Caring For a Baby
Instalment Three: Baby Health and Safety

Part Four
Not Being Rough With a Baby or Toddler, Either in Fun or When Disciplining Them

Not Playing With a Baby Too Boisterously

The book What to Expect the First Year says though a lot of babies love to be played with boisterously, for instance being thrown up and caught by a parent, it's a very risky thing to do for a child under 2 years old. A baby's body can be injured by forces that wouldn't affect an older child's body. Shaking a baby in anger, or throwing a baby in the air for fun, or vigorously bouncing them, for instance if jogging while carrying them in a baby carrier at the front or back, could cause a variety of types of injury. One is the kind of whiplash injury a person might get in a car crash when another car rams their car from behind and their neck jolts forward and back again very quickly. Because the baby's head's heavy compared to the rest of their body, and their neck muscles aren't well developed, their muscles don't support their head well. When the baby's shaken roughly, the head whipping back and forth can cause the brain to move and rebound again and again against the inside of the skull. Bruising of the brain can cause it to swell, bleed, and sometimes cause permanent brain damage that can lead to mental or physical disability.

Another kind of injury that could be suffered is damage to the baby's delicate eye. If the force causes detachment or scarring of the retina or damage to the optic nerve, lasting visual problems, even blindness, can result. The risk of damage can be made worse if a baby is crying or being held upside down during the shaking, because both of those things increase blood pressure in the head, making fragile blood vessels more likely to rupture.

Injuries like that are quite rare, but the damage can be so severe that the risk isn't worth taking.

Most injuries like that happen when a baby's shaken in anger; but they can occasionally happen when the baby's only being played with, so it's best to avoid the kind of rough play that vigorously shakes or jostles the baby's unsupported head or neck. It's also best to avoid jogging with the baby attached to us in a baby carrier or other activities that'll bounce them roughly. We could always run with them in a push chair if we really want to.

That doesn't mean treating them like delicate flowers all the time; more gentle rough stuff won't hurt them. For instance, a lot of babies love 'flying', that is, being smoothly glided through the air while we support them by holding their middle securely. And a lot of babies enjoy being chased when they're old enough to crawl.

There are some babies though, male and female, who don't like any kind of rough play. They have the right not to be played with roughly at all.

Anyone who's played with their baby roughly in the past doesn't need to worry unless their baby's showing signs that might be some kind of brain damage. Anyone worried can speak to their doctor. But injuries during playing don't happen all that often.

Part Five
Making Sure Toys are Safe

The book What to Expect the First Year says over 100 thousand injuries are caused a year because toys that were presumed to be safe weren't, often because they were given to a baby too young to play with them in the way they're supposed to be played with. The author gives several tips on buying safe toys:

• They need to be sturdy. Toys that could break or fall apart easily could injure a little child.
• It's important that the paint or other substance on the toy to make it look nice is non-toxic. Babies love putting things in their mouths.
• It's important the toy doesn't have sharp edges.
• It's best if toys are washable, because if they're not, they can become breeding places for bacteria.
• For a baby or small child, it's best if all the parts of a toy are quite big. Since babies put so many things in their mouths, a small toy, small removable parts or little bits that could be broken off, that are small enough to fit in a toilet paper tube, are small enough for a baby to accidentally swallow so they could choke on them.
• A toy needs to be light enough so if it's possible it could fall on the baby, it won't do them any harm.
• The noise level needs to be safe. Some toys are so loud they risk damaging the baby's hearing, such as loud guns. It's better to buy toys with musical or gentle sounds than ones with loud, sharp or noisy squeaky ones.
• It's also worth thinking about what lifestyle message a toy is sending a child, for instance whether certain behaviours are OK.

Kids like cute cuddly things, but it's important they're safe:

• Buttons aren't a good idea on a toy. It's best not to get teddy bears if their eyes or noses are buttons or if they have buttons elsewhere on them such as on any clothes, or similar little objects. A child could chew or pull them off or they might fall off, and the child could suck them and choke on them.
• It's best if they haven't got wires as part of the design, for instance attaching ears and so on. Even if they're covered in fabric, they could still be unsafe, since the fabric could be chewed off or wear away and the wire could break and scratch or cut the child.
• It's best not to get toys with strings or bows attached that are so long the baby could chew on them and swallow and gag on them. Worse, strings or cords that are over six inches long could be a strangulation risk. That goes for all toys, for instance some plastic toys might have cords to pull them along with. In fact, anything at all with a string attached should be kept out of the way of the baby. Toys can be attached to cots and playpens and other places with plastic links that are safe, and also brightly-coloured so the baby's likely to find them attractive.
• The seams should be checked both when the toy's bought and sometimes after that to make sure they're sewn tightly so stuffing isn't likely to come out, which the baby could put in its mouth and choke on.
• All stuffed animals should be washable and should be washed from time to time to stop bacteria building up on them.
• Stuffed animals shouldn't be put in a baby's cot, because if they end up in the wrong place the baby risks suffocating. Also the baby could chew on them unsupervised so if any bits come off like ears, the baby risks choking.

The guidelines on the packaging of toys about what age groups they're appropriate for take safety into account as well as how much skill it takes to play with them. So even if a baby seems advanced for their age, it still might not be a good idea to get them something for an older child. Besides, they might be able to play with it but not in the way it was intended to be played with; and by the time they get old enough to learn how to play with it easily, they might be bored of it, so they stop playing with it before they get all the enjoyment out of it they could. Still, some babies can enjoy toys meant for children a little bit older or younger.

Part Six
Keeping the Baby Safe as They Become More Active

As the baby becomes more active, they'll learn to climb over things and will want to do things they don't realise the dangers of. It'll be important to get a stair gate, for one thing. Even if a baby's good at climbing the stairs, they might start climbing, then hear something or want to look at something below and turn round to look, and fall down.

My sister was worried her baby would do that. She started really enjoying crawling up the stairs, and she knew she shouldn't, and would crawl up one or two and then look back at my sister with a cheeky grin on her face. When my sister got a gate, she was annoyed. She would shake it and call out with a noise that meant she wanted something done. Obviously she meant she wanted the gate removed. But my sister wasn't about to do that.

The book says a baby who's just learned to walk will often want to practice their skills a lot, and it's nice to let them so they get better at it. But it is important to keep a watch out for dangers they might get into, especially near roads and driveways.

Also, most babies love climbing over things. They might climb up a slide, for example. It's best to climb up behind them or be ready to catch them if they fall. Or they might climb onto and over chairs and things. They should always be supervised.

Babies of that age often love scribbling with crayons. It's best to give them those rather than pens or pencils, because waving the sharp points near their eyes could lead to a nasty injury.

When the baby learns to climb around the place, anything that could be hazardous to them, or anything valuable that they could damage, needs to be locked in something or put way out of their reach. The baby will develop clever ways of getting hold of things or getting them down from places, but it'll be quite some time before they develop the good judgment to think things through and decide beforehand whether doing what they want to do is really a good idea.

So we shouldn't leave the baby unsupervised if there's any risk whatsoever they'll harm themselves. More than that, the book recommends we go around the house thinking of all the things that might be a danger if the baby reached up to grab them or climbed up to get them, and we put them in a safer place, or guard them in some way. It says toddlers can be quite resourceful in getting what they want, piling up books to stand on to reach a shelf, pulling a chair across the room to stand on to reach a window, standing on a toy to reach a work surface in the kitchen, and so on. We should try to make sure any chair or shelf or table or anything else the baby might climb on is sturdy enough to hold their weight.

It says we should say no to them when they want to climb on something that might be hazardous, but we shouldn't expect a child that young to remember we said no the next day or even later that day. So if they do the same thing again, it won't be as if they know we don't want them to do it and are deliberately disobeying us; it'll be that they've forgotten we said no. At that age, they won't be able to think things through and work out why something's a bad thing to do. So we'll need to be patient with them.

Part Seven
Keeping the Baby Safe From Hazards When the Weather's Very Hot or Cold

Protecting the Baby From Over-Heating in Hot Weather

The book What to Expect the First Year says a lot of parents over-dress babies in hot weather, being scantily dressed themselves but keeping the baby in clothes they might have worn much earlier in the year. It says unless a parent's noticed they always feel warm when others are cool or feel the cold a lot more than others, what they feel like wearing themselves in the temperature should be a good guide as to what to dress the baby in, even if they're a very young baby.

It says if the baby's dressed too warmly, it can lead to a prickly heat rash, or in extreme cases, heatstroke. It says light-weight, loose-fitting, light-coloured clothes will be good to dress a baby in when the weather gets very hot. A light-weight cap made of a material that's likely to absorb sweat will protect the baby's head without over-heating it.

It says the material of all the baby's clothes should be absorbent so they'll soak up sweat, but when they get damp, it's best to change them, so it's best if we bring a change of clothes out with us.

It says a lot of babies do get a heat rash in the summer; they get little red spots on their face, neck, armpits and upper body. Cool baths can help, as long as very mild soaps are used, though it's best not to put any powder or lotion on the baby, since it might block the sweat glands so the bit of the baby's body with it on can't sweat to cool down. The rash will probably fade on its own after a week or so, but the book advises calling the doctor if increased swelling, redness or pustules develop, since they might mean the baby's picked up a yeast or bacterial infection.

There are things we need to be careful of when using baby slings. With some designs, the baby's head can slump down into fabric and they risk suffocating, so we ought to check them often and make sure we can see their face. But also, in hot weather, ones made of heavy-weight fabric can make the baby way too hot. They can be like nice protective wrapping in cold weather, but in hot weather, they can be like a thick extra layer that keeps the baby too hot, especially ones that cover the baby head to toe. Contributing to the heat can be the warmth from our own bodies, and if not much air is getting to them.

Indoors, the baby might like a fan on in the room if we do, but we should make sure it isn't blowing directly onto them in case they get too cold, and we shouldn't let the temperature in the room get below about 22°C. We should also make sure the equipment and especially electrical cords are out of the baby's reach.

It says on hot nights, it'll be allright if the baby just sleeps in a nappy, though if there's air conditioning in the room, they might need a bit of extra covering.

It says if the baby's got cool hands and feet, it isn't a sign they're a bit cold. We can get a more accurate idea of what temperature their body is as a whole by checking their forehead, neck and under their arms. If they're sweating, it means they're a bit too hot.

Heatstroke

The book says that in the first year of life, a baby's temperature regulation system hasn't developed fully, so it's more difficult for it to cool them down if they get too hot. So they're more vulnerable to over-heating than an adult would be. If the over-heating's serious, it can even lead to heatstroke. That could even be life-threatening. It usually comes on suddenly. Things to look out for include a very high body temperature, diarrhoea, agitation or listlessness, confusion, convulsions and loss of consciousness. Emergency help needs to be called immediately if the baby has symptoms like that. While we're waiting for it, sponging them down with cool water can help.

Naturally, preventing heatstroke is best. The book gives a list of things it's important to do:

• A baby or child should never be left alone in a parked vehicle in warm or hot weather. (They shouldn't be left alone in one in any other weather, for that matter.) It says even with the windows open, the temperature inside can rise quickly and dangerously for a baby. It can become much hotter in the car than it is outside, and babies can even die if they're left in such heat.
• It's important not to bundle up a baby with a high temperature in blankets or anything else. The idea of sweating a fever out might work with some people but it shouldn't be tried with a baby or young child. They'll need cooling down.
• The baby should be dressed lightly in hot weather, and parents should be cautious about letting them be in direct sunlight.
• Parents need to be cautious about carrying the baby in a baby carrier for long and ought to check the baby isn't over-heating.
• It's best to give the baby more fluids than usual in hot weather to make up for fluids lost through sweat.

Preventing Damage to the Baby's Skin From the Sun

It's enjoyable to be out in the sun, but there is the risk of skin cancer, that can appear years after the actual damage was done to the skin. The book What to Expect the First Year says being in the sun can also increase the risk of getting cataracts in years to come. It says tanned skin looks healthy, but the tanning happens when the skin is damaged and is really the skin's attempt to protect itself from more damage, though more damage can still be done by further sun exposure.

It says it was once crucial that people did get a fair amount of sunshine because that was the only thing they could get vitamin D from that strengthens bones. But now it's added to some dairy products and formula milk.

The book gives some tips on stopping the baby getting too much sun. It says that's important because babies are particularly vulnerable to sunburn because their skin's thinner. It says even a single instance of severe sunburn when very young can double the risk of the worst skin cancer when older, and the risk of less severe skin cancers is increased when children even just tan but don't burn. So it advises a few things:

• It's best to avoid exposing babies under six months old to strong sunlight, especially when it's at its strongest in the hours surrounding the middle of the day. A sunshade or parasol can be put on push chairs or prams to shield them.
• If we can't avoid exposing them to the sun, we should put a sun cream on their hands, face and body at least 15, but preferably 30 minutes before going out. We should put it on generously for older babies, but in smaller amounts for babies under six months old, while still limiting their exposure to direct sunlight. One thing we need to be careful of is that we don't get sun cream in their eyes or on their eyelids or in their mouth.
  That reminds me. I once put sun cream on near my eyes, which is useful to do because under my eyes is one place where I tend to get sunburned; but I must have got it too close to my eyes; I went in the sea, and got splashed by a wave, and it washed sun cream into my eyes, and it really stung for quite some time afterwards.

  The book says we should put fresh cream on the baby every few hours, and more often than that if they're playing in the water or if the baby's sweating a lot.

  We ought to carry some sun cream with us whenever we go out in warmer weather in case we need it unexpectedly.

• It might be that the baby can build up a bit of tolerance to the sun if we expose them to it gradually, at first for just a few minutes, then for a bit longer and a bit longer, perhaps two minutes or so extra every day, till they're being exposed to it for about 20 minutes.
• It's good if babies and children can wear light hats with brims to protect their eyes and face, and also shirts to protect their upper bodies, even in the water (the shirts that is). It's best if clothing's made of light-weight fabric that doesn't have holes in it as part of the design that the sun could get through. The book says two thin layers can sometimes be best, since the sun gets through some fabrics; but we'll need to be careful the baby doesn't over-heat.
• Sun can damage the eyes as well, so a young child who has a lot of sun exposure might do well to wear sunglasses that filter out harmful sun rays. They need to meet European safety standards, and it's best if they say they provide 100% protection against UV rays.
• It's safest if most outdoor activity in the sun is scheduled for early morning or late afternoon, so the baby's not exposed to the sun when it's at its strongest around midday.
  Wow, following this too closely would take all the fun out of the summer! Still, we can bear the tips in mind as guidelines.
• It says if the child's taking any medication, we'll need to check it isn't making them extra sensitive to sunlight before we expose them to the sun.
  Now I like that suggestion.
• It recommends we set a good example by using sun cream ourselves.

What to Look For When Choosing a Sun Screening Cream

Sun creams are labelled with a sun protection factor (SPF) number. Some only have very low ones, and some have high ones. I think the highest is about 50. The book recommends parents get sun creams for babies with at least a protection factor of 15, and about 30 to 45 for any with very fair or sensitive skin.

It says tanning products aren't worth using because they don't give any protection at all. I don't know what those are.

Apparently there are two types of ultraviolet sun rays that ought to be screened out, UVA and UVB, so we ought to look for sun creams that screen out both.

The book recommends we put a little bit of the sun cream we get on the baby's forearm a couple of days before we want to use it all over them, to check to see whether it irritates their skin or they're allergic to it, since some sun creams do contain chemicals that can irritate the skin. There are ones available specially made for children and babies or hypoallergenic ones. It might be worth buying one, especially if we've used another one on the baby and they've developed some kind of rash or their eyes have seemed irritated.

We ought to buy a waterproof sun cream if they're going in the water. Or we could get a water-resistant one. They last half as long as waterproof ones do. Waterproof ones do stop working after a while, so we'll need to put fresh cream on them every so often.

It says sunburn doesn't make the skin go red immediately, so skin could be getting sunburnt without us realising it. So it's best not to wait till redness appears before using sun cream.

I know someone who put some sun cream on her baby outdoors, but then the phone rang so she left him for a little while. When she came back, he'd covered himself in lots of sun cream.

Trying to Protect the Baby From Insect Bites and Stings

The book recommends we keep the baby out of places where there are likely to be a lot of bees such as fruit orchards, fields full of wild flowers or clover, or near bird baths. If we have a wasp's nest or bee's hive near us, it's best to get experts to remove it.

It suggests we all wear light-coloured clothing, not bright or dark colours or flowery clothes, and that we don't wear fragrant things.
I don't know how much difference that really makes, if any. Still, it might not be hard to do.

It says mosquitoes breed in water (they don't transmit nasty diseases outside the tropics, but some suck blood and people can get skin irritation after being bitten). It recommends that anyone who lives where there are lots of them drains anything near them outdoors that contains a bit of water, such as toys left in the garden, puddles, bird baths, gutters and other things. It can be best to keep the baby indoors at dusk when they swarm, and to have windows screened in some way. Even a mosquito net over the pram can be good, if those can be found. When a baby's over six months old, putting an insect repellent on them is OK, though it ought to be one specially formulated for children. But it's important to follow the manufacturer's directions, to use only sparingly, to not get it on the baby's face and hands, and to wash it off with soap and water when we get indoors. It's better to use a lotion than a spray, since we can get it exactly where we want, whereas with sprays, they could get where we don't want them, like the baby's eyes, and the baby could inhale the fumes.

If we see any ticks on the baby or on anything we're using, they should be removed when we spot them.

If we're going to an area where we know there are a lot of biting or stinging insects, it's best to wear clothes that'll cover us as much as possible, tucking trousers into socks.

Keeping the Baby Safe Indoors in Warm Weather

Toddlers especially love to look out of windows, and they'll often lean out some way, not realising the dangers. We can stop them falling out the window if we make sure not to open any window wide while they're around. The book recommends opening them no more than six inches, unless they're too high up for the baby to even climb up to. But we'll have to make sure the baby can't easily open them. It says there are such things as window guards and window stops. Window stops can be attached to the frame and will stop the window opening more than four inches. It doesn't say where to get them. Perhaps a hardware store. It says we need to make sure we can over-ride them and open the window if we have to though, in case we have to use it one day as an emergency exit.

It's important not to put furniture or anything else the toddler can climb up on under any window that can open enough for a baby to fall out of.

Doors can be left open in warm weather, but once a baby can crawl, they can quickly go out the door and get into hazards outside. So it's best to keep all doors, including sliding doors and screens, locked.

When outdoors with the baby, it's important we keep an eye on them all the time once they can crawl or toddle, and that we be especially watchful around swings or other playground equipment.

Yes, I can imagine if a baby walked too close to a swing, they could get a nasty kick by accident from someone swinging on it.

We need to make sure any play equipment in our own garden is at least six feet from any fence or wall, so a toddler couldn't bash into it if they fell off. Also, there needs to be a soft surface under it so they couldn't hurt themselves that much if they fell off, such as rubber, sand, wood chips or something similar.

Babies under a year old should be put only in swings that have such things as seatbelts and other straps, or in specially designed bucket-type swings for babies they can't fall out of.

It says it's important to feel metal slides first in hot weather if we're thinking of putting the baby on them, because the sun can heat them up so much they can even cause burns.

It's important not to put the baby down in long grass or undergrowth or anywhere where there might be poison ivy or where they might get a hand on or nibble other poisonous flowers, shrubs or trees. In wooded areas, the book recommends we make sure the baby's protected by being covered up. If they do come into contact with some poisonous plant, washing them with soap and water as soon as we can can be best.

If we go to a barbecue or have one, we'll need to protect the baby from getting burned. Grills should be kept out of reach of a baby's hands, and we need to make sure there aren't any chairs or anything else a baby can climb on and reach them. After all, babies can think things would be fun to touch or climb on or put in their mouths or reach for, being absolutely unaware of the dangers.

The book says tabletop grills should only be put on stable surfaces. It says hot coals can stay hot for a long time after they're used, so when they're finished with, they should be drenched in cold water to reduce the risk of burns, and then disposed of where the child can't get to them. It says we should never use grills in an enclosed space, both because of the risk of carbon dioxide poisoning and the risk of fire.

Giving extra fluid to the baby on hot days is good, though it's best if it's only in small amounts. Since a baby's stomach's only small, Giving too much could cause them to start spitting it up a lot. Once the baby's on solids, fruits with a lot of juice in them can help with fluid intake, such as bits of melon and peach. It's best not to give them drinks with a lot of sugar or added salt in them.

Taking the Baby Swimming

The book says a lot of parents think it'll be good to enrol their babies in swimming classes so they get to feel comfortable in water and so they get good at swimming from an early age. But it says safety experts say swimming for babies isn't a good idea. It says though it's easy to teach a toddler to float, especially since they float naturally since they have a higher proportion of body fat than adults, it's unlikely they could use the skill in a life-threatening situation. Also, swimming lessons for babies don't make them better swimmers in the long run than they would be if they started a few years later. In fact, it's not at all clear that children under three can benefit at all from swimming lessons. And there are possible health risks. If a baby's head keeps being put under the water, they can swallow a lot of water. That increases the risk of them swallowing germs along with it and taking in too much fluid. Water getting into the ears can cause problems as well.

That doesn't mean babies should be kept away from swimming pools. Introducing them to swimming pools gently can be good. But some safety tips need to be borne in mind:

• A baby should not be taken swimming before they master the skill of good head control, so they can hold their head up themselves and lift it up themselves if it flops down or if it were to go under the water. They usually learn to do that at around four or five months. Before then, their head could bob under the water accidentally.
• A baby with a chronic medical condition, including frequent ear infections, should be cleared by a doctor to go swimming before they're taken there. A baby who's got a cold or other illness, especially diarrhoea, shouldn't be taken swimming till they're completely better.
• It's important not to leave a baby unattended even for a small length of time near any kind of water, including baths, swimming pools, puddles and so on. There's even more of a risk if they like water, because they'll want to play in it more. Leaving them alone is risky even if they've got something on that helps them float like a rubber ring, or if they've had lessons in the water. The book says a baby can be drowned in less time than it takes to answer a phone and in only a couple of centimetres of water. So it says if we have to leave the water, even for a second, we should take the baby with us.
• It says all water activity with a baby or little child should be done with one-to-one supervision, and the adult with the child shouldn't be fearful of the water at all, because the child will pick up their fear and start being fearful too.
• Swimming instructors of young children should be qualified to teach young children, and qualified to do first aid, including resuscitation, on young children. We'll need to be wary of claims that sound too good to be true, such as if an instructor claims to be able to 'drown-proof' a child.
• If a baby's fearful of going in the water or doesn't like something about being in it, they shouldn't be forced to put up with it.
• Water a baby or little child plays in should be comfortably warm. So should the air temperature around the water. It's best not to play with them in the water for over half an hour in case they get cold. Also, to reduce the risk of infection, it's best if swimming pool water is chlorinated, and natural outdoor bodies of water should be unpolluted and certified as safe for family use by the local authority.
• Babies taken into the swimming pool while they're still in nappies should wear either waterproof pants that have snug elastic around the leg, or disposable nappies specially designed for use in the water. If the baby poos in their nappy, it's naturally best to take them out of the pool rather than relying on the chlorine in the water to kill any germs.
• We might think putting the baby on a lilo or float will keep them safe, but it wouldn't take a moment for them to fall off and go under the water. So they still need to be supervised at all times.
• Babies will reach for things, not realising the dangers. They could even launch themselves head-first into pools to try and get something they want. If there's a toy bobbing around in one in a garden or somewhere where we are, or anything else that a baby might possibly want to reach for, we should take it out, so it doesn't become a dangerous lure for the baby.
• A pool or any other water attraction with a missing drain cover shouldn't be used till it's mended. Otherwise, the force of the suction could actually seriously injure a baby or young child.
• Adults supervising children around a pool should be familiar with the way to resuscitate a baby or young child, preferably by having been on a course where they've learned about it and had practice. There ought to be life-saving equipment near the pool side. Ideally, a poster explaining how to resuscitate a baby should be on a wall near the pool, and a phone should be nearby for if emergency help needs to be called.

Keeping Food From Going Off on Hot Days

Little children and babies are more vulnerable to food poisoning than adults. Something that might cause a mild bout of diarrhoea in an adult could make a baby seriously ill. And bacteria multiplies much more quickly in warm temperatures. So we need to take special precautions with the baby's food. We ought to be careful all year round really. Food poisoning's quite common, but there are easy things we can do to significantly reduce the risks. That not only goes for food poisoning, but also for transmitting other germs. The book gives some advice:

• We need to always wash our hands with soap and water before feeding the baby. If we touch raw meat, raw fish or raw eggs during the feed, all of which can have a lot of bacteria living on them before they're cooked, we should wash our hands again. We should also wash our hands if we blow our nose or touch our mouth. Any open cut on the hands should be covered with a plaster before feeding the baby.
• We ought to store dry baby cereals and unopened baby food jars in a cool dry place away from extremes of temperature such as they might be subjected too if they were stored over the stove or in an unheated cellar.
• We should wipe the tops of baby food jars with a clean cloth or run them under the tap before opening to remove any dust.
• We need to make sure the button's down on safety lids before opening jars of baby food for the first time, and when we do, we need to listen for the 'pop' to make sure the seal was intact. We need to throw away or return to the shop any jar that has a raised button or that doesn't pop. If we use canned foods for an older child, or anyone for that matter, we ought to throw away cans that are swollen or leaky. Bacteria that might well cause us trouble might be in them. We also shouldn't eat or give anyone foods in a liquid that should be clear but has gone cloudy or milky.
• If we find a jar difficult to open, we should run warm water over the neck of it or pry the side of the lid open with a bottle opener until we hear a pop; we mustn't tap the top, because that'll risk splintering glass into the food.
• Whenever we use a can opener, we should make sure it's clean. We could wash it in the dishwasher. We should throw it away if it begins to get rusty or if we can't get it clean.
• We mustn't feed the baby directly out of a baby food jar unless it's the last meal in the jar, and we shouldn't save a bowl of food the baby's eaten from for the next meal, because enzymes and bacteria from the baby's saliva will begin 'digesting' the food, turning it watery and causing it to spoil more quickly.
• We should remove one serving of baby food at a time from the jar with a clean spoon; if the baby wants a second helping, we should use a fresh spoon to scoop it out. After all, we might have put the spoon down on a surface that's got germs on it.
• Especially in the summer, it's best to chill the food we take out so the bacteria don't multiply so fast. The book says there's such a thing as ice packs that can be bought that can be put around food, and recommends we get several and take them out with us to chill any milk or perishable food and baby food we're carrying. It'll be bound to get warmer. If it gets warm, except if it's unopened juice cartons or unopened jars of baby food, the book recommends we no longer use it. It suggests we could put juice in a thermos flask with added ice cubes, though we shouldn't do that with any kind of milk, since that shouldn't be diluted with melted ice.

Keeping the Baby Safe in Winter Weather

On the whole, we can use what we want to wear ourselves as a guide to how to dress the baby; but babies do need a bit of extra protection, since when they're under six months old, they can't shiver to generate heat like adults can. Even when the weather's slightly cool, it can be good to put a hat on them, since a fair bit of heat's lost via the head; and when the temperature gets near freezing, it should become a matter of routine to put a hat, mittens, warm socks and booties, and a scarf or neck warmer on the baby. When the wind's biting or temperatures are very low, a scarf or hat can be put around the baby's face. But we'll need to be careful it can't go over the baby's nose and stop them breathing, or that a scarf can't come undone and hasn't got a long bit trailing, so it can't get caught in a push chair wheel or playground equipment.

But even when bundled up warmly, a baby shouldn't be out in cold weather for a long time. Exposure to the cold for some time or without adequate clothing could cause a baby to get hypothermia, and they might need emergency medical treatment. In severely cold weather, exposed parts of them might even get frostbite. If that happens, and it can be a sign it's started if parts of them go totally white or yellowish-grey, besides seeking medical treatment as soon as possible, it's important to spend some time trying to warm them, for instance taking off wet clothes, wrapping them in blankets or other cloth, giving them warm soup or milk, and holding them close to us. It's not a good idea to put affected areas of the skin under hot water, since the temperature changing from one extreme to the other in an instant could be dangerous.

The book recommends that when we do take the baby out in the cold, we dress them in several light-weight layers of clothing rather than one or two thick ones, since it could keep the baby warmer, especially if one layer's wool.

It gives several other tips on keeping a baby comfortable in cold weather:

• It's best if the baby's just had a meal or snack when they go out; it gives the body more energy to cope with the cold.
• If any of the baby's clothes become wet, we should get indoors and change them immediately if at all possible.
• If the baby's walking, they should wear waterproof lined boots in wintry weather, roomy enough to allow air in, which will help to keep them warm once it's warmed up itself.
• If there's quite a dramatic temperature change between outside and the inside of the car or a bus, it can be good to take a layer of clothing off the baby inside to reduce the risk of them over-heating.
• In windy weather, the book recommends we use a mild moisturising cream or lotion on any of the baby's skin that's exposed to the air, to stop it chapping.
• If the baby's nose runs outdoors in the cold, it doesn't necessarily mean they've got a cold. Noses can just run in cold weather. Putting a mild moisturiser on the skin under their nose (not in it) can stop the skin getting so sore from getting wet and being rubbed dry.

In spring and autumn, it can be difficult to know what to dress the baby in, since it could be a lot colder or warmer than it was the day before, or the temperature could change a lot within hours, so what we dress them in could easily be too hot or cold.

Oh yes, someone told me once that she felt a bit guilty because she'd thought the weather was quite warm and told her children they'd be allright going off to school in shorts. But it turned out to be quite cold.

The book says putting several thin layers on the baby can be good, as they can be taken off or put on as the weather gets colder or warmer. A blanket can also be taken with us for the baby in case it gets quite chilly.

A good way of feeling the baby's body temperature to see if they're too cold or too hot is to touch their armpits or thighs; the book says touching their hands or feet won't tell us accurately, since they're usually cool in a little baby.

Indoors, we need to be careful about over-dressing baby for bed. If the room's warm and they're under thick bedclothes, they shouldn't need a lot of layers on as well. If we find they're sweating, we'll know to make them a bit cooler.

If the Baby Gets Dry Skin in the Winter

If we notice the baby's skin is dry, it could be something to do with the heating indoors drying the air out, and being in the dry air drying the baby's skin. We could see if making the air more humid does any good. Putting a bowl of water near the radiator might help; some of the water will evaporate and go into the atmosphere. Giving the baby a bit more fluid could help as well, since moisture inside the body could help make the skin a bit softer as well. Putting a mild moisturiser on the baby's skin, especially just after a bath, could help as well. We could ask the doctor to recommend one, or buy one labelled hypoallergenic. Also, we could reduce the amount of soap we use on the baby. Soap dries the skin. A little baby doesn't usually need to be washed with soap apart from in the nappy area once a day. When they start crawling, they might need some on the knees, feet and hands, but we won't need to put all that much on them.

It's best if we don't use bubble bath or make bubbles for the baby in the bath with liquid soap, because soapy water can dry the skin more than clear water. It'll be best if we use a gentle soap or moisturising skin cleanser; we can ask the doctor to recommend one.

If There's a Fireplace in the Home

Some families still enjoy using a coal or wood fire in the winter. But there are things to watch out for:

• The fire needs to be covered or enclosed by some kind of screen/fireguard that's too heavy for a child to move even if they try hard. The fire needs to be enclosed for hours after it's been put out, because embers can stay hot for hours. Parents who feel unable to protect the baby or young child from the fire because they haven't got a good enough barrier to shield babies from it shouldn't have the fire on. Finding some harmless way of teaching the baby the fire's hot and will hurt anyone who touches it will provide added protection, though young children can easily forget what they're told.
• Parents will need to make sure regularly that the flue's clear so toxic fumes don't invade the room and so there's no risk of a chimney fire.
• If the baby or anyone else in the house has a condition that often causes breathing difficulties such as asthma, parents will need to consult with a doctor about whether having a fire's wise before using one.

Hazards at Christmas

Christmas time can be exciting for a baby, with the house decorated with fancy things. But some of them can present new hazards, so we need to be careful.

• It's best not to have any mistletoe in the house, or to let a baby play near something like that when visiting others, since it's deadly if nibbled on. Since babies are so keen on putting things in their mouths, we need to keep them away from plants that could be poisonous.
• Holly's only a bit poisonous, but it's still best to keep it out of the baby's reach, especially since it's so prickly! We need to bear in mind that when the baby starts being able to move around themselves, they can soon start climbing on things. Holly might look nice to a baby, and they might want to climb up to touch it, not realising the dangers. So if it's going to be in the house at all, it needs to be seriously out of the baby's reach.
• As for the Christmas tree, it should be fresh and well-watered, since if it becomes dry, it could be a fire hazard. Artificial trees aren't problem-free either; we ought to choose one that's labelled 'fire-resistant'; and we shouldn't put Christmas lights on a metallic tree.
• We should never allow the baby to play unsupervised under a Christmas tree, since if they pull up on a branch, they could accidentally pull the Christmas tree down on them.
• It's important to sweep any pine needles up regularly, and to keep pine trees, wreaths and branches out of the reach of the baby/toddler wherever possible. The most important reason is that pine needles can cause a persistent croupy cough if they get stuck in the throat. Medical help should be sought if we think that might have happened.
• Some decorations and pretty things can cause a baby problems if they're broken and bits swallowed. We need to think about what might happen if the baby swallowed them when deciding where to put them. Some sprays used to decorate with artificial snow and so on could cause difficulties for anyone in the family who already has breathing difficulties.
• We need to be careful to put Christmas tree lights out of the reach of a baby or toddler. Young children can think they look nice to eat and bite them, and then they can cause internal cuts. We need to keep cords out of a baby's reach as well. We need to be especially careful with small blinking tree lights, which contain a chemical that can be dangerous if swallowed.
• If candles are used, we need to be very careful to keep them out of the reach of a climbing baby who wants to explore and will probably think they look fun to examine. We naturally need to keep them away from curtains or other things that might catch fire if they get knocked over somehow. They should never be left lit and unsupervised. We need to make sure they're thoroughly extinguished before we go out or go to bed for the night. If they're displayed in a window, we need to make sure curtains are securely tied back.
• Very small Christmas tree ornaments, tree lights or anything small enough to fit in a toilet paper tube, or anything with parts that small that could be broken or pulled off, are small enough to go right into a baby's mouth and cause choking. They shouldn't be used, or at least, should be kept well out of a curious baby's reach.
• Tinsel, plastic or glass ornaments can cause a choking hazard if bits are bitten off. Some could also cause internal bleeding if swallowed. So they need to be put high enough up so a baby wouldn't even attempt to get them to play with, no matter how fun it looks.
• We need to be careful that anything we put in the Christmas tree container won't damage the baby if they play with it or swallow any of it.
• When the presents are unwrapped, chances are that a baby won't just want to play with their own toys but will want to investigate the gifts of other family members. So anything that could possibly harm a baby in any way if they drop it, swallow bits, play with it and so on, should be put somewhere out of the baby's reach.
• We need to be careful the baby doesn't eat or drink something they shouldn't. The book says hundreds of young children are rushed to the emergency department of a hospital every year because they drink a martini, beer or some other alcoholic drink that's been carelessly left within reach of them. It says others choke on olives, nuts, cocktail sausages, hard sweets and other favourite adult nibbles. So it says we need to make sure the baby doesn't get hold of any enticing-looking but hazardous drinks or food. We shouldn't leave alcoholic drinks or food that could be a choking hazard for a baby or is otherwise inappropriate for them to eat unattended even for a short time on a coffee table or anywhere else where a baby old enough to move around themselves could reach it. We need to bear in mind that certain foods, such as fruitcake that's been doused with something alcoholic, popcorn, chocolate, nuts, and anything containing honey, are inappropriate for babies to eat no matter what time of year it is, so we should always be careful they can't get hold of them.
• Unfortunately, the doom and gloom doesn't stop there.
  The book says we even need to be careful about letting the baby get too close to the wrapping paper! It says festive ribbons, bows, figurines and even wrapping paper can be a choking hazard and even present a suffocation risk to a curious baby exploring under the Christmas tree. So it says we need to keep wrapped gifts and ripped-off wrapping out of the baby's reach.
• It says it's good to learn first aid and particularly resuscitation techniques, just in case despite all our precautions, something bad does happen to the baby.
• It says we naturally need to make sure the toys we buy for the baby are safe; toy manufacturers can't always be relied on to make sure they are themselves.

Talking about drinks being left within reach of a baby, I know hot drinks left within reach of them can do a lot of damage; I know my own hands were scalded badly when I was a baby when I put them in hot coffee. And I once heard about a baby who died after a teapot was left on a coffee table and she sucked the boiling hot spout, not realising it was hot and a serious hazard. I think she died because her throat swelled up so she couldn't breathe.

Part Eight
Preventing Cot Death

The risk that the average baby will die from cot death, or sudden infant death syndrome as it's often called, is very small. But there are things that can be done to make the risk smaller still.

The book What to Expect the First Year says the majority of cot deaths happen before the age of six months. It says it used to be thought that it happens in healthy babies for an unknown reason, but now it's thought that babies who suffer cot death only seem healthy, but have a problem that's not very noticeable but that makes it more likely.

Still, the risks can be reduced. It says if a parent smokes, the risk of their baby dying of cot death increases by three times. Premature or low birth weight babies are also at a higher risk. There are quite a few things we can do to reduce the risks. Other things that increase them include a baby sleeping on its tummy, sleeping on soft or loose bedding or with pillows or toys, exposure to tobacco smoke or being over-heated. It seems that most things that increase the risks are things that could be a suffocation risk, such as if a baby gets its face buried in a pillow or soft toy and hasn't learned to move its head or is too sound asleep to, or if smoking makes it more difficult for the baby to breathe.

The book says the number of cot deaths has gone down quite a lot since people became more aware of the risks and started doing things to reduce them.

It gives several tips:

• We could put the baby to sleep on their back. And we can tell anyone who cares for them any time and is likely to put them to bed, such as a baby-sitter, a day care worker, a relative or anyone else, to do the same.
• We can use a firm mattress and tightly fitting sheets for the cot. It's best to remove any loose bedding, pillows, fluffy quilts, sheep skins and soft toys from the cot. If we're using a blanket, it's best to make sure it's a thin one most of the time, and to tuck it in around the mattress, and make sure it reaches only the baby's chest level.
• We ought to make sure the baby doesn't get over-heated. They shouldn't be hot to the touch. Their room shouldn't be too warm. And we need to be careful about putting them to bed with a lot of clothes on or blankets. The book says over-heating increases the risk of breathing difficulties.
• It's best not to let anyone smoke in our home or near the baby.
• It says that breast-fed babies might have a lower risk of sudden infant death syndrome, especially those breast fed for longer than four months, though it isn't clear whether the risk is significantly lowered.

The book says wedges to stop the baby moving into a different sleeping position or things to stop them breathing the same air aren't recommended, as it isn't certain how safe they are, and they don't seem effective at stopping cot death.

It says baby monitors could be useful, but can often cause more worry than anything, because they can give false alarms. It suggests that worried parents could learn to resuscitate babies who've stopped breathing, and tell others who care for the baby how to as well.

Well I'll try to remember all that. I think I'll have to remind myself by re-reading some of it every so often!