WHAT EVERY MOTHER SHOULD KNOW

Was my baby healthy at birth?
“Dear Mom, you brought me into this new land, don’t you want to know how I’m feeling?” this is what the newborn baby seems to be saying imploringly.
Sure, the new mother should be abreast of her baby’s condition:
• What’s his birth weight?
• Is he premature?
• Did he cry after birth?
• Is he feeding properly?
• Is he sick?
• Does he have any abnormality?
• Does he need any special treatment?
During the baby’s stay in the hospital it is preferred that the mother be constantly involved in the baby care. This early mother-child bonding is the 1st step of early intervention to support normal development.

Is my child developing normally?
This is a question that comes to every mother’s mind as she fondly cradles her baby. But unfortunately, very few have a clear concept of the developmental milestones and we professionals fail to provide the required information to them.
In an attempt to make up for this shortfall, I put forth here a simple list of achievements of your little master, for you mothers to go through:
At three months of age, most babies:
• turn their heads toward bright colors and lights
• move both eyes in the same direction together
• respond to their mother's voice
• make cooing sounds
• bring their hands together
• wiggle and kick with arms and legs
• lift head when on stomach
• become quiet in response to sound, especially to speech
• smile
At six months of age, most babies:
• follow moving objects with their eyes
• turn toward the source of normal sound
• reach for objects and pick them up
• switch toys from one hand to the other
• play with their toes
• recognize familiar faces
• imitate speech sounds
• respond to soft sounds, especially talking
• roll over
At 12 months of age, most babies:
• get to a sitting position
• pull to a standing position
• stand briefly without support
• crawl
• imitate adults using a cup or telephone
• play peek-a-boo and pat-a-cake
• retrieves a hidden toy
• wave bye-bye
• put objects in a container
• say at least one word
• make "ma-ma" or "da-da" sounds
At 18 months of age, most children:
• like to push and pull objects
• say at least six words
• follow simple directions ("Bring the ball")
• pull off shoes, socks and mittens
• can point to a picture that you name in a book
• feed themselves
• make marks on paper with crayons
• walk without help
• point, make sounds, or try to use words to ask for things
• say "no," shake their head, or push away things they don't want
At two years of age, most children:
• use two-to-three-word sentences
• say about 50 words
• recognize familiar pictures
• kick a ball forward
• feed themselves with a spoon
• demand a lot of your attention
• turn two or three pages together
• like to imitate their parent
• identify hair, eyes, ears, and nose by pointing
• build a tower of four blocks
• show affection
At three years of age, most children:
• throw a ball overhand
• ride a tricycle
• put on their shoes
• open the door
• turn one page at a time
• play with other children for a few minutes
• repeat common rhymes
• use three-to-five-word sentences
• name at least one color correctly

Of all these, 4 achievements must be noted:
• Social smile by 2 months
• Head holding by 4 months
• Sitting alone by 8 months
• Standing alone by 12 months


What is developmental delay?
A developmental delay is any significant lag in a child's physical, cognitive, behavioral, emotional, or social development, in comparison with the normal.
A baby's rate of development is determined partly before birth, primarily as a result of genetic make-up and partly due to various physical insults during and just after delivery. Normal development is again quite flexible, occurring over a range of time. Definite deviation beyond that range in any sector of development is developmental delay. When a child consistently reaches developmental milestones much later than other children, a professional consultation is usually warranted. Few babies develop at a uniform rate; most develop quickly in some areas and slower in others. Some babies reach most or all developmental milestones slightly later than "average." As long as a child's development falls within the broad range that is considered normal, reaching one or more milestones late is generally not a cause for concern.
Several developmental areas are of interest: gross motor skills (e.g., crawling, walking), fine motor skills (e.g., grasping and manipulating objects), receptive (understanding) and expressive (speaking) language, self-help (e.g., feeding, dressing), and social and play skills. While it is important to consider each of these areas, some are more important predictors of developmental difficulties than others.
Gross motor skills tend to be of particular importance to parents. They are readily observable and easy to compare from one child to the next. The timing of concrete achievements such as first steps is usually easy for any parent to pinpoint. But a particular achievement such as early walking bears little relationship to later intelligence. Communication and social skills are generally more important in understanding a child's developmental progress.
During the first half of the first year, baby's communication skills are largely nonverbal. Smiling, making eye contact and turning in the direction of a familiar voice, are all signs that baby is connecting with and relating to his social environment. Later in the first year, babbling begins and words may start to appear. In most cases, baby's vocabulary will continue to grow by leaps and bounds as he moves through the second year. Again, however, it is the ability to use language to communicate and relate to the social world that is most important. A child who has a limited speaking vocabulary late into the second year, but is able to communicate needs through gestures, point to named objects in books, and follow simple directions, is most likely not exhibiting significant developmental delay.
The nature of a child's play also provides important information about intellectual development. Very young children tend to play alongside, rather than with, other children. Early play consists largely of using body and senses to interact with the environment. During the toddler years there is a move toward pretend play and increasingly interactive play with other children. Flexibility and creativity become more evident as a child begins to engage in symbolic play (e.g., using a block to represent a car) and role-playing (e.g., "I'll be the mommy and you be the baby"). Steady progression toward more social and complex play suggests that development in this area is on track.
Some red flag warning signs that a child's development may not be on track include:
0-2 years:
• Little interest in surroundings and caregivers
• Absence or minimal eye-contact or smiling
• Lack of responsiveness to sound
• Absence of babbling by end of first year
• Failure to walk by 15 months of age
• Failure to use hands to manipulate and explore objects.
Toddlers (2-3 years):
• Little interest in other children
• Limited use of words or gestures to communicate needs
• Repetitive non-communicative or parrot-like speech
• Very repetitive, non-purposeful play (e.g., focuses only on parts of objects such a wheels, knobs; obsessively turns pages of book without attending to or recognizing content).
Pre-schoolers (3-5 years):
• Speech that is very difficult to understand
• Little or no pretend or imaginary play
• Little interest in social interaction
• Difficulties with balance, running
• Difficulty using crayons or scissors, manipulating small objects.
What are the different developmental disabilities (NDD)?
At least 8 percent of all children from birth to six years have developmental problems and delays in one or more areas of development. Some have global delays, which means they lag in all developmental areas.
Common neuro developmental disabilities (NDD) include:
• Cerebral Palsy
• Mental Retardation
• Speech and language disorders
• Attention Deficit Hyperkinetic Disorder (ADHD)
• Autism
• Learning disabilities
• Visual and hearing defects

Where do I go to?
Consult your Pediatrician immediately.
Remember to get an Eye and Hearing test done.
You will be referred to a Child Developmental Clinic for Early Intervention Therapy through a team approach.

What is done for Early Intervention?
Early intervention starts right from the baby’s stay at the NICU. The environment is rendered developmentally supportive through the following:
• Optimizing lights in the Nursery & mimicking diurnal variation
• Reduce noise to minimum
• Use of soft music
• Club painful procedures & interventions
• Non nutritive sucking
• Tactile stimulation through soft stroking and caressing.
• Kangaroo mother care

Later, early intervention is continued through the provision of :
• Stimulation in all sectors of development
• Stimulate the child through the normal developmental channel and help him to achieve the next milestone every time.
• Passive exercises to prevent stiffness
• Parents are encouraged to constantly provide appropriate stimulation.
• Counsel the parents. Assess the parenting skills and provide necessary education.

What can I expect?
Early Intervention is neither a single dose therapy nor a magic medicine. We do not expect miracles that the child will be absolutely normal, coming 1st in class or winning an obstacle race. But we help him to win his own obstacle race.
Through EIP the child gradually achieves the best of his potentiality. He is taught to perform to the best of his ability to survive independently in society. His strong points are brought into focus, through which his life is made purposeful.
And again, in some, much is achieved beyond expectation, bordering on a miracle!
The take home message is “Be patient and sincere, you will be rewarded.”

HOW IMPORTANT IS EARLY INTERVENTION?

We often refer to a person as a ‘complete man’. Have you ever wondered what we exactly meant by ‘complete’? We all seem to be complete; nobody has seen a half-man after all! But no, completeness encompasses many a parameters & dimensions.

A baby grows from a neonate to a toddler, and then through the stages of childhood and adolescence, gradually evolves into an adult. All the while he grows in length, breadth and weight; his sensory perception, cognitive ability & intelligence develop so that he gradually gains control over his own self, then over his surrounding environment. The better control he has over himself, the more poised his personality becomes. The extent and magnitude of his control over his environment determines his level of success. This constant evolution starts from the moment of conception of life. It occurs in different dimensions: physical, mental, intellectual, emotional and spiritual. Evolution to the fullest in all these dimensions ultimately produces a complete personality.

We, the care-givers of small babies, visualize this evolution when we think of his growth & development. Any deficit, any deviation at any point will curb the blooming process. A thousand and one deficits may be silently residing in the baby’s system, which, if not identified in time, will manifest as a hindered development in later days. For example, a child who doesn’t learn to smile in time may not learn to interact and play like other children and he may develop mental retardation later on. Similarly, a baby who is late in holding his head may be late in all limb activities like sitting, standing, walking, etc. So all who care for babies and children must know the markers of normal development and must learn to pick up deviations EARLY.

How does this early detection help? Any inherent deficit in a developing child can be supported and the process of development in that area enhanced through early intervention. It’s like offering a hand to a person unable to climb a high step. He can make it with your help and the next time he has the confidence to try it himself.

What exactly is early intervention? It is a comprehensive process, by means of which stimulation is given to the child in areas where his development is faltering, thus guides him through the normal developmental channel. Through these techniques the affected brain parts are stimulated to become more active. But how can a dead cell in the brain become alive and active? It has been proved that though brain cells do not regenerate, synapses (connections between cells) are regenerable and with early stimulation healthy brain cells, through new synapses, take up the job of the damaged cells. Thus brain activity can be made to improve. This plasticity of the brain is made use of in early intervention techniques.

Who does this early intervention? As different aspects of brain function, like gross motor (sitting, walking etc), fine motor ( picking up things, handling etc), cognitive
(understanding, imagination etc), language, learning etc may need to be assessed and supported, this process calls for a very well co-ordinated team approach. The team comprises of a developmental Pediatrician, Ophthalmologist, Psychiatrist, Physiotherapist, occupational therapist, developmental psychologist, speech therapist, special educator and counselor. Whatever these specialists have to offer need to be conveyed regularly to the child, and, who else, but the mother, will happily render this effort 24 X 7? So she remains the pivot of the early Intervention program. It is thus obligatory for her to be well informed and convinced about the whole approach, to get the best benefits for her child. This is a long process and calls for a lot of perseverance and patience to reap the ultimate reward.

So, mothers (& fathers as well), get informed about your child’s normal development and danger signs to be identified. Next time we will talk about these issues.

What Silence Had To Say

A FIRE WAS BURNING. We were terrorized. The crowd was in frenzy. Everybody seemed to be asking, “How did this happen? Who is to blame?” Replies came as sparks, “They did it”, “It’s him”, “Hit him”, “Beat them up”…. Flames, fumes and wrath filled the space… suffocating destruction was engulfing us as we screamed and ran frantically like a bunch of lunatics. Only the little girl, Silence, stood aside, tears streaming down her cheeks. She knew the answer, but nobody asked her for it, because her name was silence. Silence never speaks where commotion reigns. But, she had the answer.

No, I did not recognize silence on that day of gloom and destruction. I discovered her much later, one summer afternoon when I was lazing alone on the grass on the bank of Lake Eire. She was humming softly, with a sweet smile on her face. Stretching my ears, I heard, “Be gentle, be soft. Don’t let the trifles in life upset you. Feel the tranquility of the lake within yourself.” Yes, she was right! I could feel the calmness! “Silence, why didn’t you tell us this on that fated day? You were there then.” “You never asked” came the answer.

Her personality charmed me. It was instant love. I kept looking for her till I again met her at a small village inPurulia. She was sitting under the old Banyan tree. “How long have you been here?” I asked her. “I’ve always been here. You can stay on too, but you’ve got to be patient.” “Learn to give and wait for no return, like this huge tree … she asks for nothing for the shade & shelter she has been giving to us for ages. Patience will give you peace” “Silence, you are wonderful!” I blurted out.

We became fast friends. She kept beckoning me, I kept looking for her. Chatting with her was always a treat. There she was when I looked out of my bedroom window, dancing merrily with the young maple leaves against the clear blue sky in spring. Like me, a tiny squirrel was also waiting for her, in a small hole in the tree trunk. Silence talked a lot of blissful joy that spring morning at Dunkirk.

By now she had divulged a secret to me. Aloft the sky, she could always be found. Now I knew, looking up, I could always see her smiling at me. We started a new game. Up in the sky I saw her in new dresses every time. In her beautiful black shimmering dress on a star studded midnight sky at Purulia, or a sunset sky over the St Laurence River where she had spilt her colour palate on her dress, spreading red, yellow, orange, purple and blue all-over, she would always talk of her sister, ‘Eternity’. She actually introduced me to Eternity on these wonderful occasions.

I invited her to my place. But, a shy girl, she would only drop in at dawn, when the bleeding hearts bloomed, to say Good Morning. Smiling at the pretty flowers, she would say, “Endure your own pain, but never cause pain to others. The Bleeding Heart bleeds to bloom, to give you pleasure. Love and endurance is the magic word of Nature. That is why Mother Nature thrives on, through thick and thin and is always smiling.”

Last week it was along day I spent with Silence, at Shenandoah. As we drove through the mountains, a long 100 miles through solitude and beauty, she constantly kept company, pointing out the depth of blue in the layers of mountain ranges ahead, the tranquil enormity of the lofty hills. Yes, she was right, eternal peace and harmony reined in the mountains and valleys, through which the clouds gently breezed through. The bold stature and the undaunted stance of the tall peaks quietly seemed to instill a unique strength of tenacity into one: a strength that rises out of Truth and conviction.
“ Mountains stand for Truth and strength” she whispered in my ears.
That reminds me of another enchanting experience with her in the mountains. It was up in the hills of Arunachal Pradesh, where Silence would sing a wonderful humming tune. Straining our ears, we used to hear the tinkling of the temple bells all around, as if Mother Nature was performing arati to deify the Almighty. I still wonder where she got that heavenly melody! Was it from the tiny cricket like insects in the woods?

Now Silence visits me regularly, morning and evening, in the little corner of my room they call my Thakur Ghar, but I call a chat room. Its here I get to chat with Silence. She keeps explaining how love, patience, endurance, truth—all are manifestations of the Divine. The Divine we tend to search for, but cannot reach because of the haze created by the ‘sound and fury’ of life. Silence, I’m grateful to you, you let me get a glimpse of the truth! Oh Silence, don’t leave me, or I wont be able to get that glimpse again!

Last night I met her again, at a very unusual place, at an International Airport, at the strike of midnight. Lots of people, lots of colours, lots of religions, all walking through their own tracks, with no commotion, no conflicts & no controversies. At that late hour one thing was common to all that was weariness. So a faint smile or a gesture of accommodation was the only communication between the transit passengers. Here again, the world met together, but there was no scourge, no sting, no scoff. Silence, you were standing there, in the midst of all, with a gleaming smile, at that wee hour!

But then, why didn’t you speak on that fated day, Silence? You know we all need you, only that most of us aren’t quite acquainted with you. Why didn’t you come forward to put the fire out? Poor thing, you are such a shy and sensitive person, you withdraw from all commotion. And who ever lends an ear to the beautiful music of Silence?