Posts Tagged ‘tiredness’

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.

THE SIDE EFFECTS OF PREGNANCY

Why does pregnancy make you feel so sick?
Although no one is really clear about the cause of sickness in pregnancy it is thought to be due partly to the hormone human chorionic gonadotrophin (hCG), released early in pregnancy. For most women, symptoms are mild and begin to ease at 12 weeks. For some, the sickness may last throughout the day and continue beyond this time. A small percentage of women experience severe nausea and vomiting, known as hyperemesis gravidarum (see p 92).
There are practical measures you can take to relieve nausea and sickness (see p 82).
I’m two months’ pregnant and feel incredibly tired all the time. Is this normal?
Yes tiredness is a common complaint in pregnancy with most women feeling a sudden loss of energy in the early stages as their body gets used to the changes caused by pregnancy. This often lasts throughout the first trimester, but after about week 13 you should start to feel a bit more energized When you’re not resting, try to stay active and take some gentle exercise.
Another cause of tiredness is anaemia, a common condition in pregnancy that needs to be monitored. Although it’s more likely that your tiredness is due to the pregnancy itself, when you see your midwife you will be offered a blood test to check your iron levels, and if these are found to be low you will be offered supplements. To avoid anaemia, eat iron-rich foods, such as dark green leafy vegetables, red meat, wholegrain cereals, pulses, and prune juice. Vitamin C helps your body to absorb more iron from your diet, so try drinking fresh orange juice with meals, and limit your tea and coffee intake, as caffeine inhibits iron absorption.
I often feel faint - what could be causing this?
Feeling faint or having a dizzy spell is quite common in pregnancy as pregnancy hormones cause your blood vessels to relax and widen Although this improves the blood flow to the baby it also has the effect of slowing down the flow of blood around your body which can lead to low blood pressure, known as hypotension. Although this is unlikely to be a risk in itself, it can cause feelings of faintness, most commonly when you stand up too fast from a sitting or lying position.
Other causes of faintness include lying on your back (as this can put pressure on several large blood vessels involved in returning blood back to your heart, which can cause low blood pressure and in turn make you feel dizzy and faint); a lack of food or drink: getting overheated; and fast breathing (hyperventilating).
Sometimes, feeling faint can be more serious. If the feeling does not pass by eating, drinking water, cooling down, or taking things slowly as you stand up, it may need investigating further and you should seek the advice of your midwife or doctor as this could be due to anaemia (see above) and you may need treatment in the form of iron tablets.
Is it normal to have pelvic pain in early pregnancy?
Pelvic pain is associated with the soft area supporting your pelvis, the symphysis pubic joint. This can swell or separate causing considerable pain, termed symphysis pubis dysfunction, or SPD This is thought to be caused by pregnancy hormones and is quite common in late pregnancy, but can occur earlier. Many women feel most pain when walking or lying Wear comfortable shoes; use pillows to support the hips and legs in bed; keep your legs together when getting out of bed; avoid breast stroke; and get lots of rest. Some women find sitting on a birthing ball helps You may be referred to an obstetric physiotherapist and advised to wear a support belt. In severe cases, crutches may be needed. Most cases resolve after the birth.
I’m embarrassed because I think I’ve got piles. I don’t want to go to the doctor - what can I do?
Haemorrhoids (piles) are swollen veins at or near the anus that can be very uncomfortable, especially during pregnancy. Piles area common feature in
pregnancy, with many women experiencing them at some stage, so your doctor will not be at all surprised You could also speak to your midwife about the problem if this is easier Your doctor or midwife will be able to recommend a treatment, such as a cream or a cooling maternity gel pad.
As piles often develop as a result of straining due to constipation, increasing your fibre and fluid intake may help you to have regular bowel motions, which in turn may help to relieve the problem Eat fresh fruit and vegetables and drink lots of water If you are very constipated, you could ask your doctor to prescribe suppositories I know you may feel embarrassed, but it is best to approach someone rather than to suffer alone.
I’ve been getting regular headaches since becoming pregnant - should I be worried?
Headaches in the early stages of pregnancy are quite normal and are thought to be related to the effects of pregnancy hormones. Headaches can also be caused by other factors such as dehydration, low
blood sugar, a stuffy environment, tiredness, and lack of sleep. Try increasing your intake of water, aiming to drink at least eight glasses of water a day, and have small regular meals to maintain your blood sugar. If you feel a headache coming on, drink two glasses of water and have a rest for 30 minutes. Taking a lose dose of paracetamol is considered safe, although it is best to avoid this if possible
If you are suffering with headaches at around
28 weeks or more, you should inform your doctor or midwife of these, especially if your headaches are accompanied by blurred vision, an inability to focus, or flashing lights, as this may be a sign of pregnancy-induced hypertension (high blood pressure), which could indicate pre-eclampsia (see p.89). Try not to worry, as even though many women complain of headaches and some will have high blood pressure in pregnancy, few go on to develop pre-eclampsia. It is thought that the incidence is somewhere between two and five per cent of all pregnancies.
My gums have started bleeding since I’ve been pregnant -why is this?
It is very common for gums to bleed in pregnancy The pregnancy hormone progesterone causes areas of tissue that connect muscles and ligaments to soften and become stretchier so that your body can make room for the growing baby However, this can affect tissue in other parts of the body, such as in the gums, making them softer and more prone to bleed.
Also, some women crave sweet foods in pregnancy, an excess of which can affect the gums, causing them to become tender, swollen, and more likely to bleed, and increasing the chances of developing gingivitis, a gum infection. Pregnant woman are encouraged to see a dentist early in pregnancy for a checkup (dental care is free up until the baby’s first birthday)
It is important to brush your teeth more than usual and floss regularly when pregnant to minimize the risk of an infection Unlikely as it may sound, it has been suggested that there is a link between premature birth and gum disease
Whenever I sneeze, I leak - is that going to last for ever?
Many women suffer from stress incontinence during pregnancy, which means a leakage of urine when you cough or sneeze The leaks are caused by the loosening of muscles in the pelvic floor - a group of muscles and ligaments that support the pelvic organs - due to pregnancy hormones. Also, as the growing baby puts more pressure on the bladder stress incontinence becomes more likely,
It is recommended that you carry out pelvic floor exercises (see p.57) to reduce the likelihood of leakage. These can be started at any stage of pregnancy, but the earlier you begin the better; once you get the technique right they are simple. As these are such discreet exercises it is easy to practise without anyone else realizing what you are doing
Stress incontinence should improve following the birth, although it can take up to six weeks There is some suggestion that the problem can persist longer depending on the type of birth you have, with a natural vaginal birth more likely to cause ongoing problems than a Caesarean delivery.
I’ve been getting nosebleeds for the first time in my life. Why is this?
It’s not unusual for nosebleeds to occur in pregnancy due to the increased blood supply in the body Nosebleeds are not serious, but if the bleeds are severe, you can ask your doctor for a spray to help the blood to clot. If your nosebleeds are frequent, a simple surgical procedure can cauterize the vessel
When you have a nosebleed, sit for a few minutes with your head upright and apply pressure to the bridge of the nose. To avoid further nosebleeds, make sure you blow your nose gently, drink plenty of fluids to avoid dehydration, use vaseline on dry nostrils, avoid smoky environments, and open your mouth when you sneeze to relieve nasal pressure
I’m 30 weeks’ pregnant and have persistent backache - is there anything that can help?
The weight of your baby and the fact that joints and ligaments soften in pregnancy can cause backache Sometimes sciatica occurs, a sharp pain that travels down the back and leg when the sciatic nerve is
trapped in a joint in the lower back
For lower backache warm baths and a warm compress can help, and gentle massage done by an experienced practitioner Exercise, such as yoga, pilates, or aquanatal classes (see p.55), strengthens back muscles, but check with your doctor before embarking on a new exercise regime. Watch your posture, making sure that you sit upright - you could try using a birthing ball - and wear flat shoes.
If you have sciatica, ask your doctor or midwife to refer you to a physiotherapist to assess your condition and teach you exercises to help relieve the pain and minimize a reoccurrence. Some women have a maternity girdle or back brace fitted.
Little moles are appearing on my skin. Why is this happening?
Skin changes occur frequently in pregnancy due to the effect of pregnancy hormones However, some changes, such as new moles and freckles appearing,
although not usually serious, should be discussed with your midwife or doctor, particularly if new or existing moles seem to change shape, are red or tender or start to bleed
In general, skin either becomes quite oily in pregnancy due to an increase in the production of the skin’s natural oil, sebum or, if skin is prone to dryness, it may become even drier and more sensitive. Many women experience a darkening of the skin, while others notice a pattern on their face that looks like a patchy sun tan, called chloasma (see p. 105). If your skin is sensitive, avoid scented creams and oils, and perfume. Regular cleansing of the skin and avoiding oil-based products may also help
My mum had varicose veins -am I likely to get them in pregnancy?
Around a third of women suffer from varicose veins in pregnancy to some degree (see p.86). These occur because increased levels of the hormone progesterone cause the walls of the veins to become more relaxed; there is also increased pressure within the veins as a result of the enlarged uterus pressing on major veins in the pelvis A family history of varicose veins does increase the possibility of them occurring, but there are several things that you can do to reduce the risk or severity of varicose veins.
If varicose veins do appear during pregnancy, they usually improve within three months of giving birth although unfortunately in subsequent pregnancies they are likely to recur.
My feet are swollen and tight; can I do anything about it?
Swollen feet and ankles, known as oedema, are due to excessive fluid seeping into the tissues because of the increased volume of blood By late pregnancy as blood volume continues to rise, this is a common problem. The swelling is usually worse later in the day and when the weather is warmer There are steps you can to take to help reduce the swelling, such as elevating your legs when sitting, rotating your feet, and lying on the floor with your feet up the wall. Wearing support tights or stockings also improves circulation in the legs. Make sure that you drink plenty of fluids, particularly water, as this improves the kidney function and reduces water retention. Gentle exercise, such as swimming or aquanatal exercises, also increases the efficiency of the circulatory system. There is evidence that reflexology from a registered practitioner may help.
If you also have swelling in your hands or face it is worth having a blood pressure check to rule out pre-eclampsia (see p,89) Most women find that the swelling gradually disappears after they give birth
My fingers are tingling and my midwife said it might be carpal tunnel syndrome - what is this?
Carpal tunnel syndrome occurs when swollen tissues in the wrist compress the nerves and cause pins and needles and numbness. Other symptoms include difficulty grasping with fingers and thumb and a general weakness in the hands. This is common in pregnancy due to the increased volume of blood, which can cause fluid retention
There are ways to reduce the symptoms, such as circling and stretching exercises to improve circulation and increase wrist mobility Wearing wrist splints and elevating your hands on a pillow at night can also help. There is some inconclusive evidence that ultrasound treatment may help in mild cases
I’m 35 weeks and get terrible leg cramp. What can I do?
Leg cramp, where the leg muscles go into a painful spasm, is common in pregnancy, particularly at night, which may be due to the pressure of the uterus on pelvic nerves This usually resolves itself once you are out of bed and using the muscle. However, if the pain doesn’t recede and there is any reddening or swelling in one leg, you should seek medical advice urgently to eliminate the possibility of a clot.
To reduce the incidence of cramp or its severity; drink lots of water to prevent dehydration and try leg stretches and ankle exercises, circling your heel first and then wiggling your toes, before going to bed. Gentle exercise, such as walking or swimming, can also help and getting your partner, friend, or relative to massage your legs, particularly the calf muscle, can improve circulation Some research suggests that taking magnesium supplements reduces the incidence of cramps but further studies are needed.
I’m itching to the point where I’m bleeding. What can I do?
Most itching in pregnancy, especially on your tummy, is due to stretching of the skin, hormonal changes, and heat. However, if you have significant itching, see your midwife or doctor to determine whether you have a condition called obstetric cholestasis, a serious but rare condition that affects the liver and occurs in about one per cent of pregnancies (see p 90) - a blood test can rule out this condition
Using a non-perfumed moisturizing lotion or emoillient cream daily after washing may help, and avoid bathing in very hot water Try not to scratch, as broken skin is vulnerable to infection; wearing cotton gloves at night may stop you scratching in your sleep After 28 weeks, five drops of essential lavender oil in a bath helps to soothe the skin. Antihistamine creams or tablets may be prescribed by your doctor if the itching is severe and other measures aren’t working.
My breasts keep “leaking”. Should this be happening now?
In pregnancy, your body prepares for breastfeeding and some women find that they leak colostrum, the first watery, yellowish milk. as early as 16 weeks Some leak large amounts, some small amounts, and some not at all. The amount you leak has no bearing on the amount of milk produced after the birth or your ability to breastfeed. If you are self-conscious,wear breast pads to protect clothing You may leak more when sexually aroused as oxytocin, one of the hormones responsible for the “let-down” reflex in the breasts, is released at this time.
I’ve got terrible indigestion -why is this?
Progesterone, the hormone that relaxes smooth muscle (muscle that controls unconscious actions) in pregnancy, has the unfortunate side effect of relaxing all smooth muscle in the body, including the whole of the digestive tract. This slows digestion and the ring of muscles called a sphincter at each end of the stomach become less effective, which can cause heartburn and indigestion as acidic juices from the stomach leak back into the oesophagus. In addition, your growing baby is squashing your stomach so that you have a smaller space to digest food.
To relieve indigestion, eat little and often, eat slowly, don’t eat late at night, and cut down on fatty or spicy foods. Rather than lie flat, prop yourself up with pillows Talk to your midwife, doctor, or pharmacist about remedies that are safe to use in pregnancy.

Varicose veins
how can I avoid them
Self-help measures to avoid the risk of varicose veins include:
* Wearing support hosiery - this is one of the best ways to avoid varicose veins All pregnant women are entitled to two free pairs of compression tights
* Doing regular ankle and foot exercises to reduce swelling and cramp
• Avoiding standing for long periods.
• Raising your legs when sitting down
• Getting up to take regular walks if you have to sit for long periods.
* Avoiding high-heeled shoes, which reduce the work done by the calf muscles, to maintain blood flow in the legs.
Sleeplessness
You are often very sleepy at the beginning and end of pregnancy, and towards the end of pregnancy you may find it increasingly difficult to sleep restfully in the night as your bump makes it hard to find a comfortable position, pressure on your bladder causes you to get up frequently to use the toilet and your baby may not share the same sleeping pattern as you and wakes you frequently with his kicking. Coupled with the fact that your body is working extremely hard, a poor night’s sleep adds to your general levels of fatigue. If possible. try to compensate for broken night-time sleep by catnapping in the day, or find time to sit down and put your feet up

Coping with morning sickness
To alleviate feelings of nausea and sickness in pregnancy, try eating little and often, and sip water continually during the day Some women find ginger helps, so you could try nibbling ginger biscuits, perhaps before you get out of bed. Acupressure bands worn on the wrists and available from most chemists are also thought to relieve the symptoms.
Fatigue

One of the most cited complaints in pregnancy, particularly in the first trimester, is extreme tiredness as your body deals with its extra workload. Accepting this and adapting your routine accordingly can help you cope. * Slow down and take a break, or even a catnap, whenever possible.
* Eat small, healthy snacks throughout the day and drink plenty of fluids to maintain energy levels
• Whenever possible go to bed earlier.
• Take regular, gentle exercise to relieve stress and improve your fitness and stamina.