Posts Tagged ‘growth’

MENOPAUSE
*Turn the thermostat down to reduce hot flashes
•    Use the lowest-dose estrogen and progesterone therapy for the shortest time possible
•    Try Remifemin for hot flashes    ***
•    Eat tofu or tempeh or drink soy shakes    **
•    Ask your doctor about Paxil (paroxetine) or Effexor (venlafaxine) for hot flashes
•    Inquire about Neurontin (gabapentin) for hot flashes
•    Apply olive oil topically for vaginal dryness
•    Squeeze vitamin E out of a capsule as a sexual lubricant
•    Experience slippery sex with Sylk
•    Experiment with aloe vera gel
•    Get a prescription for Estring (estradiol)    ***
Decades ago, menopause used to be referred to in whispers as The Change. The mystery surrounding the event gave it a sinister aura. Now, though, more than 5 000 women enter menopause every day in the United States. ~21 That’s because the baby-boom generation is aging. We are not a bashful bunch, and female boomers have brought menopause out in the open. Women refer to hot flashes, somewhat jokingly, as power surges. But few women relish them. Most would like some way W ease this symptom, even it it is the consequence of a perfectly natural biological process.
We ought to begin with some explanation of menopause. Most people know this refers to the time when a woman’s ovaries stop making the hormones that support the ripening and release of eggs. It is a gradual process that may be spread out over years, perhaps even a decade, and is properly referred to as perimenopause. Menopause itself is technically just one point in time: the day when an entire year has passed since the end of a woman’s last menstrual cycle.722 The average age on this day is 51 years, but women may be as young as 40 or as old as 58 and still be within the normal range for menopause.
Just as the timing of this change in ovarian function differs from one woman to another, so do the timing and intensity of menopausal symptoms (yes, we should be calling them perimenopausal symptoms). Some women barely notice a hot flash or two. We’ve even spoken with women who had “cold flashes” rather than hot flashes. Others are distressed by intense heat waves that may plague them daily for years. Most fall between those extremes but would still welcome some respite from the sweating, the flushing, and the distracting feeling that they might spontaneously combust. (Not to worry—that has never happened!)
I hope you can recommend something for my wife, who feels like she is about to burst into flames. Her doctor suggested Premarin, but she refuses to take it because she is worried about the increased risk of breast cancer What other options are there?
If it is any comfort, this period of discomfort lasts about 4 years, on average. That means, though, that some women zip through it much more quickly, whereas others take longer, sometimes much longer, to get through to relief.
The Hormone Controversy
For years, women suffering from hot flashes and other menopausal discomforts were told that their doctors had the magic solution: Just take hormones to replace the ones their ovaries were no longer making. Hormone replacement therapy, or HRT, has had its ups and downs over the decades, beginning with Premarin’s approval in 1942. Since then, more than 30 billion doses of this h101MIOnt di Wled from pregnant mares’ urine have been dispensed.
When doctors discovered that women taking Premarin were at greater risk of developing cancer of the uterine lining, this prescription went out of vogue for a while. But then researchers found that adding progestin, a synthetic form of progesterone (usually prescribed under the brand name Provers), could reduce this risk. In the 1990s, Premarin became the most prescribed pill in history. Besides easing hot flashes,night sweats, and other menopausal problems, HRT was supposed to save women’s lives by reducing their risk of heart disease, colon cancer, osteoporosis, and other serious health
threats.
These days, though, the story has changed, and a lot of menopausal women are feeling confused and betrayed. For years, they were told that they were suffering from an estrogen deficiency syndrome. Replacing the hormones their bodies no longer made was supposed to ease menopausal symptoms. Women who resisted a prescription for HRT were sometimes treated as difficult cases. Some were told that though HRT might raise the risk of breast cancer, it was a much less significant concern than heart disease, which HRT might protect against.
After I was operated on for breast cancer, I was told that I could no longer take estrogen, because my tumor was ‘estrogen-dependent’ My primary physician actually had the gall to tell me: The benefits of estrogen far outweigh the threat of breast cancer, and besides, we can cure breast cancer’
Women have a right to be furious. The hormone hype that lasted for several decades represents one of the biggest scams in modern medicine. Millions of women were guinea pigs in an uncontrolled experiment. Physicians who pride therpselves on practicing “evidence-based medicine” prescribed drugs that were unsupported by data. Many women who expressed their fears to their physicians were told in no uncertain terms that the benefits of HRT outweighed the risks.
When the National Institutes of Health announced a huge, long-term study of hormone replacement therapy, advocates of HRT were thrilled. They anticipated that the best available science would support their convictions that HRT had many health benefits, far beyond simply easing hot flashes. Thousands of women were recruited to the study and randomly assigned to take either Prempro or a look-alike placebo pill.
When the results of this study—called the Women’s Health Initiative (WHI)—were announced in 2002, many physicians were surprised and women were shocked to learn that instead of protecting women from heart disease and cardiovascular complications, HRT actually increased their risk. A few doctors had anticipated that the study might show an increased risk of breast cancer. As early as 1995, the Nurses’ Health Study, which followed more than 100,000 women, had confirmed that estrogen replacement therapy significantly increased the risk of breast cancer in postmenopausal women and demonstrated that progestin did not diminish that risk 723 If anything, the data suggested that adding progestin could increase the risk .721
Although there had been hints from previous research that estrogen, with or without progesterone, might increase a woman’s risk of breast cancer, such concerns were mostly downplayed. Opinion leaders reminded physicians that the leading cause of death in postmenopausal women is heart disease. (Breast cancer  comes in second.) Some eminent gy- necologists opined that if breast cancer was a risk, it was a minimal one, associated only with long-term HRT use. Such cancers were thought to be “good” cancers in that they were “early” cancers, easily detected and treated and not associated with increased mortality.
Further results from the WHI gave the lie to that claim. The investigators found that women taking combined HRT (Prempro) were more likely to be diagnosed with breast cancer than those on placebo and were more likely to have invasive, more advanced cancers. They concluded, “These results suggest estrogen plus progestin may stimulate breast cancer growth and hinder breast cancer diagnosis.”115
As a result of these new findings, doctors may also be feeling betrayed. They too were sold a bill of goods that did not turn out to be as advertised. It is now clear to all that HRT is not a panacea for the miseries of menopause. But what remains unclear is exactly how women should cope with hot flashes, night sweats, sleep disruption, and vaginal dryness. Finding out that estrogen doesn’t really prevent heart disease still leaves women with plenty of options for reducing their risk of heart trouble. And there are other possible treatments for osteoporosis, another condition for which women were given long-term estrogen treatment. But what can be done for those annoying, sometimes debilitating hot flashes?
Alleviating Hot Flashes
Certain simple lifestyle adjustments might be all that some women need to make hot flashes tolerable. First, turn down the thermostat. This seems too simple to work, but many menopausal women are less uncomfortable when the temperature is cooler.726 Second, dress in layers that can be easily removed. ‘Ibis is simple common sense.Third, follow the Southern belles’ example and keep a fan and a nice coot (nonalcoholic) drink handy. Fourth, keep exercising. Or if you are not already walking, swimming, or dancing, start. It’s not a miracle, but women who exercise regularly seem to have fewer hot flashes or find them less bothersome. Besides, exercise eases depression and anxiety and is beneficial for the heart and the bones as well.
Hormone Replacement Therapy
When it comes to taming hot flashes, estrogen is undeniably the gold standard. Estrogen, either alone or in combination with progestin, clearly reduces the frequency and severity of hot flashes by about 75 percent.727 This is significantly better than placebo, although women with hot flashes are susceptible to the placebo benefit.
In most studies of HRT or herbal alternatives, women taking the placebo had nearly 60 percent fewer hot flashes per week at the end of the studies, on average, than at the beginning. 721 Women on HRT, either estrogen alone or estrogen together with progesterone, also seem to have less trouble with night sweats that awaken them and disturb their sleep. There’s little evidence that herbal treatments have much effect on menopausal sleep problems, which many women find extremely disdirbing.
If it weren’t for the WHI, doctors would still be prescribing Prempro (a combination of Premarin and Provers) to virtually every menopausal woman who would take it. And they would still be encouraging women to keep taking it long after menopausal symptoms faded away, as a general-purpose “health and beauty aid.”
The characteristics of the women who were willing to use HRT before the WHI results were available probably accounted for many of the benefits seen with HRT in earlier, observational studies. Women were told that HRT was good for their health, so those who chose to take it were more likely to be the health-conscious, careful eaters, regular exercisers, nonsmokers, and occasional drinkers. Their healthy behaviors, rather than the HRT per se, are now believed to be responsible for their lower rates of heart attack, stroke, and many other problems.
The WH I put the issue of HRT and heart attack prevention to  Estrogen and Progesterone
Hormone replacement therapy reduces hot flashes significantly for most women. Women who still have a uterus need to take progesterone along with estrogen to protect themselves from endometrial cancer.
The risks of this therapy rise significantly at 5 years of use. For most women, intense hot flashes last less than 5 years. Ask for the lowest possible dose, and increase the dose only if that does not adequately relieve the hot flashes and night sweats. Hot flashes may return if HRT is stopped abruptly, so gradually tapering off it may be more successful. Transdermal estrogen (Climara, Estraderm) may be less likely to trigger nausea, but there haven’t been good headto-head comparisons.
Side effects: Breast tenderness, nausea, gallbladder problems, migraine headaches, intolerance to contact lenses, elevated blood sugar. If progesterone is given only 1 week a month, vaginal bleeding resembling a menstrual period is common.
Downside: HRT increases the risks of breast cancer and blood clots that could trigger heart attacks and strokes. These risks increase over time. HRT should be used only as long as it is needed for perimenopausal symptoms.
Cost: Approximately $40 to $75 per month for brand-name HRT; generic is available for $12 to $20 per month
the test with more than 16,000 postmenopausal women. Unfortunately, HRT did not pass. Women who had never undergone hysterectomy were randomized to Prempro or placebo, but the study was stopped early when it appeared that the women taking HRT were at greater risk than those on placebo .129 Although Prempro had been expected to protect women from heart attacks and strokes, the results showed that women taking this HRT were nearly 30 percent more likely to develop coronary heart disease and twice as likely to come down with a pulmonary embolism, a dangerous blood clot in the lung.730
None of this has much bearing, though, on the use of hormones to treat hot flashes. The risks are primarily for women who take Prempro or other forms of estrogen and progester-one for extended periods of time.The most recent recommendations, based on subanalyses of the WHI data, suggest that women just entering menopause (ages 50 to 54 in particular) may be more resistant to the dangers of estrogen and might even get some protection from heart attacks by taking it. 31 Short-term use (for a few months up to a couple of years) to get through the worst of the hot flashes doesn’t seem to pose an excessive risk for most women. Those who have previously had dangerous blood clots or breast cancer or who have a strong family history of breast cancer should probably avoid estrogen even in the short term, however.
O. 1 took hormones for 4 years and then discontinued them for a year. Now I have started again, at the urging of my doctor. While I was not taking hormones, I had hot flashes, night sweats, and vaginal dryness.
I stopped taking hormones because the progesterone component made me irritable and depressed. (I was taking Premarin and Provera.) My doctor put me on Estrace and Prometrium this time, but I still feel prickly and sad.
I’m convinced progesterone is the problem, so I wonder if I can take the estrogen alone. I recently read that estrogen has heart benefits.
A. The hormone controversy has heated up again. A study showed that women between the ages of 50 and 59 taking estrogen alone were not at increased risk of heart attacks (Archives of Internal Medicine, February 13, 2006►. These women had previously undergone hysterectomies, so they did not need progesterone.
Estrogen alone is not safe for a woman who still has her uterus since it increases the risk of endometrial cancer. Progestins like Provera protect against this kind of cancer. When added to estrogen, however, they may increase the risk of heart attacks and strokes and possibly breast cancer as well. For some women, progesterone lowers libido and leads to depression.
Doctors have followed the practice of prescribing progestin along with postmenopausal estrogen for many years, since research determined that estrogen alone increased the risk of cancer of the lining of the uterus (the endometrium). Endometrial cancer is not an issue for women with no uterus, and in the WHI study, these women were randomized to Premarin (estrogen alone) or placebo. This works just fine for hot flashes. Don’t count on it to provide any cardiac benefits, though. Overall, women in the WHI study were not protected from heart attack or stroke by HRT whether they took Prempro or Premarin alone.32
Some critics of the WHI have objected to the use of Premarin or Prempro, and suggested that other forms of postmenopausal estrogen replacement therapy would be preferable. There aren’t studies to prove or disprove that idea. Epidemiologists at Group Health Cooperative, a big health maintenance organization in Washington, compared rates of heart attack and stroke among women taking Premarin and those taking another form of estrogen such as Estratab or Menest. They found a hint that the other forms of estrogen might be somewhat less likely to trigger a heart attack or stroke, but these data need to be confirmed.733
Bioidentical Hormones
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Q. I am a family physician. Back when we were prescribing HRT regularly, I used to offer women the option of plant-based estrogens instead of synthetic hormones. Since we learned the results of the Women’s Health Initiative (WHI), though, I’ve viewed all estrogens as carrying similar risk until proven otherwise.
There are practitioners who are saying that bioidentical hormones are safer. They encourage women to use them as an alternative for treating menopausal symptoms. Is there any research that shows that the risks are lower for plant-based HRT than for synthetic?
A. There is no comparable study of plant-based estrogens, and there is not likely to be one. The WHI was a very large and expensive study funded by the National Institutes of Health. Women were randomly assigned to receive Prempro or placebo. The results showed that postmenopausal hormones increased the risk of breast
cancer, heart attack, and stroke.
Women’s health expert Susan Love, MD, responded
to a question like yours: “I think that it is very unlikely that bioidentical hormones, as they’re called, will be any safer than Prempro.”
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The American College of Obstetricians and Gynecologists (ACOG) came out with a very strong caution about bioidentical hormones in 2005. Michele Curtis, MD, is associate professor of obstetrics and gynecology at Houston’s University of Texas Medical School. On behalf of ACOG she said. “There are a growing number of women who are seeking therapy with bioidentical hormones, but there is a lot of misinformation about the assertion that these are plant-derived and therefore more closely mimic the estrogen that is in a woman’s body….. These are hormones. They act just like estrogens that are 34    commer-
cially produced.,,7
The obstetricians and gynecologists of ACOG are concerned that plant-based hormones are unregulated and, as a result, women may not be informed about risks. In addition, lack of oversight may mean that it is hard to guarantee quality. Many of these products are made in small compounding pharmacies that act like micro–drug companies but escape the kind of regular FDA inspections one might expect a bigger manufacturer to undergo. When the FDA did check on samples from 12 compounding pharmacies, ACOG reports that “34 percent of them failed one or more standard quality teStS.!,131
Progesterone
Kau Nwmnwe intrigued by the possibility that a progesterone cream derived from plant sources can be applied to the skin to relieve hot flashes naturally. Although wild yam can be used as a raw material for the manufacture of progesterone-like compounds, the human body can’t convert wild yam to progesterone. A controlled study suggests that a cream containing wild yam extract is not much better at reducing hot flashes than a placebo.736 Other creams formulated to contain progesterone can provide a dose comparable to taking progesterone by mouth.”‘ Progesterone pills or long-lasting injections such. as Depo-Provera can ease hot flashes, but questions remain about the long-term safety of this hormone for postmenopausal women. 738
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0. A nasty divorce has left me feeling slightly depressed, despite the relief of being out of a bad marriage. At times my heart races and then I break out in a sweat. I don’t know if these episodes are just anxiety or if they are hot flashes, since I am menopausal.
I am reluctant to take estrogen because I’ve heard about negative effects. IV rather use a more natural approach. Would a progesterone cream be safe?
A. Many women experience hot flashes much as you have described them, with an accelerated heart rate, a vaguely anxious feeling, sweating, and feeling too warm. Progesterone cream may help reduce hot flashes. Women’s health expert Susan Love, MD, points out, however, that high levels of progesterone are not natural after menopause. She worries that potential side effects might arise with long-term progesterone use. In addition, progesterone has been linked to depression.

Care
Boundaries
Birth is an immense change for the baby. Her whole physiology changes fundamentally and she experiences a completely new environment. The boundaries of the womb are left behind and she enters a ‘boundless’ world. In the womb, the child was able to grow harmoniously, protected from the world.
This reveals that everything that is developing requires a protective environment. With a newborn baby, and actually throughout childhood, this protective environment is constantly provided to establish firm foundations for later life. Unconsciously, the child is constantly reminded of the situation in the womb, which is related to an experience of security, safety, protection and fundamental confidence.
Warmth
The womb not only protects the embryo from the world; it also surrounds it with an even temperature of 37°C (98.6°F). A ‘warm environment’ is provided in the best possible way.
After birth, a child has to learn to maintain her own body temperature at a constant level, at first with the help of adults. She must interrelate the warm and cold parts of the body. This is achieved by means of a sensitive metabolic process which generates heat.
Normal growth and the development of the normal physical processes are also dependent on this metabolism. All the heat which the baby does not have to produce herself in order to maintain her temperature at the right level will benefit growth.
It takes the child a long time to regulate her own temperature; the normal difference of PC (2°F). between the body temperature during the night and the day is achieved by most children between their fifth and ninth months. Up to that time they are extremely dependent on the extra warmth provided in the form of good physical care, clothes, and hot water bottles used to warm the cradle before they are placed in it.
The ability to distinguish whether something is hot or cold is learnt during the initial period. The better this ability has been developed by providing sufficient warmth in childhood, the better the child can use it at a later age.
Cold feet are an important sign that extra attention should be devoted to regulating the child’s temperature. A baby should have warm feet, warm legs, a warm body and warm arms.
Special attention to warmth also has another significance. A warm environment helps the child to ‘warm up’ for life on earth. However, our motto is not ‘the warmer, the better,’ because always being dressed in too many clothes or being covered up can actually make a child either drowsy or very restless, and overheating can be very dangerous. Detailed research has revealed that there is a relationship between overheating and cot death. Duvets and synthetic materials can especially cause overheating. Therefore we certainly advise against using these.
In our view, the important thing is to learn to observe the needs of the child with regard to warmth, and to read the signs when more or less warmth needs to be provided in the form of clothes, bedding or ambient heating. The body temperature of the child is the most important thermometer, and in a healthy baby, this fluctuates around 37°C (98.6°F). You can learn to take the baby’s temperature with your hands so that you can literally feel how the child is regulating its own temperature. In the first week or two after birth, take the baby’s temperature every day, as well as feeling how warm she is. Then start testing yourself: feel how warm the baby is, then predict her temperature and check with the thermometer for a few days. If your predictions are correct, you will only have to take the baby’s temperature when you are doubtful or if she is sick.
Impressions
Everything we do, feel and think around the child is assimilated by the child. She is still completely open and has a boundless trust in the environment. The buffer which
we have between ourselves and the world as adults is formed by recognising and understanding that world. A small child is not yet able to do this. Up to about the third year, the child identifies with the environment in which she is living in a very natural way. This is followed by a stage in which thinking gradually assumes set patterns, and the child leans to distinguish herself from the outside world. For the first time, she makes a distinction between her own individuality and the world which is perceived. In this light it is understandable that first memories only go back to the third year, and there are no, or very few, memories before this.
The child is one big sensory organ. Up to the third year, all impressions are assimilated in an uninhibited way and disappear into the subconscious. There they are combined with other physical processes, and a sort of print is made; it is as though the child models the influences of the environment in its own `clay.’ Therefore, it is important that we are aware of what ‘goes into’ the child — also for later on.
Example. A child in a boat on the water, experiences the swell, feels the sunlight on her skin and the wind in her hair, smells the odour of water and fish, is taking in healthy impressions which build up the whole organism. The situation is quite different for a child at a department store who is placed in a rotating ship, which goes round and round when a coin is placed in the machine. The child will enjoy both these experiences, but they affect the organism in significantly different ways. The ‘boat on the water’ situation sounds idyllic; this is usually a vacation experience. However, there are also impressions closer to home, which can be constructive and have the above-mentioned character
Positive, constructive impressions are those impressions in which the natural origin of materials, sounds etc, can be perceived by the child. For hearing, these are the sounds of people and animals, and natural sounds such as the rustling of the wind. For sight, they are natural colours. For the sense of touch, they are materials such as wool, cotton, silk, wood, sand and water.
Many domestic appliances such as vacuum cleaners, washing machines, radio, television and plastic toys were created as a result of human technical ingenuity. For children, these are actually an abstraction, lacking in natural connection.
Radio, television and plastic toys are things you can consciously choose to have or not to have in a small child’s immediate environment. With household appliances, you can take care to minimize the sound in the baby’s immediate environment. So-called ‘white noise’
from household appliances is not a good idea for the young child as it blocks out normal impressions. Autistic children can also become obsessed by white noise. Playing a lyre, humming or singing are better background sounds for the child.
Simple actions such as washing hands, or sweeping up with a dustpan and brush in the child’s presence show how things are done. These actions are enjoyable and you can invite children to imitate them.
The feelings of people around the child also have an effect. It is obvious that a child will thrive best in a genuine atmosphere of joy and warmth. This has a positive effect. But there is not a parent in the world that is always cheerful and relaxed at every moment of the day (and night). It is worth aiming to achieve these qualities, but at times when you do not succeed, you must take them for what they are — also real human emotions. In every family there are days when everything goes pear-shaped and the ideal image of a happy family seems a long way off. Humour is always a good remedy. It can be a relief if you can laugh about yourself and the situation.
The needs which were mentioned above — that is, the need for boundaries, warmth and positive impressions — make great demands on the environment. It means that parents must have clear insight and a good level of empathy to get things right: too cold or too warm, too many im-pressions or too quiet, well-protected or not enough room to breathe?
From this point of view, we would like to discuss a number of practical aspects of childcare.
Clothes
Clothes are like a second skin, which support the functions of the skin. The skin helps to regulate body temperature and protects us from infections. In addition, the skin is a sensory organ with which we perceive the environment. These three functions are most effectively supported with clothes made of wool, silk, cotton or hemp. These fibres are preferable as they provide sense impressions from a natural source via the skin, which help the child to build up its body. Other fibres are more alien, and even viscose, which is made from cotton or wood, is processed quite strongly, in a way which is now known to be quite polluting.
Wool
Sheep’s wool protects the sheep from heat and cold, rain and toxic waste. The curls trap the warm air around the sheep’s skin. The wool keeps out the rain, and waste products are absorbed and emitted through the wool via perspiration.
All these qualities are found in woollen clothes. The warmth of the wool protects the child from cooling down too quickly and supports her unstable heat regulation system which cannot yet retain body heat.
Its absorbent capacity (30 to 40%) ensures that the child remains comfortably dry. The quality of the wool depends on the age of the sheep, the animal’s diet and health, as well as the way in which the wool was turned into clothing.
Finely knitted woollen vests are available, which forma soft, flexible outer skin. Woollen jumpers and cardigans should be loose fitting so that they are easy to put on and take off. Woollen pants are wonderful to use over cotton nappies. They can be knitted easily, preferably from slightly greasy sheep’s wool, and are ideal for absorbing moisture and neutralizing the waste products in urine.
A woollen shawl will keep the baby warm when there are fluctuations in temperature. Woollen socks will also keep the feet nice and warm. Furthermore, wool does not attract dirt, and therefore woollen clothes do not have to washed as often as cotton clothes, though they do have to be aired regularly.
Silk
The silkworm spins its cocoon of silk thread, in which the worm is sealed off from any negative external influences. The silk is made under the influence of sunlight — at sunset, the silkworm stops spinning, and at sunrise, it starts work again.
If you use silk in clothes, you will feel its enclosing qualities. Furthermore, silk can absorb 30% of its weight in moisture without feeling damp. In addition, silk retains heat when it is cold and releases heat when it is warm. That is why silk is worn especially in summer. Silk and, in particular, knitted silk is an excellent basic material for vests, but it is advisable to put a woollen vest over the silk vest as well.
Children who are sensitive to wool against the skin, and children who are very sensitive to impressions and consequently become restless, will benefit from wearing a silk vest.
Cotton
Cotton is widely used nowadays for children’s clothes, especially as this material can be washed so easily in the washing machine. At the same time, it should be said that it actually has to be washed often because it attracts dirt easily. Cotton can absorb 20% of its own weight in moisture.
As cotton cannot absorb heat, this passes easily through the material to the outside air. Consequently, this material is not the best choice for a child’s underclothes throughout the year. Furthermore, the way in which cotton is grown is not particularly environmentally friendly, and chemical products are often used in the treatment of the material. Fortunately, there are several eco-cotton projects which now promote its environmentally-friendly cultivation and processing, and eco-cotton is becoming increasingly available in shops and over the internet.
We suggest dressing the baby in at least two layers of clothing, covering the whole body, including the arms, legs and feet. This produces a layer of air between the two layers which retains heat. In a temperate climate, a long-sleeved woollen vest — or a vest of wool and silk — can be worn for most of the year.
In practice, we regularly find that babies are not dressed warmly enough, and they are often restless and troubled by stomach cramps, or they are constantly crying. The simple remedy of dressing the child more warmly, in better fitting clothes, will do wonders for this.
Bonnets
Unfortunately, bonnets are no longer in fashion. In comparison with the rest of their bodies, little babies often have an enormous — and sometimes rather bald — head. The head is constantly losing heat, which should really be retained for the development of the brain and organs. On the one hand, a silk bonnet will retain the baby’s heat, and oil the other hand, it protects the head and the open fontanel from a restless environment. It is important for the forehead to be free, because this part of the body acts as a sort of thermostat for regulating body heat. Where it is often windy, it may also be necessary for the baby to wear a second bonnet made of wool. There are wonderful bonnets on sale, or they can be knitted in material which is so soft that it is like a second skin.

Bonnets can be removed when the child is in the cot as long as the baby is well protected.
Wraps and swaddling
Because of the need for boundaries, it is understandable why many babies, as well as older children, calm down and fall asleep easily when they are firmly tucked in, or if they are wrapped up or swaddled.
Usually, babies have a flannel sheet wrapped around them, during the postnatal period, but this often disappears, to be replaced by a babygro/sleepsuit. We recommend continning to use a swaddling cloth and wrapping it firmly around the babygro/sleepsuit before putting the baby to bed (see illustration). As the baby still lies with its arms and legs bent, it should be swaddled in this position, to increase the sense of security. The baby can now relax and will fall asleep warm and snug. However, you must make sure that the baby is not wrapped up too warmly (see p.25).
The woollen wrap can serve as a blanket outside the cot for when the baby is fed. When the woollen cloth is no longer sufficient, use a (woollen) baby sleeping bag for in bed.

Children who remain restless and have difficulty falling asleep despite being wrapped up, as well as babies who do not establish a good rhythm of drinking/sleeping, may benefit from the old-fashioned method of swaddling in which the arms are also wrapped up so that the child cannot flail about. Flailing is often a response to crying, cramps or fright, but because it is involuntary, it can cause new restlessness. Swaddling can help to break this vicious circle.
Many parents find it difficult to restrict their baby in this way; in our age of boundless freedom, it is not so easily accepted. However, parents usually overcome their resistance when they see how the baby responds to swaddling. For most babies, it results in a much greater sense of peace, and consequently they sleep well and establish a pattern of sleeping and feeding every few hours. Nowadays, two methods of swaddling are recommended: either ready-made swaddling blankets or swaddling wraps, or using the method shown at the back of this book (see p.108). (See also Blom, Crying and Restlessness in Babies.)
The cradle
The cradle is an important successor of the smallest home in which the baby lived before birth. You can opt for a basket cradle (Moses basket), a wooden (rocking) cradle or
a cot. For safety considerations, the baby’s feet should always be placed at the end of a cot, with its head halfway down. Tuck in the blanket in such a way that the head is free and the shoulders are covered. A hood or canopy over the cradle or cot makes the space more intimate, so that the child is not distracted by the environment and can sleep more peacefully.
For the canopy, it is best to use plain materials in soft colours. A canopy made of light blue silk combined with a layer of pink silk gives a very subtle calming colour.
The mattress must be absolutely flat, providing good support, and it must be well-ventilated and warm. Our preference is for a mattress of kapok, cotton or another natural material. A sheep’s fleece can be placed on the mattress. The fleece is soft and gives a beneficial warmth so that the newborn baby is protected from cooling down too quickly. Make sure that the fleece is not too large and lies on the mattress without any folds. Cover the fleece with a sheet. The bedding should be made of cotton and wool. Do not use synthetic materials. The sheets and blankets should be big enough to tuck the baby in quite firmly. The fleece and the mattress should be regularly aired. If you use a woollen wrap there are likely to be patches of damp under the mattress. If necessary, use a waterproof sheet. There are cotton sheets available that are impregnated with rubber and do not feel clammy. We do not recommend the use of duvets, even those made of wool, because of the risk of suffocation.
If the cradle is next to the window, watch out for overheating in the sun. A baby can easily become too hot in a heated room when the sun shines through the window.
The playpen
Up to the age of four months, it is not really necessary to have a playpen. Nevertheless, when the baby is downstairs, it is a good idea to have a safe place to place it. A wicker basket with a soft cover, or the bed of a pram, are quite suitable.
We do not recommend the frequent use of a baby seat or recliner, as the baby is stimulated by the ac-
tion of sitting in an upright position at a stage when he is still physically immature. The baby can only lie passively in a baby seat, which does not matter for a short period, but is harmful to physical development in the long term.
This objection does not apply so much to the use of a recliner, but there are other objections; when the baby discovers that he can bounce the recliner with one leg, he often finds it difficult to stop, even when he gets tired of the mechanical movement.
When the baby starts to reach out for things and becomes more active in its motor development, it is time for a playpen. Quite apart from the fact that this provides a safe place for the child to learn to sit and stand, it is often a favourite place for being quiet and for playing undisturbed. A cloth cover, like a curtain, along three sides of the playpen will increase the sense of security, and is not to be confused with cot bumpers, which are not recommended as they pose a suffocation risk for the young child. For motor development, it is important that the floor of the playpen is sturdy and not too smooth (for example, a cloth folded double), so that the child can roll over and can put pressure on it.
Walkers and baby bouncers
We emphatically advise against the use of walkers and baby bouncers. These are ‘aids’ which speed up the child’s motor development in an unnatural way. Children certainly like to use these things — especially if they can move around in them quickly — and want to use them more and more. However, it is much better for a child to learn to stand and walk at his own pace. In this sense, walkers and baby bouncers do not help healthy development in any way, and are actually more of a deterrent to healthy development.
Prams and baby carriers (slings)
The pram can be a safe and sheltered place in which the baby can sleep outside during the first few months. For walking, a baby carrier is often a better alternative because it means
that the baby moves in time with the pace at which the adult is walking, and is not shaken about so much as in a pram, as it goes up and down the pavement. The child is carried in a natural position in a baby carrier (sling), (see the illustration on p. 106).
However, at this point a warning should be given. It has been shown that babies can become too hot and stuffy, particularly if carried under a coat. Unfortunately, there are even a few cases, which resulted in a baby’s death. We recommend that you keep a careful eye on a baby in a baby carrier, and if possible carry it on top of a coat rather than underneath, with, if necessary, a woollen cloth around the baby.
The disadvantage of a baby carrier in which the baby is in a vertical position is that the baby did not take up this position itself. In this sense, the baby carrier is not for babies until they reach the age of nine months. A sling is preferable, as the whole back and head are supported, although it might be tiring for the mother to carry.
When a baby has reached the age for a pram, the best model is one in which the baby faces the parent. In this way, the baby constantly has the comforting face of its father or mother in front of it, and can find out from that face what is happening in the big wide world. A traditional pram has the advantage that the child lies flat, as at this age the baby’s head is still relatively heavy and the neck cannot keep the head in a stable position. We recommend a buggy only from the age when the child is able to sit unassisted.

General Points of View
In this section we describe a number of points of view which serve as a guideline for the way we view, and relate to, young children.
The child’s development and care, sleeping and waking, play and toys, safety and feeding are subjects which will be tackled in this section in terms of content. A practical approach to these subjects can be found under the advice for every stage (see Chapters 3-6).
The child’s development
From the moment the child is born, the parents have the important task of monitoring his or her development. This gives rise to many questions. How can we best prepare for the child’s future? Should we, or should we not, familiarize the child with elements of adult life at an early stage, so that she will be prepared for this later on? The answers to these questions will depend on your view of the child’s developmental stages.
We proceed on the assumption that the more successfully a child is able to fully develop at a particular stage, the more harmonious the development will be. This also applies for future development.
Fora baby and young child, this means that we must create the conditions in which a baby can most successfully be a baby, and a young child can most successfully be a young child.
The first developmental stage after birth is strongly centred on the child’s physical and motor development. Growth is quite exceptional during the first year of life, and is still rather like the growth of the embryo. The development and growth, which takes place outside the womb in humans, takes place completely inside the womb in other mammals. When the child is one year old, the development has reached a level comparable to the birth level of other mammals.
For the baby’s development, it is good if the conditions after birth are still quite similar to the situation in the womb. This particularly concerns the protective cocoon around the child. Warmth, a sense of security and some protection against environmental influences promote the baby’s health. It is extremely important for the baby’s physical development for her to have physical contact — rocking, cuddling or simply holding the baby in your arms. Children who lack this physical contact do not develop well, even if they have ‘the best feeding.’ These babies immediately start to grow again when attention and care is devoted to physical contact. Satisfying the need for physical contact gives the child a basis for the rest of his or her life.
Nevertheless, in humans, a good environment alone does not guarantee development. Every person has his own rate of development and his own way of developing. For example, there are babies who develop motor skills very quickly, sit up at an early stage, roll over, stand and walk. On the other hand, other children appear to ’stand still’ in their development fora long time, then seem to miss out a few stages and can suddenly walk, even though they never crawled. Some children start to develop speech very early, while others remain unintelligible for a long time.
It is important to be aware of a child’s own way of developing. There may be a tendency to a certain one-sidedness. This sort of one-sidedness — for example, the slow development of speech — can be regarded as the child’s own way of developing. It is only when this one-sidedness is particularly strong that it may be seen as a developmental disorder.
Thus, the first year of the child’s development can be seen as a continuation of the embryonic stage.
During this first year of life, the body matures to the extent that the child becomes able to control it for herself. A one-year-old child can stand and go where she likes and move about freely in space. It is as though she is taking charge of her own physical body. This stage of development depends on healthy physical growth and development. Illness and malnutrition will immediately delay the process. Development at this stage is mainly influenced by the physical organism and the care of this organism.
The basis for the later development of speech is laid during the first year of life. Talk to, and with, the baby, and play with her. She sees the gestures which accompany words, and hears the songs. All this contributes to the child becoming increasingly familiar with human language. The clearest sign of this is contented baby talk by the end of the first year of life.
After the first year, the child depends on being able to imitate what she has heard. She will start to copy the words herself, first words of one syllable and then words of several syllables. She then begins to combine words, and finally produces short sentences. In this way, the child enters a second area in which she can move about freely — the field of language. By mastering speech and language, the child takes part in social life in her own way, and becomes able to express herself through the spoken word.

The next stage of development is the time at which the child starts to say ‘U Prior to that stage the child called herself by her own name. This can be seen as an expression of the fact that the child was not yet deeply connected with her own body; thus in a sense the child saw herself from outside, as other people see her.
When she becomes more closely connected with her own body, the first, still primitive, sense of self-consciousness emerges and the child experiences a sense of self; she starts to say ‘F and experiences herself as a centre. As a result of this process, the child may also feel cut off from the world around her.
By the age of three or four, the child has gone through a sort of first cycle of development. By learning to stand and walk, she has achieved a certain degree of freedom in space. By learning to speak and understand, she can develop socially and communicate with others. With the deeper connection of the self and the body, self-consciousness emerges for the first time, and this is expressed when the child uses the word ‘I’ to talk about herself.
Learning to use language independently is an important psychological development, as is developing a sense of individuality. However, healthy physical development is always a prerequisite for this. Motor development is particularly important for the development of psychological functions later on. Playing
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with bricks, simple ball games, finger games, circle games — in short, everything we do with the physical organism of the child as the point of contact — will have a positive influence on development.
The behaviour of the people in the child’s direct environment is very important for development. A small child learns and develops by imitating what she sees, hears, feels and so on. In this way the child learns to walk, speak and think, and during this first learning process carefully assimilates all the details — particularly during the first three years. This once again underlines the importance of being conscious of our own behaviour as well as the material environment of the child (see also Impressions, p.25).
Admittedly, the aspects of child development described here are very general, but they can still provide a direction for the way in which we behave with the child. The care for the physical processes of growth and development are of central importance. We can measure and weigh growth, while we can assess development from the development of the motor system, the mastery of language, and the birth of the ’self’ when the child starts to say ‘F.
Sleeping and waking
During the course of life a person’s need for sleep undergoes great changes. A newborn baby often sleeps for between eighteen and twenty hours out of every twenty-four. A one-year-old can sleep for fourteen hours, while an adult needs between six and eight hours of sleep. Therefore, in the first year of life, the child should spend a great deal of the time asleep.
We have seen that there are two important things in this first year — growth (a baby’s weight triples in the first year) and development. Growth takes place particularly during sleep, while development is stimulated during the waking hours. The various organs ‘learn’ to operate in a sense, with the use of the body during, the daytime (by eating, moving, etc.). What the organs ‘learn’ during the day continues to have an effect while the baby sleeps, and is assimilated in the body’s growth activity.
A one-sided predominance of growth and excessive stimulation to develop both have a negative effect. There should be a healthy balance between the two processes; an alternation between waking and sleeping which is suitable for each stage. When the child is about one year old, this balance will have become established in the operation of the organs, in a particular day/night rhythm — the biological clock.
For good health and for the child to be able to make use of his physical capabilities properly, it is essential for this day/night rhythm to become well established. Therefore, it is literally of vital importance for a small child to establish a steady pattern during the day with regard to sleeping, eating and waking.

A steady pattern of set times in the life of a child promotes growth and development and helps to establish a healthy rhythm of sleeping and waking. Too much stimulation during the day may prevent the child from falling asleep; however, a completely unstimulating environment, without healthy challenges for the child, can also lead to problems with sleep because the child is not sufficiently tired. A healthy routine in the day, alternating challenges and periods of quiet, being together and being alone, can help to correct sleeping problems. Rituals for going to sleep can also be helpful — rocking, singing lullabies, the use of musical boxes or a prayer for the child are methods used by many families.
Sleeping well means that the child must be able to surrender and ‘let go.’ This is not as easy for some children as for others. It is helpful to give the child a sense of security, for example, in the enclosed space of the cradle (possibly with a hood) or lying against the mother. Warmth promotes a sense of comfort and relaxation; a bonnet, a sleeping bag, some drops of lavender water on the pillow, or a hot water bottle can sometimes help babies who find it difficult to fall asleep. Hot water bottles should always be removed before the baby is placed in the warm cradle. A light silk bonnet is appropriate for indoor use, but be aware of the risk of overheating. Wrapping the child up firmly pro-
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vides a sense of security as well as a feeling of warmth.
However, there are babies who assimilate everything that happens around them so greedily that they actively seem to suppress their feelings of tiredness and the need for sleep. The more stimulation they are given, the hungrier they seen to be. They are unable to set their own boundaries. Increasingly, we see babies who spend many hours of the day — and sometimes the night —awake, constantly asking for attention from the environment. For these children, the parents must learn to see when they show signs of being sleepy. The fact that this is quite an art is clear from the many stories told about this problem. If you miss the right moment, the child appears to go past his sleepiness and will keep going for many hours. Signs of sleepiness are restlessness or agitation, looking away, rubbing the eyes and face, warm hands and red ears, grizzling and crying. By responding to these signs of sleep immediately and consistently, by placing the baby in his cot, it is possible to create a healthy need for sleep. By not responding straightaway every time the baby cries, he will learn to resolve minor discomfort for himself. It is important to realize that any attention wakes the baby up. All the extra attention and special behaviour associated with going to sleep often achieve quite the opposite of what the parents hope to achieve.