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Pediatric

Development of Toddler

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Introduction:
Brain fact: Brains are ready for learning from birth.
The human brain function and development grows amazingly fast, starting from day one in the womb. By age 6, your baby’s brain will be almost adult-sized. Even at birth, babies’ brains contain millions of brain cells, which are called neurons.

Brain fact: Brain connections are strengthened with experience.
Brain connections are called synapses. Thousands and thousands of them are formed with everyday experiences. Synapses are crucial because they transmit brain impulses, which control body functions, thinking, feeling, learning, memory, and language.

Your toddler has a new toy, which he is exploring with lots of energy. His brain cells are firing away, and new synapses may occur. Toddlers‘ brains will make many more synapses than needed for good brain functioning. Synapses that are used frequently will be strengthened and remain. Those that are not will eventually disappear. So by hugging and reading to your toddler, you can encourage the growth and strengthening of brain connections.

When a baby is born, parents must consider their most important job is to take proper care  of their child, leaving aside    every other important  job  in   life.

Toddlers are children ages 1 – 3.

THEORIES
Jean Piaget, in the cognitive (thought) development theory, includes the following:

•Early use of instruments or tools
•Following visual (then later, invisible) displacement (moving from one place to another) of objects
•Understanding that objects and people are there even if you can’t see them (object and people permanence)
Erik H. Erikson‘s personal-social development theory says the toddler stage represents Autonomy (independence) vs. Shame or Doubt. The child learns to adjust to society’s demands, while trying to maintain independence and a sense of self.

These milestones are typical of children in the toddler stages. Some variation is normal. If you have questions about your child’s development, contact your health care provider.

PHYSICAL DEVELOPMENT
The following are signs of expected physical development in a toddler:

GROSS MOTOR SKILLS (use of large muscles in the legs and arms)
•Stands alone well by 12 months
•Walks well by 12 – 15 months (if the child is not walking by 18 months, he or she should be evaluated by a health care provider)
•Learns to walk backwards and up steps with help at about 16 – 18 months
•Throws a ball overhand and kicks a ball forward at about 18 – 24 months
•Jumps in place by about 24 months
•Rides a tricycle and stands briefly on one foot by about 36 months

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FINE MOTOR SKILLS (use of small muscles in hands and fingers)……click & see
•Makes tower of three cubes by around 15 months
•Scribbles by 15 – 18 months
•Can use spoon and drink from a cup by 24 months
•Can copy a circle by 36 months

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LANGUAGE DEVELOPMENT

click & see

•Uses 2 – 3 words (other than Mama or Dada) at 12 – 15 months

•Understands and follows simple commands (“bring to Mommy”) at 14 – 16 months
•Names pictures of items and animals at 18 – 24 months
•Points to named body parts at 18 – 24 months
•Begins to say his or her own name at 22 – 24 months
•Combines 2 words at 16 to 24 months — there is a range of ages at which children are first able to combine words into sentences; if a toddler cannot do so by 24 months, parents should consult their health care provider
•Knows gender and age by 36 months.

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SOCIAL DEVELOPMENT…....click & see
•Indicates some needs by pointing at 12 – 15 months
•Looks for help when in trouble by 18 months
•Helps to undress and put things away by 18 – 24 months
•Listens to stories when shown pictures and can tell about immediate experiences by 24 months
•Can engage in pretend play and simple games by 24 – 36 months

BEHAVIOR
Toddlers are always trying to be more independent. This creates not only special safety concerns, but discipline challenges. The child must be taught — in a consistent manner — the limits of appropriate vs. inappropriate behavior.

When toddlers try out activities they can’t quite do yet, they can get frustrated and angry. Breath-holding, crying, screaming, and temper tantrums may be daily occurrences.

It is important for a child to learn from experiences and to be able to rely on consistent boundaries between acceptable and unacceptable behaviors.

Toddlers always imitate their parents and so  toddlers behavior with others depends  on their parents behavior .
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SAFETY

TODDLER SAFETY IS MOST IMPORTANT
•It is important for parents to recognize that the child can now walk, run, climb, jump, and explore. This new stage of movement makes child-proofing the home essential. Window guards, gates on stairways, cabinet locks, toilet seat locks, electric outlet covers, and other safety features are essential.
•As during the infancy period, place the toddler in a safety restraint (toddler car seat) when riding in a car.
•Do not leave a toddler unattended for even short periods of time. Remember, more accidents occur during the toddler years than at any other stage of childhood.
•Introduce and strictly stick to rules about not playing in streets or crossing without an adult.
•Falls are a major cause of injury. Keep gates or doors to stairways closed, and use guards for all windows above the ground floor. Do not leave chairs or ladders in areas that are likely to tempt the toddler into climbing up to explore new heights. Use corner guards on furniture in areas where the toddler is likely to walk, play, or run.
•Childhood poisonings are a frequent source of illness and death during the toddler years. Keep all medications in a locked cabinet. Keep all toxic household products (polishes, acids, cleaning solutions, chlorine bleach, lighter fluid, insecticides, or poisons) in a locked cabinet or closet. Many household plants may cause illness if eaten. Toad stools and other garden plants may cause serious illness or death. Get a list of these common plants from your pediatrician.
•If a family member owns a firearm, make sure it is unloaded and locked up in a secure place.
•Keep toddlers away from the kitchen with a safety gate, or place them in a playpen or high chair. This will eliminate the danger of burns from pulling hot foods off the stove or bumping into the hot oven door.
•Toddlers love to play in water, but should never be allowed to do so alone. A toddler may drown even in shallow water in a bathtub. Parent-child swimming lessons can be another safe and enjoyable way for toddlers to play in water. Never leave a child unattended near a pool, open toilet, or bathtub. Toddlers cannot learn how to swim and cannot be independent near any body of water.

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PARENTING TIPS
•The toddler years are the time to begin instilling values, reasoning, and incentives in the child, so that they learn accepted rules of behavior. It is important for parents to be consistent both in modeling behavior (behaving the way you want your child to behave),and in addressing appropriate versus inappropriate behavior in the child. Recognize and reward positive behavior. You can introduce time-outs for negative behavior, or for going beyond the limits you set for your child.
•The toddler’s favorite word may seem to be “NO!!!” It is important for parents not to fall into a pattern of negative behavior with yelling, spanking, and threatening of their own.
•Teach children the proper names of body parts.
•Stress the unique, individual qualities of the child.
•Teach concepts of please, thank you, and sharing with others.
•Read to the child on a regular basis — it will enhance the development of verbal skills.
•Toddlers thrive on regularity. Major changes in their routine are challenging for them. Toddlers should have regular nap, bed, snack, and meal times.
•Toddlers should not be allowed to eat many snacks throughout the day. Multiple snack times tend to suppress their appetite for regular meals, which tend to be more balanced.
•Travel and guests can be expected to disrupt the child’s routine and make them more irritable. The best responses to these situations are reassurance and reestablishing routine in a calm way.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://www.nlm.nih.gov/medlineplus/ency/article/002010.htm
http://www.enfamil.com/app/iwp/enf10/content.do?dm=enf&id=/Consumer_Home3/Toddlers3/Toddlers_Articles/brainDevelopment&iwpst=B2C&ls=0&cm_mmc=paid%20search-_-Enfagrow-_-Google-_-2010&csred=1&r=3482830970

http://www.whattoexpect.com/funnel/registration.aspx?18=toddlerdevelopment&xid=g_reg&s_kwcid=TC|21967|the%20development%20of%20toddlers||S|b|8765848023&gclid=CKbri6_J56gCFRG4KgodSz8bCw

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Categories
Ailmemts & Remedies Pediatric

Babies Eye Sight

Vision in a baby’s first few months
To start with, they can see a toy or face in front of them but anything much further away is a blur. Slowly, the distance that they can see clearly increases, until by about six months they can see across a room.

CLICK & SEE

Many tiny babies also have a squint (their eyes look in different directions), which usually gets better within a few months.

Faces are a good test
Most babies can recognise their parents by about two weeks and start to smile at about six weeks. In these early days, most babies are particularly fascinated by faces and will focus on one in front of them – following it with their gaze (they prefer familiar faces).

This gives you a chance to test your baby’s sight from the age of six weeks.

•Sit your baby on the lap of someone they’re comfortable with
•Crouch down so your face becomes level with your baby’s face and about an arm’s length away from them
•Your baby should fix his or her eyes on your face (rather than looking everywhere else)
•Keep looking at your baby but move your head around from one side to another
•Your baby should keep his or her eyes fixed on your gaze
Alternatively, use a toy moved in front of your baby. They should be able to follow a brightly coloured moving toy held about 20cm (8in) away from them by about six weeks.

It can be difficult to be certain
Small babies are easily distracted and it can be very difficult to test their sight with certainty, so any worries you have are best checked by a professional.

Small babies can seem to take longer than normal for their brain to register what their eyes are seeing, even though there’s no problem with their vision. This is more likely in premature babies. After a matter of weeks, their visual sense suddenly kicks in and the problem’s resolved.

Serious visual problems are rare at this age, especially if his eyes appear normal, but occasionally they do occur.

A parent’s instincts should never be ignored. If you’re worried, talk to your doctor.

You may click to see to learn more :

How a Baby’s Vision and Eyesight Develops

Vision Development in Babies

Developmental milestones: Sight

Source : BBC Health.

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Featured Pediatric

WHO Breastfeeding Guidelines

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Over the past decades, evidence for the health advantages of breastfeeding and recommendations for practice have continued to increase. WHO can now say with full confidence that breastfeeding reduces child mortality and has health benefits that extend into adulthood. On a population basis, exclusive breastfeeding for the first six months of life is the recommended way of feeding infants, followed by continued breastfeeding with appropriate complementary foods for up to two years or beyond.
………………
To enable mothers to establish and sustain exclusive breastfeeding for six months, WHO and UNICEF recommend:

•Initiation of breastfeeding within the first hour of life;
•Exclusive breastfeeding – that is, the infant only receives breastmilk without any additional food or drink, not even water;
•Breastfeeding on demand – that is, as often as the child wants, day and night;
•No use of bottles, teats or pacifiers.
Breastmilk is the natural first food for babies, it provides all the energy and nutrients that the infant needs for the first months of life, and it continues to provide up to half or more of a child’s nutritional needs during the second half of the first year, and up to one-third during the second year of life.

Breastmilk promotes sensory and cognitive development, and protects the infant against infectious and chronic diseases. Exclusive breastfeeding reduces infant mortality due to common childhood illnesses such as diarrhoea or pneumonia, and helps for a quicker recovery during illness.

Breastfeeding contributes to the health and well-being of mothers, it helps to space children, reduces the risk of ovarian cancer and breast cancer, increases family and national resources, is a secure way of feeding and is safe for the environment.

While breastfeeding is a natural act, it is also a learned behaviour. An extensive body of research has demonstrated that mothers and other caregivers require active support for establishing and sustaining appropriate breastfeeding practices. WHO and UNICEF launched the Baby-Friendly Hospital Initiative (BFHI) in 1992, to strengthen maternity practices to support breastfeeding. The BFHI contributes to improving the establishment of exclusive breastfeeding worldwide and, coupled with support throughout the health system, can help mothers sustain exclusive breastfeeding.

WHO and UNICEF developed the 40-hour Breastfeeding Counselling: A Training Course and more recently the five-day Infant and Young Child Feeding Counselling: An Integrated Course to train a cadre of health workers that can provide skilled support to breastfeeding mothers and help them overcome problems. Basic breastfeeding support skills are also part of the Integrated Management of Childhood Illness training course for first-level health workers.


The Global Strategy for Infant and Young Child Feeding describes the essential interventions to protect, promote and support breastfeeding.

Source:BBC News

You may click to see :-
:: Complementary feeding
:: Baby-friendly Hospital Initiative
:: Breastfeeding counselling: a training course
:: Infant and Young Child Feeding Counselling – An Integrated Course
:: Documents about infant feeding/breastfeeding

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Ailmemts & Remedies Pediatric

Ankyloglossia or Tongue -tie

Definition:
By definition, complete ankyloglossia is the total adherence of the tongue to the floor of the mouth. Partial ankyloglossia is incomplete separation of the tongue from the bottom of the mouth due to a short frenulum, which is a fibrous membrane extending from the bottom of the tongue to an area below the bottom front teeth. Tongue-tie can be evident when the baby is crying or by careful inspection.

CLICK TO SEE THE PICTURES…..>….(01)....(1).…..….(2)..……...(3)..……..…………..

List of images in Gray's Anatomy: XII. Surface...
List of images in Gray’s Anatomy: XII. Surface anatomy and Surface Markings (Photo credit: Wikipedia)

Symptoms:
There are certain facial features that have been found to be associated with a short frenulum.

*High-arched palate: characterized by a higher than normal arch of the roof of the mouth.
*Retrognathia: very small chin.
*Micrognathia: a recessed or undefined chin.
*Prognathism: a protruding lower jaw.
*Can’t stick the tongue forward
*Difficulty feeding
*Excessive attachment of tongue to bottom of the mouth
*V-shaped notch in tip of tongue

Causes:
Tongue-tie causes a significant portion of of the problems encountered with breastfeeding. It also is thought to pose other short term and long term complications, such as speech impediments, problems with swallowing, and the formation of teeth arrangement. There is some controversy over the defining characteristics of tongue-tie as well as the treatments.

When we hear the term “tongue-tied”, most of us have a mental image of someone who is struggling to speak in public, but is stammering nervously and is at a loss for words. In reality, tongue-tie is a medical condition that affects many people, and has special implications for the breastfed baby.
The medical term for the condition known as tongue-tie is “ankyloglossia”. It results when the frenulum (the band of tissue that connects the bottom of the tongue to the floor of the mouth) is too short and tight, causing the movement of the tongue to be restricted.
Tongue-tie is congenital (present at birth) and hereditary (often more that one family member has the condition). It occurs relatively often: between 0.2% and 2% of babies are born with tight frenulums.

To tell if your baby is tongue-tied, look at him and stick out your tongue. Even tiny babies will imitate you. If he is unable to extend his tongue fully, or if it has a heart shaped appearance on the tip, then you should have him evaluated by his doctor. You can also try putting your finger in his mouth (pad side up) until he starts sucking. See if his tongue extends over his gum line to cup the bottom of your finger. If not, you may want to have him checked.
In most cases, the frenulum recedes on its own during the first year, and causes no problems with feeding or speech development. A lot depends on the degree of the tongue-tie: if the points of attachment are on the very tip of the tongue and the top ridge of the bottom gum, feeding and speech are more likely to be affected than if the frenulum is attached further back.

Severe tongue-tie can cause problems with speech. Certain sounds are difficult to make if the tongue can’t move freely (especially ‘th’, ‘s’, ‘d’, ‘l’, and ‘t’). In addition to forming specific sounds, tongue-tie may also make it hard for a child to lick an ice cream cone, stick out his tongue, play a wind instrument, or French kiss. While these may not seem like important skills to you as a new mother, someday they may be very important to your child! Dental development may also be affected, with severe tongue- tie sometimes causing a gap between the two lower front teeth.
Of more immediate importance is the negative impact that a tight frenulum can have on a baby’s ability to breastfeed effectively. In order to extract milk from the breast, the baby needs to move his tongue forward to cup the nipple and areola, drawing it back in his mouth and pressing the tissue against the roof of his mouth. This compresses the lactiferous sinuses (the pockets behind the areola where the milk is stored) and allows the milk to move into the baby’s mouth. The tongue plays an important role in breastfeeding, and if the baby’s frenulum is so short that his tongue can’t extend over the lower gum, he may end up compressing the breast tissue between his gums while he nurses, which can cause severe damage to the nipples.
Tongue-tie can cause feeding difficulties such as low weight gain and constant fussiness in the baby. Nursing mothers may experience nipple trauma (the pain doesn’t go away no matter what position is used), plugged ducts, and mastitis.

Some tongue-tied babies are able to nurse effectively, depending on the way the frenulum is attached, as well as the individual variations in the mother’s breast. If the mother has small or medium nipples, the baby may be able to manage to extract the milk quite well in spite of being tongue-tied. On the other hand, if the nipples are large and/or flat, then even a slight degree of tongue-tie may cause problems for a nursing baby.
In addition to problems with nipple soreness and weight gain, some other signs that the baby may be having problems nursing effectively include breaking suction often during feedings, and making a clicking sound while nursing. Since these symptoms can also be caused by other problems, it’s a good idea to be evaluated by a knowledgeable health care provider (a lactation consultant if possible) to rule out causes other than tongue-tie. Tongue-tie should definitely be considered a possibility if breastfeeding doesn’t improve even after other measures such as adjustments in positioning have been tried.
If it is determined that tongue-tie is causing breastfeeding difficulties, there is a simple procedure called a “frenetomy” that can quickly correct the problem. In a relatively painless in-office procedure, the doctor simply clips the frenulum to loosen it and allow the tongue full range of motion. It takes less than a second, and because the frenulum contains almost no blood, there is usually only a drop or two of blood. The baby is put on the breast immediately following the procedure, and the bleeding stops almost instantly. Anesthesia and stitches are not necessary. The baby cries more because he is being restrained for a few seconds that he does because of pain. Comparing the procedure to ear piercing is a good analogy. Both involve a second or two of discomfort and a very small risk of infection, but are overall very safe and simple procedures.

Diagnosis
According to Horton et al., diagnosis of ankyloglossia may be difficult; it is not always apparent by looking at the underside of the tongue but is often dependent on the range of movement permitted by the genioglossus muscles. For infants, passively elevating the tongue tip with a tongue depressor may reveal the problem. For older children, making the tongue move to its maximum range will demonstrate the tongue tip restriction. In addition, palpation of genioglossus on the underside of the tongue will aid in confirming the diagnosis.

In most cases, the mother notices an immediate improvement in both her comfort level and the baby’s ability to nurse more efficiently. If the tongue-tie isn’t identified and the frenulum isn’t clipped until the baby is several weeks or months old, then it may take longer for him to learn to suck normally. Sometimes suck training is necessary in order for him to adapt to the new range of motion of his tongue. If tongue-tie is causing severe breastfeeding difficulties, then the sooner the frenulum is clipped, the better. Sometimes children end up having the procedure done when they are much older, because the problem isn’t identified until after they begin developing significant speech problems.

Even though clipping the frenulum is a simple, safe, and uncomplicated procedure, it may be difficult to find a doctor who is willing to perform it. The history of treating tongue-tie is somewhat controversial. Up until the nineteenth century, baby’s frenulums were clipped almost routinely. Because of the potential for feeding and speech problems, midwives were reported to keep one fingernail sharpened so that they could sweep under the tongue and snip the frenulum of just about all newborn babies. Any procedure that involves cutting tissue in the mouth can potentially involve infection or damage to the tongue, especially back in the days before sterile conditions and antibiotics. Because the procedure was overdone and in most cases, wasn’t really necessary, doctors became very reluctant to clip frenulums at all and the procedure was rarely performed.

Part of the reason frenotomies fell out of favor for many years was the fact that doctors discovered that in all but the most severe cases, speech was not affected by tongue-tie. They preferred to take a “wait and see” approach and let nature take it’s course. Most of the time, the frenulum would stretch out on its own with no intervention.

During the same time period that frenotomies were becoming less common, the rate of breastfeeding also declined dramatically. Bottle-feeding doesn’t present the same feeding difficulties for tongue-tied babies that breastfeeding does, because the mechanics are very different and extension of the tongue doesn’t play as big a role in feeding from the bottle. Since the majority of babies were bottle fed, it was easy for doctors to say that they weren’t going to perform an unnecessary procedure that didn’t interfere with feeding, and rarely caused speech problems.
Even today, with most infants in this country starting out breastfeeding, it may be difficult to find a doctor who recognizes the problem that tongue-tie can present for a nursing baby and is willing to perform a frenotomy. The procedure is seldom mentioned in the pediatric literature, and is no longer routinely taught in medical school.

If you feel that your baby’s breastfeeding difficulties may be due to tongue-tie, you may need to work at finding a health care provider who can diagnose the problem and clip the frenulum. Although any pediatrician or general family practitioner can theoretically perform a frenotomy, many prefer to make a referral to an oral surgeon, dentist, or ENT specialist.

Diagnosis of Clinically Significant Tongue-Tie
Based on a combination of anatomical appearance and functional disturbance:

Anatomical Type I: Frenulum attaches to tip of tongue in front of alveolar ridge in low lip sulcus….

Type II: Attaches 2-4mm behind tongue tip and attaches on alveolar ridge…..click for picture.

Type III: Attaches to mid-tongue and middle of floor of the mouth, usually tighter and less elastic. The tip of the tongue may appear “heart-shaped”

Type IV: Attaches against base of tongue, is shiny, and is very inelastic

CLICK & SEE THE PICTURES

Effects:-
Ankyloglossia can affect feeding, speech, and oral hygiene   as well as have mechanical/social effects.   Ankyloglossia can also prevent the tongue from contacting the anterior palate. This can then promote an infantile swallow and hamper the progression to an adult-like swallow which can result in an open bite deformity.   It can also result in mandibular prognathism; this happens when the tongue contacts the anterior portion of the mandible with exaggerated anterior thrusts.    The authors sent a survey to a total of 1598 otolaryngologists, pediatricians, speech-language pathologists and lactation consultants with questions to ascertain their beliefs on ankyloglossia; 797 of the surveys were fully completed and used in the study. It was found that 69 percent of lactation consultants but only a minority of pediatricians answered that ankyloglossia is frequently associated with feeding difficulties; 60 percent of otolaryngologists and 50 percent of speech pathologists answered that ankyloglossia is sometimes associated with speech difficulties compared to only 23 percent of pediatricians; 67 percent of otolaryngologists compared to 21 percent of pediatricians answered that ankyloglossia is sometimes associated with social and mechanical difficulties. Limitations of this study include a reduced sample size due to unreturned or incomplete surveys.

Feeding
Messner et al. studied ankyloglossia and infant feeding. Thirty-six infants with ankyloglossia were compared to a control group without ankyloglossia. The two groups were followed for six months to assess possible breastfeeding difficulties, defined as nipple pain lasting more than six weeks, or infant difficulty latching onto or staying onto the mother’s breast. Twenty-five percent of mothers of infants with ankyloglossia reported breast feeding difficulty compared with only 3 percent of the mothers in the control group. The study concluded that ankyloglossia can adversely affect breastfeeding in certain infants. Infants with ankyologlossia do not, however, have such big difficulties when feeding from a bottle.  Limitations of this study include the small sample size and the fact that the quality of the mother’s breast feeding was not assessed.

Wallace and Clark also studied breastfeeding difficulties in infants with ankyloglossia.[8] They followed 10 infants with ankyloglossia who underwent surgical tongue tie division. Eight of the ten mothers experienced poor infant latching onto the breast, 6/10 experienced sore nipples and 5/10 experienced continual feeding cycles; 3/10 mothers were exclusively breastfeeding. Following a tongue tie division, 4/10 mothers noted immediate improvements in breastfeedings, 3/10 mothers did not notice any improvements and 6/10 mothers continued breastfeeding for at least four months after the surgery. The study concluded that tongue tie division may be a possible benefit for infants experiencing breastfeeding difficulties due to ankyloglossia and further investigation is warranted. The limitations of this study include that the sample size was small and that there was not a control group. In addition, the conclusions were based on subjective parent report as opposed to objective measures.

Speech
Messner and Lalakea studied speech in children with ankyloglossia. They noted that the phones likely to be affected due to ankyloglossia include sibilants and lingual sounds such as [t d z s ? ð n l]. In addition, the authors also state that it is uncertain as to which patients will have a speech disorder that can be linked to ankyloglossia and that there is no way to predict at a young age which patients will need treatment. The authors studied 30 children from one to 12 years of age with ankyloglossia, all of whom underwent frenuloplasty. Fifteen children underwent speech evaluation before and after surgery. Eleven patients were found to have abnormal articulation before surgery and nine of these patients were found to have improved articulation after surgery. Based on the findings, the authors concluded that it is possible for children with ankyloglossia to have normal speech in spite of decreased tongue mobility. However, according to their study, a large percent of children with ankyloglossia will have articulation deficits that can be linked to tongue tie and these deficits may be improved with surgery. The authors also note that ankyloglossia does not cause a delay in speech or language but, at the most, problems with enunciation. Limitations of the study include a small sample size as well as a lack of blinding of the speech-language pathologists who evaluated the subjects’ speech.

Messner and Lalakea also examined speech and ankyloglossia in another study. They studied 15 patients and speech was grossly normal in all of the subjects. However, half of the subjects reported that they thought that their speech was more effortful than other peoples’ speech.

Horton et al. discussed the relationship between ankyloglossia and speech. The authors believe that tongue tie contributes to difficulty in range and rate of articulation and that compensation is needed. Compensation at its worst, the article states, may involve a Cupid’s bow of the tongue.

While the tongue tie exists, and even years after removal, common speech abnormalities include mispronunciation of words. The most common is pronouncing Ls as Ws; for example the word “lemonade” would come out as “wemonade.”

Mechanical/Social

Ankyloglossia can result in mechanical and social effects. Lalakea and Messner studied 15 people, aged 14 to 68 years. The subjects were given questionnaires in order to assess functional complaints associated with ankyloglossia. Eight subjects noted one or more mechanical limitations which included cuts or discomfort underneath the tongue and difficulties with kissing, licking one’s lips, eating an ice cream cone, keeping one’s tongue clean and performing tongue tricks. In addition, seven subjects noted social effects such as embarrassment and teasing. The authors concluded that this study confirmed anecdotal evidence of mechanical problems associated with ankyloglossia and that it suggests that the kinds of mechanical and social problems noted may be more prevalent than previously thought. Furthermore, the authors note that some patients may be unaware of the extent of the limitations they have due to ankyloglossia since they have never experienced normal tongue range. A limitation of this study is the small sample size that also represented a large age range.

Lalakea and Messner note that mechanical and social effects may occur even without other problems related to ankyloglossia such as speech and feeding difficulties. Also, mechanical and social effects may not arise until later in childhood as younger children may be unable to recognize or report the effects. In addition, some problems may not come about until later in life, such as kissing.

Complications

The complications are rare, but recurrence of tongue tie, tongue swelling, bleeding, infection, and damage to the ducts of the salivary glands may occur.

Treatment:
Surgery is seldom necessary but if it is needed, it involves cutting the abnormally placed tissue. If the child has a mild case of tongue tie, the surgery may be done in the doctor’s office. More severe cases are done in a hospital operating room. A surgical reconstruction procedure called a z-plasty closure may be required to prevent scar tissue formation.

Prognosis:
Surgery, if performed, is usually successful.

Disclaimer: This information is not meant to be a substitute for professional medical advise or help. It is always best to consult with a Physician about serious health concerns. This information is in no way intended to diagnose or prescribe remedies.This is purely for educational purpose.

Resources:
http://tonguetie.ballardscore.com/
http://www.breastfeeding-basics.com/html/tonguetie.shtml
http://en.wikipedia.org/wiki/Ankyloglossia
http://www.righthealth.com/topic/Tongue_Tie_Treatment/overview/adam20?fdid=Adamv2_001640&section=Full_Article

http://www.blueskydentaloffice.com/Children_s_Dentistry.html

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Pediatric Pregnancy & Child birth

Baby Development & Care from Birth to Three Months

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It is very difficult to know  what a newborn baby is capable of. In the early days and weeks after birth, to the naked eye, not much. Eating, crying, sleeping, and pooping seem to take up the majority of her day, with a few moments of alertness thrown in for good measure. But recent research has shown that she’s doing a lot more than that. “Even in the first minutes of life, babies are a wonder,” says Naomi Steiner, MD, a developmental and behavioral pediatrician at Tufts-New England Medical Center, in Boston. “The newborn has a superactive brain and is primed to learn.”
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Recent research, much of which relies on high-tech advances in intrauterine photography and brain imaging, now offers empirical proof of what parents have known all along: Babies are smart. What’s more, each baby is born with a unique personality that becomes readily apparent within the first few weeks of life. “Babies come into the world as themselves,” says Dr. Steiner. “It’s our job to get to know them.”

Baby’s Ability

Even though your baby can’t care for herself, what she is capable of at birth may surprise you. She’s born with 70 innate reflexes designed to help her thrive, some of which are truly remarkable. “Reflexes like the tonic neck reflex — in which your baby turns his head to one side, straightens one arm, and holds the other out — are critical to labor and delivery, helping your baby squirm around during the birth process, stimulating the uterus to keep contracting,” says Dr. Brazelton. In essence, he’s helping your labor progress.

Other reflexes are less subtle to a new parent. If left on his mother’s abdomen in a dim, quiet room after birth, a healthy newborn “will rest for about 30 minutes and will gaze at his mother’s face on and off,” reports Marshall Klaus, MD, who wrote the first textbook on neonatology and has coauthored a number of popular books for new parents, including Your Amazing Newborn (Perseus). Then he’ll begin smacking his lips and moving toward the breast completely unaided, using a powerful stepping reflex and bobbing his head up and down to gather momentum. Once at the breast, a newborn will open his mouth wide and place his lips on the areola, latching on all by himself for his first feeding. From that point on, these inborn responses will affect your newborn’s every move. The rooting reflex, for example, helps your baby seek nourishment. However, seemingly random, reflexive movements may be more intentional than we first thought. “When in a quiet, alert state, and in communication with a caregiver, some babies will reach out to try and touch something,” says Dr. Klaus.

Normal newborns at birth apparently have the underlying potential to reach for things, he explains, but their strong neck muscles are linked to their arms, so that a slight neck movement moves the arms as well. This connection protects the baby’s head from suddenly dropping forward or backward.

Baby’s Thinking

It depends upon how you define thought; of course, a newborn can’t share ideas. But some researchers believe that babies do put concepts together (albeit on a primitive level), evidenced by the fact that they remember and recognize their mother’s voice from birth, and express and respond to emotions before and immediately after birth. One could argue that memory and emotion are inextricably linked to thought. “A baby’s brain grows very differently depending on what sorts of experiences the baby has both in utero and after birth,” says Wendy Anne McCarty, PhD, the founding chair and faculty of the Prenatal and Perinatal Psychology Program at the Santa Barbara Graduate Institute, in California. “During gestation, birth, and early infant stages, we learn intensely and are exquisitely sensitive to our environment and relationships. From the beginning of life, we’re building memories.” Other experts say that a baby’s brain is too undeveloped to do more than orchestrate vital body functions. One fact remains clear: Newborns learn every day and apply that knowledge to their growing repertoire of skills. So can a newborn really think? Watch your baby, and judge for yourself!

Yopu may find the following:-In the first three months, your baby will learn to raise his or her head, smile, kick, move both arms and legs, roll over and make babbling noises. You will also learn to distinguish your baby’s cries, which will help you determine what your baby wants from you. Baby may also learn to wake up less as his or her stomach grows bigger and takes more in at a feeding.

Dr. Klaus discovered that newborns instinctively reach out until about 3 weeks of age, when this ability apparently disappears until about 3 months of age. This coincides with the time it takes your baby to start learning how to integrate his senses and gain control over his muscles. This is a prime example of how your baby’s need to learn so much, so quickly, means he must set aside some tasks while focusing on other, more important ones, such as regulating his sleep-wake cycles and figuring out how to focus his brand-new eyes on all the new sights around him.

So why do all these useful survival instincts seem to disappear so early — some as early as the 2-month mark? A baby spends the first few months of his life reacting to the world around him. But once he starts to understand where he ends and the world begins, which is partly a matter of brainpower, and partly a matter of practice, some behaviors that were once reflexive become active, as gradually baby learns that he can make things happen on his own and affect his environment. And, says Dr. Brazelton, “Just watching a baby learn is enough to give you hope for the human race.”

Baby’s Senses and Sensibility:-
Touch:
Your newborn’s skin is his largest and most highly developed sensory organ. At birth, your baby can respond to variations in temperature, texture, pressure, and pain. Your newborn’s lips and hands have the largest number of touch receptors, which may account for why newborns enjoy sucking on their fingers.

Smell:
By the 28th week of pregnancy, your baby can use her nose. One piece of evidence: Newborns placed between a breast pad from their mother and one from another woman most often turn toward the one with the alluring Mom-smell.

Taste:
In your womb, your baby gets a sampling of flavors as he swallows amniotic fluid. Studies have shown that fetal swallowing increases with sweet tastes and decreases with bitter or sour tastes.

Hearing:
Although your baby’s middle ear is still somewhat immature at birth, as are the sound processing centers of his brain, your newborn can hear you and will prefer human speech over any other sounds, especially if the voice is yours.

Vision:
By the time you actually meet your baby, her eyes are capable of excellent vision; however, her brain is still too immature to distinguish between different shades of color. By the time your baby is 3 months old, she will want to look at the world around her. She’ll prefer bright colors or sharp contrasts, and her favorite thing to look at will be faces.

Resources:

http://www.parents.com/baby/care/newborn/your-baby-from-birth-to-3-months/?page=5
http://www.thebabydepartment.com/babycare/baby-development.aspx

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