Study nails secret of child sleep

He may not have had enough exercise today. Researchers have confirmed what parents have long believed - running around in the day means your child may well fall asleep faster at night. But the study of 500 children provides a figure: for every hour they sit, they need three minutes longer to nod off. Interestingly, it was not relevant what the child did while they sat. TV was no more detrimental than quietly reading. And the Archives of Disease in Childhood found those who took longer to get to sleep were no worse behaved. Experts from Monash University in Melbourne and the University of Auckland looked at 519 seven-year-olds. The majority fell asleep within 45 minutes, and the average "sleep latency" - the time it took - was 26 minutes. Sleepyhead Children who were very physically active during the day tended to take less time to fall asleep, but the more prominent association was between being sedentary and taking longer to drift off. Those who fell asleep faster also tended to sleep for longer. There has been much discussion about the impact of reduced sleep duration on children. "As short sleep duration is associated with obesity and lower cognitive performance, community emphasis on the importance of promoting healthy sleep in children is vitally important," the researchers wrote. Activity is not the be all and end all, and shouldn't be encouraged right before bedtime Mandy Gurney Sleep specialist "This study emphasises the importance of physical activity for children, not only for fitness, cardiovascular health and weight control, but also for sleep." They did not however find any evidence of bad behaviour, as measured by professional charts, among those who took longer to fall asleep. Nor did they find any significantly different sleep latencies for children who went to bed after 9pm. Mandy Gurney, founder of children's sleep clinic Millpond, said the research was useful confirmation of the benefits of exercise for sleep as well as fitness and weight. "But activity is not the be all and end all, and shouldn't be encouraged right before bedtime. What's essential is a routine wind-down hour, a quiet time before bed. A warm bath, but no longer than 10 minutes, and then straight into a darkened bedroom. "That way you make the most of the the natural sleep trigger of the warm water, and you can cap it all off with a bedtime story."

Unraveling how children become bilingual so easily

The best time to learn a foreign language: Between birth and age 7. Missed that window?

New research is showing just how children's brains can become bilingual so easily, findings that scientists hope eventually could help the rest of us learn a new language a bit easier.

"We think the magic that kids apply to this learning situation, some of the principles, can be imported into learning programs for adults," says Dr. Patricia Kuhl of the University of Washington, who is part of an international team now trying to turn those lessons into more teachable technology.

Each language uses a unique set of sounds. Scientists now know babies are born with the ability to distinguish all of them, but that ability starts weakening even before they start talking, by the first birthday.

Kuhl offers an example: Japanese doesn't distinguish between the "L" and "R" sounds of English — "rake" and "lake" would sound the same. Her team proved that a 7-month-old in Tokyo and a 7-month-old in Seattle respond equally well to those different sounds. But by 11 months, the Japanese infant had lost a lot of that ability.

Time out — how do you test a baby? By tracking eye gaze. Make a fun toy appear on one side or the other whenever there's a particular sound. The baby quickly learns to look on that side whenever he or she hears a brand-new but similar sound. Noninvasive brain scans document how the brain is processing and imprinting language.

Mastering your dominant language gets in the way of learning a second, less familiar one, Kuhl's research suggests. The brain tunes out sounds that don't fit.

"You're building a brain architecture that's a perfect fit for Japanese or English or French," whatever is native, Kuhl explains — or, if you're a lucky baby, a brain with two sets of neural circuits dedicated to two languages.

It's remarkable that babies being raised bilingual — by simply speaking to them in two languages — can learn both in the time it takes most babies to learn one. On average, monolingual and bilingual babies start talking around age 1 and can say about 50 words by 18 months.

Italian researchers wondered why there wasn't a delay, and reported this month in the journal Science that being bilingual seems to make the brain more flexible.

The researchers tested 44 12-month-olds to see how they recognized three-syllable patterns — nonsense words, just to test sound learning. Sure enough, gaze-tracking showed the bilingual babies learned two kinds of patterns at the same time — like lo-ba-lo or lo-lo-ba — while the one-language babies learned only one, concluded Agnes Melinda Kovacs of Italy's International School for Advanced Studies.

While new language learning is easiest by age 7, the ability markedly declines after puberty.

"We're seeing the brain as more plastic and ready to create new circuits before than after puberty," Kuhl says. As an adult, "it's a totally different process. You won't learn it in the same way. You won't become (as good as) a native speaker."

Yet a soon-to-be-released survey from the Center for Applied Linguistics, a nonprofit organization that researches language issues, shows U.S. elementary schools cut back on foreign language instruction over the last decade. About a quarter of public elementary schools were teaching foreign languages in 1997, but just 15 percent last year, say preliminary results posted on the center's Web site.

What might help people who missed their childhood window? Baby brains need personal interaction to soak in a new language — TV or CDs alone don't work. So researchers are improving the technology that adults tend to use for language learning, to make it more social and possibly tap brain circuitry that tots would use.

Recall that Japanese "L" and "R" difficulty? Kuhl and scientists at Tokyo Denki University and the University of Minnesota helped develop a computer language program that pictures people speaking in "motherese," the slow exaggeration of sounds that parents use with babies.

Japanese college students who'd had little exposure to spoken English underwent 12 sessions listening to exaggerated "Ls" and "Rs" while watching the computerized instructor's face pronounce English words. Brain scans — a hair dryer-looking device called MEG, for magnetoencephalography — that measure millisecond-by-millisecond activity showed the students could better distinguish between those alien English sounds. And they pronounced them better, too, the team reported in the journal NeuroImage.

"It's our very first, preliminary crude attempt but the gains were phenomenal," says Kuhl.

But she'd rather see parents follow biology and expose youngsters early. If you speak a second language, speak it at home. Or find a play group or caregiver where your child can hear another language regularly.

"You'll be surprised," Kuhl says. "They do seem to pick it up like sponges."

Nursery Equipment Safety for Newborn Babies

What to look for when buying things for baby

Some parents buy just a few essential pieces of nursery equipment for their newborn baby, such as a crib and a stroller. Others purchase the whole kit and caboodle: carrier seat, bassinet, change table, playpen, and more. Here are a few safety considerations when choosing nursery equipment for your newborn baby.

Cribs

Your newborn baby’s crib is one of the most important purchases you will make in terms of nursery equipment. As with most nursery equipment, if you buy a new crib labelled with the initials of your national safety association, you can be quite confident that it meets national safety requirements. However, you need to be especially diligent about safety concerns if your baby will be using a “previously enjoyed” crib. In Canada, crib safety standards changed in September 1986, so you should only use a crib that was manufactured after that date. When choosing a crib, make sure it meets the following safety requirements:

• slats spaced no more than 6 cm apart, so your baby’s head cannot squeeze through
• no missing or cracked slats
• a snugly fitting mattress with less than two finger widths between the edge of the mattress and the side of the crib
• corner posts that are no higher than 1.5 mm, to prevent your baby’s clothing from getting entangled on the posts
• head- and footboards that do not have cutouts where your baby’s head can become entrapped
• drop-side latches that stay securely in the raised position and are not easily released
• screws and bolts that are secure and tightly fastened

Never leave your baby in a crib with the drop side down. Place the crib away from blinds or curtains where your baby can become entangled in the cords. When your child reaches 90 cm or about three feet in height, or can climb over the sides of the crib, she should be moved to a bed.

Bassinets and cradles

A bassinet or cradle should have a sturdy bottom, a wide base, and no protruding staples or other hardware that can harm your newborn baby. The mattress should be firm and fit snugly. The legs of the bassinet or cradle should be sturdy and strong. If the legs can fold, they should have locks to prevent folding while in use. Follow the manufacturer’s instructions and make sure not to use the bassinet or cradle if your baby is above the height or weight requirement of the device.

Carrier seats

A carrier seat should have a wide, sturdy base and a non-skid bottom to prevent slipping. The seat should come with an easy to use buckle or strap that secures your newborn baby’s crotch and waist. Carrier seats should not be used as car seats.

Change tables

Change tables need to have safety straps to prevent falls. Choose a table that has easily accessible drawers and shelves. Always strap your newborn baby into the change table and never leave her on the table unattended.

Playpens

A wooden playpen should have slats spaced no more than 6 cm apart. If there are staples, they should not be missing or loose.

If you choose a mesh playpen, make sure that the openings in the mesh are no more than 7 mm wide and that there are no tears, holes, or loose threads. The mesh should be securely attached to the floor plate and top rail.

Never leave your baby in a drop-side playpen with the drop side down. Your baby might roll into the area between the mattress and the dropped mesh side and suffocate. Even newborn babies can roll unexpectedly and become hurt in this way.

Playpens are not designed for sleeping. Do not leave your baby sleeping in a playpen.

Strollers

Make sure that your baby’s stroller has a wide base to prevent tipping. The brakes should securely lock the wheels. The seat belt should be securely attached to the frame and the buckle should be easy to use. Always use the seat belt when you take your newborn baby out in the stroller.

If your stroller has a shopping basket, make sure it hangs low in the back, directly over the rear wheels for stability. If your stroller does not have a shopping basket, do not hang items on the stroller, as this could cause tipping.

Pacifiers

When choosing a pacifier, make sure that its shield is large and firm so it will not fit in your baby’s mouth. The shield should contain ventilation holes so your baby can breathe if it does get into her mouth. Make sure that the pacifier nipple does not have any holes or tears and that the nipple cannot easily break off in your baby’s mouth. Do not attach strings or cords to the pacifier, and never hang a pacifier around your baby’s neck.

Toys

Rattles, squeeze toys, and other toys should be removed from your newborn baby’s crib while she sleeps, to prevent suffocation. If you do wish to use a toy in the crib, make sure it has no small parts that could be considered a choking hazard and no strings longer than 18 cm. If the label on the toy has a warning that it should be removed from the crib by a certain age, make sure to do so when your baby reaches that age. Remove crib gyms when your baby is able to pull or push up on her hands and knees.

When using toys and rattles outside the crib, make sure they are made of sturdy construction and will not break apart easily. Avoid toys and rattles that have small parts that can detach and become lodged in your baby’s throat.

Safety considerations for older babies

If your newborn baby is less than one month of age, she is still too young for back carriers and high chairs, and she probably will not need gates or a toy chest yet. Safety considerations for these items will become important as your baby gets older.

• Back carriers: A back carrier should not be used until your baby is four or five months old, when her neck is strong enough to withstand jolts. When choosing a back carrier, make sure it contains a restraining strap for your baby, and that the frame is covered with padding, especially near baby’s face. Also check that the leg openings are small enough to prevent your baby from slipping out, but large enough to prevent chafing.
• Gates: Make sure that the slats are spaced closely enough that your baby’s head cannot become stuck between them. Accordion-style gates are especially prone to causing head entrapment. Also make sure that the gate is strong enough and secured tightly enough to resist the strength of a child.
• High chairs: The chair should have a wide, stable base and a tray that locks securely. If this is a folding chair, it needs to have an effective locking device so that the chair will not collapse when in use. Ensure that the chair has an easy-to-use child restraining strap, and that any such straps are separate from the tray itself. When using the chair, always buckle in your baby, to prevent her from sliding under the tray and falling or strangling.
• Toy boxes: Toy boxes without lids are preferable. If you choose a toy box with a lid, make sure it does not have a latch, which could trap a child inside. A spring-loaded lid is safer than a free-falling lid, to avoid head injuries. Make sure that the toy box has ventilation holes in case your baby gets trapped inside.

Nursery equipment to avoid

Baby bath rings or seats and baby walkers are not recommended for use due to safety concerns. Baby walkers are banned in Canada; it is illegal to import or sell them, even second-hand. If you have one, Health Canada recommends that you destroy it and throw it away so it cannot be used again.

Modern signs of childhood obesity

 

Times have changed.

“When we started the clinic 15 years ago, we primarily saw kids who had congenital heart problems; problems they had inherited,” says Brian McCrindle, chief of the paediatric cholesterol and cardiac clinics and a cardiologist at Toronto’s SickKids Hospital. “Today we’re seeing obesity as the cause of these problems. And it’s not just my clinic. Across the board, gastroenterologists are seeing an increase in fatty livers; endocrinologists are seeing a boom in diabetes.”

Dr. McCrindle could well have added juvenile heart attack, high blood pressure, insulin resistance, unsafe cholesterol levels, and stroke to this inventory, all on the rise and caused in large measure by unhealthy weight gain in children. “The implications of what happens when kids become overweight is like putting the pedal to the floor in accelerating atherosclerosis,” he says, adding yet another obesity-related condition to the list.

Childhood obesity has become so bad that a new populist label has been coined to describe what happens when kids suffer with three or more symptoms. “This cluster of risks is loosely defined as ‘metabolic syndrome’,” Dr. McCrindle says, explaining that these risks together make children more susceptible to further problems.

Lifestyle changes for long-term health

Dr. McCrindle blames the epidemic on calorie-dense, sugary foods marketed directly to kids. This, he says, comes at a time when physical activity is being programmed out of school and an explosion of media-based pursuits is replacing outdoor activity. “It takes two minutes to eat a chocolate bar, and 40 minutes of running to use up those calories.” He says schools must teach children fitness routines for life, otherwise heart conditions and other “diseases of the old" will more and more become diseases of the young. “We need a coordinated action plan.”

Dr. McCrindle advises parents to make sure their children are snacking on fruits and vegetables. He says the only thing children over the age of two should be drinking is low-fat milk or water with their meals. He also says there should be limits set on computer and other passive activities. “If possible, being active with your children is the best example you can set,” he says.

The alternative to being active and eating right

Bariatric surgery, where the stomach is surgically reduced up to a tenth of its size, is now performed routinely in the U.S. on children. A smaller stomach means less food can go in it at any one time. The surgery is a last-ditch attempt at weight loss and like any operation, should not be taken lightly.

Botox for babies

Toxin's uses more than just skin deep

The temporary paralysis induced by Botox injections, making them effective at reducing wrinkles on the face, has other, less superficial uses. In addition to righting crossed eyes, reducing excessive drooling, and relieving chronic headache pain, Botox is now commonly used to control involuntary muscle spasms and contractions in children with cerebral palsy (CP) and other disorders.

"I've seen two-year-olds trying to stand up, legs crossed, bent at the knees and on their tippy-toes wanting to walk," says Dr. Ellen Wood, paediatric neurologist at IWK Health Centre in Halifax, describing some of her pre-Botoxed CP patients. "Over a couple of months with therapy, some of those children are walking on their own."

Botulinum toxin

Botox is a commercial name and the popular short form for a protein molecule called Clostridium botulinum toxin, of which there are several types. When injected into a muscle, type A binds to specific presynaptic nerve terminals, essentially shutting them down, causing paralysis and muscle relaxation. Over time, neurotransmission resumes after new nerve endings sprout and reform contacts with muscle fibres. This takes from three to six months.  

"It's the brain's job to tell the muscles to relax. In CP, the brain isn't doing that so you get the constant contraction," says Wood. This effect can be mild or severe, and can take place on different parts of the body, although contracted leg muscles are common. "They may just walk on their tip-toes, or their legs may cross over in scissoring pose to the point their hips come out of the joint."

The process starts with a needle

"Just the calf muscle of one leg is four Botox injections," says Wood, adding the number of needles goes up from there. "These are intra-muscular injections, which are normally painful, and they need to be in the right place." For most kids, especially the younger ones, this means a general anaesthetic and sleeping thourhg the procedure. "If you don't, you might get the first one in the right place but the rest, no. Not with a screaming child."

Although the kids wake up feeling the same, within a few days changes are noticed. Botox's maximum effect comes in a couple of weeks. The relaxation Botox provides creates a window in which the muscles can grow and other therapies can be used to help stretch out muscles, making them more mobile.

"We might put the child's leg in a cast to help with muscle stretching and the Botox may mean just one surgery, or perhaps surgery avoided, rather than multiple operations," says Wood, adding the ongoing process is ultimately dependent on brain function. "In the long term, we don't know what will happen. We are building them up physically and giving them opportunities. If they have the ability in the brain, we can deal with the legs. Sometimes the brain can't coordinate movement and this is why the treatment doesn't always work."

But often it does, which is a special experience for Wood. "As child neurologists we don't ever make anyone better. We are dealing with injured brains. We are not used to dramatic change," she says. "But when the first child I did came back a month later walking with help, that was pretty neat."

Not bad for the most toxic protein known to humanity.

No proof' for filling baby teeth

Children can be afraid of going to the dentist Filling rotten baby teeth may be an unnecessary trial for children to endure, experts say. Some 40% of five-year-olds in the UK have tooth decay and at least one in 10 of these is treated with fillings. But anecdotal evidence from 50 dentists gathered by Manchester University researchers suggests filling baby teeth may not offer significant benefits. Advisers to the NHS are now beginning a study on treatment options to provide dentists with clear guidelines. Experts already know there is wide variation in care which means that a young child with signs of tooth decay could have no treatment, a filling or the tooth pulled out depending on which dentist they attend. At the moment there is no clear [treatment] winner and we do not know which is best to recommend Dr Gail Topping University of Dundee Without any clear guidelines, dentists currently have to rely on their experience and judgement to decide whether or not to intervene. If the child is in severe pain and having sleepless nights, and the parent is confident that their child will cope with and benefit from the treatment, then the choice may be clear. But when the decay is not causing symptoms, it can be difficult to decide what is in the child's best interests given that their tooth will ultimately fall out by the time they are 11 anyway. Indeed, anecdotal evidence gathered from the case notes of 50 dentists suggests filling baby teeth may achieve nothing but expose children to the discomfort of an injection and the sound of the drill. Dental phobia Professor Martin Tickle, of the University of Manchester, found no difference in the numbers of extractions for pain or infection whether baby teeth had been filled or not. And when he surveyed the parents of all five-year-olds living in Ellesmere Port and Chester in 2003, he found only 6% would want their child to have a filling if they had symptomless decay in a baby tooth. You do not want to upset the child and make them phobic of future treatments Kamini Shah British Association for the Study of Community Dentistry In comparison, a third would want the dentist to monitor the tooth but provide no treatment. Experts working for the Health Technology Assessment Programme plan to recruit over 1,000 children from across the UK to take part a study that will compare the outcomes of three treatment options. They are conventional drilling and filling, no fillings or a painless paint-on tooth treatment that merely seals and contains the decay. Lead investigator Dr Gail Topping, of the University of Dundee, said: "This is a really big question to answer. "At the moment there is no clear winner and we do not know which is best to recommend. There is no guidance or mandate. "At the moment, dentists are doing what they believe is the right option for the child on a case by case basis." She said dentists would welcome evidence-based guidelines because the treatment decision can be a difficult one to make. Softly, softly Kamini Shah, dentist and honorary secretary of the British Association for the Study of Community Dentistry, said: "There are two schools of thought, one being that baby teeth can cause pain and sleepless nights and so dentists should fill. "The other is that actually the evidence around filling baby teeth is questionable. "Sometimes you need to adopt a pragmatic approach rather than go in with all guns blazing. "If a child is very uncooperative but has a mouthful of non-symptomatic holes you might decide to apply a fluoride varnish to stabilise the disease rather than to do conventional fillings." Painted on with a small brush, the banana-flavoured varnish is totally painless and can slow or even stop the decay if applied often enough. Sophie Waller had an extreme phobia of dentists, an inquest was told Dr Shah said: "That way you gain the child's confidence and can work on prevention. You do not want to upset the child and make them phobic of future treatments. "The problem arises when children come in aged three or four and it is their first experience of the dentist and it is because they are in pain. "In that scenario you can well imagine that they might not be most cooperative." She said in extreme cases, and when the decay was so bad it necessitated treatment, a child might be referred for anxiety management or have the teeth removed under general anaesthetic. Recently, an eight-year-old girl starved to death because of an apparently severe dental phobia. Sophie Waller, from St Dennis in Cornwall, is thought to have been so traumatised by her phobia that she refused to open her mouth after having eight teeth removed under general anaesthetic. The full trial will run for four years from 2011 across England, Scotland and Wales, with a feasibility study starting in the coming months.

No rush to lose extra baby pounds

Victoria Beckham was back in shape shortly after giving birth to her boys

Trying to copy celebrities who are back in skinny jeans weeks after giving birth is unrealistic and dangerous, new mothers are being warned.

It can take women six months or even a year, not weeks, to shed the weight they put on in pregnancy, say experts.

Crash diets and intensive exercise programmes are not only likely to fail but can harm mother and baby.

The advice comes from Germany's Institute for Quality and Efficiency in Health Care.

According to the Institute, women are under too much pressure to lose weight quickly after giving birth, when many need some of that extra weight to provide nourishment for the baby.

For about half of all women, the weight will not go away as quickly The Institute's director Professor Peter Sawicki

And celebrities who snap back to their normal weight within weeks of having a baby are not a true reflection of real life.

Stars like Nicole Kidman and Victoria Beckham were back in their skinny jeans weeks after giving birth, while model Heidi Klum was on the catwalk in her underwear weeks after having her baby.

No rush

The Institute's director Professor Peter Sawicki said: "Often, the extra effort women have to make to look after a new baby and breastfeed after giving birth means the kilos just melt away without effort.

"But for about half of all women, the weight will not go away as quickly."

Those new mothers still in their maternity wear weeks later should not rush to do punishing exercise classes, says the guidance, but should instead follow a sensible diet and build up slowly to more strenuous exercise.

We would discourage a rush to lose weight after pregnancy Louise Silverton of the Royal College of Midwives

"Even though many magazines have 'get your bikini body back quickly' diets on their covers, promising women they can achieve their ideal weight in time for summer, it is not getting quick results that counts the most.

"This is particularly true after pregnancy. It is normal for it to take three to six months for women to lose the weight they gained in pregnancy," it says.

Professor Sawicki said women could avoid weight problems after birth by eating sensibly during pregnancy.

"It is not a good idea to 'eat for two' in pregnancy and forget about your weight until after the baby is born if you are at all overweight - or prone to overweight - already."

Louise Silverton of the Royal College of Midwives agreed with the advice.

"We would discourage a rush to lose weight after pregnancy, it places undue strain on the mother's body when she needs her strength to look after her baby, and the evidence suggests that slow and sustained weight loss, if needed, is the sensible option.

"Also, following the birth and to breastfeed well, women need a good diet with adequate energy intake, so restricting the amount of food they eat simply to lose weight should be avoided."

UK guidance on weight management for mothers after childbirth is due to be published by the National Institute for Health and Clinical Excellence next year.

Can a toddler have an eating disorder?

Any parent of a toddler knows that mealtimes can be a minefield.

But in this week's Scrubbing Up health column, child health specialist Su Laurent says some are attributing their offspring's dietary foibles to an eating disorder, rather than bad behaviour.

I spend a significant amount of time seeing healthy young children whose parents are convinced that their child has an eating disorder.

Some parents think that their baby has an inability to swallow solids, others think that their child will fade away unless they are offered the few foods which they like and some parents say that their child eats nothing at all, despite the fact that they are consuming a packet of "Wotsits" in front of me!

It's often easier for a doting parent to believe that a child has a medical problem rather than a behavioural one

All three situations are examples of how powerful a weapon food is and how quickly children can gain the upper hand over their parents.

All three scenarios can be helped by a good health visitor, but sadly there are no longer enough health visitors to spend the time needed with first-time parents.

The difficulty I face is that parents often have a fixed idea that their child has a disorder and it can be very hard to convince them that, on the contrary, their child is very powerful and is getting away with eating exactly what they want!

It's often easier for a doting parent to believe that a child has a medical problem than a behavioural one.

Chips - or chips

FROM BBC WORLD SERVICE More from BBC World Service

My heart sinks when I hear stories of mealtimes taking hours, of children being force-fed and parents sneaking food into their child while they're watching TV so that they won't notice they are being fed.

Some parents surprise their toddlers by popping out from behind the sofa in an attempt to stuff a spoon full of food into their mouths.

Others accept that their child will only eat chips, chicken nuggets and chocolate cereal.

Some parents surprise their toddlers by popping out from behind the sofa in an attempt to stuff a spoon full of food into their mouths

One mother told me with pride that since the last time I saw her seven-year-old in clinic he'd tried a new food: he was now happy to eat KFC chips in addition to McDonald's chips.

You can imagine the expression on my face!

These children are often overweight, and yet their parents live in fear of starving their child unless they are given exactly what they want to eat.

In these families food dominates, the parents have got themselves into a rut and can't see a way out.

'Don't give in?'

So how should these issues be tackled?

The basic principles are:

• Make eating fun
• Eat with your child whenever possible
• Stop any force-feeding
• Let him follow your example and feed himself, however messy he becomes
• Remember that a normal child will not allow himself to starve

This sort of article makes my blood boil! My daughter had a genuine medical problem but I was fobbed off by several GPs. Jenny, Notts, England Read your comments

Babies can eat finger foods from a very young age but parents are often fearful of the resultant mess and prefer to feed them off a spoon.

A baby who feels he's being force-fed has an amazing ability to clamp his jaw shut, turn his head away and even gag on food and refuse to swallow.

Offer your child a small amount of healthy food and clear the plate away after 15 minutes even if he's eaten nothing.

Don't make a big thing about it and resist all temptations to give him a snack before the next meal even if he's grumpy.

Your child won't fade away if he eats nothing for a day or two

Limit milk to a pint a day, many poor eaters get most of their calories from milk. Encourage your child to drink water or very dilute fruit juice.

Reward your child for trying something new and don't punish him for refusing to try.

A very stubborn child may refuse to eat for two or three meals but eventually will have to give in unless he's being offered snacks between meals.

Of course, as a mother of three I confess that all of this can be easier said than done.

Remember the basic principles that food is a powerful weapon and your child won't fade away if he eats nothing for a day or two.

Is TV delaying child development?

New research suggests having the TV on may impair young children's development by reducing the amount of conversation between infant and adult. So how bad is the box for young minds?

A US team recorded more than 300 children aged between two months and four years on several days every month over two years.

They found that when the TV was audible - either on in the background or being watched - the number of words spoken and sounds made by either adult or child reduced considerably.

It is the latest study to imply that delays in language development may be the fault of TV, a medium blamed for a host of other modern ills, from bullying to obesity.

But while it is not without its problems, experts warn that to expunge it from our children's lives completely may be as undesirable as it is unrealistic.

Mixed picture

Certainly there is a body of research building up that finds a correlation between heavy TV viewing at an early age and linguistic problems.

This study is the first to demonstrate that when the television is on, there is reduced speech in the home Dimitri Christakis Lead researcher

The exact nature of the relationship is unclear, and the role that family circumstances and other social influences play has not been established. However lack of interaction at a personal level is thought to be a key culprit.

But there is equally evidence that, for those over two at least, monitored levels of age-appropriate programmes can in fact foster language skills and indeed improve attention.

Watching with an adult and discussing the contents after a shared experienced has been found to be particularly beneficial, but not always necessary providing children are watching high-quality, tailored programmes which contain familiar words and scenarios.

Indeed some psychologists argue that given young children cannot read their own books or surf the internet, watching may be an empowering experience that gives them access to other worlds which present useful information in a way their parents may not be able to.

But there are some serious caveats: what appears to be particularly undesirable is the viewing of general audience or adult programmes both alone or in the company of a carer.

National Literacy Trust's TV tips Limit TV time to one hour for 3-5 year olds Where possible, watch together Switch off when finished Encourage imaginative play based on what was watched Videos/dvds may be better due to repetition of words Avoid TV in the bedroom

In addition while some TV may be beneficial for the over twos, the evidence for those younger is more shaky. First words, it is argued, are learnt far more effectively from real people than voices on the TV.

In the US, the American Academy of Paediatrics recommends no exposure to TV and computer screens for those under two, but lack of evidence for such a measure means there is no such policy in the UK.

Constant hum

This latest study into TV's effect on children comes from the University of Washington's Dimitri Christakis, the researcher who made headlines after reporting that infants who watched the Baby Einstein series - a set of programmes billed as educational - learnt fewer new words than those who did not.

His new study did not differentiate between TV being watched or background TV, nor did it examine the kind of programmes that were on. But it did find that overall, adults barely spoke to children when the TV was audible.

Research published last year also in the US also found problems with background TV, concluding that it affected both the quality and quantity of play in young children.

Liz Attenborough, director of Talk to Your Baby at the UK's National Literacy Trust, agrees that the permanent presence of the TV in the background is something parents should try to reduce.

"Even if you think you're not paying attention to it, you probably are - and this may well interfere with how much you speak to your child. The TV shouldn't be on all the time.

"But we are lucky to have some high-quality children's programmes in the UK. They are usually well thought-out, often featuring a clear, single voice, and incite children to make responses," she said.

"Of course we need to be aware of the problems TV can pose, but equally we don't want to throw the baby out with the bathwater."

Not an only child anymore: Helping your child adjust to a new sibling

Being an only child
rocks. You're the centre of your parents' universe, you get to name the
pets, you have the backseat of the car to yourself, and chances are,
you're the apple of Grandma and Grandpa's eyes. But suddenly, the bump
in Mommy's belly turns into a real live brother or sister… and
your world's never the same again.

While most kids will bond
with their new siblings – involving them in the pregnancy by
having them come along on doctor's appointments, and helping you
prepare baby's layette will help – the adjustment from Only Child
to First Child can sometimes take time. Here are some tips for helping
your firstborn cope.

Toddlers
Child No. 1
may soon never even recall a time when she was an only child. Cool.
(But the challenge for parents is dealing with diapers and dependence
times two!)
• Give him a baby doll he can take care of, just as you take care of your new baby.
• If he's moving out of the nursery, start the process a few months before your second child arrives so you have the energy to help him adjust, and so he doesn't "blame" baby for the move.
• If you have the energy, stagger their naptimes so you have some one-on-one time with him while baby sleeps.

Preschoolers
Some
experts believe kids between 18 months and 3 years of age have the
hardest time adjusting to this life change. Be patient, involve him,
and get him psyched about his role introducing baby to world and vice
versa.
• Don't share the news too early. It
can be hard to be patient for nine months. (Also, miscarriages can
happen even if your first pregnancy was complication-free, and
explaining what happened won’t be easy.) Later in your pregnancy,
feel free to take him along for your ultrasound appointments.
• Sign him up for a sibling orientation session at the hospital.
• Enlist that preschooler desire to help. Ask him to fetch diapers, to entertain baby at "the other end" while you change diapers, to help you feed baby, and so on.

Grade school kids
Give her the opportunity to prove
what a big girl she is. But don't forget what a little kid she remains
at heart, and be sure to pay extra attention to her.
• Double up on your shopping. Take her for her back-to-school-gear, holiday formal wear, summer-camp gear and so on, and let her pick some of her little sibling's stuff, too.
• Appoint her your enforcer.
It can be awkward to ask guests to wash their hands as soon as they
walk in the door. Luckily, your bossy little seven-year-old can be
trusted with getting them to the sink or assailing them with hand
sanitizer.
• Decorate the nursery with her artwork. Frame it and hang it low so she can see it.

Tweens & teens
While
overt rivalry is less of an issue, too-cool-for-school big kids can act
like having a new sib's nothing to get excited about. Get them
interested and on-board by engaging their maturity.
• Bond through humour.
Joking about diaper changes and sleepless nights can diffuse tension
(and maybe even segue into another discussion about birth control!).
• Resist the urge to use him as a free babysitting service. It's not fair to saddle him with "parenting" responsibilities unless he expresses interest and aptitude.
• Engage him in reading to the baby. This is a low-pressure activity that allows him to help out, bond with baby and build his own reading skills at the same time.

All ages
• Spend some quality time alone with your firstborn. Hit the playground, see a movie, go out for a meal together. Make it a regular habit.
• Get them books about adjusting to a sibling. Ginger by
Charlotte Voake is a charming board book about a pampered cat who must
adjust to life with a new kitten; it's perfect for toddlers through to
seven-year-olds, as is Kevin Henkes' funny Julius, Baby of the World. Some Dog! By Mary Casanova is great for first and second graders. The ages six to 10 set will probably like the zany world of Ruby Lu, Empress of Everything by Lenore Look.
• Don't forget the gifts!
Take your firstborn on a shopping date before Baby No. 2 arrives. Catch
a movie, have lunch, and let her choose a gift for her new sibling.
Have it wrapped and put it aside, so she can "present" it to her new
baby sib when he arrives home. Don't forget to have a gift from baby
waiting for her, too! Remind those close to you that a small gift for
your older kid would be appreciated if they are visiting with gifts for
the newborn, but it can be a smart idea to have some inexpensive
wrapped items set aside in a closet for when guests forget.

Jealousy is a normal response with the arrival of a new baby.