Preparation For Parenthood

By the end of this post, the reader should be able to:

·         Describe the processes of conception and pregnancy.

·         Describe the signs and symptoms of pregnancy.

·         Discuss the need for antenatal care.

·         Discuss the preparations to be made before child birth.

·         Explain the processes of child birth.

·         Explain the importance of post-natal care.

·         Describe the stages of development of a child from post-natal to preadolescent.

·         Describe the care for a baby.

·         Describe the feeding needs of the baby.

·         Identify the clothing needs of a new born baby.

·         Describe the common childhood ailments and their prevention.

·         Explain the importance of play to the child's development.

·         Explain the reasons why the size of the family has to be planned.

·         Describe the various methods for controlling birth.

Processes of Conception and Pregnancy

(i) Conception

It involves fertilization and implantation of the fertilized egg. During sexual intercourse sperms from a man are introduced into the vagina of the woman through the penis. The sperm swims through the vagina into the uterus and to the fallopian tubes. If there is a mature egg or ovum, then fertilization can occur and the woman becomes pregnant.

(ii) Fertilization

It is the fusion of the male sperm and the female egg inside the fallopian tube. It is the injection of the male sperms into the vagina of the female. The product of fertilization is called zygote. The zygote moves down to the uterus through the fallopian tubes.

(iii) Implantation

The attachment of the fertilized egg to the uterus. Three days after fertilization, the fused egg swims up the fallopian tube and attaches itself to the uterus wall. It becomes implanted on the wall of the uterus. The zygote grows into a fetus which crows and gradually assumes a human form. The place at which the fetus is attached is called the placenta. The embryo is connected to the placenta by the umbilical cord. The embryo is enclosed by two protective amniotic membranes. The inner one is amnion and the outer one called chorion. It is also surrounded by a fluid known as amniotic fluid which protects the child from physical shock and injury. The fluid flows out at the time of birth.

Gestation Period

It is a period of development in the womb until birth. That is the period between conception and childbirth. It is about 36 to 40 weeks long. Gestation period is divided into three stages of three months each. Each stage is referred to as a trimester. Thus, there are first, second and third trimesters.

Signs and Symptoms of Pregnancy

(i) Menstruation fails to occur on the expected date.

(ii) Breast becomes fuller, firmer and tenderer. As pregnancy advances, the nipples become darker and longer.

(iii) Nausea or vomiting may occur in the mornings. This is often described as morning sickness. For some people it may stop by the third month. It may last for the whole period of the pregnancy for others.

(iv) There may be frequent urination as the kidneys become over— burdened in their function and the bladder is filled with urine more quickly as pregnancy advances.

(v) A feeling of fatigue.

(vi) The abdomen enlarges from three months onwards.

(vii) As the pregnancy advances, the mother may feel the baby's movement.

Problems in Pregnancy

(i) Constipation: The muscle tone of the gut is lowered throughout pregnancy. This often leads to constipation. Later in pregnancy, the problem becomes aggravated by the pressure on the lower abdominal region by the enlarged uterus. This could be reduced by increased fluid intake and the inclusion of roughage in the diet from fruit and vegetables. Serious cases can be reported to a doctor.

(ii) Heartburn: This occurs later in most pregnancies. It is caused by the passage of small amounts of the contents of the stomach into the lower part of the digestive tract. This occurs in pregnancy because the enlarged uterus presses against the stomach. This problem can be overcome by eating small meals more frequently, and by increasing fluid intake. Greasy and fried foods should be avoided.

(iii) Leg Cramps: Some women experience leg cramps in late pregnancies. This occurs mostly at night. The intake of milk can be increased, and in severe cases it might be necessary to report to a doctor.

(iv) Nausea and Vomiting: Some women suffer from nausea and vomiting at the early stages of pregnancy. The problem normally disappears at the end of twelve weeks.

(v) Weight Gain: Pregnant women normally put on some weight. The fetus, placenta, amnion fluid, fat stored in the tissue, and other related developments resulting from the pregnancy contribute to weight gain. The weight gain should not be allowed to be excessive through over eating. It is, therefore necessary to have regular weight checks.

Positive State of Mind During Pregnancy

(i) Listening to calming and inspiring songs.

(ii) Reading positive literature.

(iii) Deep breathing exercises and prayers.

(iv) Having a supportive environment.

(v) Resting in mind.

(vi) Tolerance, companionship and family support.

Support System for Pregnant Women

(i) Husband and family.

(ii) Community.

(iii) Workplace environment.

(iv) Health facilities.

Ante-Natal Care or Pre-Natal Care

Ante-natal or pre-natal care is the care given to pregnant women before the birth of the child. A pregnant woman should take good

care of herself, and also attend the ante-natal clinic regularly. The following are guidelines for care during pregnancy:

1. Ante-Natal Clinic

The pregnant woman should attend the ante-natal clinic regularly. At the clinic, she will be thoroughly examined by a qualified midwife or doctor. Examinations carried out at the pre-natal clinic include urine and blood test, blood pressure and weight checks, an abdominal examinations and pelvic assessment. The pregnant woman is also given the necessary advice on how to care for herself, with regard to feeding, rest, etc.

Reasons for Attending Ante-natal Clinic

Series of examinations are carried out to identify any complications or health problems:

(i) Advice on drugs that should be avoided.

(ii) Given education on child care.

(iii) Rest; especially in the afternoons.

(iv) Exercise, regular exercise each day will help with child delivery.

(v) Exercise need not be strenuous.

(vi) Avoid lifting heavy items.

(vii) Avoid purgative or enema, etc.

Advantages of Regular Attendance at Ante-natal Clinic

(a) The series of examinations help to expose any complications that the expectant mother might experience.

(b) She is given any medical treatment that she may require.

(d) The unborn baby is also taken care of through regular check of its position and heart beats.

(e) She learns about child care.

(f) She is given adequate training on what to expect and do when she is in labor. She is also helped to develop a good attitude towards labor. Thus, regular attendance to an ante-natal clinic enables the expectant mother to reach the peak of fitness at the time of labor.

(g) It helps reduce the number of deaths in mothers and babies.

(h) It also helps reduce number of complications before and during labor

Personal Hygiene and Healthy Lifestyle

i. Feeding

The pregnant woman should be selective in her choice of food. She should provide the nutrients necessary for the growth of her child, as well as for her own needs.

ii. Clothing

The pregnant woman should wear clothes that are comfortable and in which she is most attractive. Gowns that hang from the shoulders are often comfortable.

iii. Bathing

The pregnant woman must maintain good personal hygiene. She must take her bath regularly and where possible, twice daily.

iv. Care of Breasts

Good care of the breasts during pregnancy is important for successful breastfeeding. The nipples should be drawn out gently for about two to three minutes a day. The expectant mother should always wash her nipples. She can also rub Vaseline on the nipples, especially if they are dry.

v. Exercise and Rest

Pregnancy is not a disease; it is a normal event. Exercise should be encouraged if it is the expectant mother's usual habit. She needs to have some rest every afternoon. Strenuous work, such as lifting heavy loads, should be avoided

vi. Drugs

Indiscriminate taking of drugs during pregnancy should be avoided. Drugs should only be taken when prescribed by a qualified doctor or midwife. Smoking and alcohol are not recommended for pregnant women.

Preparation For Childbirth

For the Baby

Every expectant mother is supposed to prepare adequately before child birth. Some preparations that the expectant mother needs to make include:

· Clothes for baby

· Safety pins, (if necessary)

· Napkins/ Nappies: There are presently disposal nappies (pampers)

· Towels

· Toiletries e.g. baby soap oil, lotion, powder, etc.

· Baby's comb

· Blanket or shawl

· Baby's feeding unit, including feeding bottles, sterilizing unit, baby's cup, spoon, feeding, bottle brush, etc.

· Baby's food, in case it is needed, other-wise breast milk is most appropriate

For the Mother

· Sanitary pads/towels

· Personal clothing, including night gowns, nursing brassiere, pants, etc.

· Toiletries, toilet soap, cream, powder, etc.

· Bed linen, that is, if the hospital allows patients to bring their own bed linen.

· Disinfectant, such as "Dettol"

Processes of Childbirth

Labor is the act of giving birth. A process by which the baby is born or delivered. It involves the expenditure of much energy, contract of the uterus occurs, and the cervix dilates to allow the head of the body to pass through.

Preparing for Labor

Stages of Labor

There are three stages of labor.

A. The First Stage of Labor

This is the period of time from the onset of labor to the full dilation of the cervix. It lasts on for an average of about 10 hours in first pregnancy and 7 hours in subsequent ones. This can however, vary with individuals. During the first stage, the uterus contracts. The contractions of the uterus are not very strong at first and occur at long intervals. As the uterus contracts, it exerts a pull on the cervix and causes it to dilate or open up. This first phase of labor lasts until the cervix is 2 to 3 finger-breadths or 4 to 5 cm dilated. At this stage, the mother is asked to relax during contractions.

B. The Second Stage of Labor

This is the stage at which the mother-to-be has to work very hard. She has to aid the passage of the child through the birth canal. The second stage is frequently announced by the rupture of the fetal membrane or "bag of water". In some cases, it could rupture at the end of the first stage.

During the second stage, the mother gets the urge to push. This is caused by the pressure of the baby's head on the pelvis. The uterus continues to contract. With each contraction and pushing efforts of the mother, the baby's head moves nearer the vulva opening, until the baby is born. This second phase could last less than one hour but also varies with individuals.

The baby comes out, head first, connected by the umbilical cord to the placenta. The umbilical cord is tied with a thread to prevent bleeding and then cut to separate the baby from the mother.

C. The Third Stage of Labor

The last stage involves the expulsion of the placenta. It is also known as after-birth. It breaks away from the wall of the uterus as the child is born. Further contraction of the uterus causes it to pass out through the vagina. The third stage is, therefore very short.

Complications in Child birth

(i) Retention of placenta: Placenta may be withheld after birth and thus could be extremely dangerous to the health or life of the woman.

(ii) Bleeding: Excessive bleeding before and after child birth/labor could lead to anemia.

(iii) Breech birth: Baby may come out with legs or buttocks first (This is called breach birth). This may be corrected by a doctor.

Post-Natal Care

The care mother and the newly born child receive after delivery until about 6 weeks. That is the care required by the mother and the baby after child birth.

Importance of Post-natal Checkup

(i) It enables the doctor to examine the mother to ensure that all is well with her.

(ii) It gives the mother the opportunity to discuss any problems which she has with the doctor.

(iii) It also provides the woman with an opportunity to discuss the subject of birth control.

(iv) The baby is also examined and treated for any problems. His weight gain is also checked.

(v) There could be demonstrations on child care, including food preparation processes.

(vi) Ensures babies survival and health.

(vii) Baby is immunized.

(viii) Monitors baby's growth.

(ix) Monitors mother's health.

Developmental Stages of a Child

Infant 0 — 1 year

Toddler 1 — 3 years

Pre-schooler 3 — 5 years

School age 6 — 9 years

Pre-adolescent 10 — 12 years

Development is an increase in skill and complexity of function. A child is developing when he/she is making progress in what he/she does with his/her mind and body, such as holding up the head, holding a toy, gaining understanding, etc.

The Principles of Human Development

l. Development in children is predictable. Although the pattern of development is similar for all children, each child follows the predictable pattern in his own way at his own rate.

2. Follows a definite pattern starting from infancy through childhood and from adolescence to adulthood.

3. It should be steady.

4. Stages in child development include,

i. Pre-natal period, that is before birth,

ii. Infancy

iii. Early and late childhood, puberty and adolescence.

5. Development starts from the head and spreads all over the body. Therefore, a child first gains control of the eyes, then the head, followed by the arms, trunk and legs.

6. Developmental changes are orderly and progressive in a normal child. This is because the changes move forward rather than backward. Therefore, a child

is expected to be able to sit first, stand and then walk.

7. Children differ from each other.

8. Children develop at different rates. Some may be fast and others slow.

Factors That Influence Prenatal Development

There are two major factors that influence development-heredity and environment

(a) Heredity

This is the tendency for a parent to transfer his/her characteristics to his/her child, e.g. color of skin, eyes, nose, etc. The units which bear heredity or the hereditary factors in our body cells are called genes.

These genes which are inherited from parents determine such characteristics as colour of the eyes, hair texture, and whether the child should be short or tall. Each child inherits a separate sec of genetic combinations. Thus, no two individuals are exactly the same except perhaps in the case of identical twins. This tendency for children to differ from each other and their parents is called variation.

(b) Environment

This includes all the conditions, circumstances and influences surrounding and affecting the development of a child. Thus, environment is an outside influence as against heredity which is an inside influence with which a child is born. The child's environmental conditions stem from the home, school and society. These help the child to develop into a person. The child's environment gives him the opportunity to grow and enables him to develop the inherited characteristics to the fullest. From the child's environment come such factors that influence growth and development as:

i. Good Nutrition: Good nutrition in the form of a balanced diet is important for good health and growth.

ii. Love: The child needs to feel loved and wanted. This enables him to trust and feel trusted. Also, he is encouraged to strive to achieve all that he is capable of achieving.

iii. Good Care: The infant depends on the adult to meet his needs. Meeting the needs effectively and promptly aids the child's development.

iv. Conducive home environment: The child needs a comfortable and warm home environment for maximum development.

v. Good School: When the child is old enough to go to school, the school should provide him an environment that stimulates his physical, mental, emotional, and social abilities.

vi. Society: The society is a child's widest environment. It helps to shape his development. It provides many opportunities which help to broaden a child's cultural outlook and helps him to learn those things which the school and home do not teach.

vii. Disease: Serious and prolonged diseases can affect the normal development of a child. It is therefore, important that parents work hard to protect their children from diseases. They should also be vigilant enough to identify diseases early enough so that prompt medical attention can be obtained. Common ailments in children and signs of ill-health have already been discussed.

Areas of Development

Children develop in these areas — physical, mental, emotional, social and moral. They need adult attention all along the way in order to make the best of their development.

Physical development

This is development of the physical structures and functions e.g., the brain, muscles, nerves, bones and their functions. Physical development is basic to all other aspects of development. For instance, a child's brain has to develop first, physically before he can develop mentally.

Mental development

This is the development of intellectual abilities. It involves ability to think, understand, solve problems, etc. Children come into the world helpless and without knowledge and skills. They learn from parents, but they also learn through experiences and play.

Social development

This includes:

i. The development of behaviors approved by society or social groups.

ii. Playing socially approved roles.

iii. Development of social attitudes: Social development enables individuals to participate in and enjoy social activities and take interest in people. Social development actually begins at birth. Infants are calmed by a soothing voice and by being picked and held. It is important to give them attention early in life.

Emotional development

Emotions involve feelings and how a person expresses such feelings. For instance, by smiling, crying, frowning, etc. Emotions are the first language with which parents and infants communicate before the infant acquires speech. A child develops in the way he/she feels. Emotional well-being is deeply rooted in how well parents provide for the emotional needs of their children. Providing love, attention, support, and encouragement is especially important for good emotional development.

Moral development

This development shows in behavior and in how children treat others. Moral development starts early in life. Children learn to base their behavior on what they believe is right or wrong from the family, most often parents. This starts as children begin to learn the rule that parents and other care givers set. Between the ages of five and seven, children begin to develop a conscience. By this, doing something wrong triggers guilt because they know what they should be doing.

Conditions Necessary for Child Development

The following environmental conditions are necessary for a normal development of a child:

1. Love and care from family

2. Good nutrition: Children are growing at a rapid rate and need plenty of

nutritious foods to help them grow and develop strong, healthy bodies. Their meals must always be balanced. Breast feeding is very important and should be continued up to two years if possible. When semi-solid food is added, it must be balanced.

3. Clothing: Children need clothing that is suitable for different weather conditions.

4. Exercise: Children need plenty of opportunities for exercises. These help them to develop strong bones, muscles and motor skills.

5. Rest: Children are very active, and they grow rapidly. Therefore, their bodies need plenty of rest. Good sleep habits promote health and well-being.

6. Medical care: This is very important for the development of the children.

7. A safe and conducive environment: Safety is vital for children to develop. Parents must provide safe environment for their children always. This includes the home environment.

Caring For a New Born Baby

A new born baby needs:

(i) Food: The new born baby needs good food to keep fit and grow properly. A baby can be fed either by the breast or feeding bottle. It is important that the body gets enough food, of the right kind, and when he wants it. (at the right time).

(ii) Sleep: The new born baby must enjoy good sleep. He must be provided with a baby's cot, that is, the bed in which the baby rests or sleeps. It must be well equipped with a suitable mattress and fitted with a clean mosquito net where necessary.

(iii) Warmth: The baby needs clothing for protection and to keep him warm and aid in the regulation of body temperature. This will make him look beautiful or it will enhance his appearance

(iv) Fabrics for baby: Clothing should be soft non-flammable, safe and not irritate the baby delicate body and should have large openings so they can be easy to put on or take off.

(iv) Love: The child needs to feel loved and wanted. This enables him to trust and feel trusted. And he is encouraged to strive to achieve all that he is capable of achieving.

(v) To be kept clean and dry: The baby must be kept clean. At least, he should bath twice a day. His skin is delicate and should not be allowed to be dirty. His skin provides him protection and regulates his body temperature. It is therefore important to keep the baby's skin fresh and clean through regular baths.

Materials Needed for Baby's Bath

l. Baby's bath tub. This can be a plastic wash bowl or enamel ware tub.

2. Large towel. It must be soft enough for covering the baby.

3. Small towel for drying the baby.

4. Soft small cloth or face towel.

5. Soft sponge

6. Absorbent cotton for nose and ears if necessary.

7. Flask for hot water.

8. Baby's oil, cream or lotion, and baby's powder.

9. Baby's comb and brush.

10. Clean clothes for dressing baby after bath.

11. Napkins, napkin pins and plastic pants.

Preparation Before Bathing the Baby

l. Choose a suitable place where you have plenty of space to lay out the baby's clothes and other materials for the bath. The room should be warm.

2. Get everything needed for baby's bath ready and keep within easy reach.

3. Place a floor cloth on the floor to protect it from splashes of water.

4. Shut the door and windows to keep out draughts, especially on cold days.

5. Make the baby's cot.

Breast Feeding (Natural Feeding)

Breast feeding is the natural way to feed a baby. It can be started immediately after birth. A baby should be fed exclusively on the breast milk from birth to six months.

Importance / Advantages of Breast Feeding

(i) Breast milk contains all the nutrients needed by a baby more than any other

food.

(ii) It contains antibodies which protect the child against disease infection.

(iii) It is sterile and free from germs.

(iv) It is produced in the right temperature.

(v) It does not require any elaborate preparation.

(vi) It is easily digested and absorbed by the baby.

vii) Breast-fed babies are not easily constipated.

(viii) Breast feeding brings mother and child very close. It makes the baby happy.

ix) Breast milk never goes sour or bad. It is cheaper than artificial feeding.

(x) Breast feeding helps mothers to protect themselves against another pregnancy. Women do not ovulate or menstruate while breast feeding.

Guidelines for Breast Feeding

1. Wash your hands and then clean the breast with a clean wet soft cloth. Pay attention to the nipples.

2. Sit comfortably and carry the baby close to you. Help the baby by holding the breast in such a way that he can easily get the nipple into his mouth.

3. Hold the breast away from the baby's nose, so that he can breathe easily.

4. Let the baby nurse at both breasts, but the first breast should be emptied before he starts on the other.

5. Once or twice, when the baby is feeding, it may be necessary to stop and give him a chance to get up any swallowed air by winding him. Winding can be done at the end of the feeding. To wind, hold the baby up so that his stomach is against your shoulder, and gently pat his back to help him get the air up.

6. Clean the nipples after each nursing. Wear a clean brassiere that gives you good support.

7. Supplementary feeds should never be introduced before breast feeding has been fully established, except on medical advice.

Bottle/Artificial Feeding

This is the process of feeding a baby with artificial milk, often through the feeding bottle. There are different brands of baby's milk or infant's formula in the market. They are commonly made from cow-milk. It is best to breast-feed babies. However, there are times when it becomes necessary to bottle-feed babies.

Advantages / Reasons for Bottle Feeding

(i) Mother unable to produce breast milk, mother is sick — AIDS and other serious sicknesses.

(ii) When mother is working full-time outside the home, she has to bottle feed her baby.

(iii) When there is multiple births (e.g. twins or triplets), the mother's milk may not be sufficient for the babies.

(iv) When the mother cannot produce enough milk.

(v) The baby can reject or wean himself from the breast before his mother is ready to do so.

(vi) Some mothers refuse to breastfeed their babies.

(vii) A nursing mother who suddenly becomes pregnant will normally wean the baby and bottle-feed him.

Disadvantages of Bottle-Feeding

It is expensive.

(ii) The milk can easily be contaminated by disease /germs during preparation.

(iii) Constipation is common with bottle fed babies.

(iv) Artificial milk is not as rich as breastmilk. It does not contain antibodies.

(v) It requires elaborate preparation and sterilization of feeding unit.

(vi) It does not make for close contact between mother and child.

(vii) It is wasteful since any remains after feeding the baby cannot be stored and reheated.

Guidelines for Bottle Feeding

1. Boil all water used for preparation of baby's food.

2. Sterilize baby's feeding unit after each meal.

3. Follow the manufacturer’s instructions found on the back of the milk tin for the preparation of baby's food.

4. Wash your hands before preparing baby's food.

5. The food should be made up when it is required. It should not be made before time.

6. The teat of the feeding bottle must be suitable for the baby.

Preparation of Baby's food

Materials needed

1. Feeding bottles and teats.

2. Graduated measuring cup.

3. Sterilizing unit, which can be a small plastic bucket or basin with a closely fitted lid or cover.

4. Milton for sterilizing the bottles.

5. Bottle brush.

6. Baby's spoon

7. Baby's milk

8. A flask for keeping hot water.

It is best to reserve a table for keeping these materials.

Guidelines and Procedures for Preparing Baby's Milk

1. All water used for the preparation of baby's feed must be boiled, and then allowed to cool to a temperature slightly above the normal room temperature. With boiling water, fat tends to separate and with cold water feed is more difficult to mix.

2. The feed should be made up immediately it is required.

3. Your hands and all the equipment used must be thoroughly washed and kept clean.

4. Ensure that the teat of the feeding bottle is suitable for the baby.

5. Avoid underfeeding or overfeeding the baby by following strictly the recommended intakes for different ages on the milk tin.

To prepare the milk

1. Collect everything necessary for the preparation.

2. Wash your hands thoroughly.

3. Prepare the milk according to the manufacturer's directions. Feed can be made straight in the feeding bottle or in a measuring jug and then poured into the feeding bottle.

a. Pour the correct quantity of boiled water into the feeding bottle or jug.

b. Open the milk tin and scoop the feed, taking care not to touch the powder with your hands.

c. Press the milk powder down with the flat edge of a table knife and level off before putting it into the feeding bottle or measuring jug.

4. Cover up the feeding bottle and shake vigorously until the powder dissolves completely and the feed is ready. If a measuring jug is used, mix with a spoon until a uniform mixture is obtained. Then pour the milk mixture from the jug into the bottle.

Guidelines for Feeding the Baby

1. Hold the baby comfortably close to you with his head resting on your left upper arm. Let him feel your warmth and love. Ensure that both you and the baby are fully relaxed.

2. Hold the bottle in your right hand and feed the baby.

3. Halfway through the feed, the baby should be made to bring up wind. Wind him again at the end of feed. Change his napkins. Show him some love and, if possible, talk to him for one or two minutes, and then put him into his cot to sleep.

Care of the Feeding Bottle

Provide a special container with a good lid for the storage of baby's feeding unit. The container or sterilizing unit can be glass or plastic but not metal. As soon as the baby has finished eating, the feeding bottle should be washed and stored away in the sterilizing unit.

The following procedures can be adopted:

1. Unscrew the teat of the feeding bottle. Rinse the feeding bottle, teat, the screw ring that holds the teat on to the bottle and cap with clean water.

2. Wash the rinsed articles with soapy water and bottle brush and then rinse.

3. Rub the teat with common salt inside and outside and rinse.

4. Fill the sterilizing unit with clean cold water and add I teaspoonful of Milton for every liter of water or I capful of Milton to 2 pints of water

5. Completely immerse feeding bottle, teat, screw ring, and cap into the Milton solution until next feed.

6. At feed time remove bottle, teat, screw ring, and cap from solution. Simply drain and do not rinse. Change the Milton solution every morning.

Weaning/ Complimentary Feeding

Weaning is the process whereby feeding from the breast or a bottle is replaced by the use of unmodified cow's milk and other suitable foods. For up to the first four months of age, milk and milk preparations are adequate sources of nourishment for a baby. After this period, (there are however, variations with children), the baby needs other food supplements besides milk, and otherwise, he / she may develop anemia and malnutrition.

Weaning Foods

Weaning foods are usually very nutritious and soft. These include:

(i) Akasa with milk and egg.

(ii) Mpotompoto.

(iii) Weanimix.

iv) Soft banku and soup or vegetable stew.

v) Mashed yam with palaver sauce.

Guidelines for Weaning Babies

(i) Weaning should take place gradually unless in emergency.

(ii) The baby must be weaned on suitable diet to avoid malnutrition.

(iii) On the first day, solid food could be substituted for one feed from the breast or the bottle.

(iv) The baby should be started on a small quantity of food.

(v) Always introduce a new food at a time and let the baby get used to it before another introduction.

(vi) Continue to observe strict cleanliness in preparing the baby's food.

(vii) After weaning and in the latter half of infancy, milk should still form a major part of the child's diet.

(viii) Start with small amounts and increase the quantity with time.

(ix) Food should be soft and not spicy.

Care of Toddlers

A toddler is a child of one or two years of age. A healthy toddler is active.

Care of the toddler includes:

1. Provision of adequate food

2. Provision of suitable clothing: The toddler needs sleeping gowns, outing dresses, play dresses, under-garments, good shoes and stockings etc. His clothing should be made of suitable fabrics that are non-flammable and do not irritate the skin. Clothes should provide enough room for growth and free movement. His clothing should not be excessively large for his size.

3. Personal hygiene of the toddler should be ensured. He must be given his bath regularly.

4. For proper development, the toddler should have regular rest and sufficient exercise. He should be provided adequately with suitable toys and play materials.

5. Immunization should be given at the right periods.

Toilet Training

Toilet training involves helping a child learn bowel control and later bladder control. It is important to give children toilet training. It is bad to see children messing the floor.

Guidelines for Toilet Training

1. Toilet training should start early. Some people advocate starting toilet training as soon as the child is able to hold up his head when placed in a sitting position. Others recommend three to six months after birth. The time to start will, however, depend on the rate of development of the child. The mother should thus decide when best to start.

2. Provide the child with a comfortable potty with a good fitting lid.

3. Sit the baby comfortably in the potty and help him relax. He should be made to feel at ease.

4. Let him sit in his toilet chair only a few moments during the first few times.

5. Training should be done slowly. Being in a hurry could cause a lot more trouble that dirty napkins.

6. Recognize the baby's signs for toilet.

7. Train consistently.

8. Keep the child's potty spotlessly clean after each use.

Clothing Needs of Baby

Baby’s Layette

Baby's layette is a complete outfit of the new born baby OR it is the complete set of clothes required by a new-born baby. The baby's layette or at least part of it, should be provided before the baby's arrival

The Importance of Providing Clothes for Babies

The baby requires good clothing:

(i) To protect the baby.

(ii) To keep his body warm.

(iii) To make him comfortable.

(iv) To keep baby looking beautiful, that is to enhance baby's appearance.

Items In The Baby's Layette

Items in the baby's layette can be categorized into two, namely clothes and toiletries.

Clothes

i. Two to three dozen napkins: These should be soft, absorbent, easy to wash and quick to dry. Disposal pampers are also available and can be used.

ii. Two to three special napkins with safety pins for fastening the napkins

iii. Three to four plastic pants: These should not be tight. Beatable or perforated plastic pants are preferable.

iv. Four vests: These are under-shirts. They should be comfortable and easy to put on and take off.

v. Two- or three-night gowns: These should be loose and long enough to cover baby's feet.

vi. Three dresses and suits: These will include outing clothes.

vii. Two pairs of stockings and bootees: These should be soft and loose enough for the baby's active toes to wriggle.

viii. Two sweaters: These will not be worn directly to the skin.

ix. Six bibs: These protect baby's clothes from soil and moisture. Absorbent cotton fabric with a plastic underline is suitable.

x. One shawl: This is used for wrapping the baby. Other textile articles required by baby include

Toiletries

These include:

(i) Baby soap or shampoo should be mild

(ii) Baby's sponge should be soft not to irritate baby's skin.

(iii) Baby's towel should be soft and mild.

(iv) Baby's comb should be soft and not sharp at the ends to hurt the baby.

Guidelines for Selecting Clothes for Babies

(i) Fabric for baby's clothes should be soft, non-inflammable and washable.

(ii) Fabric should be safe and not irritate baby's delicate skin. Suitable fabrics include cotton, flannelette, toweling cotton/polyester.

iii) Baby's clothes should be easy to put on and take off.

(iv) Fastenings that can injure the baby should be avoided.

(v) Elastic bindings should be avoided.

(vi) Flat seams, such as French or flat-fell or run-and-fell seams, should be used for baby's clothes.

(vii) Water-proof pants should be loose, to encourage air circulation.

(viii) Baby's clothes should be selected on

basis of the weather conditions.

(ix) Baby's clothes should be attractive.

Care For Baby's Clothing

(i) Provide suitable storage for baby's clothing.

(ii) Do not allow baby's clothes -to become dirty before washing them.

(iii) Wash baby's clothes with mild soap.

(iv) Rinse baby's clothes thoroughly. Remove every trace of washing powder or Soap.

(v) Dry baby's clothes in the sun whenever possible to kill any germs on it.

(vi) Iron baby's clothes properly. This gives them good appearances and kills any germs that escaped the laundry processes.

(vii) Provide a separate bucket with a lid for soaking baby's napkins.

(viii) Wash baby's napkins thoroughly, and rinse well to prevent nappy rashes.

(ix) Do not stiffen baby's clothing; starched clothes can irritate the baby's tender skin.

common

Child Ailments

(i) Whooping cough

(ii) Measles

(iii) Diphtheria

(iv) Poliomyelitis

(v) Meningitis

(vi) Tuberculosis

(vii) Tetanus

(viii) Hepatitis B

(ix) Haemaplilus influenza type B

A. Whooping Cough (Pertussis)

It occurs mainly in children. It is an airborne disease which is caused by the Bordetella pertussis bacterial. Severe coughing bouts with cough which is normally followed by a "whoop" sound as air is inspired through narrow air passages.

Treatment of Whooping Cough

Give antibiotics

Control Whooping Cough

Vaccination which kill bacteria

B. Measles

Measles is an airborne disease which occurs mainly in young children especially between 6 month and 3 years who have not been immunized. It is characterized by sore throat, running nose, watery eyes, cough and fever. Usually small white spots (koplik's spots) appear inside the mouth, on wall of the cheek. Two days later, rashes will spread all over the child's body and sometimes at hairline, on neck and behind ears.

Treatment of Measles

The child should be sent to the hospital. Injection of gamma globulin a few days after exposure.

Control of Measles

(i) Live, attenuated vaccine.

(ii) Isolation of patient and avoidance of over-crowding in schools.

C. Diphtheria

It is also an airborne disease caused by coryne bacterium diphtheria. The bacteria grow on mucous membranes of the respiratory tract, releases power toxin. It has high maturity rate.

Signs and symptoms: include slight fever and sore throat, these are followed by damage to the heart, nerve cells and adrenal glands.

Treatment Diphtheria

Injection of antitoxin or anti biotic therapy e.g., penicillin, amoxicillin and erythromycin.

Control of Diphtheria

(i) Vaccination which kills the bacteria.

(ii) Mass immunization with diphtheria toxoid.

D. Poliomyelitis (Polio)

Children under three years are most at risk of contracting polio. One can be infected through contact with an infected person or by eating food or drinking water contaminated with an infected person's faces. It causes weakness or lameness or paralysis in the arms, legs or upper part of the body. Injections do not cause polio but can bring about paralysis in a person who shows early signs and symptoms.

Signs and symptoms of polio: include fever, headache, and neck stiffness and muscle pain.

Prevention of Poliomyelitis

Immunization with the polio vaccine (anti-polio myelitis) It is administered orally. Dose of oral polio vaccine (OPV) should be given:

(i) At birth or soon after birth.

(ii) Six weeks after birth.

(iii) Ten weeks after birth and

(iv) Fourteen weeks after birth.

Other ways by which polio can be prevented include:

(i) Cover all food and drinking water to prevent contamination.

(ii) Hands should be properly washed after visiting the toilet before eating.

(iii) Maintain a high level of personal and environmental hygiene.

(E) Meningitis

It is an airborne disease caused by a bacteria called Neissera meningitides. The bacteria multiply in mucous membranes of the nose and throat producing sore throat, then enter blood stream and infect brain coverings (meningis).

Signs and symptoms of Meningitis

include high fever vomiting, severe headaches, with general body rash.

Treatment of Meningitis

Antibiotics e.g., Penicillin / Benzy and Sulphonamides.

Control of Meningitis

Prevention of overcrowding especially at sleeping places.

(F) Tuberculosis (TB)

Tuberculosis is an airborne disease caused by the bacteria mycobacterium tuberculosis. It occasionally affects people through infected cow milk. The disease may affect any part of the body but the commonest part is the lungs. The disease may also manifest or show itself many years after first infection.

Signs and symptoms of Tuberculosis

Signs and symptoms include cough that last for more than three weeks, chest pain, mild fever, loss of weight, evening or night sweating etc.

Treatment of Tuberculosis (TB)

Give antibiotics e.g., Streptomycin, 1M

Control of Tuberculosis

(i) Vaccination with BCG (Bacille Calmette Guerin).

(ii) Immunization of new born or at first contact.

(iii) Eradication of cattle TB.

G) Tetanus (Lock Jaw)

Tetanus is infection of the nervous system with the potentially deadly bacteria Clostridium tetani (C. tetani). Spores of the bacteria live in the soil and are found around the world. In the spore form, it may remain inactive in the soil, but it can remain infectious for more than 40 years.

Infection begins when the spores enter the body through an injury or wound. The spores release bacteria that spread and make a poison called tetanospasmin. This poison blocks nerve signals from the spinal cord to the muscles, causing severe muscle spasms. The spasms can be so powerful that they tear the muscles or cause fractures of the spine.

The time between infection and the first sign of symptoms is typically 7 to 21 days. Most cases of tetanus in the occur in those who have not been properly vaccinated against the disease.

Treatment of Tetanus

· Antibiotics, including penicillin, clindamycin, erythromycin, or

· Bedrest with a non-stimulating environment (dim light, reduced noise, and stable temperature).

· Medicine to reverse the poison (tetanus immune globulin).

· Muscle relaxers such as diazepam. Sedatives

· Surgery to clean the wound and remove the source of the poison (debridement)

Control of Tetanus

Tetanus is completely preventable by active tetanus immunization with tetanus toxoid. Immunization is thought to provide protection for 10 years.

(H) Haemophilus Influenzae Type B (HIB, Haemophilus B)

HIB is a bacterial illness that can lead to a potentially deadly brain infection in young children. HHIB may cause diseases such as meningitis (inflammation of the coverings of the brain and spinal column), bloodstream infections, pneumonia, arthritis and infections of other parts of the body.

It may cause the following diseases:

· Pneumonia: An infection of the lungs. It is also call acute respiratory infection (ARI).

· Meningitis: Meningitis is a bacterial infection of the membranes covering the brain and spinal cord.

· Septic arthritis: Septic arthritis is inflammation of a joint due to a bacterial or fungal infection.

· Septicaemia: Septicaemia is the presence of disease-causing bacteria in the blood.

· Osteomyelitis: Osteomyelitis is a bone infection caused by bacteria or other germs.

· Epiglottitis: Epiglottitis is inflammation of the tissue that covers the trachea (windpipe). It is a life-threatening disease.

The HIB bacteria is passed from one child to the other when the infected child coughs or sneezes onto an uninfected child. It can also be spread when children share toys they have put in their mouths.

Control of HIB

The disease is prevented by administering the HIB vaccine through immunization in the form of an injection on the infant's thigh. The vaccine is given at 6, 10 and 14 weeks. Children should be vaccinated before their first birthday.

Immunization

Immunization protects children against diseases. Children can be immunized against diphtheria, tetanus, whooping cough, polio, smallpox, measles and tuberculosis.

Immunization is given in the infant welfare clinic and hospitals. Immunization is very important in order to protect children against diseases and their effects.

Types of Vaccines for Immunization

(i) Triple Vaccine (D.T.P): This is a mixture of three vaccines — the tetanus, the whooping cough and the diphtheria vaccines. It is given by injection for protection against the three diseases.

(ii) Polio Vaccine: There are two types of polio vaccine; one taken through the mouth and the other given by injection for protection against polio. The latter could be combined with the triple vaccine.

(iii) Quadruple Vaccine: This contains four vaccines: diphtheria, tetanus, whooping cough and polio-myelitis vaccines. The quadruple vaccine is given by injection and protects the child against the four diseases.

(iv) Smallpox Vaccines: This is given by injection as protection against smallpox.

(v) Measles Vaccines: This is also given by injection for protection against measles.

(vi) B.C.G. Vaccines: This is given by injection against tuberculosis.

immunization Schedule

AGE	Vaccine
At birth	BCG + Polio O (TABLE)
At 6 weeks	1st PO io + Diphtheria Perturssis/Hepatitis B/Haemophilus influenza (5 in 1)
At 6 weeks
10 weeks	2nd Polio + Diphtherial/ Perturssis/Hepatitis B/Haemophilus Influenza B (5 in 1)
14 weeks	3rd Polio + Diphtherial/ Perturssis/Hepatitis B/Haemophilus Influenza B (5 in 1)
9 months	Measles + Yellow Fever

Diarrhea

Diarrhea is a sudden increase in the number of bowel movements, especially if they are loose and watery.

Causes of diarrhea include:

a. Unsuitable diet

b. Overfeeding and

c. Infection or disease

The child should be given oral rehydration therapy made up of a mixture of sugar and salt dissolved in boiled water. This is a method of treating diarrhea at home. If it persists, the child should be taken to hospital.

Procedure for Oral Dehydration Therapy (ODT)

a. To make the sugar-salt solution:

i. Boil the water and let it cool.

ii. Pour a beer bottleful (h litre) of boiled water into a clean bowl.

iii. Add I level teaspoonful of common salt.

iv. Add 10 level teaspoonful of sugar

v. Mix well

Two soft drink bottlefuls of water can be used instead of one beer bottleful. And five cubes of sugar can be used instead of 10 teaspoonfuls:

1 beer bottleful (1/2 litre) of boiled water + 1 level teaspoonful of salt + 10 level teaspoonfuls of sugar = O.R.T. solution.

b. Give the mixture slowly with a teaspoon after every stool.

c. Give as much as the child wants to drink.

d. Make a fresh mixture every 24 hours.

e. If the child shows signs of dehydration or the sickness continues, see a doctor.

f. When diarrhea stops, give extra food to the child to enable him to regain his weight.

Types Of Toys and Play Materials in Early Childhood

Toys and play materials can be classified according to their uses.

1. Toys and Play Materials for Exploration

These are the first set of toys which the child handles and plays with. They include soft dolls, tinkle blocks of bright colors which can also produce sounds, rattles, and nylon plush balls spool on strings. They enable the child to explore.

2. Toys and Play Materials for Muscular Exercise

These are the toys and play materials that help the child to exercise his muscles. They include large balls, tricycles, push and pull toys, swings, slides, etc.

3. Toys and Play Materials for Creative Plays

At about three years of age, they should be provided with toys and materials with which they can construct things. Such materials include large crayons and drawing sheets, plasticine, soft clay, nonpoisonous paint and paint brush, sand and sand toys, soap bubble pipes, etc.

4. Toys and Play Materials for Role-playing and Imagination

At about the age of four, children enjoy role-playing. A girl can play the role of a mother cooking or bathing a baby. A boy can enjoy writing like father. Thus, the children should be provided with opportunities to imagine and do the things they enjoy, Things like big doll babies, bigger toy cars, colorful plastic plates, and spoons.

5. Toys and Materials for Sports and Skill Development

As a child gets old, he requires to carry out more challenging activities. Thus, a child of eight to ten years would need a football, table tennis ball, bats, etc. They also enjoy constructing or producing useful things. Girls can be provided with yarns, knitting and crocheting pins. They should be encouraged to knit and crochet. Boys can be provided with materials for assorted crafts. They may need a paint box, board, etc.

A suitable space should be provided for storing the children's toys and play materials. They should be given only a few things at a time to play with. They should be taught and encouraged to put away their toys properly when they are old enough to do so.

Importance of Play to a Child's Development

Play contributes to learning and development of the child:

(i) Through play, a child learns about the world of work. For instance, a small

child pushing a small block or cube on the floor, pretending that it is a car, is hard at work training himself for useful work later.

(ii) Play and play materials help a child to develop imagination.

(iii) They stimulate his memory and give him opportunities to reason.

(iv) Through play and the use of play materials, a child develops mental alertness.

(v) Children can use play to get rid of their fears and frustration and develop emotionally.

(vi) Play enables the child to express himself in different ways.

(vii) Play helps children to exercise their muscles. Exercise is important for good health.

(viii) Teaches the child about the world.

(ix)) Gets the exercise he needs.

(x) Develops creativity.

(xi) Helps growth.

(xii) Promotes physical, mental, social, and emotional development.

(xii) Developmental tasks achieved. Through play a child learns how to use the legs, hands and handle things.

Points to Consider in Selecting Toys and Play Materials for Children

Toys are not only important as play materials; they are tools for learning. A lot of thought should therefore, go into the selection of toys for children. The usefulness of a toy to a child depends partly on the type of toy selected.

The following guidelines can be useful in selecting toys and play materials:

(i) They should be large enough so that the child cannot swallow them.

(ii) They should not have sharp points or edges. Toys and play materials should have smooth finishes.

(iii) They should have no parts that can become loose, fall off and be put in the mouth, e.g. buttons, and "eyes" on stuffed animals.

(iv) Toys should be safe and hygienic so that if the child sucks them, he would not be sick.

(v) Toys should have some educational value for the child. For instance, they could help the child learn about colors.

(vi) The toy or play material should be suitable for the age of the child. A toy that is too advanced for a child will be frustrating, while one that is far below his age level will be boring. The toy should be stimulating for the child.

(viii) The toy should be strong, durable and simple.

Planning The Family

When people marry and want to raise a family, they should plan how many children they wish to have. Planning the family is important because frequent births and large family size has dire consequences for both the family and society. Family planning therefore involve spacing out pregnancies so that there is a reasonable gap between each child. To do this, the couple must use some form of birth control which will prevent the woman from becoming pregnant.

The following points should however be considered when planning the family:

· The financial status of the couple.

· The age of the couple.

· The health of the couple. Other social and financial responsibilities.

Reasons for Planning and Controlling Family Size

(i) To contribute to improved health and development of children through better health facilities, and good nutrition.

(ii) To improve family living and have better quality of life for the individual. (iii) Conditions in society also improve.

(iv) It makes it possible for couples to have only the number of children they can take care of in terms of food, care, attention, education and opportunities to obtain life that suits them.

(v) Planning and controlling family size promote the physical and mental health of both the mother and child.

Birth Control

It is the process of parents controlling the number of children they want and when to have them. Birth Control methods include:

· Traditional methods

· Scientific methods

· Barrier methods

(a) Traditional Birth Control

(i) Involves separation of man and wife after delivery until the child is about 1-2 years.

(ii) Prolonged breast feeding. This can reduce and limit child bearing. During breast feeling, the woman secrets prolactin normane which delays the return of the menstrual cycle.

iii) Abstinence from sex — (Withdrawal). Avoiding sexual intercourse with your spouse or during the act, the man withdraws his manhood or removes his penis from the vagina before ejaculation.

(b) Scientific Methods

(i) The pill: Contraceptive pills are taken by the women to disrupt the hormonal balance and thus prevent ovulation or prevent the maturation and release of the eggs.

(ii) Intra-uterine devices and cervical caps. They are plastic devices fitted into the uterus by a doctor or a midwife to prevent pregnancy. e.g loop and tubal ligation

(iii) Calendar method/safe periods: That is having sexual intercourse only during safe periods.

(c) Barrier Methods

(i) A diaphragm or cap: This is a plastic device used to fit over the cervix. The woman inserts this in the vagina before sexual intercourse. She is supposed to remove it within 8 hours after sexual intercourse.

(ii) Spermicidal: These are vaginal jellies or creams which are applied in the vaginal before sexual intercourse. The jelly or cream kills the sperms.

(iii) Condom prevents sperms from reaching and entering the woman's uterus.

(iv) Sterilization has two ways or forms;

(a) Tubal ligation (female): This is a permanent surgical procedure to prevent pregnancy.

(b) Vasectomy (male): Involves cutting and tying the sperm ducts through surgical operation.

Preparation For Parenthood - Child Birth