tag:blogger.com,1999:blog-29693991110314676102024-02-18T21:28:17.898-05:00The Way is PlayHow do we help children reach their potential? The way is play! <br><br>When kids play, their neural pathways open up <br>and learning takes place. This blog is a place to discover <br>and share fun ways to enhance your child's development.<br><br>Your author and host is pediatric occupational therapist, <br>Joan Warren.
Joan Warrenhttp://www.blogger.com/profile/16976285305117110189noreply@blogger.comBlogger4125tag:blogger.com,1999:blog-2969399111031467610.post-20681125318363503892023-10-12T13:04:00.005-04:002023-10-12T13:04:53.084-04:00Playing for Milestones at 3 MonthsNow that baby is starting to master bottle feeding, sleeping, and eye gaze, many parents start to wonder about the next milestones. In this post, we'll discuss those milestones and cover some FUN ways to help baby achieve them.<br />
<br />At three months, babies average 14 to 17 hours of sleep daily! Some may sleep up to seven hours at night, and nap two to three times a day. They typically eat every two to four hours, some lasting longer at night. Here's a quick list of what else baby may do at this age: <br /><br /><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div style="text-align: left;">Bring hands to mouth</div><div style="text-align: left;">Turn in direction of a sound</div><div style="text-align: left;">LOL. Yes, baby may surprise you by laughing out loud. Can you resist laughing back? So ADORBS.</div><div style="text-align: left;">
Roll from tummy to back (usually by surprise)</div><div style="text-align: left;">
Lift head 90 degrees while laying on tummy</div><div style="text-align: left;">
Start stringing together vowel sounds -- Ahhhh, Oooo!</div><div style="text-align: left;">Grasp presented toys that are easy to hold on to </div></blockquote><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div style="text-align: left;">Enjoy looking at pictures as you turn pages to read to baby (If baby can stay awake!) </div></blockquote><p> </p><blockquote style="border: none; margin: 0px 0px 0px 40px; padding: 0px; text-align: left;"><div style="text-align: left;"><table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVe9MvgMaN44T0ErwAjiT8mnjV-T1xtIQDXRMFX_R8il19_rPzqTbpnp9G1MgMvqiD6-DAqD4jNYH7COOT3pvkijKUhUk_PDBGN4DnADVCHs84PJh50MIVBrBK67BEdSXnMwEYfizxJyL9FVD0DdW_ioNYnzfE843kYvFqP1o81NuRBOa1zhrBPx_2pJ8Q/s1500/tummy%20time%20asleep%20reader%20baby.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="900" data-original-width="1500" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjVe9MvgMaN44T0ErwAjiT8mnjV-T1xtIQDXRMFX_R8il19_rPzqTbpnp9G1MgMvqiD6-DAqD4jNYH7COOT3pvkijKUhUk_PDBGN4DnADVCHs84PJh50MIVBrBK67BEdSXnMwEYfizxJyL9FVD0DdW_ioNYnzfE843kYvFqP1o81NuRBOa1zhrBPx_2pJ8Q/s320/tummy%20time%20asleep%20reader%20baby.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Canva.com</span></td></tr></tbody></table><br /></div></blockquote><br /><div><br /></div><div><br />
<br />And how can you help baby at this stage?</div><div><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: right;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhK8geE4BwuUsyPUA5tZrI2G8PV3x8ixGoGUIFZpHC6EDLpqPRa-mDAhslv21XhqOjTXbwdLlizuEDU_KuEcXJ5jQ3Gz5-yR8S17x9mtuzFgxczXJ4-3J1hjk-vlLzE0uT5nO87WxBSc_6gR9oqkxmgR8XkuG7PTJ30EUOhxlmJLPll4ntNNVHseW3AIAPI/s1500/baby%20hugs.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="900" data-original-width="1500" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhK8geE4BwuUsyPUA5tZrI2G8PV3x8ixGoGUIFZpHC6EDLpqPRa-mDAhslv21XhqOjTXbwdLlizuEDU_KuEcXJ5jQ3Gz5-yR8S17x9mtuzFgxczXJ4-3J1hjk-vlLzE0uT5nO87WxBSc_6gR9oqkxmgR8XkuG7PTJ30EUOhxlmJLPll4ntNNVHseW3AIAPI/s320/baby%20hugs.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Canva.com</span></td></tr></tbody></table><br /><ul style="text-align: left;"><li>
Hugs! Studies show that hugs help with cognitive development, so give baby all the hugs!</li><li>Provide play times with baby gyms, mats, and sensory toys (music, lights, voice, movement) that respond to baby's touch and movement</li><li>
Sing songs to baby, using different voice tones, and give some fun surprise endings</li><li>
Raspberries (not to eat, but you know, blowing those vibrating lips on baby's hands, cheeks, neck, tummy. . . it's a tickle and a kiss all in one)</li><li>Help baby clap hands, especially to a song or rhyme</li><li>
Take baby outside to see new things</li><li>Tummy time, help baby reach for toy from prone position</li><li>Lay baby on a play mat to reach for items and to kick freely or at an object/toy</li><li>Provide a child safe mirror for baby to see him/herself</li><li>Provide mobile or other interesting item for where you lay baby (swing, crib, mat on floor) </li><li>Entice baby to interest in the things you've provided and play together</li></ul></div><br /><div><table cellpadding="0" cellspacing="0" class="tr-caption-container" style="float: left;"><tbody><tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuj1HZMWwS1V6PPWteJQr84yZ0IAg4tWEBpLhecrhSi2kkEdrnYIwGTm4PSOUWXdIHRmkYRU-Q-dUdGjmTeDUdDv6OXKU__79UvwNdHjm1E2RtE6dgbp9pDgRCcWwZ1YPSNm67LExfllChs3yqnJ4ju8Z9M378d_qCuEEQOCbnqXA4L6vXQZj5rGixIKD6/s1500/head%20up%20peeka%20boo.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><img border="0" data-original-height="900" data-original-width="1500" height="192" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhuj1HZMWwS1V6PPWteJQr84yZ0IAg4tWEBpLhecrhSi2kkEdrnYIwGTm4PSOUWXdIHRmkYRU-Q-dUdGjmTeDUdDv6OXKU__79UvwNdHjm1E2RtE6dgbp9pDgRCcWwZ1YPSNm67LExfllChs3yqnJ4ju8Z9M378d_qCuEEQOCbnqXA4L6vXQZj5rGixIKD6/s320/head%20up%20peeka%20boo.jpg" width="320" /></a></td></tr><tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Canva.com</span></td></tr></tbody></table><br />
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<br /></div><br />Joan Warrenhttp://www.blogger.com/profile/16976285305117110189noreply@blogger.com0tag:blogger.com,1999:blog-2969399111031467610.post-45952749694004502582019-10-18T15:43:00.001-04:002019-10-18T15:43:45.209-04:00FEEDING FRENZY!<br />
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<span style="font-size: large;">It's simple to us. We feel hungry. We grab a bite and eat it. </span><br />
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<span style="font-size: large;">We may take it for granted, but for a newborn, eating is a huge accomplishment! </span><br />
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<span style="font-size: large;">We see it happen so naturally in newborns, it seems simple. Newborn puppies find their mama’s teat before they can open their eyes, latch on and feed instinctively. Newborn humans typically need to be fed within the first hour of birth. Off they go, it's a </span><br />
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<span style="font-size: large;"><span style="color: blue;"><b><i>FEEDING FRENZY! </i></b></span></span></div>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjU7vIaMjp63IHgKQo3_IJQMEhXXA_ko7x5jmh4YIzd2bM6TVICnDALqzq09a24BBvSuHBYjvB2ps0AnXIrrMPJXQN2rSdSg2tFMvOe_sI_SyZN21CX-SV1Io7TOP_75FAxcoLh-1JqNwyW/s1600/Feed+me+mommy.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="1024" data-original-width="683" height="640" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjU7vIaMjp63IHgKQo3_IJQMEhXXA_ko7x5jmh4YIzd2bM6TVICnDALqzq09a24BBvSuHBYjvB2ps0AnXIrrMPJXQN2rSdSg2tFMvOe_sI_SyZN21CX-SV1Io7TOP_75FAxcoLh-1JqNwyW/s640/Feed+me+mommy.jpg" width="425" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">Thanks to www.creativecommons.org</span></td></tr>
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<span style="color: #38761d; font-size: large;"><b><i>If you're lucky, all will go well with those mealtimes. You'll be looking for ways to make meaningful, bonding, quality times. Here are some suggestions to support fun during these mealtime frenzies:</i></b></span></h3>
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<li><span style="font-size: large;"><span style="color: blue;">Set the feeding area up for comfort! </span>Bring a pillow or two nearby in case you need a quick adjustment. Don’t forget the remote control, a drink and perhaps a snack for yourself. Create a place you can prop your feet up.</span></li>
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<li><span style="font-size: large;"><span style="color: blue;">Set the mood with appropriate lighting and sound.</span> Music is preferable to television, as it frees you to watch baby and respond to her signs during the meal. However, this is not the time to play blaring rap or heavy metal music. Music with a <a href="https://journals.sagepub.com/doi/abs/10.1177/025576149803100101" target="_blank">steady rhythm is shown to be calming</a>, whereas irregular rhythm (like jazz) stimulates the nervous system. If you do watch television, <a href="https://www.sciencedirect.com/science/article/pii/S0193397307001281" target="_blank">be aware of what you’re watching while feeding your baby</a>. If the show is suspenseful (yes, baby feels your body tension) or even just too loud, baby won’t be able to maintain the right alertness level. Perhaps you think baby sleeps through these loud or scary shows, so it doesn’t matter. Newborns will fall asleep if they are OVER-AROUSED as easily <span style="mso-spacerun: yes;"> </span>as if they are tired. You don’t want to over-arouse baby, and you don’t want to put baby to sleep during mealtime. Adjust the environment to find the just-right stimulation that supports baby’s ability to calmly complete mealtime.</span></li>
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<li><span style="font-size: large;"><span style="color: blue;">If you’re inclined to hum or sing, go ahead! </span>Mealtime is a good time to do the things that support your happiness and help baby feel happy, too. Watch baby’s body and face for signs of contentment. Enjoy them together. A recent scientific study found that mother's voice helps normalize (ie., modulate) baby's arousal state. If baby's stressed, it calms. If baby's too groggy, it alerts. Find this study <a href="https://journals.sagepub.com/doi/abs/10.1177/03057356030314002" target="_blank">here</a>.</span></li>
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<li><span style="font-size: large;"><span style="color: blue;">Interact with eye contact and facial expression as suits the two of you.</span> At first, newborns cannot establish eye to eye gaze, but they may try to focus on your face briefly. This develops readily in the first couple of months, so it won’t be long until baby wants to engage with you eye to eye. These times can really touch your heart. Smiles start to be shared, as do other facial expressions, even during feeding. These back and forth playful exchanges of love and contentment are super-healthy—for both of you! If you're uncomfortable with eye contact, now is the time to get some practice for yourself! Baby won't judge you, so go ahead and give it a try. </span></li>
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<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFsE8pjjpI56Mi9uU4buXeaqbsfHxXgd4Hc6TZkOjtPw3rUqxT5KVmSlP7X8K2tux-qbtfOd8b7DpVKI9nLMsdUXMw914US4mSb4V6b_NK7v2KV4r_Hv7QbiB9gbwNbW_zeURaFf8iHT0e/s1600/baby+eye+gaze+feeding.jpg" imageanchor="1" style="clear: left; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="685" data-original-width="1023" height="214" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFsE8pjjpI56Mi9uU4buXeaqbsfHxXgd4Hc6TZkOjtPw3rUqxT5KVmSlP7X8K2tux-qbtfOd8b7DpVKI9nLMsdUXMw914US4mSb4V6b_NK7v2KV4r_Hv7QbiB9gbwNbW_zeURaFf8iHT0e/s320/baby+eye+gaze+feeding.jpg" width="320" /></span></a></td></tr>
<tr><td class="tr-caption" style="font-size: 12.8px;"><span style="font-size: x-small;">Thanks to www.creativecommons.org<br />Sweet baby gazing time!</span></td></tr>
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<span style="font-size: medium;"><span style="color: red; font-size: x-large;"><b><i>But sometimes things aren't so simple. If you're having any trouble with mealtime, read on. . . </i></b></span></span><br />
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<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHIaBd1umEbywJZKxHxJOK0IsFIdTYwW8H5Ar_2UzUh0rIBjM79Ve0onm_3DCtdm3GGaSJLswx50TtsuU6QPYeQqGw2DWf3K6FEYN1XH14Z43jF94-QmXkL8vDSDYJyhqDGhm_CwG3CcOJ/s1600/baby+cries+tongue+cupped.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><img border="0" data-original-height="407" data-original-width="360" height="320" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgHIaBd1umEbywJZKxHxJOK0IsFIdTYwW8H5Ar_2UzUh0rIBjM79Ve0onm_3DCtdm3GGaSJLswx50TtsuU6QPYeQqGw2DWf3K6FEYN1XH14Z43jF94-QmXkL8vDSDYJyhqDGhm_CwG3CcOJ/s320/baby+cries+tongue+cupped.jpg" width="283" /></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;">Photo courtesy of www.milkmatters.org.uk</td></tr>
</tbody></table>
<span style="font-size: large;"><span style="font-size: large;"></span></span><br />
<a name='more'></a><span style="font-size: large;"><span style="font-size: large;">Babies need plenty of nutrition for all the growing they're doing, so if there's a problem feeding, they need your help. </span>You may be surprised to find that feeding is an extremely complex task, requiring a delicate balance of structure and function on both the feeder and the feedee’s parts. If one small thing goes awry, the whole process can be thrown off, with potentially disastrous results.</span><br />
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<span style="font-size: large;">Think about it. </span></div>
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<span style="font-size: large;">The feeder (usually the mother) must be
equipped with a nutritious and delicious product that is the proper consistency
and temperature. She must have a method to administer this delightful product
that guides it into the baby with an appropriate rate of flow and frequency,
while also providing adequate physical comfort, so both mother and infant can
comfortably sustain the mealtime without fatigue and distress.<o:p></o:p></span></div>
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<span style="font-size: large;">On the infant’s side, baby must be supported in a position
that permits comfort so he can focus on the primary task. He must be able to
coordinate and sustain a rhythmic pattern of sucks and swallows, and breaks to
breathe without any fluid going down “the wrong way,” as we say. The baby’s
internal organs must be strong and mature enough to keep the food where it
should be for proper absorption. <o:p></o:p></span></div>
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<span style="font-size: large;">The swallow process itself is incredibly complex. We take it
for granted—until something out of the norm happens. If you’ve ever experienced
choking or gagging; something “going down the wrong pipe,” then you know what I
mean. Suddenly, nothing else matters! All mealtime activities and conversations
stop until the bolus is cleared and the airway is safe. <o:p></o:p></span></div>
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<span style="color: red; font-size: large;">To safely swallow, the mouth forms a vacuum seal. Lips must
seal tightly, whether against one another or around a straw. . . or, in the
case of a baby, around a nipple. </span></div>
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<span style="font-size: large;">Try taking a sip of water and swallowing it
with your lips NOT sealed. What happens? How does it feel—physically? -emotionally?<o:p></o:p></span></div>
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<span style="font-size: large;">As the lips seal, the bolus must move from the front and
sides of the mouth to the back of the tongue. Yes, right there in the “gag”
area, WITHOUT initiating the gag response. </span></div>
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<span style="font-size: large;">Find that spot. Touch the “gag” area
of your tongue with your finger. It is right in the middle and to the back of
your tongue. It is just before the entry way to the throat. It is there to help
you automatically avoid swallowing things that aren’t meant to be swallowed. It
is also designed to permit safe swallowing when all the pieces of the puzzle
are just right. </span></div>
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<span style="font-size: large;">When the lips seal and the <a href="http://milkmatters.org.uk/2011/04/15/hidden-cause-feeding-problems/" target="_blank">tongue (a muscle that, when evenlyinnervated, shapes and moves properly to guide the bolus) does its job</a>, the
bolus is smoothly pressed to the back and top of the mouth, where that vacuum
seal completes the pushing of the bolus past the mouth and down the hatch. <span style="color: red;">This
action only works if the lips can seal and the tongue can push up against the
roof of the mouth, also known as the palate. </span><o:p></o:p></span></div>
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<span style="font-size: large;">Try it! Take another sip of water and hold it in your mouth.
Now focus on trying to swallow it without letting your tongue touch the roof of
your mouth. Are you able? What did it take? How does it feel trying—physically?
–emotionally?<o:p></o:p></span><br />
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<iframe width="320" height="266" class="YOUTUBE-iframe-video" data-thumbnail-src="https://i.ytimg.com/vi/3Ql8GrGzP5A/0.jpg" src="https://www.youtube.com/embed/3Ql8GrGzP5A?feature=player_embedded" frameborder="0" allowfullscreen></iframe></div>
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<div style="text-align: center;">
<span style="font-family: Arial, Helvetica, sans-serif; font-size: xx-small;">(Here's a video borrowed from YouTube showing a normal infant swallow study)</span></div>
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<span style="font-size: large;">There’s even more that goes into getting the food past the
mouth. <span style="color: red;">There’s hunger and desire to eat. There’s alertness on the part of the
feeder. There’s aroma, taste, temperature, and positioning. </span></span></div>
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<span style="font-size: large;">It’s pretty easy to
imagine how uncomfortable you would be if someone tried to feed you when you
weren’t hungry, or when you were sleeping, or if the food smelled bad (or didn’t
smell at all), <span style="mso-spacerun: yes;"> </span>tasted nasty, or was too
hot or cold. The last one, though—positioning—we tend not to consider. As adults, we sit up to eat. If we can’t sit up, we at least need to tilt our head
up enough to safely swallow. This position allows our oral structures to overpower
gravity so we can properly control and guide the bolus to the back of the mouth
without overdoing the amount or eliciting a gag response. <o:p></o:p></span></div>
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<span style="font-size: large;">Infants have a d<a href="https://dysphagiacafe.com/2015/09/03/newborn-and-early-mouth-throat-development-feeding-swallowing/" target="_blank">ifferently shaped palate</a>. Actually, there are many things different about a newborn's oral structure, but we'll stick to the basics. The shape of the
roof of their mouth doesn’t permit upright positioning to swallow; not until
they’ve achieved motor control in the upright position. Their head, neck and
torso strength not enough to overcome gravity, they need physical
support during feeding so they can focus on the difficult job of coordinating
lips, tongue and swallow musculature without choking or gagging. The nipple
provides assistance by placing the milk toward the back of the mouth, and its
size lets baby’s lips seal around it with minimal effort. The reclined
position, with head, shoulders and torso supported so the chin can tuck
slightly in, facilitates ease of suck and swallow control. The chin tuck
position is still important as adults. <o:p></o:p></span></div>
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<span style="font-size: large;">Try this: take a sip of water and hold it in your mouth. Try
to swallow with your chin jutted out (pushed forward). Can you do it? Try it with
your head tilted to one side, and to the back. All positions EXCEPT midline
with chin tuck make it very difficult to swallow, right?!?<o:p></o:p></span></div>
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<span style="font-size: large;"><i><span style="color: red;">If abnormalities of muscle tone in the tongue, lips or shape
of the palate exist, professional treatment (ie, physician, and speech
or occupational therapist specializing in feeding) is warranted. </span></i><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: large;">The third part of this “simple” task of feeding is coordinating
the need to breathe while feeding. Did you know that the tube that takes the
food to the stomach is shared (partially) with the airway passage? A junction
with folds and a flap controls which way food, fluid and air can go. It opens to permit air to the lungs and closes to block the airway and let food and liquid pass to the stomach. If there is a malfunction at this junction, permitting
leakage into the lungs, we have aspiration. The lungs are not made for food or
water. They do their best to expel anything wrongly placed there, but even the
tiniest amounts can lead to pneumonia. </span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><span style="color: red;">If baby frequently gags or coughs when
feeding, we must closely attend to all the factors involved rather than ignore or minimize it. </span>Just as conversation at the table stops when someone chokes or gags, so
must mama stop and attend if baby chokes. Change her position to move her upright
and forward. Raise one of her arms. Clap her back as you would when burping
her. Attending to the need can prevent disaster. Frequent choking or coughing
during feeds should alert you to consider changes in baby’s feeding position,
the consistency (ie., viscosity) of the fluid and the flow rate of the nipple.
Slower flow rate and thicker fluid may be all that is needed. If baby’s
coordination of sucks/swallows and breathing seems problematic, provide
external pacing to help baby take a break to breathe. External pacing is simply
pulling the nipple back so baby takes a brief break to swallow and breathe. Click
here to read more on the exact details of this pattern and process. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: large;">Of importance to note is <i>not all babies actively cough when
fluid is aspirated</i>. Some may have what is called “silent aspiration,” but
typically we can notice signs of discomfort when this happens. Baby may squirm,
grimace, and turn away from feeding. Baby’s breathing may sound gurgly or “wet.”
<b>We MUST attend to and respond to these signs as seriously as we would to coughing.</b>
If baby develops <span style="color: red;">pneumonia, this is a huge red flag!</span> Ask your pediatrician for
a swallow study, also known as videofluoroscopy. This is imaging that traces
exactly what happens in all phases of baby’s swallow. It can help determine
exactly what and where the problem lies, and help determine the best course of
action to correct it. Early intervention can save baby’s life, and it can
prevent serious feeding aversion and attachment issues down the line. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: large;">In most cases, the bolus successfully passes this junction
and travels to the stomach, where the body begins to break down food for
nutrients. In some infants, another problem happens here. The muscular junction
at the esophagus and the stomach can be weak, permitting back-flow (along with
some powerfully acidic gastric juices) into the esophagus. The esophagus is not
meant to handle digestive acids. It can become quite irritated by this
back-flow. <span style="color: red;">Signs this is happening may include spitting up, grimacing,
squirming, crying and arching the back during or after eating. Baby may start
turning away from feeding. Often, you’ll notice extra gassiness and general
fussiness. When these signs are noted, a visit to the pediatrician is due. </span></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<table cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjb72MSu85ZUyj0d8uCbvptMIz4tT_9Z1mwHHnXv4aJ6UtM9wxf_ZIahIuBnD-tesHFzNd9N-ErhbYhgcLrQYOaHdwPKSiV4rlAe6lQKsfXnpe74Q2SsTR4NxV4gSKvq6wILM_9OoIyEy3v/s1600/GERD.jpg" imageanchor="1" style="clear: right; margin-bottom: 1em; margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="335" data-original-width="493" height="135" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjb72MSu85ZUyj0d8uCbvptMIz4tT_9Z1mwHHnXv4aJ6UtM9wxf_ZIahIuBnD-tesHFzNd9N-ErhbYhgcLrQYOaHdwPKSiV4rlAe6lQKsfXnpe74Q2SsTR4NxV4gSKvq6wILM_9OoIyEy3v/s200/GERD.jpg" width="200" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Note loosened sphincter permitting gastric juices to splash into the esophagus. Picture from: <a href="https://www.webmd.com/heartburn-gerd/ss/slideshow-heartburn-overview">https://www.webmd.com/heartburn-gerd/ss/slideshow-heartburn-overview</a></span></td></tr>
</tbody></table>
<div class="MsoNormal">
<span style="font-size: large;">If reflux
is the issue, there are several strategies you can implement prior to, or in
addition to, medication. These are often referred to as first line treatment, as medication may have side effects that can be avoided if these strategies help. They include:<o:p></o:p></span></div>
<div class="MsoNormal">
</div>
<ul>
<li><span style="font-size: large;"><span style="color: red;">Position baby more upright during feeds</span> (about 45 degree
angle). This employs gravity to help the fluid stay in the
stomach. Be sure to provide adequate head, neck, shoulder and torso support so
that swallowing is still supported.</span></li>
<li><span style="font-size: large;"><span style="color: red;">Interrupt feeding every 1.5-2 ounces to facilitate burping</span>.
Place baby prone on your chest and shoulder rather than sitting forward on your
lap. Burping with baby sitting places more pressure on the organs which can
push fluid out of the stomach. Burping with baby laying on your chest and
shoulder with her body straighter helps keep the fluid in the stomach. </span></li>
<li><span style="font-size: large;"><span style="color: red;">Try a slower flow nipple</span>. <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5033656/" target="_blank">See here</a> for a chart of real-life flow
rates for various brands. Slowing the flow and taking frequent
breaks can help by giving more time for the stomach to process what it has so
it doesn’t get backed up.</span></li>
<li><span style="font-size: large;"><span style="color: red;">Try anti-gas bottle feeders</span>, such as <a href="https://www.drbrownsbaby.com/reduce-colic-dr-browns/" target="_blank">Dr. Brown’s,</a> which keep
gas from getting into the fluid as baby feeds. Be sure to read and follow the
instructions that come with the bottle. Don’t shake a bottle prior to feeding. This
adds gas bubbles to the fluid. Swirl or gently stir instead.</span></li>
<li><span style="font-size: large;"><span style="color: red;">Try <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485971/" target="_blank">thicker formula</a> or a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4671396/" target="_blank">thickening agent </a>approved for
infant use.</span> Be sure to only thicken slightly. This is best done with doctor’s
advice, and with a feeding therapist’s close supervision as you establish the
best viscosity. Thickeners like rice cereal can be dangerous because they can
clump and cause baby to gag or choke on clumps. Only use this if your doctor recommends it, and even then watch very closely for signs of gagging (in the mouth) or choking (in the "tube."</span></li>
<li><span style="font-size: large;"><span style="color: red;">HOLD baby upright for 30 minutes
after meals</span>. Laying on your chest position is optimal, according to <a href="https://www.aappublications.org/news/2019/06/04/reflux060419" target="_blank">recent research</a>, following the recall of supine-incline infant sleepers. If baby must lay down, lying
on his <a href="https://www.slideshare.net/TauhidBhuiyan1/gastroesophageal-reflux-in-preterm-neonate" target="_blank">left side</a> after meals is preferable to the right. This is due to the
angle of the structures; when lying on the left, food is more likely to stay in
the stomach rather than being forced out.</span></li>
</ul>
<table align="center" cellpadding="0" cellspacing="0" class="tr-caption-container" style="margin-left: auto; margin-right: auto; text-align: center;"><tbody>
<tr><td style="text-align: center;"><a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiMw5SMF0tdOjy0EU9K14_aDCKcLsTbBpDotGpepJFUM8GNl7Rc37HDa0Bfi0y3ONWcUl_KIZeWH88t-AGBN-PP9w5s5fe1YqxmqczEzSg3eALbsHlXO3tOioqg0rOURtyN5aIpnhjN16D/s1600/gastroesophageal-reflux-in-preterm-neonate-18-638.jpg" imageanchor="1" style="margin-left: auto; margin-right: auto;"><span style="font-size: large;"><img border="0" data-original-height="479" data-original-width="638" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEiiMw5SMF0tdOjy0EU9K14_aDCKcLsTbBpDotGpepJFUM8GNl7Rc37HDa0Bfi0y3ONWcUl_KIZeWH88t-AGBN-PP9w5s5fe1YqxmqczEzSg3eALbsHlXO3tOioqg0rOURtyN5aIpnhjN16D/s320/gastroesophageal-reflux-in-preterm-neonate-18-638.jpg" width="320" /></span></a></td></tr>
<tr><td class="tr-caption" style="text-align: center;"><span style="font-size: xx-small;">Note in chart pictured, how fewer episodes occur in the left side position. This is from research found at this site: <a href="https://www.slideshare.net/TauhidBhuiyan1/gastroesophageal-reflux-in-preterm-neonate">https://www.slideshare.net/TauhidBhuiyan1/gastroesophageal-reflux-in-preterm-neonate</a></span></td></tr>
</tbody></table>
<span style="font-size: large;"><o:p></o:p></span><br />
<div class="MsoNormal">
<span style="font-size: large;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: large;">If all of these are not enough to resolve the issue, consult
with the pediatrician again. She may suggest drops to decrease gas, and may suggest a
course of prescription medication. It is important to attend to these needs as
chronic inflammation of the esophagus presents medical complications and can also
lead to feeding aversions and attachment issues. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span></div>
<div class="MsoNormal">
<span style="font-size: large;">Now, with all these bases covered, <b><i>feeding can progress as a
happy, fun time.</i></b> Bonding and attachment occur during these precious routines
between caregivers and baby. Baby learns she can feel secure and loved because
caregivers respond to her needs and help her thrive. With the suck, swallow,
breathe pattern established and with food staying down, <span style="mso-spacerun: yes;"> </span>mealtimes can be times for watching and listening
to mommy and daddy, learning to gaze into your eyes, and exchanging love and
trust. <o:p></o:p></span></div>
<div class="MsoNormal">
<span style="font-size: large;"><br /></span>
<span style="color: red; font-size: x-small;"><b>References for the above are blended into the text. If you see a different color text, except for red and green which are used to highlight, you should be able to click on it to the source or further reading. Most photos also have clickable links to their source for more information.</b></span></div>
<h3>
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<br />Joan Warrenhttp://www.blogger.com/profile/16976285305117110189noreply@blogger.com0tag:blogger.com,1999:blog-2969399111031467610.post-56098319336483480942019-09-15T13:28:00.001-04:002019-09-15T13:28:20.810-04:00Playing with Baby Builds Strong ConnectionsHow do you play with a tiny infant? Is it important?<br />
<br />
Many people seem to think that all tiny babies do is eat, sleep and decorate their diapers! Though this is much of what we observe, another important milestone forms in early infancy:<br />
<br />
<div style="text-align: center;">
<b><span style="color: blue; font-family: Courier New, Courier, monospace; font-size: x-large;">ATTACHMENT</span></b></div>
<br />
Healthy attachment between parents, caregivers and baby <b><i>directly correlates</i></b> to the child's social and emotional development later in life--according to many experts in the Infant Mental Health (IMH) field.*<br />
<br />
But how does attachment happen? Fortunately, most of it comes naturally with parental instinct! Our nurture instincts lead us to create a place of safety, warmth and comfort for baby. We're naturally wired to respond to baby's signals when she needs feeding, changing, or rest. Yet many new parents wonder how to connect with baby, especially when baby doesn't yet maintain good eye contact, smile or return facial expressions. So, here we will mention again--<br />
<br />
<div style="text-align: center;">
<span style="color: red; font-family: Courier New, Courier, monospace; font-size: x-large;"><b>THE WAY IS PLAY!</b></span></div>
<br />
Here are a couple of suggestions for playful interactions and strategies that help build attachment (and thereby, good learning and development) for infants.<br />
<br />
<h2 style="text-align: center;">
<b><span style="color: magenta;">Look, Look Away</span></b></h2>
<div style="text-align: center;">
<br /></div>
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrp2lxiogtPL9dGFnT5SQ0avIilo79xhFiGVdOi4WL99MODYcz2mvDZwI0ql1RZhYKSAMeFHfcV645TGHMofzWw-eG5xvKBA2DsAMqYjX70X3c4hy6d7ZYiz21Z-OcIxyYPwjP43tqizDo/s1600/baby+gazing.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="195" data-original-width="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhrp2lxiogtPL9dGFnT5SQ0avIilo79xhFiGVdOi4WL99MODYcz2mvDZwI0ql1RZhYKSAMeFHfcV645TGHMofzWw-eG5xvKBA2DsAMqYjX70X3c4hy6d7ZYiz21Z-OcIxyYPwjP43tqizDo/s1600/baby+gazing.jpg" /></a></div>
<br />
<h2>
<span style="font-size: small;">This game is a pre-cursor to Peek-a-boo. Here's how to play:</span></h2>
<br />
<ol>
<li>Before baby can maintain eye gaze or track you around the room, watch for times when she seems to be in a <span style="color: purple;"><a href="https://www.healthychildren.org/English/ages-stages/baby/Pages/States-of-Consciousness-in-Newborns.aspx" target="_blank">quiet-alert state</a></span>. </li>
<li>Bring your face closer to hers until she seems to gaze at you. She may not discern your eyes for eye-to-eye contact, but that's okay. </li>
<li>Smile and speak comfortingly about anything that comes to mind (hopefully positive things like, "Hi Sweetheart, I'm so glad to see you!" or "Here's Mama (Dada, Nana, whichever), I'm right here. . . I'm here for you."). </li>
<li>Then move your head from baby's midline slightly off to one side, then to the other. This slight movement helps baby begin to recognize that she can track you in her visual field by moving her head to maintain contact. </li>
<li>Watch all along for baby diverting her gaze. When she looks away, you look away. Pull your face back a bit to give her a rest. </li>
<li>When she looks back toward you, move in again to play the game again.</li>
<li>Play this game with her in short spurts throughout each day. As she improves her focus and tracking skills, you'll notice she also improves her tracking skills and begins to imitate some of your facial gestures!</li>
</ol>
<div style="text-align: center;">
<span style="color: blue; font-size: large;"><b>Heads Up!</b></span></div>
<div style="text-align: center;">
<span style="color: blue; font-size: large;"><br /></span></div>
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtPV33kULPdWqWIg1LDCSjgJ5rbhGq0Ax0Mzr-rP6CGt9lvmp77gKAOJur5GmWe865Mkg_1y9rbHQXy5Fd9rFxSYuqgJyldhzGPaiQToYvFGL5O1beQjK7Ge5GcjU8Yp-36rI-vgfQ5riQ/s1600/baby+held+on+shoulder+head+up.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="768" data-original-width="1024" height="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEhtPV33kULPdWqWIg1LDCSjgJ5rbhGq0Ax0Mzr-rP6CGt9lvmp77gKAOJur5GmWe865Mkg_1y9rbHQXy5Fd9rFxSYuqgJyldhzGPaiQToYvFGL5O1beQjK7Ge5GcjU8Yp-36rI-vgfQ5riQ/s320/baby+held+on+shoulder+head+up.jpg" width="320" /></a></div>
<br />
<br />
<div>
This game helps strengthen attachment between you and baby, as well as strengthen baby's head control. Here's how to play:<br />
<br />
<ol>
<li>Before baby can hold his head up, provide him with head support in all positions and transitions. </li>
<li>When baby is in that calm-alert state, hold baby with his head on your shoulder but fully able to rest against your shoulder in an upright or slightly reclined position.</li>
<li>Sit or stand up so that you're not resting back against the chair, and gently bounce baby up and down (while still secure in your arms against you) about 3-10 times (depending on baby's response). You want the bounces to be small and quick. This movement stimulates baby's muscles to activate.</li>
<li>Observe for baby's response of starting to hold his own head more erect for a second or so. You may say, "Heads Up!" or "Time for Head Up!"</li>
<li>Rest and praise baby for being so strong. </li>
<li>Repeat a few times throughout each day.</li>
<li>As baby strengthens head control, be sure to only very gradually reduce your support for his head. Respecting his gradual changes and adjusting your level of stimulation, challenge and rest times builds both strength and attachment.</li>
</ol>
<br />
<br />
As baby grows he'll be ready to lift his head to turn it from side to side while on his belly, and then eventually to raise his head, propped on his forearms while laying on his belly. To promote this, you can play the same game but with baby laying on his belly on the bed, crosswise, and you kneeling on the floor right next to him, so your faces are level when he lifts his head to look at you!<br />
<br />
<div class="separator" style="clear: both; text-align: center;">
<a href="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFVjsh3JiAIW_NBmAOIx1cPoRUSd1IXyvcxcQgdLU-uNrb7smYAQcRgC-HkpUf0T5OTMpQJY6caPqY45Z7xV2wB6LaTU7e7klkjgvTPxulPpZk6ncEdq-8zAeEdjcqmztjNYft9rxdcygw/s1600/Baby+prone+head+up.jpg" imageanchor="1" style="margin-left: 1em; margin-right: 1em;"><img border="0" data-original-height="160" data-original-width="240" src="https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEjFVjsh3JiAIW_NBmAOIx1cPoRUSd1IXyvcxcQgdLU-uNrb7smYAQcRgC-HkpUf0T5OTMpQJY6caPqY45Z7xV2wB6LaTU7e7klkjgvTPxulPpZk6ncEdq-8zAeEdjcqmztjNYft9rxdcygw/s1600/Baby+prone+head+up.jpg" /></a></div>
<br /></div>
<br />
<span style="color: magenta; font-size: large;">Have you found a way to interact in a playful, fun manner with your newborn? Please share!</span><br />
<span style="color: magenta; font-size: large;"><br /></span>
<span style="color: blue;">NOW IT'S YOUR TURN--PLEASE COMMENT BELOW TO SHARE YOUR EXPERIENCES, SUGGESTIONS, QUESTIONS, ETC. </span><br />
<br />
*Links to sources for this assumption follow:<br />
<br />
<a href="https://doi.org/10.1002/1097-0355(200011/12)21:6%3C428::AID-IMHJ2%3E3.0.CO;2-B">https://doi.org/10.1002/1097-0355(200011/12)21:6<428::AID-IMHJ2>3.0.CO;2-B</a><br />
<br />
<a href="https://www.nichd.nih.gov/sites/default/files/publications/pubs/documents/seccyd_06.pdf">https://www.nichd.nih.gov/sites/default/files/publications/pubs/documents/seccyd_06.pdf</a><br />
<br />
<a href="file:///C:/Users/Owner/Documents/Writing%20OT%20Pediatrics/ZeanahCP-Thescopeofinfantmentalhealth.pdf">file:///C:/Users/Owner/Documents/Writing%20OT%20Pediatrics/ZeanahCP-Thescopeofinfantmentalhealth.pdf</a><br />
<br />
All photos today are courtesy of <a href="https://creativecommons.org/" target="_blank">creative commons</a>!<br />
<br />
<br />Joan Warrenhttp://www.blogger.com/profile/16976285305117110189noreply@blogger.com0tag:blogger.com,1999:blog-2969399111031467610.post-43885713910749833082019-09-11T18:15:00.002-04:002019-09-11T18:16:03.737-04:00Playing from the Start<h3>
<b>It's true--when kids play, they learn. </b></h3>
Think peek-a-boo, when infants start to learn that people exist even though gone from view. Think building blocks, where little ones begin some basic physics lessons on their own. Skip forward to the Alphabet Song, in which the fun of singing a rhyme makes all the difference in memorizing a sequence of 26 letters. These are just a few examples of the countless ways play is the way a child learns.<br />
<br />
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This blog is dedicated to sharing various ideas and resources to help us (the grown-ups) facilitate play as we teach our children.<br />
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But first, <span style="color: red;">a word of caution.</span> For play to truly be play, <b><span style="color: magenta;">it must be voluntary</span></b> to the child. Intrinsic motivation to play is essential. If we overly construct play, or impose it as mandatory, we lose the therapeutic nature of play. As adults, we can present playful activities and ideas. We can playfully invite, begin and even demonstrate activities. Ultimately, the child has the choice: to engage or not. The child may engage and then change our playful plans. We must sometimes abandon plan A, plan B, and even plan C, and simply follow the child's lead. These become opportunities for the child to teach us. When this happens, it's the <span style="color: blue;"><i><b>best connection of all.</b></i></span><br />
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So, with the basic framework laid, let's get started!<br />
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We'll begin in a natural place: <b>at the beginning</b><i>.</i> 👶This first section of posts will feature playful ideas and strategies to enjoy with baby even while in the womb or newborn. Here goes!<br />
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1. <span style="color: magenta;">READ WITH BABY</span><br />
Won't you feel silly reading baby books to your baby while she's still inside you! Imagine that. You're sitting alone on a bench at the park, reading aloud to yourself, using your finest melodic tone of voice. They'll think you've gone batty! Who cares? Read with gusto, emotion and energy. Relish each word, each sensory experience and joy. Your baby is learning! The secret benefit--you'll feel better, too.<br />
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2. <span style="color: blue;">FINGERS AND TOES, EYES AND NOSE</span><br />
We know babies need swaddling. We know they need holding, feeding, and changing. We know they need us to interpret their stress signs so they get enough rest and time to adjust. When all the essentials are covered, they need play! This play activity helps baby develop body awareness, and supports auditory and tactile processing. You can do this activity while holding baby or when baby lays on the changing table, or even while you sit in front of baby and baby's resting in his cushion or infant seat.<br />
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Simply engage with baby, smiling and talking in your special style. Playfully teach baby the names of his basic body parts while you touch, tap or gently massage them. Risk being sing-song with your voice, perhaps singing the "<a href="https://kids.niehs.nih.gov/games/songs/childrens/head-shoulders/index.htm" target="_blank">Head, Shoulders, Knees and Toes</a>" song, but adjusted to baby's tolerance level for volume, rate and tone. Then swaddle him back up and give him a gentle squeeze while you rock him, perhaps continuing to hum the song for a bit.<br />
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The link for the above song takes you to an amazing resource you'll want to explore, from the National Institute of Environmental Health Sciences. Here's their main page:<br />
<a href="https://kids.niehs.nih.gov/" target="_blank">Kids Environment Kids Health</a><br />
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<span style="color: red;">NOW IT'S YOUR TURN! </span>In the comments section, please share your experiences, links and resources so we'll have plenty of learning play ideas for infancy. Remember to like and follow the blog, and share it with others! Together, we'll fill the world with happy, well-loved children, who grow into happy, well-adjusted adults. We can make a difference in the future, and <i style="text-align: center;"><span style="color: red;">THE WAY IS PLAY!</span></i><br />
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<br />Joan Warrenhttp://www.blogger.com/profile/16976285305117110189noreply@blogger.com0