Babyquant – Page 4 – Baby facts for parents that know more

When do Babies start walking?

When do Babies start Walking?

[mme_highlight] Most children can walk well by 15 months. In the weeks prior to independent walking parents can observe their child showing transient upright skills. When infants start their first steps, being without shoes can help refine the coordination and balance. Walkers should be avoided as they can be at harmful. [/mme_highlight]

In the weeks prior to independent walking parents can observe their child showing transient upright skills: children hold to furniture to acquire and sustain an upright position and hold parents’ hand or to furniture to make steps forward. Note that furniture or parents compensate for the missing levels of leg strength and balance control.

The main milestones in infant’s motor development are:

Sitting, at approximately 6 months.
Hands and Knees Crawling, at 8,5 months.
Walking, at 12 months.

From Cruising to Walking

Cruising is a term used to describe the sideways movement when babies hold to furniture. This “pre-walking” way of locomotion is important because helps strengthen legs and create a notion of balance and coordination, also improving the security for the further achievement of independent walking. Researchers assume that there is a functional continuous from cruising to walking, since both involve locomotion in an upright posture.
There is consensus implying that there are two major factors essential for walking in children: acquisition of leg strength and control of balance. It is easy to understand that infants cannot walk before they can sustain body weight and keep the balance on one leg while the other goes forward to make a step.

Learning from falling?

Yes, walkers fall. Investigations estimate that, on average, 14-month-olds can fall 0 to 12 times in only 16 min of free play and 0 to 14 times during a short walk around a city block. However, most of these falls are not serious enough to need medical assistance, despite being one of the leading causes for accidental injury in children under five years.
Do not worry, because researchers think that learning from falling can be an impetus to control locomotion. It is believed that the experience of falling or of the near falls instigates awareness and can serve as a stimulus for adaptative avoidance.

What can I do to help my child walk?

You can stimulate your child by positioning in front of him with your arms open and encourage him to walk in your direction. When infants start their first steps, being without shoes can help refine the coordination and balance.

Walkers should be avoided as they can be at harmful various levels: they can impair legs muscles from strengthen and they can turn leading to a fall that may be dangerous.

When should I be worried?

There is a normal variation within the above milestones, but in the end most children can walk well by 15 months, while some children walk later, at around 18 months. You can expect a 3-year-old to walk, stand, run and jump but some actions like standing on tiptoes or only on one leg can take longer to refine.
The evaluation and surveillance of the motor development and the gait is part of the routine of the general practice doctor or pediatrician. Yet, if you think you have concerns in this field, do not hesitate in searching for medical assistance. Bear in mind that sudden alterations in gait, coordination and balance or if your children looses any already acquired motor skill you should seek medical advice.

Summary and Recommendations

Cruising is considered as a pre-walking phase in which children walk holding to furniture.
If your child has recently started walking, falls will occur. Specialists believe that minor falls can indeed be a stimulus for confident walk.
Parents should encourage children to walk by positioning in front of them. In the first walking attempts, children should be without shoes.
Walkers should not be used, as they impair muscle development and can result in dangerous falls.
Most children walk well by months of age.

[mme_references]
References

Karen EA, Sarah EB, Andrew JL. Developmental Continuity? Crawling, Cruising, and Walking. Dev Sci. 2011 March ; 14(2): 306–318.
Frankenburg, WK.; Dodds, J.; Archer, P.; Bresnick, B.; Maschka, P.; Edelman, N., et al. Denver II Sceening Manual. Denver Developmental Materials, Inc.; Denver, CO: 1992.
Amy SJ, Karen EA. Learning from falling. Child Development, January/February 2006, Volume 77, Number 1, Pages 89 – 102.
National Center for Injury Prevention and Control, C. D. C. (2003). Web-based Injury Statistics Query and Reporting System (WISQARS).

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When do Babies start teething?

[mme_highlight] Generally, the primary teeth appear between 6 and 8 months with a tendency to emerge first in girls. The first to erupt are usually the four front teeth. there is probably an association between teething and irritability, diarrhea, increased salivation, slight rise in temperature and sleep disturbance. [mme_highlight]

Teething is a natural process that can be defined as the migration of tooth from its intraosseous position in the jaw to erupt in the oral cavity.

When do teeth start to erupt?

Generally, the primary teeth appear between 6 and 8 months with a tendency to emerge first in girls. The first to erupt are usually the four front teeth. Usually between 2^1/2 and 3 years of age the full set of 20 temporary teeth are already in the oral cavity. As the child’s jaws continue to grow, they become prepared for the eruption of the first permanent teeth between 5 and 7 years of age.
The permanent teeth can be up to 32, if the third molars erupt, which does not happen always. The chart below helps understand the estimated chronology of the eruption of the first teeth, the central incisor being in the midline of the jaw and the other being situated lateral to it, in the order shown.

[mme_databox]

	Upper Jaw	Lower Jaw
Central Incisor	8-12 months	6-10 months
Lateral Incisor	9-13 months	10-16 months
Canine	16-22 months	17-23 months
First Molar	13-19 months	14-18 months
Second Molar	25-33 months	23-31 months

[/mme_databox]

What symptoms can be linked to teething?

Tooth eruption is believed to be linked to a variety of symptoms in children, but there is not a consensus yet, because the association of the time of teething and the onset of symptoms may simply coincide. The latest evidence from studies points that there is probably an association between teething and irritability, diarrhea, increased salivation, slight rise in temperature and sleep disturbance; these associations shown to be significant on the day of eruption and one day after eruption.
Keep in mind that teething is not associated with severe signs or symptoms.

Early Teeth

Natal teeth (when a baby is born with teeth) or neonatal teeth (teeth that develop during the first 28 days of life) are a rare occurrence, although the first situation occurs more frequently than the latter in the proportion of 3:1. The estimated prevalence of early teeth varies between 1:1000 and 1:30.000.
In approximately 85% of cases, these teeth are located in the region of the mandibular central incisors (i.e. central position in the lower jaw). This early appearance of teeth can cause concern among parents and in many cultures this is a poorly understood subject that can lead to superstitions. In addition, the early teeth can cause pain on suckling, refusal to feed and traumatic ulceration both in the mother’s breast and in the baby’s mouth.
The cause of this premature appearance remains to be proved, but probably it can be due to a conjugation of various causes, such as hereditary, endocrine disturbances, infections, nutritional deficiencies, superficial position of the tooth gem and genetics.
If this is the case, the baby should be observed by a pediatrician as there is risk of inhalation, ulceration or feeding difficulties. The pediatric dentist will evaluate the teeth and will decide the best treatment option, which can range from “attentive follow-up”, in most cases where the teeth is of normal dentition, to the extraction.

Taking care of baby’s teeth

0 to 6 months

clean your baby’s gums with a moist gauze or towel
do not put sugar in the nursing nipple

6-18 months

introduce cups with a mouthpiece (the baby bottles increase the incidence of caries).
introduce tooth brushing.
The first visit to the dentist around 12 months.

Summary and Recommendations

Primary teeth appear between 6 and 8 months.
The first teeth to appear are the four front teeth.
Permanent dentition starts appearing by 6 years.
It has not been proven that teething is associated with symptoms, but it is believed that irritability, slight rise in body temperature and diarrhea can occur with teething.
Natal teeth (when a baby is born with teeth) is more frequent than neonatal teeth (teeth that appear during the first 28 days of life), but both conditions are rare. As there is a risk of inhalation, ulceration and feeding problems, the child should be observed by a doctor.
Teeth your child’s teeth with a gauze from birth to 6 months and then introduce the toothbrushing.

[mme_references]
References

Wake M, Hesketh K, Lucas J. Teething and tooth eruption in infants: A cohort study. Pediatrics. 2000; 106:1374-9.
Maheswari NU, Kumar BP, Karunakaran, Kumaran ST. Early baby teeth: folklore and facts. J Pharm Bioallied Sci. 2012 Aug;4(Suppl 2):S329-33.
Joana Ramos-Jorge, Isabela A. Pordeus, Maria L. Ramos-Jorge and Saul M. Paiva. Prospective Longitudinal Study of Signs and Symptoms Associated With Primary Tooth Eruption. Pediatrics 2011; 128;471.

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When do Babies start Talking?

[mme_highlight] A baby shows surprising speech processing skills since birth. Lexical acquisition starts at the second half of the first year of life, before children uttering their first words. Learning the meaning of words requires advanced abilities, which starts at 14 months.[mme_highlight]

Language is a uniquely human capacity. Interestingly, research has shown that the functional organization of a newborn brain in terms of language processing is similar to the adult brain. A baby shows surprising speech processing skills since birth. Studies have proved what the daily life shows: babies prefer their mother’s voice over other female voices and their native language over foreign languages. Surprisingly, newborns are able to distinguish most sound contrasts used in language.

How is the language development during the first year of life?

During the first year of life, however, this ability is somewhat narrowed because babies usually only listen to their native language, but at the same time this ability is increased to discriminate sound contrasts of their own native language.
Nevertheless, some babies learn more than one language: how do they distinguish? Scientists believe the answer is in the babies’ sensitivity to language rhythm – this discrimination ability emerges as early as at 4 months of age.
Also surprising, lexical acquisition starts at the second half of the first year of life, before children uttering their first words. At 8 months, before start learning the major amount of words, babies discriminate a minimal pair of words and can associate them with two different objects. In fact, learning the meaning of words requires advanced abilities, which starts at 14 months.

What are the major language milestones?

The major milestones are listed in the table below. Expressive language refers to the ability of using language, while receptive language is the ability to understand it. Note that these milestones are based on the 50^th percentile and, thus, they are merely indicative and intended for general developmental surveillance by primary care assistance.

[mme_databox]

Age	Expressive Language	Receptive Language
Birth - 2 months	cry	Turns toward sound
2- 4 months	Open vowel sounds: “ooh”; “ahh”	Social smile Attention to faces
6 months	Repetitive combinations: “bababa”	Responds to name
12 months	First word. Repeats sounds to get attention	Responds to “no” Follows simple verbal commands if made with gesture
15- 18 months	Points to body parts when named	Follows simple verbal commands (one-step commands)
18-24 months	Two-word sentences (e.g., “daddy water”)
24- 36 months	Answers simple questions	Follows two-step verbal commands
36- 48 months	Sentences with 4-5 words; pronouns; plural	Understands placement in space
48- 72 months	Complete sentences with grammar markings	Follows three-step verbal commands

Adapted from: Sices, L. Use of developmental milestones in pediatric residency training and practice: time to rethink the meaning of the mean. J Dev Behav Pediatr 2007; 28:47.
[/mme_databox]

When should parents be worried?

Language learning is frequently viewed by parents and society with anxiety and there are a lot of associated myths. There is a significant variability in the normal range of development of language in young children. There are some identified risk factors that can contribute for language delays: poverty, if the parents’ level of education is low, prematurity and low weight at birth, family history of language delays, maternal depression and male sex.

As part of the general development surveillance, your family doctor can use screening validated tools at the main milestones and refer the child for further evaluation if considered necessary. Note that approximately 10 to 15% of the 2-year olds have language delay, but this delays remains only in 4 to 5% of children after three years.

Can I help my baby learn words?

Sure! Studies show that the quantity and quality of the language babies hear from their parents or caregivers influences the early lexical development. This implies that babies who are exposed to richer language may interpret words better and thus be able to learn more words.

Summary and Recommendations

At 6 months starts the lexicon acquisition, as well as babbling using repetitive combinations; the baby respondes to name.
The first words are said at 12 months in 50% of babies. Babies understand the meaning of certain words at around 14 months.
Expect 2 word sentences from your baby by 18 to 24 months.
Between the age of 2 and 3, your baby answers simple questions.
Complete sentences with complex grammar are expected between 48 and 72 months.
Note that 10 to 12% of 2-year-olds present language delay.

[mme_references]
References

Mehler J, Gervain J. Speech Perception and Language Acquisition in the First Year of Life. Rev. Psychol. 2010. 61:191–218
Swingley D. 2009. Contributions of infant word learning to language development. Trans. Royal Soc.
Nereyda H, Virginia A M, Anne F. Does input influence uptake? Links between maternal talk, processing speed and vocabulary size in Spanish-learning children. Dev Sci. 2008 November ; 11(6): F31–F39.
Sices, L. Use of developmental milestones in pediatric residency training and practice: time to rethink the meaning of the mean. J Dev Behav Pediatr 2007; 28:47.
van Noort-van der Spek IL, Franken MC, Weisglas-Kuperus N. Language functions in preterm-born children: a systematic review and meta-analysis. Pediatrics 2012; 129:745.

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When do babies start eating solids?

[mme_highlight] The American Academy of Pediatrics recommends that complimentary foods should be introduced when an infant is 4 to 6 months, being exclusive breastfeeding preferred in the first 6 months; the World Health Organization defends exclusive breastfeeding during the first 6 months of life.[/mme_highlight]

The American Academy of Pediatrics recommends that complimentary foods should be introduced when an infant is 4 to 6 months, being exclusive breastfeeding preferred in the first 6 months; the World Health Organization defends exclusive breastfeeding during the first 6 months of life.
Note that this recommendation is not solely based on age, but on other development milestones that should be met before the introduction of solids, such as sitting and supporting the head. Over time, you will notice your baby develops more refined skills to eat, like grasping, chewing and swallowing food at 8 to 10 months of age.

What’s the problem with introducing solids too early?

Premature introduction of solids, before a child is 4 to 6 months old, may:

increase the risk of food allergies;
Increase the risk of inhalation, as swallowing and other skills are not fully developed;
increase the risk of obesity, although evidence from studies remains unclear;
be a frustrating experience for both parents and children, as before 5 months babies still have the extrusion reflex, meaning that if an object – like a spoon – is placed between the lips it will be automatically pushed out.

What’s the problem with introducing solids too late?

On the other hand, the introduction of solids should not be postponed after the 6 months, as at this point the breastfeeding or formula alone may not provide children with the adequate amount of nutrients and calories, potentially leading to decrease in the growth rate, iron deficiency and complications like celiac disease, eczema and asthma.

How to start and progress with solid foods?

The first solid aliments that should be introduced are single-ingredient foods like cereals and puréed meats, as they provide zinc and iron. As these foods are accepted, you can introduce strained or puréed fruits and vegetables. It is recommended that at least one aliment containing C vitamin is given per day, because this vitamin promotes iron absorption, and thus prevents anemia.
The addition of salt and sugar should be avoided at all costs, as this does not increase the infant’s acceptance. Over time, children develop their motor skills for feeding and their acceptance of foods, so new textures and more complex food can be introduced.

Are there foods to avoid?

There are certain foods that should not be given to an infant prior to 12 months of age: foods that can lead to chocking (like nuts, round candies, grapes and raw carrots) and honey, since there can be an association with botulism. The American Association of Pediatric also recommends avoiding cow’s milk until the child is one year old.

What are the allergenic foods?

Eggs, fish, shellfish, cow’s milk, nuts and peanuts can be highly allergenic aliments and it has been suggested that delaying their introduction until an infant is four to six years old can prevent atopic disease in children who are at high risk – those with a first-degree relative with documented allergic disease. If your child is in this high-risk group, there are some precautions to take introducing the foods cited above:

give a first taste of the aliment to the infant at home, which is preferable than a restaurant or a day care;
if you cannot see any reaction, introduce the aliment gradually and in increasing amounts;
if some reaction occurs or if you see a skin rash after giving the aliment it is recommended to take your child to see a doctor:
if previous food allergies have occurred or if the infant has a sibling with food allergy it is recommendable to have an allergy evaluation before introducing those aliments.

Summary and Recommendations

AAP recommends start introducing solid foods between 4 to 6 months, while WHO puts the recommendation on 6 months to ensure exclusive breastfeeding during these first months.
To start solids, there are some motor milestones that should have been attained, like supporting the head and sitting without support.
Starting solids too early can increase the odds for allergic reactions, inhalation and obsesity.
Starting solids too late can lead to a failure to thrive or anemia due to iron deficiency.
Start with cereals and puréed meats; then introduce vegetables and fruits.
Do not add sugar or salt to your baby’s food.
Avoid in the first year aliments that have a shocking risk, like nuts, round candies and grapes. Also avoid honey because of the danger of botulism.

[mme_references]
References

Jonsdottir OH, Thorsdottir I, Hibberd PL, et al. Timing of the introduction of complementary foods in infancy: a randomized controlled trial. Pediatrics 2012; 130:1038.
Agostoni C, Decsi T, Fewtrell M, et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 2008; 46:99.
Underwood BA, Hofvander Y. Appropriate timing for complementary feeding of the breast-fed infant. A review. Acta Paediatr Scand Suppl 1982; 294:1.

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When do Babies start Crawling?

[mme_highlight] Crawling starts at 8, 5 months. Differently from what happens with other milestones in motor development, like sitting and walking, crawling is not absolutely crucial for this progression. Most infants crawl and cruise concurrently for extended periods prior to walking. [mme_highlight]

If you have a baby, you must have thought many times “where do new skills come from?” Well, that is the same question researchers have been answering and asking too. Those who defend a developmental theory, claim that new skills come from the seeds of prior achievements.

[mme_databox]
Main infant’s motor development milestones

Sitting, at approximately 6 months.
Hands and Knees Crawling, at 8,5 months.
Walking, at 12 months.

[mme_databox]

What is the importance of crawling for my baby’s development?

Bear in mind that, differently from what happens with other milestones in motor development, like sitting and walking, crawling is not absolutely crucial for this progression.
Although scientific evidence favors that crawling experience serves as a mediator of cognitive skills and also that crawling experience is important for the development of spatial memory, it is ultimately the way the child discovers and positions in relation to the space that stimulates motor development. And this discovery can occur without crawling as we classically define it (hands and knees crawling) but in several forms, some of them very funny: for instance, with the forearms pulling the rest of the body or even backwards.
Every way is a good way to move and, at last, start walking. To sum up, it is the transition that matters, not so much the way it occurs.

Another form of crawling is belly crawling, which does not always occur, but when it does it occurs prior to crawling on hands and knees. Most infants crawl and cruise concurrently for extended periods prior to walking. After weeks of crawling, children’s judgments become increasingly accurate.

How can I help my baby crawling?

The goal is not to directly encourage your child crawling, but help him/her discovering and feeling increasingly safe moving in the space around – and this can happen through crawling. Walking is what comes next. You can help by putting objects/toys that your child wants easy to see but out of reach – it is simple, but will encourage movement towards the desired object. ?

How can I provide a safe environment for my infant to crawl?

Another important aspect is, indeed, to provide a safe environment for your child to crawl freely. Obviously, do not leave infants without supervision: at this stage they move around quickly and do not stay in the same place as before. Stairs can be harmful: you should always use protections to avoid potentially dangerous falls.
Note that falls are one of the leading causes for accidental injury and death in children under five. Another important point is to protect electric outlets as they are positioned right at the level of the eyes of a child who crawls.

When should I be worried?

As stated above, there is no reason for concerns if your child crawls differently from the classic manner (knees and hands) or even if an infant does not pass though a crawling stage. The evaluation and surveillance of the motor development is part of the routine when you take your child to a general practice doctor or pediatrician. However do not hesitate to search for medical assistance if any concerns arise.
Bear in mind that sudden alterations in coordination and balance or if your children looses any already acquired motor skill – like holding the head, for instance – you should seek medical advice.

Summary and Recommendations

Crawling is not a compulsory phase of motor development of children.
Crawling can be a transition to the next stage: walking.
Babies crawl in different ways, all of them are perfectly ok: either the typical hands-knees or the belly crawling.
Ensure the environment is safe for your child, because crawling gives her/him more movement freedom.
Take your child to a doctor if she/he looses a skill which had already been acquired or if you notice any sudden change in coordination.

[mme_references]
References

Karen EA, Sarah EB, Andrew JL. Developmental Continuity? Crawling, Cruising, and Walking. Dev Sci. 2011 March ; 14(2): 306–318.
Frankenburg, WK.; Dodds, J.; Archer, P.; Bresnick, B.; Maschka, P.; Edelman, N., et al. Denver II Sceening Manual. Denver Developmental Materials, Inc.; Denver, CO: 1992.
http://www.scientificamerican.com/article.cfm?id=crawling-may-be-unnecessary (Access: 10.04.2013).
National Center for Injury Prevention and Control, C. D. C. (2003). Web-based Injury Statistics Query and Reporting System (WISQARS).

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When do babies roll over?

[mme_highlight] Rolling over is the flipping of your baby from back to tummy, tummy to back or back to side. Babies should start rolling over in one direction at least by the age of 5 months and in both directions by the age of 7 months. [mme_highlight]

Monitoring the milestones development and growth of the baby, as well as accompanying the baby crossing each step of the developmental process is frequently a half solved question for most parents. The time of development of each milestone widely varies among babies and it depends on many factors. Even siblings who grow in the same environmental conditions achieve milestones at different times. Thus, “Rolling over” is not an exception and it is achieved by babies at different times ranging from 2 and a half months to 7 months of age.

What is Rolling over?

Rolling over is the flipping of your baby from back to tummy, tummy to back or back to side. It is a part of the developmental process, which is considered to be a starting step for reaching next milestones like crawling and creeping.

When can you expect your baby to roll over?

As we discussed earlier, rolling over onset greatly varies among babies and on an average they roll over from tummy to back first at the age of 3 to 5 months and later from back to front at around 5 to 8 months. The later requires stronger coordination of neck and shoulder muscles. You should not be worried though, if the roll over occurs in a different sequence.

What happens during roll over?

At 3 months duration neck holding develops. When put on his/her tummy, the baby tries to lift the head, puts weight on shoulders, and the ongoing exercise strengthens the muscles. The coordination of the muscle groups of neck, shoulder, chest and abdomen over a period of time which varies among babies is responsible for him/her to successfully roll over from tummy to back, back to tummy or both sides.

Rolling over can be divided in 4 stages:

Tummy to Back
Back to Tummy
To the side
In both directions

As early as baby develops neck holding capacity and strength in the arms to sit with the help of support, it is the time to be alert as the baby can roll over to reach a toy or the mother.

Tummy time for your baby

It’s rolling time for your baby! Spare some “tummy time” during day time, when your baby is alert and awake, to help her/him practice rolling over. The baby should be placed on tummy and then encouraged to roll over by placing a toy or by giving gentle support with your hands. This can be done several times a day and it helps the baby strengthen his/her neck and shoulder muscles. Soon you will see your baby start rolling over. Clapping hands and smiling, when your baby rolls over, is a positive reinforcement you should give your baby.

You should be careful at the same time, as most babies roll over for the first time in an unexpected time. Baby should be always supported and should not be left alone or unattended.

When should I be concerned?

Rolling over is not a mandatory milestone for every baby. It can be missed by some babies and, if it is the case, the next milestones like sitting and crawling can develop bypassing rolling over. You should not be concerned if your baby is active and interested in you and surroundings. In fact, skipping milestones shouldn’t be a reason for you to worry, if the baby reaches the next milestone and is active enough.

If the baby is not flipping over from one side to another even after 6 to 7 months of age, then it is a reason of concern and you should take her/him to be evaluated by a specialist. Fat babies as well as premature babies tend to develop milestones later when compared to other babies and it should also be taken into consideration.

Summary and Recommendations

Rolling over involves the flipping of your baby from back to tummy, tummy to back or back to side.
This milestone achievement requires strength and coordination of the muscular groups of neck and shoulders. You can help your baby do this by placing her/him on tummy and stimulate her/him with a doll. Then give a positive reinforcement with every little success towards rolling over.
Although the moment of rolling over onset can vary, a study conducted by the American Association of Pediatrics, concluded that babies should start rolling over in one direction at least by the age of 5 months and in both directions by the age of 7 months.
Fat babies and premature babies tend to develop milestones later.
Take your baby to a doctor if she/he does not roll over after 6 to 7 months of age.

[mme_references]
References:

Berk, Laura E. (2012). Infants and children: Prenatal through middle childhood. Allyn & Bacon. ISBN 0205011098.
Aslin, Richard N. (1993). “Commentary : the strange attractiveness of dynamic systems to development”. In Thelen, Esther; Smith, Linda C. A Dynamic systems approach to development applications. Cambridge, Mass: MIT Press. ISBN 0-585-03867-8. OCLC 42854628.
Caring for Your Baby and Young Child: Birth to Age 5; American Academy of Pediatrics.

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What is the right diet for breastfeeding moms?

[mme_highlight] Maternal diet directly affects the content of vitamin A, B1 (thiamin), B2 (riboflavin), B5 (pantothenic acid), B6 (pyridoxine), B12 (cobalamin), D, E, selenium and iodine in human milk. There is no specific need for restrictive diet but the diet should be such to replenish the body’s reserve supplies of fats, calcium etc. [mme_highlight]

Research studies have demonstrated that the calories required for the adequate production of breast milk are supplied by the body’s fat reserves laid during pregnancy. The energy required to produce an average of 750 mL quantity of milk is 630 kcal per day. About 400 to 500 calories are needed above your intake during pregnancy in order to provide enough energy to supply the needs of your growing baby. Therefore, it is very important for a breastfeeding mother to eat a well-balanced diet.

How can diet affect the composition of mother’s milk?

Mother’s diet can affect the concentration of vitamins and minerals in breast milk. It has been found in research studies that vegan mothers may require supplementation with vitamin B₁₂to their diet. Maternal diet directly affects the content of vitamin A, B1 (thiamin), B2 (riboflavin), B5 (pantothenic acid), B6 (pyridoxine), B12 (cobalamin), D, E, selenium and iodine in human milk.
The proportion of the different fatty acids present in breast milk also varies with the fat content in the mother’s diet.

What is the relationship between breastfeeding, diet and weight loss?

Research has proved that mothers who breastfeed their baby, reach their pre pregnancy weight faster when compared to mothers who do not breastfeed. It has also been found in studies that aggressive weight loss programs or dieting should not be considered during breastfeeding as it may be harmful for the baby.
When weight loss happens fast, the fat of the body is burned and stored toxins are released, which may reach mother’s bloodstream ending up in the breast milk thus posing a potential damage to the baby.

You should lose weight gradually, using a healthy combination of a low fat, well balanced diet and moderate exercise. Breastfeeding burns up the fat deposited during pregnancy to produce milk and hence aids in the weight loss. It has been shown in research studies that most breastfeeding mothers can lose about 0.5 Kg a month due to the energy demands required for producing milk.
Limiting the food that a breastfeeding mother eats in the early weeks of lactation may hamper the production of milk and reduce the milk supply.

How can mother’s diet affect the baby?

Research has provided ample evidence that the presence of even traces of a particular substance in breast milk may upset some babies. It is advisable that before cutting down a particular substance from diet, a breastfeeding mother should consult her doctor to ensure that she continues to receive a healthy and balanced diet.
The American Academy of Pediatrics has also stated that babies who are breastfed have a lower risk for SIDS (Sudden Death Infant Syndrome).

The table below enlists the most common culprits that may upset your baby.

Food type	Sample	Effect on baby	What to do?
Vegetables	Cabbage, onion, garlic, broccoli, Brussels sprouts, turnip	Wind, crying	Leave these vegetables out of diet for two weeks
Cow’s milk and products	Milk, cheese, yogurt, butter	Allergic reaction, intolerance	Exclude dairy products from your diet. Consult your doctor
Cold foods	Ice-cream, yogurt, frozen dessert	A type of food poisoning listeriosis (but very unlikely)	Ensure that the frozen desserts are pasteurized. Use well-cooked desserts as boiling will kill the bacteria.
Ready to eat foods	Preservatives, dyes and additives	Upset baby, discomfort	Remove ready to eat meals from your diet
Ready to eat foods	Eggs, citrus foods, wheat, corn, spicy food, peanuts, soy, chocolate, oily fish especially tuna fish	Allergen, may cause restlessness, discomfort, crying, posseting and colic	Keep them out of diet for two weeks. Minimize the intake of oily fish as it contains mercury and pollutants.

What is the effect of mother’s diet on baby’s weight?

Breastfed infants have been shown to gain the right amount of weight and are usually not overweight. It is known that if there is a reduced caloric intake, it leads to reduced milk supply and ultimately leading to weight gain problems in the baby. Studies have also shown that most of the babies gain an average of 4 to 7 ounces per week for the first month of life, 1-2 pounds per month for 2 to 6 months and about 1 pound per month in the next 6 months.
It has also been seen that breastfed babies grow at the same rate as their formula fed counter parts for the first four months of their life but at a slower pace after that. In fact it is a proven fact that frequent feeding sessions and thorough emptying of the breast at each feed causes the baby to gain more weight.

Diet recommendations for a breastfeeding mother

The Indian Council of Medical Research has recommended the following dietary allowance for lactating mothers;

0-6 months: 550 Kcal per day (over and above the pre pregnancy intake)
7-12 months: 400 Kcal per day (over and above the pre pregnancy intake)

Mothers should maintain a balanced diet and take their pre natal vitamins. There is no specific need for restrictive diet but the diet should be such to replenish the body’s reserve supplies of fats, calcium etc The American Academy of Pediatrics recommends nutritive foods such as carbohydrates, vegetables, fruits and whole grains for nursing mothers.
Certain nutrients required by the baby may be lacking in the breast milk if the mother’s diet is inadequately supplied with them such as iodine and Vitamin B₁₂.

The most important factors to be considered while constituting the diet for a nursing mother to produce milk and stay healthy herself are:

Proteins: One serving of protein is equivalent to 2&1/2 to 3 glasses of skim or low fat milk; 1&1/4 cups evaporated skim milk; 1&3/4 cups low fat yogurt; ¾ cup low fat cottage cheese; 2 large eggs plus two whites; 5 egg whites; 3 to 3 & ½ ounces fish, meat or poultry; 5 to 6 ounces tofu; 5 to 6 tablespoons peanut butter.

Vitamin C: ½ cup strawberries, ¼ small cantaloupe, ½ grape fruit, 1 small orange, ½ to ¾ cup citrus juice, ½ large kiwi, mango or guava, 2/3 cup broccoli or cauliflower, 1 cup cabbage or kale, ½ medium green bell pepper or 1/3 medium red bell pepper, 2 small tomatoes or 1 cup tomato juice is equivalent to 1 serving of Vitamin C.

Calcium: The foods which provide calcium are Parmesan cheese, skim or low fat milk, non- fat dry milk, low fat cottage cheese, broccoli, collards or kale, molasses, salmon and sardines.

Green leafy and yellow vegetables and yellow fruits: Fruits like apricot, cantaloupe, mango, peach, and vegetables like broccoli, carrot, winter squash, sweet potato, canned pumpkin, tomato, red chili or pepper should form a part of daily diet of the nursing mother.

Carbohydrates: Carbohydrates such as cooked brown rice, wild rice, millet, kasha, barley, whole cornmeal, wheat germ, unprocessed bran, whole grain crackers, lentils, beans, split peas, lima beans should be given.

Iron rich foods: Foods like beef, blackstrap molasses, chick peas, dried legumes, dried fruit, oysters, sardines, soybeans, and soy products, spinach and liver are foods are rich in iron.

Fluids: Water is a major constituent of the breast milk. At least 10- 12 glasses of water must be taken every day. Fluids will help the body to produce the milk needed for your baby. 8 cups of fluids in the form of water, fruit and vegetable juices, milk, soups and seltzer can also be taken to make up for the fluid requirement of the nursing mother.

Vitamin supplements: Supplement in the form of a pregnancy or lactation formula is helpful as an adjunct for the daily diet. 4 micrograms of vitamin B12, 0.5 milligrams of folic acid 400 milligrams of vitamin D are necessary requirements for a nursing mother. A supplement designed for nursing mothers also provides the extra iron needed by the mother which was depleted during pregnancy.

The Australian Government, National Health and Medical Research Council, Department of Health and Ageing, has released dietary guidelines in 2013, stating the minimum servings of different food types for breastfeeding women.
[mme_databox]

Food	Serves per day
Grain (cereal) foods, whole grains, high fiber, cereal variety	5-7
Vegetable and legumes/beans	7
Fruit	5
Milk, yoghurt, cheese	2
Lean, meats and poultry, Fish, eggs, tofu, nuts and seeds, legumes/beans	2
Extra foods (eg cakes, pies, soft drinks, lollies etc)	0-2 & ½

[/mme_databox]

Summary and Recommendations

The mother’s diet directly affects the composition of breast milk, including the amount of vitamins, selenium, iodine and fat.
Losing weight after delivery should be a gradual process, using a combination of diet and exercise. Losing weight too fast can even be harmful either for breast milk production or and its composition.
Certain foods may trigger reactions in babies, like allergies or making babies cry. If you think this is the case, remove the aliment from the diet for a couple of weeks. Check first with your doctor to ensure you do not remove essential nutrients from your diet.
If you are breastfeeding, make sure your diet is balanced, containing protein, vitamins, carbohydrates and iron. It is advisable that you take supplements of vitamin B12, folic acid and vitamin D.

[mme_references]
References

Anderson, J. (2013, April). Sample Daily Food Patterns from Eat for Health: Australian Dietary Guidelines. Retrieved from Diet and Weight Loss while Breastfeeding , Australian Breastfeeding Association.
Board, B. C. (2007). Diet for a Healthy Breastfeeding Mum. Retrieved from Babycenter: http://www.babycenter.com/0_diet-for-a-healthy-breastfeeding-mom_3565.bc
Bouchez, C. (2003). Your Nutritional Needs While Breastfeeding. Retrieved from WebMD: http://www.webmd.com/food-recipes/features/your-nutritional-needs-while-breastfeeding
Coila, B. (2011, September 12). Does the Mother’s Diet Affect the Weight Gained by the Breast fed Babies. Retrieved from Livestrong.com.
Eisenberg, A., Murkoff, H. E., & Hathaway, S. E. (1996). Surviving the First Six Weeks. In A. Eisenberg, H. E. Murkoff, & S. E. Hathaway, What to Expect the First Year (pp. 536-539). NewYork: Workman Publishing.
Kent, J. C. (2007). How Breastfeeding Works. Journal of Midwifery and Women’s Health, 52(6), 564-570.
Silver, K. (2012). Should You Avoid Certain Foods While Breastfeeding. Retrieved from Parents: http://www.parents.com/baby/breastfeeding/basics/avoid-foods-while-breastfeeding/

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What does it mean Autism Spectrum Disorder (ASD)?

[mme_highlight] ASD is a neurodevelopmental condition that causes difficulties in social interaction and communication, with restrictive patterns of behavior and limited interests. Children with ASD have difficulty to read other people’s expressions, they tend to avoid eye contact and have trouble expressing their needs. It is hard for them to adapt to changes.[mme_highlight]

ASD is a neurodevelopmental condition that causes difficulties in social interaction and communication, with restrictive patterns of behavior and limited interests. The criteria issued in May 2013 prefer using the term ASD, which includes classic autism, Asperger syndrome and others. An early intervention designed by health care providers along with parents and educators can minimize the impact of ASD on children’s lives and is a cornerstone to construct their future.

How common is ASD?

[mme_databox]
Epidemiology (statistical data) of ASD

Prevalence in general population : 2-20/1000 people
Boys:girls ratio – 4:1 (4 times more frequent among boys).
Rate in siblings: 2-8%; 18.7% (according to a recent longitudinal prospective study).
Mental retardartion: present in 45 to 60% of cases of ASD.
Seizures: present in 11 to 39% of cases of ASD.
Only 10 to 25% of ASD cases are associated with a medical condition/syndrome (eg. Phenylketonuria, X fragile syndrome).

Prevalence – The total number of cases of a disease in a given population at a specific time.
[mme_databox]

What are the causes for ASD?

ASD seems to be the result of an intricate interplay between genetics and environmental factors. In rare cases, toxic exposures, complications during delivery and infections before birth may also play a role.

What are the symptoms and signs of ASD?

Children with ASD have impairment in socialization and communication. They have difficulty to read other people’s expressions, they tend to avoid eye contact and have trouble expressing their needs. It is hard for them to adapt to changes. These children may also take longer to begin speaking. They have difficulty in playing with peers and they do not do the “pretend” games. They may show repetitive actions or repeat words or phrases. They usually focus their interest in one particular thing and have very limited interest in any other thing.

Is my child “just shy” or can it be a sign of ASD?

There are key features that differentiate a shy child from a child with ASD. While in the first case, a child can be shy at new situations or places, in ASD there is a lack of spontaneous seeking to share playing with others.
A shy child may take longer to make friendships, but in ASD children prefer to play alone. When a shy child meets with strangers, she/he tends to look away, but a child with ASD has difficulty in establishing eye contact even with family members.

Does ASD increase the likelihood for psychiatric hospitalization?

Yes, among a sample of 760 children diagnosed with ASD, 11% were hospitalized. In addition, studies show this risk increases with age and overtime. The table below is taken from a study and shows factors that increase the odds of psychiatric hospitalization among children with ASD.
The main conclusions are that an early diagnosis and community based interventions may decrease the need for hospitalization in these children.

[mme_databox]
Factors associated with Psychiatric hospitalization among children with ASD (only significantly

Living in single-parent homes: almost 3 times more risk of hospitalization (OR 2.54; CI 95% 32–4.88)
Later diagnosis: 1 time more risk of hospitalization (OR 1.10; CI 95% 00–1.21)
Self-injurious behavior: 2 times more risk of hospitalization (OR 2.14; CI 95% 18–3.88)
Aggressive behavior: almost 5 times more risk of hospitalization (OR 4.83; CI 95% 24–10.42)
Diagnosis of depression: 2 times more risk of hospitalization (OR 2.48; CI 95% 33–4.63)

Diagnosis of obsessive compulsive disorder: 2 times more risk of hospitalization (OR 2.35; CI 95% 1.39–3.96)
OR – Odds Ratio; CI – Confidence Interval
[end data]

How is ASD detected?

Your doctor will do the routine developmental surveillance to your child. In addition to this, tell your doctor about any behavior you find not adequate in your child. The American Academy of Pediatrics has stated the need for validated screening tools for ASD in the latest practice guidelines.
Although there is not a consensus yet, there is only one broadband screener that has been studied to detect children with ASD – The Infant-Toddler Checklist (ITC). ITC can be downloaded for free at http://www.brookespublishing.com/resource-center/screening-and-assessment/csbs/csbs-dp/csbs-dp-itc/. It includes 24 questions with 3 to 5 choices about developmental milestones of social communication.
The ITC should be completed by a parent or caregiver when the child is between 6 and 24 months of age to determine the need for referral and further evaluation, according to the net score of the checklist. The results of the screening of a sample of children with ITC are shown below, suggesting that the ITC has high strength (sensitivity and specificity) for catching young children at risk for ASD and other developmental delays among general population.

[mme_databox]
Screening with ITC
(initial sample: screening of 36 children with communication delay + screening of 18 children with typical development; 18 of the 36 children with communication delay received a diagnosis of ASD at 3 years of age and the other 18 received a diagnosis of developmental delay in which ASD was ruled out)

Results

ASD group: 94.4% had a positive screening with ITC (17 out 0f 18)
Development Delay group: 83.3% had a positive screening with ITC (15 out 0f 18)
Typical development group: 11.1% had a positive screening with ITC (2 out 0f 18)

Estimated Sensivity of ITC

ASD group + Development Delay group : 88.9%
ASD group only: 4%

Estimated Specificity of ITC
88.9%
[/mme_databox]

What is the treatment for ASD?

There is not a cure or specific treatment. An early intervention educational project should be developed in a multidisciplinary setting: family, educators, health care providers and community.

Summary and Recommendations

Autism Spectrum Disorder (ASD) is a problem in brain, which seems to result from the interaction of genetics and environmental factors.
Children with ASD have difficulties mainly in three domains: communication, socialization and interests.
These children have more risk of psychiatric hospitalization.
Along with healthcare providers, parents and caregivers should do a developmental surveillance of children. If an important milestone seems not to be attained, the child should be taken to a doctor.
There is not a cure for ASD. An educational program should be developed early, coordinating parents, healthcare providers and educators.

[/mme_references]
References

Mandell DS. Psychiatrichospitalization among children with autism spectrum disorders. Autism Dev Disord. 2008 Jul;38(6):1059-65.
Wetherby AM, Brosnan-Maddox S, Peace V et al. Validationof the Infant-Toddler Checklist as a broadband screener for autism spectrum disorders from 9 to 24 months of age. Autism. 2008 Sep;12(5):487-511.
Wetherby, A.; Woods, J. SORF: Systematic Observation of Red Flags for Autism Spectrum Disorders in Young Children, Unpublished manual. Florida State University; Tallahassee, FL: 2004.
http://www.cdc.gov/NCBDDD/actearly/autism/case-modules/identifying.html (accessed 4.11.2013)
Blumberg SJ, Bramlett MD, Kogan MD, et al. Changes in prevalence of parent-reported autism spectrum disorder in school-aged U.S. children: 2007 to 2011-2012. http://www.cdc.gov/nchs/data/nhsr/nhsr065.pdf (accessed 4.11.2013).
Ozonoff S, Young GS, Carter A, et al. Recurrence risk for autism spectrum disorders: a Baby Siblings Research Consortium study. Pediatrics 2011; 128:e488.

[/mme_references]

What can I do to enhance my child’s psychosocial skills before entering kindergarten?

[mme_highlight] Psychosocial skills promote peer acceptance and also harmonious relationships with teachers. Parents can contribute everyday to improve their children psychosocial skills in many ways by encouraging their children to express feelings using words, to share and to interact with peers. [mme_highlight]

Psychosocial skills, such as the capability of understanding emotions and keeping a positive social behavior, promote peer acceptance and also harmonious relationships with teachers. It is a worry for parents when they see that their child shows difficulty in making or keeping close friends or if she/he is teased or even rejected by peers in school. However, parents can also help their children improve such skills with simple and funny activities.

Why are psychosocial skills so important?

At school entry, learning engagement as a whole is reflected the capacity of a child to listen, follow rules and directions, as well as in the determination to do tasks. And this engagement and skills are closely related to social-emotional competence and to positive peer and teacher relationships in the classroom too.
An overall positive learning from the beginning engagement influences dramatically future academic success of a child. Ladd et al. found that higher levels of social participation and learning engagement at the beginning of kindergarten predicted better performance in tests at the end of the school year.
On the opposite, preschool children who tend to show oppositional or aggressive coping behaviors at home often also show such behavior when they enter school, which can lead first to rejection by peers and teachers and then to a negative cycle of social and academic failure.

Some studies have reported that approximately 20% of preschool children in the general population show moderate to clinically significant levels of emotional and behavioral problems. Nevertheless, studies also have found that under optimal circumstances, social skills training has been effective in improving popularity of children who were initially among the lowest regarding peer acceptance in their classroom.

What have social skills training programs proved?

The Head Start REDI study enrolled a total of 356 4-year-old children in an intervention group. Some of the main results are shown below. The investigation of correlations among study variables revealed that growth in emotion understanding and competent social problem solving was significantly associated with growth in positive social behavior.
Of note, growth in emergent literacy skills was significantly associated with growth in emotion understanding and competent social problem solving.

[mme_databox]
Correlations among study variables

Correlation between emotion understanding and emergent literacy skills: 18; p < 0.001 (statistically significant)
Correlation between competent social problem solving and emergent literacy skills: 14; p < 0.01 (statistically significant)
Correlation between competent social problem solving and growth in positive social behavior: 14; p < 0.01 (statistically significant)
Correlation between emotion understanding and growth in positive social behavior: 14; p < 0.01 (statistically significant)

[/mme_databox]

A study conducted by Han SS et al. evaluated the post-treatment outcome effects of a classroom-based social skills program for pre-kindergarten children, using a teacher-consultation model. Some of the results are shown below. Teachers rated children in the treatment group as showing significantly greater improvement than children in the control group in terms of their total problems, as well as regarding total social skills, like cooperation, assertion and self-control.

[mme_databox]
Teacher Ratings of Children’s Behavior Problems and Social Skills

	Pre-intervention	Post-intervention
Emotionally reactive	2.80	12.35
Anxious / Depressed	3.83	2.71
Withdrawn	5.06	3.89
Attention problems	6.81	4.88
Aggressive behavior	12.80	11.05
Cooperation	12.95	14.59
Assertion	9.99	12.85
Self-control	12.35	14.13

[/mme_databox]

What can parents do to improve their child’s psychosocial skills?

Encourage your child to describe feelings using words.
Practice turn taking in daily life situations.
Practice following directions, starting with one step directions (e.g. put your shirt in the wardrobe) and progressing to more complex directions.
Give a positive reinforcement to your child for sharing belongings with other persons.
Practice sitting quietly at a table to do some work, trying a gradual increase in the amount of time spent.
Enroll your child in extracurricular activities, which should help in making new friends.
Invite friends over to the house for a play afternoon, observe children’s interactions and intervene if appropriate and needed.

Summary and Recommendations

Social skills are crucial for life and absolutely determinant in the academic achievement of a child.
Some children may show negative social behaviors and difficulty in making friends, while others may be teased by peers or experience peer rejection. Some children may have behavioral problems or diseases, but many can grow up normally if they benefit from specialized help. If you are worried, consult your doctor.
Studies have shown that interventions regarding social skills have a positive outcome in improving these.
Parents can contribute everyday to improve their children psychosocial skills in many ways by encouraging their children to express feelings using words, to share and to interact with peers.

[mme_references]
References

Robert L. Nix , Karen L. Bierman , Celene E. Domitrovich & Sukhdeep Gill (2013) Promoting Children’s Social-Emotional Skills in Preschool Can Enhance Academic and Behavioral Functioning in Kindergarten: Findings From Head Start REDI, Early Education & Development, 24:7,1000-1019.
Ladd, G. W., Birch, S. H., & Buhs, E. S. (1999). Children’s social and scholastic lives in kindergarten: Related spheres of influence? Child Development, 70, 1373–1400.
Patterson, G. R., & Stoolmiller, M. (1991). Replications of a dual failure model for boys’ depressed mood. Journal of Consulting and Clinical Psychology, 59, 491–498.
Fergusson, D. M., Lynskey, M. T., & Horwood, L. J. (1996). Factors associated with continuity and changes in disruptive behavior patterns between childhood and adolescence. Journal of Abnormal Child Psychology, 24, 533–553.
Han SS, Catron T, Weiss B, Marciel KK. A teacher-consultation approach to social skills training for pre-kindergarten children: treatment model and short-term outcome effects. J Abnorm Child Psychol. 2005 Dec;33(6):681-93.

[/mme_references]

What can I do to enhance my child’s language literacy before entering kindergarten?

[mme_highlight] The ability of a child to use adequately language is a major determinant of her/his future academic achievement and impacts greatly social and economic characteristics of families and communities. The developmental skills for reading and writing are strengthened during the preschool years, which makes these crucial times for children development. [mme_highlight]

The ability of a child to use adequately language is a major determinant of her/his future academic achievement and impacts greatly social and economic characteristics of families and communities. Children learn oral language by listening and talking to adults around them, that is why they should be included and encouraged to take part in conversations since very young age. In fact, the optimal timing to improve language literacy is during preschool and early primary school years.

Why are language and literacy so important?

The International Reading Association (IRA) and the National Association for the Education of Young Children (NAEYC) issued a joint position statement where it is stated that “One of the best predictors of whether a child will function competently in school and go on to contribute actively in our increasingly literate society is the level to which the child progresses in reading and writing”.
It is now consensual that the developmental skills for reading and writing are strengthened during the preschool years, which makes these crucial times for children development.

What can parents do to improve their child’s language skills?

Reading aloud to your child on a frequent basis is the mainstay to promote early literacy development in children however it is has been estimated that only 58% of children aged 3 to 5 year are read to daily by a family member (Forum on Child and Family Statistics, 2004).

Here are some useful tips to help your child build language:

Read aloud to your child as much as you can, if possible, on a daily basis. Ask your child to turn the pages.
Encourage your child to be active participants rather than passive listeners when you are sharing the reading of a book.
Arrange the bedroom and living room environment so that children have an opportunity to interact with books and other print materials.
Help your children get familiar with letters of the alphabet and their corresponding sounds.
Use position words when talking to your child (e.g., Put the box on the lower shelf.
Use rhyming words and sentences; use sentences with alliteration (similar sounds).
Learn the nursery rhymes and practice them at home.
Ask your child to re-tell you the story you have read to her/him.
Encourage your child to assemble the pieces of a puzzle.
Ask your child to find shapes in a picture.

The language and literacy promotion scale proposed by Green SD et al. is composed of 23 items and can serve both as a survey method and a set of useful tips to promote these skills. Results from the survey which included the answers of 180 educators using the items of the scale are shown below.

[mme_databox]
Results from a survey with educators using a 23 items Language and Literacy Promotion Scale

	“Often or Always”	“Sometimes"	“Seldom or Never”
Read aloud to children in a group setting	78.3%	16.7%	5.0%
Read aloud to children individually	50.0%	30.6%	19.4%
Set aside special time each day to read to children	75.0%	19.4%	5.6%
Read aloud a variety of books	85.6%	9.4%	5.0%
Re-read favorite books	82.8%	12.8%	4.4%
Talk about books read together	68.9%	20.6%	10.6%
Ask children questions about the books	74.4%	17.8%	7.8%
Provide opportunities for children to look at books and other printed materials on own	82.2%	13.3%	4.4%
Teach children features of a book	58.3%	21.1%	20.6%
Teach children that printed letters and words run from left to right and from top to bottom	63.3%	19.4%	17.2%
Practice saying alphabet with the children	93.3%	5.0%	1.7%
Teach children to recognize letters of alphabet	90.0%	7.8%	2.2%
Teach children to distinguish between uppercase and lowercase letters	69.4%	20.6%	10.0%
Help children learn the sounds each letter can represent	78.9%	12.2%	8.9%
Teach children to write letters of alphabet	71.7%	17.2%	11.1%
Help children to write their names	74.4%	16.1%	9.4%
Help children identify different colors, shapes, and sizes	88.3%	8.3%	3.3%
Help children learn opposites	81.1%	16.1%	2.8%
Help children recognize numbers	87.2%	8.9%	3.9%
Practice counting with the children	88.9%	9.4%	1.7%
Choose books to read aloud that focus on sounds, rhyming, and alliteration	77.2%	16.7%	6.1%
Have children sing or say a familiar nursery rhyme or song	85.6%	12.8%	1.7%
Encourage children to make up new verses of familiar songs or rhymes by changing beginning sounds or words	63.9%	20.6%	15.6%

[/mme_databox]

The same study found that some variables significantly influence early childhood promotion of language and literacy by educators, namely, the availability of books and other print materials adequate for children and the number of children cared for by the educator. The table below shows these correlations.

[mme_databox]
Variables significantly correlated to promotion of language literacy

Correlation between availability of print materials and promotion of language literacy: β = 0.52; p < 0.001 (statistically significant)
Correlation between the number of children cared for by each educator and promotion of language literacy: β = 0.17; p < 0.01 (statistically significant)
Correlation between perceived adequacy of training received by educators and promotion of language literacy: β = 0.36; p < 0.001 (statistically significant)

[/mme_databox]

Summary and Recommendations

The ability of a child to use adequately language is a major determinant of her/his future academic achievement and throughout life.
The optimal timing to improve language literacy is during preschool and early primary school years.
Parents and educators play a major role in promoting language literacy skills.
Reading aloud to children on a frequent basis is one of the most consistent ways to promote early literacy development in children. Children should be included in conversations and encouraged to participate actively since very young age.
If you think your child is not developing language and literacy skills as expected or has lose skills previously acquired, consult a doctor.

[mme_references]
References

Green SD, Peterson R, Lewis JR. Language and Literacy Promotion in Early Childhood Settings: a survey of center-based practices. Early Childhood Research and Practice. 2006. Vol. 8, N. 1.
Landry SH. Effective Early Childhood Programs. Children’s Learning Institute. University of Texas.
Committee of the Prevention of Reading Difﬁculties in Young Children, Commission on Behavioral and Social Sciences and Education, National Research Council. Preventing Reading Difﬁculties in Young Children, 4 ed. Snow, C. E., Burns, M. S.; and Grifﬁn, P. Washington DC: National Academy Press, 1998.

[/mme_references]