Category / Uncategorized

by Dr Pallavi Bapat Pinge

Sleep Hygiene: Newborns, Infants and Parents

The ‘to be parents’ are very excited to start the journey of parenthood. They eagerly wait for the little angel to come in their lives and fill it with happiness. But, as they say ‘kuch paane ke liye kuch khona padta hai’, this happiness too comes at a cost! Yes, that’s true!! The parents’ lives are turned upside down when this little munchkin comes with no manual! And so for these new parents many challenges await. From feeding the baby to changing the diaper, to understanding the baby’s language – “crying”!! But one more untold and unforeseen confrontation faced by the new parents is to understand the baby’s sleep routine and to handle baby’s sleep schedule. However, while doing this, their own sleep schedules are affected badly. And unfortunately, no one has sensitized them over these issues until they themselves face these problems of sleep in newborns and infants. Hence, today in Parenting Matters, I, Dr. Pallavi Bapat Pinge, will be discussing sleep patterns in newborns and infants, its importance and the Do’s and Don’ts for maintaining sleep hygiene in infants and their parents.

Sleep is one of the fundamentals of general well-being of an individual. It is essential for our physical, mental and social well-being too. Sleep plays a very important role in the development of the neonates too. Not only their own sleep, but also their parent’s sleep has an impact on their well-being. If a parent has inadequate sleep and is fatigued while caring for the needs of the baby, the parent won’t be able to fulfil his/ her caregiving duties efficiently. There will be irritation, mood swings, loss of temper and so on. This shall have an impact on the baby’s well-being too.

Let’s first understand sleep physiology in neonates and infants :

Newborns (i.e. babies upto 28 days old; also called neonates) and infants (1 month of age to 12 months of age/until their first birthday) sleep for more hours than adults because sleep is important for the developing brain and body. Sleep is divided into sleep cycles where each sleep cycle has 2 distinct types of sleeps- NREM (non rapid eye movement) and REM (rapid eye movement) sleep.  The NREM sleep has 4 stages depending upon the depth of sleep and difficulty in arousal. The REM sleep is the stage in which we see dreams and it has a 55% share in the total sleep of an infant which reduces  to 20-25% by the time the child is 5 years old.

A newborn baby can sleep 16-18 hours a day, with around 8-9 hours in daytime and 8 hours at night.  However, the newborn’s sleep time is irregular, lasting mostly 2.5 – 4 hours and is synchronised with feeding time due to small stomach size.

Newborn’s sleeping time is divided into 3 parts – quiet sleep (similar to NREM ), active sleep (similar to REM) and indeterminate sleep. It is during the active sleep that babies smile, frown, twitch muscle and move arms and legs. Initially, a sleep cycle in neonate consists of equal proportions of active and quiet sleep and begins with the active sleep (i.e. REM sleep) and a single sleep cycle lasts for 50-60 mins. And each sleep duration of the neonate comprises of 1-2 sleep cycles only. This is the reason that newborns and few weeks’ old babies, wake up after every 2 hours approximately.

The sleep is governed by our circadian rhythm i.e. our body’s internal clock of day and night, which regulates our wakefulness and sleep duration. However, in neonates, this circadian rhythm is not fully developed i.e. their internal clocks are not synchronised with the external clock of 24 hours day and hence, these newborns can sleep during the day as well as night.  And it is for this reason that at least upto 3 months of age, babies don’t sleep through the night for 6-8 hours like us.  By around 6 months of age, the production of melatonin starts  which develops day night rhythms. Also, levels of cortisol – the stress hormone start showing day night variations which have an impact on baby’s alertness and hence infants by 3-6 months ‘start settling at night’  i.e. sleep more than 5 hours at a stretch. However, some babies may take longer to develop this settling in during night time sleep.This disrupted day-night sleep cycle may continue even upto 1 year in some babies.

Thus, by one year of age, sleep starts consolidating into one block. Also, as the baby grows, along with other developments, baby’s sleep requirement reduces as compared to neonatal period.  Infants sleep about 13 to 15 hours including night time sleep, morning naps and afternoon naps.

Now let’s focus on the do’s and don’ts for maintaining sleep hygiene in newborn and infants as well as parents.

  1. Do’s: Understanding hunger cues

Many parents consider that when the baby cries, baby is hungry. But, it isn’t like that. Every crying is not cry for feeding and also, every time the baby need not reach the stage of crying to indicate the need for feeding. In fact crying is a late sign of hunger. Offering milk to the baby, after the baby has started crying is too late and may actually make the baby upset and baby may become irritable and refuse to feed!  Hence, parents should be able to understand the early hunger cues of the baby. When baby awakens from sleep, baby is first in the quiet alert phase. Baby is very still, may look at objects, respond to sound and motion and then may progress to active alert phase where baby is attentive to sounds and sights and moves actively.  Here, the early signs of hunger are, moving slightly, turning head sideways, opening mouth and  rooting (i.e. baby tries to search for the breast by rooting his lips to nearby objects which come in contact of the baby’s cheeks/turning head from side to side  with an open mouth in search of the nipple). Then, baby will move on to mid cues of hunger which include stretching of body, increased bodily movements and  bringing hands to face, making sucking motions and noises with the mouth  or sucking on his fingers or putting fist in the mouth! However, if these cues are not noticed, the baby may progress from quiet alert phase to crying phase which is the late sign of hunger where there are erratic body movements, baby cries loudly and even face turns red.

Hence, understand the hunger cues.

2. Do’s: Know your baby’s favourite calming strategy/ know your baby’s sleeping cues.

When baby awakens slightly from sleep, it’s not necessary always to pick up the baby and calm him down. Sometimes, the bodily movements are just part of the baby’s active sleep and baby settles by self. However, if the baby is awake and crying and needs to be calmed down explore various strategies and find what suits your baby the best. Babies can be calmed down and made to sleep by cuddling, swaddling (its a technique of wrapping the baby using a cloth) , being held skin to skin (especially important in newborns and few weeks old babies), rocking, talking, listening to music or lullaby, stroking and so on! When babies are twice their birth weight i.e. around 6 months of age, their liver matures enough to supply glucose for the night and maintain blood sugar levels and hence, they may no longer need a night-time feeding. However, baby will still wake up for the sucking as the sucking becomes a stimulant for sleeping and helps the baby go into sleep. Hence, during these night time awakenings, baby only needs sucking as a stimulant to go back to sleep. So, breastfeeding or rather sucking becomes a routine for getting sleep.

3. Do’s: Tips to  help establish day night cycle in babies:

As mentioned previously, day night cycle doesn’t develop in babies until 3 months. However, to induce day night routine, light plays an important role. The natural light of day is followed by the darkness of the night. This natural cycle stimulates melatonin secretion in the brain and helps in stimulating the development of day and night cycle. However, in our current times, the kind of lifestyle we have in urban as well as rural areas, thanks to technology and electricity we are exposed to natural light till evening and artificial light till midnight and even beyond. This impairs the melatonin secretion. Hence, it is advisable for parents to simulate the changes of day and night at their homes by putting off the lights after 7 pm if baby is sleeping. Also, during the night time, when the baby awakens, do not put on bright lights. Use dim lights while feeding and caregiving of the baby and avoid over stimulating the baby as it can negatively affect the baby’s sleep.

4. Dos:  Ensure night time feedings for establishing sleep cycle of babies.

Many working mothers have to express breast milk and keep it for their babies , to ensure their baby’s feeding in their absence. However, when with the baby, ensure baby feeds directly on the breast. It is necessary for the mothers working or not working, to continue breast feeding even in the night time, because the breast milk in the night has special sleep inducing characteristics.  Breast milk contains tryptophan, an amino acid that is used by the body to manufacture melatonin- the sleep inducing hormone. Tryptophan levels rise and fall according to maternal circadian rhythms that means, the night time human milk is richer in tryptophan than in the morning, and hence when infants consume tryptophan before bedtime, they fall asleep faster.  Thus, breastfeeding helps newborn sleep patterns synchronize with the 24-hour day. The role of  tryptophan in altering baby’s sleep duration has been proved in various studies by feeding infants formula fortified with varying concentrations of tryptophan. And hence, night time feedings can help in establishing the 24 hour day night cycle of the baby.

5. Do’s : Methods of making an infant sleep

After the newborn period and first few months of life, it is advisable to place the babies in bed when sleepy but awake, so that baby learns to get on sleep on his or her own. This shall ensure that as the baby grows old, as a child the baby is not dependent on parents for going to sleep.  Swaddling, use of white noise machines, soothing music and a dark bedroom can all help baby stay asleep for longer periods.

6. Do’s: Role of infant massage.

As it is observed by many of us, when babies are given massage and bath, they sleep well. Similarly, even in night time, a baby massage can be soothing for the baby and help the baby sleep faster, longer and with less frequent awakenings. This massage also helps the baby develop more mature levels of melatonin secretion which is a sleep inducing hormone.

7. Do’s: Understanding your baby’s sleep pattern

After 3 months of age, baby’s sleep habits become more predictable and parents can expect a regular nap schedule. Maintaining a sleep diary can help you to understand your baby’s sleep pattern. By 4 months, most babies need three naps a day; one in the morning, afternoon and early evening. Between 6 and 12 months, your baby will probably go from having 3 naps a day to 2 longer naps, in the morning and afternoon. Every baby’s napping needs are different. Some nap for as little as 20 minutes at a time, while others sleep for 3 or more hours.

8. Do’s: Rest when the baby is sleeping

This is very important, especially when the baby is just few days old and mother and baby are trying to develop a bond, understand breast feeding and its nuances. As, previously mentioned, newborns don’t have day and night cycle, they sleep for short duration all the day and night, interspersed by awakenings for feeding mostly. If mother doesn’t take rest in the day time, then when she has to be awake at night for feeding the baby, she is likely to get tired thus making the whole process of caring and feeding the baby during night a bitter experience. And then mothers have sore backs in the mornings, they stress out and this ultimately affects negatively the mother’s milk output.

9. Do’s: Take help

In many households, it is the job of the mother to take care of the needs of the baby like changing diaper, changing clothes, bathing, feeding etc; whether its day or night, whether it’s a few weeks old baby or few months old. But, this overburdens the woman, especially in nuclear family settings, as she is already occupied with her household duties and doesn’t have much of a respite even in the post pregnancy period. However, if the spouse helps in these care giving activities from the beginning, the fathers get more time with their kid from the very beginning and they also become confidant about handling the small infant! After all parenting is teamwork and so duties ought to be divided! Fathers can take responsibilities of changing nappies, calming the baby and putting the baby to sleep after feeding, talking to the baby if baby is awake but the mother needs rest and so on!! The opportunities are numerous…the only thing needs to be done is offering a helping hand!

For single mothers or mothers who are at their maternal place,  they should ask for help from their other family members or friends to share some of the duties as and when possible. And this doesn’t make you a bad mother!! No one should try to overwork themselves just to ensure that they get the tag of ‘good mother’!! You can become a good mother, by taking care of your kid with the help of other family members too..!!

So, next time you feel like taking help, ask for it…that’s your right!!

10. Do’s: Handling your sleep debt

The frequent night time awakenings for feeding and care giving, hamper the much needed good night sleep for the mother. And if mother doesn’t have respite from household work in the day time, this inadequate sleep keeps on adding. This sleep debt can be dangerous for the mother as well as the baby. Sleep debt and sleep deprivation can lead to trouble concentrating, forgetfulness, mood swings, blurred vision, and alterations in appetite. Not only this, but if the sleep deprived state continues for long, that too in a lactating mother, it can have potential long term effects on health. Cumulative sleep deprivation for long can lead to damaging health consequences like obesity, diabetes, impaired glucose tolerance, cardiovascular disease, hypertension, anxiety, and depression.

Hence, ensuring 6-8 hours of sleep is a must, for which one of the solutions is taking rest in the daytime when the baby is sleeping. Power naps can be very beneficial in such times. Also, mothers can try methods other than sleep for rejuvenating self. Listen to favourite music, read a book, cook for the joy of cooking and not as a daily chore, or even work on a favourite hobby. It’s easier said than done. And finding time for self when you have a baby, its difficult, but then, here again, ask for help, here is a chance for your spouse and family to help. Also, prioritize healthy eating and physical activity in the form of some exercises, yoga etc. This will give you better energy during the day and promote better sleep at night. 20 minutes of ‘me time’ is all it takes to experience benefits like better mood and improved alertness. And this is very important because, your better mood and alertness can help you in taking better care of your baby.

11. Don’t: Never place the baby in prone position  i.e. on the tummy while sleeping.

This is especially important till 1 year of age because infants sleeping in prone position are likely to re breathe exhaled air or have oxygenation problems and decreased arousal. Also, in prone position, the pharynx is more collapsible and hence, there is risk of airway obstruction. Hence, Infants should be placed on their back to sleep when put in their bassinet or crib, until 12 months of age.

12. Don’ts: avoid over-stimulating your baby

As the parents should learn hunger cues, they also ought to learn the baby’s tiredness or sleepy cues!. Infants often have a more difficult time falling asleep when they are overtired because cortisol, a stress hormone, is released and works to fight fatigue. This can further interfere with falling asleep. Hence, look for your baby’s signs that she is getting tired: they may include rubbing her eyes, yawning, and getting fussy. Donot force feed the baby when sleepy. Similarly, at night time, when the baby awakens, donot over-stimulate the baby by actively talking to the baby, keep the lights dim, keep the voices hushing and let the mother feed or change the nappy, whatever is the need of the hour! Sometimes, baby just stirs during the night. Give the baby a few minutes to try and settle on his/her own, before approaching the baby.

13. Don’ts:Don’t put your baby to bed with a bottle of juice, milk, or formula.

This is for babies above 6 month of age, in whom weaning has started. Water can be given if needed. Anything other than water can cause baby bottle tooth decay. Avoid use of bottle. Instead either use wati/katori/bowl and spoon or use cup for feeding. Feed or nurse your baby, and then put him or her down to sleep.

14. Don’ts: Don’t start giving solids before about 6 months of age

Up to 6 months of age, exclusive breastfeeding is recommended because the baby’s gut is not mature enough to digest outside food and also, breast milk is the complete food upto this age. However, after 6 months, the nutrients supplied by human milk is not enough as the baby is now growing and also the baby’s gut is now ready to digest semisolid and solid food. However, in some households, parents and grandparents start semi solid and solid food after 4 months of age because of the myth that solid food will help the baby sleep through the night. However, it should be noted that if baby is given solids before his/her system can digest them, he or she may have tummy ache and that shall worsen the sleep.

Now, let’s see some myths which most parents as well as grandparents have regarding baby’s sleep.

  1. Myth: Newborn babies when  get up from sleep and cry, they cry for feeding

Reality: A newborn’s language of communication is crying! So, crying doesn’t always mean baby needs feeding. Baby can cry because of wet nappy or baby has passed stool, baby can cry because baby wants to be held in arms, baby can cry for need of swaddling, baby can cry when baby is swaddled and doesn’t want to be swaddled because of high temperature and so on!! These are the other reasons for crying and getting up from the sleep. Hence, every cry is not an indication for feeding. And mothers need to understand these cues. As the baby grows, within a couple of weeks mother starts understanding these different cues.

2. MYTH – Why sometimes babies cry excessively at night, as compared to day?

Reality: As previously mentioned, babies don’t have well developed day and night cycle. Hence, they can be awake as well as sleep during day as well as night. Similarly, they cry with same intensity during day or night. However, we as adults have our day night cycle tuned to 24 hour circadian rhythm! Hence, as the darkness falls, and night begins, our brain registers it and hence is sleepy! So, at 2 am, when the baby is crying just like in the morning, our sleepy mind takes this stimulus as an excessive cry and we feel that the baby cried excessively at night. Hence, next time, when your baby is crying at night, just relax and try to find the reasons of crying like hunger, need to be swaddled or rocked, need to change of nappy and so on!

3. MYTH- Why Baby gets up every 2 hours? Is the mother’s milk inadequate and is the baby’s stomach not full? This disturbs his sleep a lot.

Reality: As babies have only 1-2 sleep cycles in their single sleep duration, with each cycle being of 50-60 minutes and also because their sleep is coordinated with feeding, they are bound to get up even at night after every 2 hours. This doesn’t mean, that baby is missing out on his sleep or is getting inadequate sleep. As mentioned previously, the day night cycle is not developed until 3 months of age and in some babies even longer. So, your baby is bound to get up from sleep every 2-3 hours even at night and this doesn’t deprive the baby of sleep! So don’t worry, do not question your milk output and don’t worry about babies inadequate sleep.

4. Myth- Why does a breast fed baby get up frequently at night and why does a formula fed baby sleeps for longer hours? Is the breast milk inadequate for the baby?

Fact: Breast milk is easy to digest. Human milk is the perfect food for the baby, especially in first six months of life, as it contains all the vitamins, minerals and nutrients in right quantity and balance, nothing extra! This makes the milk easily digestible! Hence, after feeding, the stomach gets empty after about 2 hours and the baby is awake for feeding. Hence, the breast fed babies get up every 2 hours, even at night.

On the other hand, formula milk is synthetically prepared from cow milk and the nutrients absent in cow milk but required for the baby are added to the formula! Hence, it’s called ‘formula milk’ where the formula of human milk content is used to make a substitute using the cow milk!! Thus, the nutrient profile of formula milk is near to the human milk but doesn’t match it perfectly. That’s why it takes longer for the babies to digest formula milk and hence baby sleeps for longer time. However, it should be noted that breast fed babies as well as formula fed babies, even though have difference in night time sleeps, get equal amount of total sleep in 24 hours of a day i.e. 16-18 hours/day.

So, next time when you see your breast fed baby awakens every 2-3 hours, don’t worry, baby shall ensure his adequate share of sleep and won’t be deprived of sleep! Also, remember, breast milk is the best gift from a mother to the child, so don’t get tempted by the idea of feeding your baby formula milk at night just to ensure longer hours of sleep for the baby, when the baby is being breast fed all the day. Night time feeding on the breast during the newborn period and few weeks beyond that is very important for maintaining the milk output. Hence, night time feeding is essential and hence, your baby’s night time awakenings are essential!

5. MYTH: Using Diapers at night time helps to ensure that baby’s sleep is not disturbed.

Reality: Many parents are worried that if they use cloth nappies in the night time, the baby may remain in wet nappy for long or baby’s sleep may be disturbed because of frequent urination and wetting of the nappies. However, use of diaper might allay parents’ worry regarding disturbed baby’s sleep, but it exposes the baby to the risk of diaper rash, allergy to the diapers and also  an increased risk of infection. The disposable diapers absorb the urine and so baby doesn’t feel wet, but humidity persists in there and this can be a good place for growth of bacteria, thus increasing the risk of skin infections  as well as urinary tract infections  as the bacteria may enter the urethra and the urinary tract of the babies. Hence, use of diapers for babies is not advisable, whether day time or night time. Use cloth nappies.

So, after  reading all this, sleep hygiene and caregiving of neonates and infants may seem frightening for the new parents and the-would be parents, but do not panic, all you have to do is just follow the do’s and don’ts as mentioned in this blog and get your myths regarding your baby’s sleep busted and have a good sleep for yourself and the baby too!

Do like, share our blog and give your feedback in comments section. The blog is also available as a podcast on KUKU FM. The link for the podcast is https://applinks.kukufm.com/88dJcHHYdntDFwzSA

(The author is a Developmental and Behavioural Paediatrician and deals with issues of children’s development and behaviours. The author can be contacted through mail on drpallavi.paeds@gmail.com )

(Illustrations designed by freepik.com)

by Dr Pallavi Bapat Pinge

Engaging children(3-6year olds) |Times of Lockdown

Have you ever been to a garden? Of course, what kind of question is this? Then have you noticed the children over there. There are children of all age groups; from 0 to teens!! Some infants are in their mother’s lap , some are  in a pram with their granny, and enjoying the show peacefully; some teens are busy quarrelling over cheating in a match, some 8-9 year olds are inquisitively looking at a snail or caterpillar in the bushes and planning some prank or so!!. But the happiest souls exploring the place like a free bird are 3-6 year olds!! They are the ones who are carefree, exploring the world and people around them without any prejudice!! They want to explore everything, the swings, the slide, the soil, the way a football goes up after a kick, and so on!! Nothing like a 4 year old ready to be friends with a stranger/another kid! But, these kids are still dependent on their parents. From the corner of their eye, they keep a watch whether their mom is looking for them or not! If someone offers them a food item or something, the child looks for an affirmation from his/her parents before accepting the offered item!

Thus they are not yet completely independent individuals, but are also not as dependent on their parents as an infant or a toddler. They are exploring, they are learning and they are growing up! And now, all because of the CORONA pandemic, these young explorers are trapped at home because of the LOCKDOWN. They are not able to go OUT and explore objects, people and behaviours!  No play school, no pre-school, no crèche and no gardens! Just think about a researcher whose research has been put to a halt because of lack of funds!!! Exactly, that’s the feeling your child has right now! But no worries, we are here at Parenting Matters- in times of lockdown to help you engage your 3-6 year olds at home, and create an equally stimulating environment in space limitations!

Early childhood i.e. 3 to 6 year olds is a period of child development where they develop more refined motor skills, become more self controlled and self sufficient. Their make believe play blossoms. They start relating their experiences like travelling in a train, going to a fun fair etc in their imaginative play. You find a 4 year old getting ready for office or preparing tea for the dolls in his/her play. Their thought and language expands at an astounding pace; they start using difficult words, phrases and can even tell short stories., a sense of morality starts developing , they start understanding terms like ‘good’ or ‘bad’ and initiate friendships!!

  These children form the 3rd stage of Erikson’s Psychosocial stage where children are learning to take initiative, explore and if parent’s support this sense of purpose of their child, a sense of ambition and responsibility develops. However, if too much self control is demanded at this age by the parents may lead the child to excessive guilt, thus affecting the self esteem of the child. This age group represents the Pre operational stage of Cognitive development as theorized by Piaget. And Make believe play forms the most important part of their development in all domains- motor, language, cognitive and social too! It is this make believe play  which strengthens the memory , sustained attention and logical reasoning. It highlights the imagination and creativity of the child. Imaginative play creates an opportunity for the child to understand emotions and reflect on one’s own thinking. Child starts taking another’s perspective too.

They say children are born creative, but 98% cease to be creative as they become adults! And Hence, we the 98% not creative adults find it difficult to engage these young explorers and creative minds!!!

So while dealing with this age group I would like to focus on two major areas-

First, activities for the children and                                                                                             

Second, general guidelines for parents while handling them.

Following are the ways in which you can engage your children (3-6 years) at home during these times of lockdown and beyond.

  1. PLAY– Have you ever wondered why the schools of 3-6 year olds are called PLAY schools? What does the term “Kindergarten” mean? It means children’s garden!! And what to do children do in gardens? Play. Exactly, this is the reason these schools are called play schools. Because PLAY is the single most important occupation of children. Play is the work of childhood.  Albert Einstein has rightly said “Play is the highest form of research.” It is through play that children are learning, experimenting, creating and thinking!

While playing with your child, provide your child with realistic materials like toy car, dolls, cooking utensils etc and also provide materials with no clear function like blocks, blank papers, sand etc. The combination of these shall bring out the creativity in your child’s play.

Gross Motor Activities:

  • You can engage your child in hopping, jumping, wheelbarrow walks, skipping, animal walks,(crab walk, elephant walk, frog jump etc) alphabet yoga and animal poses (cat, frog, rabbit etc).
  • Activities involving   a series of action commands, obstacle courses spanning all the rooms of the house, balloon toss using both hands fists, alphabet bull’s eye and so on promote gross motor skills.
  • Atleast 30 minutes to 1 hour of physical activity per day is a must.

Fine Motor Activities:

  • Activities like opening bottles, squeezing, punching holes, lacing, beading, finding buttons in clay dough or Atta dough, putting coins in piggy bank etc can help in refining the fine motor skills of the child.
  •  They help in developing hand grip, handedness, hand coordination and hand and finger strength.
  • Here I would like to mention, donot force a left handed child to right handedness. It’s going to do no good to the child. And being left handed is absolutely fine!! Many geniuses and creative people have been left handed.

Art and Craft:

  • Involve the child in some art activities like craft, origami, etc Start with as simple as a boat, dog, house out of colored papers.
  • You can make a collage using bits of newspaper. For example, draw a large mango on an A4 paper, and then find yellow color on the newspaper, tear those bits, and stick them.
  • Use different types of stickers and help your child decorate his/her name.
  •  Let your child scribble, draw, color different objects. Let the child go by his imagination and creativity. Donot try to limit the child by making him follow the conventions like blue sky, green plants etc. If your child wants a PINK SKY…so be it!!!

Activities promoting Pre writing and early literacy skills

These children are   learning to write, learning alphabets, numbers, colors, shapes etc.

  • Paper pencil activities like mazes, find the difference, join the dots, find the odd man out, alphabet search, number search are very useful.
  • For these, many online worksheets are available. Also, magazines like Magic Pot, Read and Color, Chiku Piku also have similar activities!
  • At home, during daily activities like arranging utensils in kitchen rack, putting clothes for laundry etc you can practice counting, identifying colors, and shapes with your kiddo.
  • Use finger paints, crayons, sand, Atta to help your child trace alphabets and numbers and thus learn and enjoy in messy play!

Activities to promote Cognitive skills:

  • Teach the child concepts like big and small, more and less using toys, food items and other objects.
  • Give sorting activities.
  • Play dumb charades with your child to teach him about various emotions, actions, weather conditions, adjectives etc.
  • Create riddles and play guess who, make a treasure hunt for your child using clues like- red objects or round objects etc.
  • Blind fold your child and let the child identify objects given in his/her hand or ask him/her to identify the sounds of animals, objects that you make (Soundscape).
  • Play games like copy me and Simon Says-these stimulate imitation, attention and right and left differentiation also.
  • Jigsaw puzzles are big cognitive exercise. If you don’t have jigsaw puzzles, you can make one at home. Select a picture of animal, cartoon etc, paste it on a card board, cut it into 4 pieces and the puzzle is ready. You can gradually increase the difficulty level by increasing the number of pieces as the child starts enjoying it. Or you can even use the front side of a Cornflakes box or Choco’s box and divide it into pieces to make a puzzle.
  • Board games like snakes and ladders; ludo, carom, Jenga etc help in understanding rules and turn taking.
  • Memory games, Ring toss also can engage and stimulate the creative minds!

2. Reading Time and Story time : This lockdown period can turn out to be a great opportunity for you to develop the habit of reading in your child. It promotes child and parent bonding where you can open the whole world of possibilities for your child.  Joseph Addison has rightly said “Reading is to the mind what exercise is to the body”. And hence a child who reads will be an adult who thinks! Daily reading for 10-15 minutes can add up to exposure to more than 1 million words in a year. Reading daily with the child can enhance General Knowledge, vocabulary, reading comprehension, verbal fluency and spellings! Children’s books actually contain 50% more rare words than prime time television. So we have to make the wise choice. Even if you are not yourself into reading regularly, start with your kid now! It’s never too late !!

 Story time is actually a part of reading time but it can be made more interesting by asking questions about the story during and after the story; Creating situations and asking the child what he/she would have done; bring a twist by asking the child to ring the bell as the names of the characters appear in the story or  just  weave a story with your child line after line!

3.  Self help skills or Activities of daily living– This is the age to learn toilet training, to undress and dress up, eating by self, brushing teeth, tying shoe laces and so on.  These are called self help skills Give opportunity to your child to do these activities even though you feel the kid won’t be able to do them properly. In our Indian culture, parents have an inclination of doing things for their child out of love and affection, but then that child doesn’t develop these essential self help skills by 6 years of age and hence in later ages is still dependent.  So you can use this lockdown period to focus on any one self help skill and help and motivate the child in doing that. Use rewards like stars to reinforce the desired behaviour.

4. Social stories: As we are practising social distancing, the opportunities for socialization are minimum for these children. And since this is the age when children socialize, make friends, learn social skills, they are indeed missing out! So, as parents you can make social stories with your child, where you can take scenarios like, visiting a friend’s place, going to the doctor, going for a haircut,  going to the movies, what to do when  hurt, etc. Then using colors, papers and framing some single line sentences, a story book can be made. This can be useful in making the child understand various situations, the social skill needed, the kind of behaviour expected in the scenarios. So even though in lockdown, you can help your children develop social skills.  

These stories later on can be used just prior to the situation also, thus helping the child reduce the anxiety of unknown , because most of the times when we take our child out, we donot convey where we are going and what is expected of him/her over there; and then suddenly we find the child being anxious or misbehaving in the social scenario.

So in this way, you can do variety of activities with your child at home, all you have to do is use some creativity and imagination!

  Now let’s focus on some general guidelines for parents while handling their children.

  1. Catch your child being good. We as parents take our child’s good behaviour for granted and hence do not acknowledge. But praising the child and acknowledging good behaviours can reinforce the behaviour and also increase the child’s self esteem.
  2. Be consistent. Both parents as well as the grandparents (if staying together) should be on same page regarding child’s behaviour. If child gets different responses for same behaviour from the mother or father or grandparents, kid is smart enough to manipulate and get things done as per his/her will.
  3. Keep promises. If promised a reward for a good behaviour, ensure that you give that reward. Hence, rewards which are doable should only be promised. Rewards like pat on the back, praise, stickers, stars, small toys, play time with parents etc are advisable.  Similarly, if any punishment or denial of privileges was promised for not obeying or for misbehaviour, it should be executed. However, any type of physical punishment is not recommended.
  4. Provide good models/lead by example. Children are very observant. They pick up habits of parents without being taught to. Hence, if you wish to develop a habit, ensure that you lead it by setting an example. Some good models of values like kindness, honesty, cleanliness can be taught in real life settings as well as through story books.
  5. Label the act not the child.If child misbehaves, donot label the child as bad boy or bad girl, rather label the act done by the child as bad. This is very important to develop self esteem of the child. Also, explain why the act is bad or wrong and what was expected from the child.
  6. Give responsibility to the child. Simple tasks of bringing a water bottle from the kitchen, to taking help of your child in caregiving of the younger sibling can boost up the self esteem.
  7. Give positive directions and clear commands to your child. Limit setting is a must. There should be a balance between child listening to your commands and you fulfilling child’s demands. Too much of permissiveness will lead to temper tantrums and behavioural issues. Too much of control can decrease the confidence of the child and even sow the seeds of shame and guilt.
  8.  Quality time or Child Directed time: This is that time of the day, where you do not tell your child what to do, but rather your child chooses what to do and you be just a part of the activity without being judgemental, without giving instructions to the child. Spend 10-15 minutes of a day with the child this way, and you shall notice your child’s independent thinking, creativity and interests. This is a chance to build up that bond and confidence between you two, so that your child knows when in need you will be there without judgement.
  9. Screen time– As per American Academy of Paediatrics, for children 2-5 year old, not more than 60 minutes of adult directed screen time is recommended. That means, the parent should be actively involved while viewing on screen, and should involve the child in interaction while watching. Parents should themselves choose the content and shouldn’t allow passive and independent watching of videos, songs and games! Studies have shown that excessive screen time  can lead to delay in language acquisition and usage, delay in motor skills due decreased opportunity  of physical activity, decreased imagination and creativity, lower parental involvement, hyperactivity, aggression, reduced sleep,  poor sleep quality , unhealthy eating habits, obesity and poor social skills. Hence, limit screen time exposure, provide good models by decreasing your own use of screens, follow no screen in bedroom, no screen during meals and no screen 1 hour prior to sleep.
  10. Sleep Hygiene– Holidays affect the sleeping habits of kids badly.  No set bedtime, late morning awakenings, screen exposure before sleep all these affect the behaviour and activity of the child during the day. Hence, even though holidays are there, set bedtime has to be a rule, child’s bedroom should be quiet and dark ,follow bedtime routines like brushing teeth, bath ,reading story etc. Physical activity during the day helps in having a good sleep at night. Avoid caffeine (which is present in colas, chocolates etc) in the evening, as it can delay sleep.

So to sum up, in these times of lockdown, the magic 8 ways of engaging the 3-6 year olds at home are

  1. Use activities that promote motor skills, pre writing and early literacy skills and cognitive skills of the child.
  2. Take the help of art and craft.
  3. Include story time and reading time in daily schedule.
  4. Focus on self help skills and build it up.
  5. Introduce Social stories.
  6. Spend quality time or Child Directed time daily for atleast 15-20 minutes.
  7. Screen time not more than one hour per day.
  8. Maintain sleep hygiene.

I hope that the information shared in this blog shall be useful to the parents looking out for solutions while dealing with their children in the age group of 3-6 years. You can also listen to this information on podcast at KUKU Fm. The link for the podcast is http://applinks.kukufm.com/bvC5frCvZCMxV95m6 We will be coming soon with our part 3 of Parenting Matters-In times of Lockdown!

 Do share, like and give your feedback and suggestions in comments section.

by Dr Pallavi Bapat Pinge

The Journey Begins

And so here, we embark on a journey which I had intended to start quite a long time ago. However, something or the other always came up or I couldn’t find the right topic to start with and I can go on telling a number of excuses like these. But this CORONA or COVID19 pandemic or the LOCKDOWN, led to THE GREAT REALISATION that we as humankind are expecting from this. And it made me finally get into action mode, and then writing mode too. When one of my friends discussed with me the issues which parents are facing in these difficult times, I realised that this is it – a problem for parents in which I could help them dealing with it, to some extent. And so, ‘PARENTING MATTERS’ became reality.

So, PARENTING MATTERS is a blog on parenting, where in you can find information on various topics related to parenting, children, families and so on! It is a blog started by me , Dr. Pallavi Bapat Pinge- a Developmental Pediatrician. I deal with the development of children , their behavioural issues and parent-child relationship!

In this journey , I shall need your help at every step, for these blogs are for you all, parents and families!! So, do give your feedback, suggestions and even queries in comments section. Do like the blogs and follow to get updates of new blogs on this site.