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TEN COMMANDMENTS For Parents to Have a Happy and Smart Baby

1. Thou shall provide a home filled with love and joy.
2. Thou shall respond promptly to the needs of your baby.
3. Thou shall talk, count, and do baby signs as often as possible.
4. Thou shall be enthusiastic, energetic, and happy when talking, counting, playing, and stimulating your baby.
5. Thou shall read to your baby as often in the day as possible.
6. Thou shall read the cues and temperament of your baby; thou shall stop reading or stimulating your baby at the first sign of tiredness or boredom.
7. Thou shall not let your baby watch Television, VCR, or computers until she is 3 years old.
8. Thou shall not shout, fight, or be angry when your baby is within sight or hearing distance.
9. Thou shall provide your baby with adequate books and toys for brain stimulation.
10. Thou shall maintain a stable and intact family.

Most of the commandments focus on what to do for the baby, like providing lots of stimulation, which will be discussed later. For now, I'd like to stress the commandments that address the fact that babies closely observe and pattern their behavior after their parents and primary caregivers.

"Thou shall not shout, fight, or be angry when your baby is within sight or hearing distance."

A baby learns everything from the world around him. He copies or imitates the words, body language, attitudes, and decision making of everyone he comes in contact with. This is why it is important that parents and primary caregivers should strive to be cheerful, enthusiastic, and animated all the time, especially in the presence of the baby. Children grow up happy and smart when they are constantly exposed to positive words, language, and attitudes.

"Thou shall maintain a stable and intact family."

This is a tall order, especially nowadays that the divorce rate is close to 50%. But if parents can avoid marital discord until the children are at least 18 years old, then that is the best gift they can give their children.

Only a few families can strictly follow the 7th commandment about TV and technology. Too much TV is responsible for many children failing at school as well as behavioral problems. It can even cause physical problems: obesity, vision, and seizures-like behaviors.

And finally, requiring no further explanation, the first and most important of all the commandments for nurturing a smart and happy child is: "Thou shall provide a home filled with love and joy."

Picture of Fetus

FETAL  PTSD

About six years ago, a couple from Manila visited Maine. Both of them were physicians. She is an anesthesiologist, he, a surgeon. They were in the USA to take a test to become a nurse. Yes, a nurse!

I asked them why they want to migrate to the USA. They said they have a son with Autism.

During that time I was studying the causes of Autism. So I asked the anesthesiologist about her pregnancy. I particularly asked about stress.

She told me that her pregnancy was stressful. Many complicated patients were assigned to her, being the youngest in the group. While telling me about her pregnancy, she became teary. Maybe she realized that her stress was the reason for having an Autistic son from my explanation.

A principal from Searsport, Maine brought her one year old son to me for consultation because of developmental delay. He did not respond to his name when called. He did not look at my eyes when I talked to him. At six months old he was diagnosed to be blind. He did not make any sound like ma, da, or bye at one year old. I told the parents that their son has possible Autism. At three years old he still could not talk in sentences and he does not look at the parents when talked to.

I took the pregnancy history. The mother had severe job related stress. Fish was not part of her diet.

Robert, a seven-year old boy has severe autism. The mother, during her pregnancy was physically and emotionally abused by her husband. To escape the situation, one day, at around 4:00 am, when she was pregnant, she moved out of the house in a winter day by walking about three hours to her mother's house a couple of miles to the city center.
From an informal survey in my practice, eight out of ten children with Autism, Asperger, or ADHD had a mother whose pregnancy was stressful. Most of them did not eat fish during pregnancy. Many were drinking community fluorinated water.

Maybe we will never know the definite cause of Autism because it is extremely difficult to directly study the brain of a fetus or infant. However, it is easier to do internet research on fetal and infant brain and find out the factors that can cause damage.

Animal studies, as well as some epidemiological human research have shown that gestational stress affects fetal brain negatively.

Rats and primates when exposed to unscheduled loud noises during gestation have offspring who can't negotiate mazes. This same offspring clings more often to his parent compared to the offspring whose mother was not stressed.

About twelve years ago Quebec, Canada experienced a natural disaster, Ice Storm. Several communities in Quebec had power failure for a week or more. This event gave medical researchers a good opportunity to study the effects of stress during pregnancy. They studied two groups – the experimental group was pregnant mothers who were in areas without electric power. The control group was pregnant mothers in communities with lights and water supply.

The researchers followed up these children up to five years and older. They found out that children whose mothers were in the Ice Storm areas had delay in language development as well cognitive difficulties. While children whose mother had electric power supply during pregnancy had mostly typical children.

The Quebec researchers found out also that the severity of the stress during pregnancy was directly related with the severity of the language delay and cognitive problems. The more stress during pregnancy, the more brain problems.

There is scientific reason that can explain the effect of stress during pregnancy. Studies in both animals and humans showed that when the mother is stressed during pregnancy, her cortisol, the stress hormone goes up in her blood. Cortisol then goes through the placenta, then to the fetal circulation. When stress occurs during the 15th week of gestation, more corticotrophin releasing hormone (CRH) in the placenta is produced 31 weeks later. Both cortisol and CRH have damaging effect on the fetal brain.

In a study of 158 women and their newborn between 1997 to 2003, Ellman et al. found that when stress hormone is high at 15 and 19 weeks of gestation, there is a decrease in physical and neuromuscular maturation of male newborns.

In animal studies an elevated maternal cortisol leads to hippocampal, memory center, cell deaths and reduced cell proliferation. This is associated with deficits in learning and memory, long lasting delays in neuro-motor development, and distractibility in children.

The brain is the largest functional organ during fetal development which is exposed to circulating blood with elevated stress hormone for a prolonged duration. With this huge exposure to increased level of cortisol, I think this is equivalent to Post Traumatic Stress Disorder in adult occurring in the fetal brain and leading to the signs and symptoms of autism, ADHD, and other chronic mental problems in children. We now have Fetal PTSD, the counter part of adult PTSD.

ENVIRONMENT CAN CHANGE BRAIN

ENVIRONMENT  CAN  CHANGE  BRAIN  STRUCTURE

In the seminal study done at Harvard by Dr. Als and her group in 2004 they were able to prove that the environment of a newborn can actually change the anatomical and functional structure of an infant's brain.

Dr. Als and her group studied 31 premature babies. Sixteen of them were in the experimental group. These newborns were handled with more care and stimulation with less isolation. The control group, 15 of them, was taken care of using the standard of care of the time with lesser stimulation and handling.

At two weeks old both groups had functional MRI and EEG -- brain wave. Both tests were repeated at nine months old.

The researchers found that a particular part of brain of the experimental group were larger and functionally more mature compared to the same part of the control group of premature babies.

With this study, for the first time in the history of medicine, researchers were able to prove that the environment can actually change the anatomical size and function of the brain of an infant.

Since the early 1980s, Dr. Vincent Felitti of the Kaiser Permante at San Diego, California studied more than 17,000 patients. His research group found that adverse childhood experiences -- ACE -- is the common denominator among adults with depression, drug addiction, suicide, obesity, smoking, and hypertension.

When young children are exposed to parents who are frequently and chronically shouting and nagging at each other, fighting and physically hurting their partner, or alcoholism, their children are high risk for failure in school, depression, suicide, and other behavioral problems later in life.

I have talked to you about the effect of stress during pregnancy and adverse childhood experience, ACE, and its devastating consequences in children and adults. Now let us talk about PEACE – Positive Environment Around Children Everyday.

To nurture more children who are happier and smarter we should expose them to PEACE from the fetal period to at least five years old. We should pretend that all newborns have the potential to develop Autism, Aspergers, ADHD, language delay, or other chronic mental disorders. I think we can reduce its signs and symptoms by starting a face-to-face, eye-to-eye contact with smiling and happy parents or grandparents from newborn. This will be the earliest intervention for mitigating and maybe preventing the signs of Autism and other developmental brain difficulties. Several studies have shown that when an autistic child is diagnosed as early as possible, the outcome is better and at times, he becomes a self-supporting adult.

Now you will ask me how to do it. Nurturing happier and smarter children should start before pregnancy. As soon a couple decides to have children, they should stop smoking or alcohol at least four months before pregnancy. They should be as healthy as possible, their weight and blood pressure should be ideal for their age.

Once a woman is pregnant, she should visit and follow the recommendations of her obstetrician especially taking multiple vitamins with folic acid, DHA, and iodine.

She should avoid or reduce stress by doing relaxation technique like yoga, tai-chi, or meditation. Arguments with their partners or in-laws should be reduced or avoided. Job-related stress should be prevented or minimized. Watching sad or violent TV or Movies should be avoided.

Once the baby is born, after the nurses have cleaned the meconium from the baby's face and body, the mother, father, or grandparents should hold their him, make an eye contact and talk to the him from about ten inches from the face.

When talking to an infant, parents should talk deliberately in short sentences. Their period is a smile. Smiling and being enthusiastic every time a parent talks with the baby is the secret in stimulating the amygdala, the emotional center of the brain.

When the amygdala receives happy messages, it stimulates the hippocampus, the memory center or hard drive of the brain. A happy hippocampus promotes sharper and better memory which is the foundation of improved cognitive ability because the hippocampus is linked to the CEO of the brain, the pre-frontal cortex.

The amygdala, hippocampus, and the pre-frontal cortex are the cognitive czar of the brain. When brain centers are exposed everyday to happy, smiling, enthusiastic people and bright, calm environment, children will have a higher chance of success in school and reduce risk for developing depression, hyperactivity, and other behavioral problems. There is also a good possibility that the signs of autism and other chronic mental disabilities can be mitigated if PEACE is applied to all infants from birth.

COMMUNITING WITH A NEWBORN
 
About one month ago, a mother who had just delivered a newborn asked me when her baby could actually see. She told me that some of her relatives had said that newborn babies could not see at all, so she was surprised to hear me say, "Your baby could see at the delivery room."
 
Soon after birth, babies can follow their mothers' faces. In fact, newborns also respond to sounds, textures, lights, and colors. Specialists in newborn care know that infants use all their senses, although hearing is better developed than vision.
 
Newborns also smile when happy and communicate their distress. They are alert to the new world around them, and it is this interest in the environment, especially to the parents' smile or tone of voice, that should be encouraged and sustained during the first few weeks after birth.
 
Your newborn baby faces two basic challenges during the first several weeks of life: first is how to become interested in the world around her, and second is how to self-regulate -- be calm and relaxed – without your help.

She hurdles both challenges by using her senses: what she hears, sees, tastes, touches, smells, and what she feels through her sense of movement. Her ability to take interest in your face, listen to your voice, and respond to your hugs, kisses, and touches makes her interested in the environment and at the same time makes her calm and relaxed.
 
Here's how you should talk with baby as soon as she comes into the world. Soon after birth, when your newborn baby opens her eyes, hold her in front of you from about 10 to 12 inches. Call her name several times and talk to her for about half a minute. Then stop and allow her to talk to you with her eyes.
 
After allowing your baby about 30 seconds "look" at your eyes, talk to her again for another half a minute. Then stop again and give her a turn. Sustain this dialogue as long as your baby allows. Give her hugs and kisses and say, "Good girl," before she gets bored or sleepy.
 
While speaking in your motherly tone, smile, and be enthusiastic, talking a bit louder than your usual voice. The tone and volume of your voice, as well as your enthusiasm will make her more interested in you and the world around her.

Do this dialogue for about five minutes at a time. If you notice that your baby is getting sleepy, tired, or bored, stop talking. Let her rest or sleep.

As soon as your baby awakes or becomes alert, with wide-open eyes, do the "dialogue" again. If you can do this activity at least four times a day, it will be great achievements that will jump start your baby's cognitive development.
 
After a few days of "dialogue" with your newborn, try another interesting activity. While holding your baby on your left arm, show her your right index finger about 8 to 10 inches from her face. Put you index finger just about two inches from your right eye. Wiggle it to get her attention. Once you notice that she is looking at your index finger, move it slowly to your left about 8 inches and slowly back to the right about 10 inches. Look at her eyes to see if she is tracking your index finger. Do it for about 30 seconds. Again, if you notice that she is getting bored, stop at once.

This special dialogue and activity with your newborn is the first step to joint attention and advanced social, cognitive development.

CHRISTINE, 6 months old, 2 Colors
 
Christine was at my office for a six-months-old routine visit. Her mother told me, "You won't believe this—Christine knows two colors, red and blue."
 
"Why do you say that?" I asked.
 
"Well, we started showing her a red and a blue Lego block. After showing them to her several times, whenever I tell her to get the red block, she would reach for it. When I tell her to get the blue one, she would correctly do it. If I changed the positions, she still gets the right color."

I placed a red and blue Lego blocks in front of Christine. Indeed, she was able to reach for the red or the blue on request.
 
Christine was my first patient who, at 6 months old, could identify two colors.
 
Face-to-face interaction between a newborn and the parent may be as critical as breast- or bottle-feeding, cuddling, talking, and kissing. After the baby is born and the newborn is handed to the mother or father, they want to hold the baby in a face-to-face position. Mothers attempt to have eye contact with their babies. The visual ability of a newborn during the first few hours after birth has a significant meaning to both the mother and the baby.
 
Genetically, a newborn is programmed to look at a human face. The eyes, the mouth, and the edges of the parent's face are attractive to babies. Newborns also like sharply contrasting colors, oval shapes, large squares, and medium-sized brightly lit items. These things bring a newborn to a prolonged alert state of fixation.
 
Soon after birth, newborns will follow a drawing that resembles a human face. Newborns follow the drawing up to a 180 degree arc with their eyes and head turning to keep the drawing in view.
 
Newborn babies can also imitate the facial expression of the mother or father. If a mother pouts her lips, baby will do the same. If a mom sticks out her tongue, baby will follow suit. A mother's blank, sad, or serious face will also be imitated.
 
How far can a baby see? Newborn babies are nearsighted. Their best visual distance is from 8 to 12 inches if the item is in front of their face. By the age of three months, a baby can see farther than eight feet. At six months old, babies can see about the same distance as an adult. Newborns are relative myopic with 20/150 vision.

BABY SIGNS Anthony, 2 months old, Signs for "drink"

Anthony's mother taught him the sign for "drink" when he was 1 month old. I demonstrated how to do the sign just before giving Anthony his formula. She should raise her right hand coming from her side with a slow arching stroke towards the front of her mouth. Her fingers should be together with the thumb touching all the tips of the other four fingers. She should do this three times, saying, "drink." Then she should give the bottle. I recommended that if the father will do the feeding, he should do the sign for "drink" also. They should both be consistent.

During the two-month routine visit, Anthony's mother told me that her baby could already understand the sign for "drink." When Anthony was hungry, she would do the sign for "drink," and he would bring his open right hand toward his mouth. When Anthony was not hungry, and she does the sign for "drink," Anthony would not bring his hand toward his mouth. And this behavior became consistent.
 
Anthony's mother excitedly shared that two days before the routine visit, when he was crying hard, she did the sign for "drink" and he stopped crying instantly. She grabbed the bottle of formula and Anthony smiled before she fed him.
 
Anthony is my youngest patient who understood a Baby Sign.

A research study involving 140 families was conducted when their babies were 11 months old. Each baby was assigned to either the Baby Signing or the Non-Signing group. The members of both groups were similar in background.

Both groups were assessed at 11, 15, 19, 24, 30, and 36 months old using standardized language measurements. Many of the children were reassessed when they were 8 years old, using the most commonly used measure of intelligence in children.

The results showed that at 24 months old, the Baby Signers were on average talking more like 27- to 28-month-olds compared to the Non-Signing babies. The children in the Baby Signer group could speak much longer sentences. At 36 months, the Baby Signers were talking like 47-month-olds, making them about one year ahead in language development than the Non-Signers. At eight years old, the Baby Signers had an average of 12 points higher in IQ than the Non-Signers.

Teaching Baby Signs to your baby is easy. Lessons are available from books for parents like "Baby Signs" by Acredelo and Goodwyn.

JENNA, 21 MONTHS, counts up to 20

Good Morning Dr. Leo,
Just an update for you on Jenna's progress. Jenna is 21 months old. She now can count to twenty, although she sometimes gets confused between 14 and 16. She knows all the basic colors: red, green, blue, yellow, orange, purple, black, white, pink. She knows all her body parts. She loves to play with her dollhouses and read books.

Newborns readily distinguish two objects from three and perhaps even three from four. Their brain comes with numerical detector that is probably laid down before birth. As early as four days old, a baby can de-compose speech sounds into smaller units syllables that he can then enumerate. Learning, rather than brain maturation, is responsible for the baby's knowledge of numerical correspondence between sensory modalities.

When infants are shown pairs of displays that differed in set size, they showed a preference for the larger of the two sets. This suggested that infants were sensitive to the quantity of elements in sets that are highly discrepant.

The ability to tell differences in visual sets is probably the strongest, consistent, and well-documented finding among the studies in babies. Various studies showed that infants could tell two items from three items based on the contrast in overall contour, length or surface area of the objects, rather than the number of items. Infants also use overall amount instead of number to perform quantitative tasks.

Research has also established that infants, from an early age, are sensitive to changes in rhythm. Infants may simply recognize that a change has occurred without necessarily knowing the nature of the change.

As young as 14-month old, infants are already sensitive to ordinal relations. These infants were able to recognize ordinal relations once that they had been trained on smaller number comparisons (one vs. two vs. three). And these infants can also learn smaller quantity when rewarded (those infants trained to respond to "less than" relations.)

On average, infants as young as 5 months old, look longer on an incorrect solution than on the correct one. This suggests that they understand something about the nature of numerical transformation. Wynn concludes, "infants are able to calculate the precise results of simple arithmetical operations"; and this indicates, "Infants possess true numerical concepts."

BASE TEN COUNTING– Chinese Advantage

Chinese children are more advanced in counting and in Math during the elementary and high school grades. There are many reasons for the Chinese advantage and one big advantage is their language.

By far, Chinese language depicting numbers are simpler. They have only 10 one-syllable words that can be used in combination to form higher numbers. The ten Chinese words are in order from 1 to 10: yi, (one), er, san, si, liu, wu, qi, ba, jiu, and shi (10). In English there are 29 words needed to express numbers. Many of the English word numbers are even two syllables such as seven, fourteen, sixteen, etc.

In Chinese, 11 is shi yi (ten plus one), 12 is shi er (ten plus two), 13 is shi san (ten plus three) etc. In English, eleven, twelve, and thirteen are the corresponding translation. These are longer words and even not logical because it is difficult to decompose eleven and twelve. For a toddler in English speaking countries, it is difficult to know that eleven is composed of 10 plus 1, but in Chinese, toddlers easily understand base 10 and intuitively know that eleven, or shi yi, is the same as 10 plus 1.

English speaking children have to learn and remember that –ty is a syllable that stands for ten; and, twen-, thir-, and fif- (none of which are English words) mean two, three, and five. On the other hand, Chinese children need not learn any new words or syllables that represent tens or decades. Their number for tens is obvious—two tens, three tens, four tens, etc.

With an easier language representing numbers, Taiwanese children also understand how tens and units are added together in the base-10 system that is common to English and Chinese. Children from Chinese speaking communities seem to understand how to add numbers together to make a target number better than the USA children.

A study by Peter Brant showed that 6-year-old Chinese children are better in handling coins than same age English speaking children. Mr. Bryant used a pretend shop where things costs 6p or 11p, and children had 1p, 5p, and 10p coins for the English children, and the equivalent coins for the Chinese. He showed that both English and Chinese children are good in counting out the 1 unit, but the Chinese children were far better at paying with 10 +1 rather than eleven 1's. Also, Chinese children are paying with 5 +1 coins while the English children are paying by the units of 6 coins.

How do we help our children understand base ten number system with ease and reduce number anxiety in the elementary grades? We should demonstrate to our children as young as six months old how to count their fingers, toes, apples, oranges, or grapes. Or for that matter any objects that could be counted should be counted as often during infancy. Parent should start counting one, two, three during the first few months of life, then increasing the count by one or two every month until about 12 months old.

Down syndrome child reading

CIARRA, ENVIRONMENT OVER GENETICS

Last December of 2004, I saw a memorable five-year-old girl named Ciarra. One of my office staff was excited and called me to witness her performance. Excitedly we both witnesses Ciarra reading from a booklet.
We were amazed to see her reading the following sentences, "I see a yellow duck. I see a blue bird. I see a purple cat. I see a brown dog. I see Ciarra. I see Jesse. I see Sarah. I see Blue. I see Callie. I see a cat."
I congratulated Ciarra's mother, Michelle, telling her how impressed I was with her daughter's performance. 
That same night, I reviewed the e-mails Michelle sent me for the whole five years of which Ciarra was under my care.
Ciarra was born full term, 6 pounds 7 ounces, and under normal delivery. She stayed 9 days at the NICU because of VSD (a hole in the heart). Her only problem was the usual ear infections of childhood.
At 1 year old, Ciarra was able to occasionally say, "Eat cookie." She fed herself with a spoon and fork at 13 months old. At 18 months old, she was using 2- to 3-word phrases and could identify several colors and shapes.
She took her first step at 22 months old and walked well at 24 months. At 27 months old, she was fully potty trained day and night. At 30 months old, she could identify all shapes and most colors.
At 3 ½ years old, Ciarra could read 3 words. And by 3 years and 9 months old, her reading ability increased to 20 words.
At 4 years old she knew all upper and lower case letters and their corresponding sounds. She could also identify numbers 1 to 20 and count objects up to 19.
At 5 year old, Ciarra can tie her shoestring using both hands and her mouth!!

Most pediatricians and developmental specialists would not be impressed with Ciarra's development. However, if they were at my office that day, they would have been amazed and impressed.
Ciarra has Down Syndrome! But through the years she has become an example of nurture winning over nature, the environment over genetics. Nurture over nature is Ciarra's everyday life.
I asked Michelle how she nurtured Ciarra. This was her answer, "LOTS of books, busy environment, new and interesting toys, lots of sound and color, new places and people. Textures and experiences -- I desensitized her very early to the world, she wasn't scared of ANYTHING! Literally hundreds of hugs and kisses and I Love You's."
From the first few hours of life, early brain stimulation, through playing, reading, counting, singing, and other fun activities could make a big difference in the advanced development of all children, whether they have Down Syndrome or normal chromosomes.
The new theories on early brain development should be part of the Routine Check up of all babies. At each routine visit, primary care clinicians should discuss the importance of reading, counting, sign language, and a minimum of 20 minutes floor time twice a day with the baby. Parents should not allow watching TV, video, and computers until their child is 6 years old -- a difficult prescription but is worth doing.
If Ciarra who has Down Syndrome could read at age 5, what would happen to normal children if parents stimulate their babies the way Michelle did? Definitely we will have happier, healthier, smarter children. More importantly it will reduce failure in school, ADHD behavior, and other social and behavioral problems.

BRAIN PARTS YOU SHOULD KNOW

There are four parts of the brain that you should know. These are the amygdala, hippocampus, pre-frontal cortex, and the fusiform face area (FFA).

The amygdala is the emotional center of the brain. Injury to this area will result to behavioral, emotional problems, and some features of autism.

The hippocampus is the memory center. If the amygdala is exposed to a happy and positive environment, the hippocampus functions more efficiently. Learning is easier and faster when the amygdala is having fun.

The pre-frontal cortex is the thinking part of the brain. For this part of the brain to function well, the hippocampus, the brain's primary hard drive, should have enough stored data for easy retrieval.

Fusiform face area (FFA) is the major area of the brain that is dedicated to "read" human face. In autistic children, the FFA is not active. Maybe this is the main reason why autistic children rarely look at the face of people. They prefer to look at objects instead. Watching TV during infancy and early childhood does not help turn-on the FFA. This is the one reason why infants should avoid television!

Mirror Neurons These are group of brain cells that can make a newborn sticks her tongue if you do it first. It is important for you to know this so you will be aware that whatever you do at the seing distance of your baby, she can copy it.

Fortunately, the FFA, amygdala, and hippocampus are easily turned-on by your happy, smiling, animated, enthusiastic face, and voice. Every minute of the day, when a baby sees your happy, smiling face, a positive development of the FFA and amygdala is a likely outcome. As a result, behavioral problems, school failure, and depression are reduced and a productive citizen is born.

On the other hand if your baby is exposed to unhappy faces, shouting, negative attitudes, naggings, and TV during the first few years of life, these four major parts of the brain will sustain some brain cell damage. This neural injury may be persists in some children.

You can save thousands of dollars of the cost of medical care and the agony of having a child with developmental delays by giving your baby a happy, animated, enthusiastic, and playful environment without television and technology.

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