, for parents several responsibilities come along with the joys of choosing toys.
To make sure you don’t succumb to the prettiest packages and the most alluring gimmicks the toy industry has to offer, and end up with a vast collection of the wrong toys for your baby, consider these questions when contemplating a purchase—or when deciding whether to keep out, shelve, or return to the store playthings that have come as gifts:
Is it age-appropriate? The most obvious reason for making sure a toy you purchase is age- appropriate is so that your baby will appreciate it and enjoy it fully now. A less apparent reason, though, is just as important. Even an advanced baby who might be interested in a toy that’s classified as appropriate for older children, and who might even manage to play with it on a primitive level, could be harmed by it, since age-appropriateness also takes safety into consideration. Giving your baby toys before he or she is ready for them has another disadvantage, as well; it’s possible that by the time baby is ready for them, he or she will also be bored by them.
How can you tell if a toy is appropriate for your baby? One way is the age range listed on the packaging, though your baby may be able to appreciate a particular toy a little earlier or a little later than average. Another is to observe your child with the toy—if you have the toy already or can try it out at a friend’s house or the store. Is he or she interested in it? Does he or she play with it the way it’s meant to be played with? The right toy will help your baby to perfect skills already learned or promote the development of new ones just about to be tackled. It will be neither too easy (which encourages boredom) nor too difficult (which promotes frustration).
For a baby, playtime is learning time. A game of peekaboo will elicit delighted giggles from a three- or four-month-old, and it will help teach the important lesson of object permanence: When mommy hides her face behind her hands, she’s still there.