Special issue with the Sunday Magazine
CHILD: February 07, 1999
Nurturing the natural way
Dr. S. Jayam
Supriya and her husband were scientists who had returned from abroad. Their daughter though two-and-a-half years did not talk and they had been told that the child had autism. She did not play with other children and was shy, silent and withdrawn. While they had accepted that she was quiet, they were not sure what to do next. So they came to me. Talking to the mother, who was a doctor, and the father, who was a scientist, I realised that the child was normal. The problem was that there was no one to interact with the child as the parents were both busy. I told them to play with the child.
"Start playing and the child will guide you." Ten days later they came back beaming with happiness. The child was talking and playing. The treatment was simple, but effective. There are many young parents who want to do their best for their children but do not know how to go about it.
Visalakshi weighed 1.2 kg at birth. She had to be nurtured and cared for with medical help. Since her whole family took special care, she grew up, an intelligent and attractive person. She was affectionate, if a little shy. She was attending college and helping in her father's business. To come to this stage from being a low birth weight infant, the total support of the parents and family is necessary. Watching a child grow up is a joyous opportunity given to the parents. Every moment of it can be enjoyed thoroughly. To the question who is happier, the child or the parents, the answer is "both".
Years ago when we were helping with the training of Integrated Child Development Services Scheme (ICDS) a Swamiji said "you paediatricians are protecting the children from diseases by immunisation, measuring growth etc. Add to that good thought and a clear mind - then the little human beings will become persons with good quality of mind and body."
This is true and that is the aim of the child. So when do we start?
Four-year-old Aditi, refuses to eat her food when upset. But she gets coaxed, patiently, by her mother to eat a balanced meal and her growth is good. She has started her schooling, learns by play and her day is filled with opportunities for learning. The care given to this girl when she is in the preschool stage, will help her in adulthood. Such is the input needed for good quality of life. It goes without saying that in our culture girls need special care.
The baby when born should be around 3 kg in weight and should kick and cry. The aquatic phase is over and the baby gets into this atmosphere with a big protest. A sound from the mother and her touch give the infant a sense of security. The mother gets emotional with the new experience and out flows the nectar of life - the breast milk. The first-fluid - the colostrum is essential for the baby's development. This total dependency on the mother soon after birth is a particularly human experience. Many studies have shown that the intimacy and care at birth is what gives the emotional strength in later life.
The new baby is delicate and requires warmth in every sense of the word. The biological adjustment takes a few minutes. The baby opens its eyes and sees the human face. The sense of taste and smell are fully developed by now. The five senses send their impulses and develop the brain.
Recently a method called "kangaroo care" - (keeping the baby in the bosom by the mother or the father) specially for premature babies is picking up as an alternative to the incubator. In "kangaroo care" the babies grow better and cry less. It is an example of going back to nature after high tech care - where they used to relentlessly separate mothers - (worrying about infection) if the babies were born preterm. After a full circle we practise the method of caring by carrying and feeding on demand with breast milk only.
Bhooma was told that she was carrying twins just before she reached full term. Her infants were small at birth and the grandfather was fretting and fuming when he was suddenly told to take the babies to the intensive care unit. "What is wrong with them? Why should they be separated from the mother?" He decided to shift the mother also along with the babies, knowing well that their survival depended on the breast milk. The foundation laid then was good: at two years, they are adorable children.
Neonatal intensive care, within the first few days of life has helped to save the babies in a big way. But much more is needed in planning the delivery properly and preventing problems.
Smitha was diagnosed to be carrying twins soon after conception. The pediatrician prepared her for what was coming - patience and giving up on little things, getting the support from her husband and parents for the big event. Siddharth and Vikram were born with good birth weight and required only routine care. Lots of love, emotional and physical support came from her parents, husband and his family, especially during the first six months. Thus parenting in the early years of life is a pleasure, provided there is access to the required knowledge, skill and support.
At birth, the human being is quite helpless unlike other mammals. If you have visited a bird sanctuary you will see how the birds care for their young and teach them to fly. Smell and taste are well developed in babies at birth and they have reflexes which can make them feed. The half hour after birth is called the "alert" period of life.
The baby at birth can hear the human voice and look at the human face. The response to "touch" is dramatic. Even if the baby has not taken the "first breath", a gentle touch at the back can bring back the breathing. Crying is usually identified with sadness but the "first cry" is a cry of joy to pediatricians and parents. If the baby yells and cries well at birth, we are happy. We know that the baby is not suffering from severe hypoxia (low oxygen) at birth.
The growth curves are generally used to find out if the infant is growing properly. But many mothers feel it is not enough and complain most of the time that the baby is not big. Weight measurement convinces the mother about the growth of the child.
The child is immunised in the first six months as protection against tuberculosis, hepatitis, polio, diphtheria, whooping cough and Tetanus. The number of immunisations may go up (as our petrol prices) and one feels that there is no other course, but to give them.
After going through the endless cycles of research and discussions - we have reached a point where we say emphatically, that breast milk is the only milk that the child needs. No water is necessary to be given to the child under six months since 80 per cent of breast milk is water. The baby can be started on home-made solids and semisolids after six months.
This is a trying period for the parents and family. The mother feels that she is unable to go out much and she is not "doing anything". Many times I tell them that by being what they are - they are helping the child grow up healthy and happy.
The child is an individual and each child is different. The right kind of stimulation (not overstimulation) helps the child to have a good all round development. Providing a good learning environment is important.
Recently, a toddler came into my room. There were lots of small chairs and toys. I asked him to play. He looked at his parents' faces and went and sat on a chair. He looked at me and I said "Isn't it nice?" He beamed at me. Then the mother said shyly - "He noticed that you appreciate him. Usually I tell him 'No' when he attempts to do these things. So he is surprised and happy."
When a child wants to do something allow him to do so - but see that he does not get hurt. Preventing him from doing things will only undermine his natural learning process.
Besides the physical needs of food, sleep, rest, exercise, fresh air, and sunshine - the child needs emotional bonding, continued love, warmth and support from the immediate care-givers. There is innate nature - which is basic to every human being - but the environment can definitely influence emotional development.
A few years ago, a little girl was brought to me because she was throwing tantrums at meal time. She did this only with her mother. When I talked to the child, I realised that she was longing to prolong the time she had with her mother. The only time the mother spent was when she was giving her food. In the child's mind she could stretch the time with the mother by being obstinate. I taught the mother to play separately with the child and to allow her to eat on her own. The child understands that she can manipulate the world around her and also appreciates it if people respond the way she wants.
By six months all the reflexes are replaced by various activities. The child is able to sit up - look at things, knows the use of hands, feet, eyes and mouth. The learning process is accentuated by movement and the ability to control the movements. From now on, learning never stops.
Manipulating, experimenting, trying out, exploring, discovering new things - memorising, communicating - the child develops by all these strategies. The eagerness to learn is inherent in the child. Providing a suitable environment, assisting, appreciating, supporting, caressing and being part of the excitement is what parenting is all about.
My friend, a mother of two children, loves to watch them play. I have never once heard her say - "Enough - go and study" or "Don't do this". I have never seen them going beyond the limit - because the warmth and protective care establishes a basic sense of security and acceptance.
In the family and later in the classroom, the child gets opportunities to observe, imitate, learn and practise many skills. Providing a nurturing atmosphere helps to bring out the best. Again, one must constantly remind oneself that no two children are alike and they should never be compared. Each child has some strengths and parents should identify that instead of finding the weaknesses.
Years ago, my friend's daughter asked me what it is to get "Very good" from the class teacher - and why her parents were suddenly treating her differently. Her doubt was "I am the same person - but suddenly my parents tell me they are happy because I got 'very good'. Does it means that earlier they were unhappy with me? I am the same person, so why this difference?" Children think a great deal about adult behaviour and inconsistent behaviour bothers them.
Child rearing has to be taken up as an opportunity and never as a "sacrifice" by the mother or father. The child cannot always be the focus of attention and working mothers need not feel guilty about this. The child's development and growing up becomes integrated into the family as a whole - and it is taken as a primary task of the parents.
A little boy was brought to me as he would not write in the class. He was punished by the teacher and the parents were worried. Talking to him for a few minutes revealed his reasoning as to why he does not want to write. He said "My father dictates to his secretary and signs; Why cannot I too have a secretary"? When I told his parents about his comments, everyone was amused. That was good reasoning too! He never saw his father write and he wanted to imitate him.
Talking to a child is very rewarding. Parents will find great satisfaction in talking to their children. Informal chats will give the adults a chance to learn a great deal. Children are good teachers and I have learnt a lot from them.
Fantasy and play are natural in a child. Many times parents become apprehensive, thinking their child is lying. Children see the picture of an elephant and they visualise an elephant coming and playing with them. That is why cartoons are a big hit with children.
Good nurturing means good nutrition, and providing an atmosphere of learning. The child is an active member and not a passive receiver. Even while eating, emotions play an important role. In the early stages, children do not eat because the food offered does not taste interesting. Children should be allowed to eat with others in the family. Maybe they will mess up but that is also part of learning to eat. But where is the time? Mothers feel that if "food" is shoved in fast - specially milk in the bottle - they are sure something has gone in.
Allow the child to use his/her hands, and touch the food - coordination skills are developed and slowly the child learns to enjoy the food. Stereotyped tinned foods mixed in water do not provide variety or taste. Hence it is rejected. Nothing like home food which smells and tastes good. Our food is clean, cooked every day and free of germs.
As a pediatrician, I have never encouraged the bottle, pacifier or tinned foods for children. I am convinced of the hazards in health and brain development if breast milk is denied to children. The primary reason for the "bottle culture" is lack of knowledge and feeling that it is OK! Is there an alternative? Yes, feeding by "paalaadai" or by a spoon is an alternative for semi-solids.
Playing music, showing pictures and telling stories can be started from the early months. Visual and auditory stimulation and listening to mother talk helps the child to start talking early. The items used for play can be household articles also. Children love household articles as play material. "Cloth dolls" are popular with them.
The upbringing of a child is an enjoyable experience. Parents can become participants and provide a good environment for the child to grow, develop and acquire skills. Love, security and family support given in childhood provide the greatest foundation for good quality of life in adulthood.
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