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Journal from Daily Practice
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Dec., 2005 - March, 2006 |
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5th grade, Chicago |
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Breast Feeding 12/22/2006 |
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12/19/2005
Birth weight: 3800 gm.
Went home on day 2 of life, weight 3810 gm.
The first doctor’s visit on day 5 of life, weight 3629gm, lost 6 oz since discharged from hospital.
Mother’s breasts are engorged. But there are only several drops of milk hanging over her nipples when squeeze the breasts.
Mother: My baby cried a lot. I worry about my baby is hungry. |
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12/19/2005
“I am hungry.”
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12/22/205
“I am full.”
Gained 7 oz in 3 days
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Dr Shi:
The full-term newborn baby usually has weight loss for initial three days of life, then gains weight 1-2 oz per day. The lost weight usually recovers around day 7 of life.
Your baby is pink, active, suck strongly, breath comfortably, and no fever. He doesn’t have signs of infection. He is most likely crying for hungry. Engorged breast tell me you have enough milk. The drops of breast milk hanging on the nipple when squeezed tell me the lactating ducts (tubes connect breast lobes to nipple) may not open well.
I suggest applying wet warm towel to breast and message the firm area of the breast several minutes before breast-feeding. This will help to open up the lactating ducts. When your baby sucks nipples, you or your husbanded can squeeze the base of breasts to help to open the lactating ducts and push milk out. I would like to get weight check in 2-3 days.
12/22/2005
Father: My baby gained 7 oz in last three days. Warm breast and message worked.
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Flat Head 12/23/2005 |
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Dr. Shi:
The American Academy of Pediatrics has recommended that babies should be placed to sleep on their backs to reduce the risk of sudden infant death syndrome (SIDS). Since this guideline put in practice in 1992, more babies were found having flat head (positional plagiocephaly).
The babies usually develop the habit to position their head during the first one or two months. To prevent flat head you should
Turn the baby’s head to right or left side alternately after each feeding from the 1 st day of life.
Place babies on stomach when they are awake and being observed persistently.
Spend minimal time in car seats or other seating that maintains supine positioning (on back), such as baby swing.
Watch the baby’s head from the back, top, and front views frequently to detect early stage of flat head. |
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5 days old
Symmetric head
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6 month old
Symmetric head
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Turn head to right |
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On stomach |
Watch from the back |
Watch from the top |
Watch from the front |
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Two-month-old infant has flat head on right side (positional plagiocephalus).
Dr. Shi:
Your baby’s head is flat on right side now. You need to reposition baby’s head to left side more than right side when baby is placed to sleep on back position.
Watch the baby’s head from the back, top, and front views frequently to adjust head position. I have several baby patients whose have flat head on right side at 2 weeks old, left side at 1 month old, on right side again at 2 month old.
Head growth and neurological examination are usually normal for falt head babies.Head remodeling continues throughout childhood and may compensate for head asymmetry that occurs during infancy. |
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Two months old
Flat on right side |
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Same baby 4 mo
Resolved flat head |
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Reference:
Losee JE, Mason AC. Deformational plagiocephaly: diagnosis, prevention, and treatment. Clin Plast Surg. 2005 Jan;32(1):53-64, viii.
Horne RS, Franco P, Adamson TM, Groswasser J, Kahn A. Effects of body position on sleep and arousal characteristics in infants. Early Hum Dev.2002 Oct;69(1-2):25-33.
Changing concepts of sudden infant death syndrome: implications for infant sleeping environment and sleep position. American Academy of Pediatrics. Task Force on Infant Sleep Position and Sudden Infant Death Syndrome. 2000 Mar;105(3 Pt 1):650-6.
Najarian SP. Infant cranial molding deformation and sleep position: implications for primary care. J Pediatr Health Care. 1999 Jul-Aug;13(4):173-7.
Pediatric News 2003; 3:46 (Dr. Nalin Gupta, chief of pediatric neurosurgery at the University of California ).
Pediatrics 2003; 112:199-20
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Pen holding – When is the time to train kids for pen holding? January 4, 2006 |
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Majority of 18-month-old kids can scribe well. |
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18 month |
18 month |
18 month |
18 month |
18 month |
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Majority of school age kids don’t hold pen well. |
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7 yr old |
10 yr old |
10 yr old |
11 yr old |
15 yr old |
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Training early for the kids 18 to 36 month old, they can gradually adopt appropriate pen holding skill. |
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2 yr old |
3 yr old |
3 yr old |
3 yr old |
>95% of Parents |
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Dr. Shi: Your daughter hold pen so well.
Mother: She is drawing daily and likes to write letters (using symbols) to me.
Dr. Shi: Did you train her?
Mother: No, she follows my school age son to draw, and write daily.
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3 yr old |
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Dr. Shi: Your boy can not hold pen well and cannot draw a round circle. It is the time to train him for correct pen holding.
Mother: Physical therapist in the hospital told me that we should not correct kid’s pen holding and let it goes by nature.
Dr. Shi: I thought same way until I found majority of elementary school age kids can not hold pen well during past five years physical exams here. I try to ask parents to train their kids to correct pen holding and found it was very hard to change their pen holding habit after 4 to 5 years old. After screening more than 400 kids from 15 month old to 18 years old in my clinic during the past eight months I found
- Majority of 18-month-old kids can scribe well, but 15 month old kids may not.
- Majority of 24 to 36 month old kids can gradually adopt appropriate pen holding skill.
- Majority of school age kids cannot hold pen well.
- More than 95% of parents hold pen well and they stated they got trained in the school.
- Majority of parents told me public school teachers did not train kids for pen holding now.
- More kids got trained for pen holding in private schools than those in public schools.
- If parents encourage kids to scribe and draw daily started at 12 to 15 month old, the kids can hold pen better, draw lines more solid, and make circle more round at three years old.
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3 yr old |
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If you have any concern or comment about pen holding, please send e-mail to us at funeducationabc@yahoo.com. |
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Busy Infant March 23, 2006 |
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Screen for Learning Activities |
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Father: My baby is very busy. It is very hard to keep his attention for book reading. He has already broken my computer and key board. We worry about he will draw everywhere and hit his eye if we will let him scrib now.
Dr. Shi: From today's screen for learning activity of your son. You did wonderful jobs. One thing bring my attention is the time of your baby's attention for book reading, which drops from 6-10 minutes at 10 month old to 2-3 minutes at 12 month old now even you do read more books to him. I can see how busy he is at the exam room now. I worry about he will get too busy in next several years and can't sit still with other kids when he starts preschool.
There are several things you can do to enhance his attention:
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10 mo |
12 mo |
Books read weekly |
7-14 |
14 |
Kid's attention |
6-10 min |
2-3 min |
# books at home |
8 |
8-10 |
Go to library per month |
1 |
2 |
Check out books |
0 |
6-8 |
Watch TV |
no |
no |
Exposure to TV per day |
15 min |
30 min |
Drawing |
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not try yet |
Music time |
no |
15 min |
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1. Read books: Read 2-3 different books per day, read one to two sentences per page, change your voice when read, hold his hands to point pictures and turn the pages.
2. Structural play: Try to find time to sit down with him to play wooden blocks, puzzles, legos, and other hands-on toys together. Play one kind of toys each time, do one thing each time, and sometime you can hold his hands to play.
3. Coloring and drawing: Use large crayola and watch him all the time so he will not hit his eye and draw everywhere. Sometime you have to hold his hands to draw or color.
4. Limit the time of TV watch and exposure.
4. Set up quiet time for reading, for story talking, and for structural playing. You win for every minute increase of his attention! |
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Sleep Habit of infants 02/06/2006
Dr. Shi: Your baby is 9 month old. How is her sleep habit now? Any concern?
Parents: No concern at all. She sleeps from 7:30pm to 6 am, wakes up once over night, and takes 2 naps about 3 hours during the day time.
Dr. Shi: That's great. I remember you both worried a lot about your baby’s sleep habit at 6 month visit and paged me weeks later because your baby would not sleep alone, and only slept 45 minutes during day time and total 9-11 hrs per day. I introduced AAP (American Academy of Pediatrics) web site for parent education to you. Did you get some help there?
Parents: Yes, we found the infant sleep expert Dr. Weissbluth there. We read his book “Healthy Sleep Habits”, and followed his recommendation which worked well.
Dr. Shi: What did you do?
Parents: We left our baby in her bedroom, closed the door, and let baby crying. In the beginning she cried over 1 hour before felt asleep, then gradually decrease the time of crying. One to two weeks later, our girl slept well.
Dr. Shi: Dr. Weissbluth sounds tougher than I am. I usually suggest leave the baby alone and keep quiet. He adds one more thing - closing the door!
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