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Beginnings Guides Blog
Parenting Education
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Posted on Monday, April 16, 2012 8:55 AM
A reflective question is one that requires the mother to think about
facts and feelings, link to her knowledge and experience, and formulate a
purposeful response. For health action planning, reflective questions
help the mother clarify what she wants for herself and her child,
clarify what is currently supporting or in the way of her desired
outcome, and clarify the next step. Hint: a Yes or No question is not
reflective.
Home Visitor Asks - Demonstrates it matters what a mother knows
- Builds mother's confidence
- Creates a teachable moment
- Suggests a way to think about a current problem
- Presents the mother opportunity to recognize & apply her knowledge & experience-to use her power
- Presents the mother opportunity to notice gaps in her knowledge & to seek info
- Teaches responsively-leaves the power with the mother by supplying info only in response to her request
- She empowers the mother
Mother Reflects - Feels respected, knowledgeable, self-confident in caring for herself & baby
- Taps into her experience, uses her knowledge
- Evaluates her experience, values, knowledge, feelings
- Applies and so learns from her experience
- Recognizes her need to know & need for info
- Asks for info-takes charge of her learning
- Increases knowledge
- Develops her life skills-problem solving, resource utilization, info seeking
- Changes behavior
- Improves baby care, interaction, teaching
- She is empowered
Baby Benefits - Has his/her needs met
- Establishes trust in the mother
- Achieves secure attachment
- Enjoys improved health & well being
- Learns appropriate behaviors
- Reduced risk of abuse & neglect
- Innate curiosity is supported
- Improved school readiness
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Posted on Tuesday, April 03, 2012 5:06 PM
Reports have been circulating on the
Internet: researchers find that the recommendation to exclusively breastfeed
babies for six months is just too hard for modern women and is making mothers
feel bad. The study author suggests the advice is fine for the developing
world, but should be changed to “breastfeed as long as you can and introduce
solids as close to six months as possible”.
There are several health literacy
lessons to be learned from this questionable reporting on questionable
research.
The
evidence is exceptionally clear and strong First, we should note that the
recommendation to feed infants only breast milk for at least six months is not
just a suggestion from some guy in a diner. It is the evidence-based consensus
from the U.S. Centers for Disease Control, American Academy of Pediatrics, the World Health Organization, and
virtually all health agencies on the planet. This level of consensus is rare
and requires an extremely strong evidence base.
Is
the recommendation unhelpful for mothers? and child that last a lifetime and save
billions in healthcare costs. The study’s author says the recommendation is
“idealistic” and
“unhelpful” as an
individual goal and calls for balance between these “theoretical” longterm
benefits and immediate family well being.Fair enough. But that can be done at the individual level without undoing worldwide policy making and without concluding that women are incapable of (or just too busy) for this womanly skill.
The
perfect food is free The big problem for breastfeeding is
this: it’s free. This study feeds a broadly-held perception that breastfeeding
is for poor people in backward countries that cannot afford or reliably use
formula.
With this twisted thinking we are
willing to disregard all the science behind the global breastfeeding
recommendation in favor of the belief that in 30 years scientists have made a
better formula than what Mother Nature developed over millennia.
Health
Literacy Lessons Literacy means the cognitive and social skills which determine
the motivation and
ability of mothers to gain access to, understand, and use information in ways
that promote and maintain their
health and that of their children.
Part of health literacy for mothers,
health promoters and clinicians alike, is reading critically, asking where is
this information coming from and how reliable is it? What does it mean to me in my situation? How can Iuse it
for health?
Read it for yourself. The study is published in BMJ Open-
that’s British Medical Journal Open, an open access journal.
BMJ ought to be a reliable source. But
here’s the detail that matters (it’s in the abstract): 541 pregnant women in
Scotland were invited to participate in monthly interviews; 72 volunteered to
participate. Of these, 36 were interviewed along with some of their partners
and relatives.
This
is not a representative sample. People who volunteer to participate in
surveys typically feel very strongly one way or the other. We need to ask, how
are these 36 women different from the 505 who declined? Further, the sample is too small to draw any conclusions beyond the individuals involved.
Telling
them what to do does not work Breastfeeding advocates, health
educators, parent educators, home visitors, clinicians can learn an important
lesson re: promoting maternal health literacy from this article. When education is perceived as “unrealistic, overly technical and rule based”, it is not going
to motivate anyone to take action for health. But you already knew that...The problem here is not the breastfeeding policy; it’ s the
delivery of information.
Stay tuned for a model reflective conversation to
promote breastfeeding.
To balance the oft quoted Scottish
mothers who were not well served by their lactation consultants and who
struggled with breastfeeding, see our Facebook Poll for comments from
our volunteer sample of mothers who work in women’s health. We asked: Do you think recommending
breastfeeding for
a minimum of 6 months is unrealistic or unattainable?
No one said Yes.
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Posted on Thursday, March 22, 2012 3:41 PM
Betty, a parent educator presented a challenging case in reflective supervision. She reported that the 19-year old mother and her seven month-old daughter live with her mother. And Grandma smokes like a chimney. Mom smokes, too. She’s begun making efforts to smoke outside. But Grandma says to Mom, “I smoked all through my pregnancy and your childhood; you didn’t die, and neither will this
child”. She bristles at any request to stop smoking or take
steps to protect the baby.
I have a lot of respect for grandmothers and their wisdom (I am one!). But this time, this grandmother is just plain wrong. Her smoking probably will not kill the child this year, and hasn’t killed the mother yet, but it might kill them both before their time.
Second-hand smoke is as harmful as first hand smoke,
and more so for an infant with small size and still-developing
lungs. Exposure to second hand smoke has been linked to increased risk of SIDS, ear infections, and respiratory disease in children. Annually, 150,000 to 300,000 cases of bronchitis or pneumonia in children under 18 months of age are attributed
to second hand smoke. And new research reported by the journal
Respirology this week shows that a child’s reduced lung function
from exposure to second-hand smoke nearly doubles the risk of
lung disease in adulthood.
Mom smoking outside does begin to reduce harm to the baby by reducing the second hand smoke in the air that Baby breathes. Betty, the home visitor rightly praises this effort and continues to encourage Mom to take the next step. Mom is in a bind because she needs a safe place to live. And, for now, living with her
mother is her best option. She has set a goal to get a job so she
can get her own place. She is taking courses for a college degree. It’s a long path to her goal. Meanwhile, Betty reports, she takes the baby to the doctor “all the time” for recurring colds and ear infections.
Third-hand smoke is as harmful as first hand smoke, too. What makes Grandma’s house hazardous to Baby’s health, in
addition to smoke in the air from her current cigarette, is the
accumulation of smoke in the furniture, curtains, carpet, bedding, dust; in her hair and clothes, and in her car. This is third-hand
smoke. It toxins remain toxic. Baby has her face in it all the time.
Information on third-hand smoke will be added to the upcoming
Rating Moms and Grandma’s Health Literacy Betty has made certain that both Mom and Grandma have plenty
of information about smoking and resources to support quitting. Both understand the information. Grandma rejects it outright.
She warrants a low score of 1 (dysfunctional) on the “Use of
Literacy Scale. She has low health literacy, not because she can’t read, but because she does not use information and resources for
health.
Mom’s health literacy is increasing. With Betty’s support she has come to recognize the risk to her child, if not to herself. She has established a medical home for the child and seeks care appropriately.
She has begun to take action to change her living situation in order to improve her health and that of her child. In this case, the barrier
to health literacy promotion is not the mother’s reading skill, it is the grandmother’s beliefs.
Promoting Health Literacy Betty planned to keep bringing information on smoking to each visit
with this family, as she has for a year now, and continue to do whatever she can to “get them to stop smoking”. When we reviewed the mother’s goals and motivations - she aims to complete her
schooling so she can get a job so she can move to a more healthful environment - a different approach emerged that is likely to be more effective and less frustrating for all parties.
Betty has been trying to fix the family and rescue Baby by
getting Mom and Grandma to stop smoking. If she could shift from pushing for her own goal to supporting what Mom wants for herself and the baby, she could build on Mom’s motivation
to graduate and get a job, celebrate smoking outside and going to school as steps in the right direction, and support Mom’s
step-by-step progress toward independent living and a smoke-free environment for her and Baby.
Epilogue At the end of the case presentation, we learned the baby
had just been taken to the local ER with seizures and
airlifted to the regional medical center. We cannot say that second- and third-hand smoke caused the seizures, but the
evidence is clear that smoke in an infant’s environment
weakens lung function and increases other health risks.
Mom is right. Time to move.
References Winickoff JP, Friebely J, Tanski SE, et al. (2009). Beliefs
about the health effects of “third hand smoke and
home smoking bans. Pediatrics 123: e740e79.
Chan S.& Lam TH. (2003). Preventing exposure to second-hand smoke.
Seminars in Oncology Nursing 19 (4): 284-290
MedlinePlus Secondhand Smoke in Childhood Linked to Lung
Disease Years Later (available until 6/17/2012)
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Sandra Smith, PhD: Posted on Friday, March 09, 2012 10:49 AM
I was on the street corner waiting for the light to change as they approached.
She was fashionably dressed, a one-year-old on her hip and shopping bags on
her arm. The five-year-old boy walked along beside her. He struggled with a
backpack that seemed too big for him. She stopped; turned to him and shouted “Get that backpack on before I sock the shit out of you!”
The boy jumped in surprise and alarm. So did I. She seemed so angry so
suddenly.
The boy had been quiet and well-behaved, keeping pace with his mother.
The problem seemed obvious. He was wearing a puffy parka a size too large;
it bunched up at the shoulders when he tried to pull up the straps.
I was speechless.
My instinct was to protest. And I was afraid she would sock the shit out of me,
too. The light changed and I went on.
I have been disappointed in my non-response and worried about the child since. If she socked me, I could have socked her back. The boy could not. If the police
came, he may have gained some protection.
Contemplating the scene, I thought maybe I could have interceded without blaming
or embarrassing her by saying something like, “Gee, your hands are full, can I help
him with the backpack?”
What would you do?
This boy was having an ACE (Adverse Childhood Experience) Thinking about the mother, I suspect ACEs in her background make violence her automatic reaction and prevent her from feeling compassion and raising a
spoke to her and/or perhaps as someone currently speaks to her.
In any case, neither threatening the boy nor actually socking him will teach him to carry his backpack properly, or to obey his mother. It will teach him to fear
his mother and do whatever keeps him from getting hit. It will teach him that socking the shit out of someone is how you solve problems, and that it is OK if you are the biggest and strongest. It will convince him that he is bad and unworthy of respect.
Using Beginnings Parents Guide to talk about discipline vs. hitting If I were her home visitor or parent educator or outreach specialist, I would plan a reflective conversation with this mother. I might start with page 186
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Sandra Smith, PhD: Posted on Wednesday, March 07, 2012 8:56 PM
The dad was carrying his two-year-old son to the park. The boy fussed
and squirmed as Dad talked in his ear. Suddenly, Dad plunked the boy
down on the sidewalk and took three steps away from him. “OK, that’s a three-minute time out!” he said louder than he intended. The fussing
escalated to a cry. Dad sighed heavily, hands on hips, and glowered at
the boy and the passersby.
First, kudos to this dad. He recognized that he and the boy both needed a break. He did not let his frustration get the better of him. He did not
hit or threaten. But he could have used time-out more effectively.
Discipline is Teaching Self Control, Not Punishing “Bad” Behavior Like his dad, when a toddler is upset, he has trouble thinking.The
point of time out is not to punish him, but to help him regain his
calm and self-control; and to create an an opportunity for Dad to regain his calm and self-control, too.
Wrong Place for Time Out A noisy, busy sidewalk with adults and pets bustling between them
and traffic whizzing by is not a soothing environment. If Dad could have made it another half block they would have been in the park
where they could sit on a bench or on the beach to be quiet together, give words to feelings, and regroup. Sitting together would show the boy that his dad did not reject him, only his behavior. It would also
show that everyone (even Dad) gets upset and needs a break sometimes
to regain composure. Naming the boy’s feelings would prepare him to
use words instead of fussing.
Unreasonable Expectations The two-year-old is too young for time out. At his stage of cognitive development, it is unlikely that time-out makes any sense to him.
So now in addition to whatever made him cranky, he feels frightened, rejected and confused to find himself dumped alone on the sidewalk
with his angry dad backing away from him. A two-year old understands that No! means Stop. But he has no idea what to do instead. He does not understand that what he wants and feels is not the same as what his dad wants and feels. He has no clue what three minutes means.
He has an innate fear of being abandoned, a survival mechanism
designed to keep him safely close to his parents; so seeing Dad walk
away is not going to calm him.
Time out is a good form of discipline starting around age three. And
then three minutes is about right, one minute per year of age.
Not the Desired Result Dad wanted to teach self control, but ended up teaching fear. He
wanted his son to be good, but showed him he is bad. He wanted
to feel good about himself and his son, but both were feeling pretty
bad when I saw them.
pages 183 to187. For discipline for a toddler aged 24-30 months,
see Book 7, pages 162-164. This information requires no revisions for the upcoming 4th Edition.
Next: While this dad did not use time out as well as he could have, he is way ahead of a mother I encountered a little later.
More on that next time.
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Sandra Smith, PhD, MPH: Posted on Monday, March 05, 2012 11:10 AM
and the Parents Guide. Nutrition is a topic warranting consistent, frequent discussion and planning with mothers in prenatal care and postpartum visits, home visiting, parent education, medical home outreach, and well-child and well-woman visits. We are reviewing
the nutrition information in the Parents Guide to prepare the forthcoming 4th edition. Here’s why nutrition matters even more
than we thought:
Chronic disease starts in the womb For every 10 Americans who die each year; seven succumb to a
chronic disease. Heart disease, cancer, and stroke account for half of all deaths. Risks for- and protections against such diseases,
plus type 2 diabetes, obesity, hypertension and osteoporosis,
begin to accumulate before birth. Nutrition plays a major role.
Adult health problems can be set in motion during pregnancy and
early childhood through “early programming”. That term refers
to exposures during sensitive development periods that may
permanently alter the function of organs and body systems. For
example, if during pregnancy a mother gets too few calories, or
sufficient calories but few essential nutrients, the baby’s body
adjusts development to make use of whatever is available. These
adjustments help ensure survival of the infant, but create organs
and systems that do not fit a healthier environment, placing the
child at risk, even in the presence of nutritious foods. Children
who did not thrive in the womb, and then consume excess calories
are at greatest risk for adult health problems.
Risks (low quality food, lack of exercise, excess weight) accumulate over time. On the other hand, protections (breastfeeding, prenatal
vitamins, high quality foods in appropriate portions) also accumulate.
Critical periods when exposure to risks and protections either promote
or compromise development and future health include pregnancy,
and birth to age 3, the timeframes addressed in the Beginnings Guides..
“Nutrition Literacy” is not enough Enabling mothers and families to eat well, takes more than health
education to ensure understanding what makes a healthy diet. It
takes supports that enable mothers to act on their knowledge. It takes supports for breastfeeding initiation and continuation after
return to work. It takes transportation to stores that carry quality food at affordable prices. It takes time to plan and prepare meals.
It takes safe places to exercise. And it takes “food security”.
For most of us reading this, nutritious safe food is plentiful and
easy to get. That contributes to our physical and mental health
and school performance. But many of the families we serve enjoy
no such food security; 37% of households headed by a single woman and 43% of families living below the federal poverty line live with
low quality food or hunger.
Want to know more, do something? University of Washington Northwest Center for Public Health Practice. The course is addressed to practitioners and includes
tools for addressing maternal child nutrition in your community.
It is self-paced and takes about an hour and 15 minutes to complete.
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Sandra Smith, PhD: Posted on Tuesday, February 28, 2012 4:40 PM
I conducted an informal Facebook poll to test directly
the proposition that some parents are
going to choose co-sleeping, despite the widely publicized recommendations of experts that infants sleep alone to prevent SIDS. Some of
these parents may be unaware of the risk, or may not understand the message. I
surmised that parents engaging in parenting-related Facebook discussions are
likely to be aware of the message and to understand it.
I asked: When you child was an infant (up to 8 months old), did you bring
the
baby to your bed? Often Never Routinely Occasionally
The single question poll was posted on
Facebook for the month of February. Almost immediately, an anonymous reader added
a response option, “every night”, which received by far the most votes. Here’s the tally.
37 every night 3 never 3 routinely 1 if he woke up we brought him in 1 occasionally
Talk
about safe bed-sharing Non-scientific as it is, the result
makes it clear; we need to talk about how to make co-sleeping as safe as
possible. Simple advice that Baby must always sleep alone in his/her own crib
is not going to fly. But this is
the proper advice when parents
habitually use alcohol or drugs, or are taking prescription medications that
suppress arousal.
“Baby
Back to Sleep” still the most important message Parents have enough anxiety. It is important to emphasize the risk
period for SIDS peaks at 2-4 months. SIDs is rare before age 1 month and after
age 6 months. A safe solution during the early months seems to be temporary
bed-sharing, where the baby shares the parents’ bed for feeding and cuddling
and then is returned to a crib within sight. Use of a pacifier at sleep time
(not other times) reduces risk of SIDS. So does a firm mattress, tightly fitted
bedding and removal of all things fluffy and soft. In all cases and places, Baby sleeps face-up.
Here’s a summary of references and
resource from our review of evidence on SIDS:
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Sandra Smith, PhD, MPH: Posted on Wednesday, February 22, 2012 8:31 PM
The home visitors at Aspiranet
Welcome Home Baby Program and their supervisor, Odessa Caton sent in two questions about the recent BulletinBlog alerting Beginnings Guides user’s to findings
that use of a pacifier reduces the risk of SIDS up to 90%. They ask, Does the pacifier
recommendation apply to
breast fed and bottle fed babies? Does the research still indicate that
pacifiers are barriers to breastfeeding?
The short answers: Yes. No. Pacifiers, SIDS & Breastfeeding recommends against any pacifier use for breastfeeding infants. Another
BG
Bulletin reader, Cathy Morris of the Heart of Georgia Healthy Start
Coalition,
suggests waiting one month before offering a pacifier to a breastfeeding baby in
order to firmly establish breastfeeding. Both of
these advisories are supported by a number of studies linking pacifiers to
reduced breastfeeding. And they illustrate the ongoing controversy fueled in
part by a few studies that have found pacifier use promotes or supports breastfeeding, and in part by competing goals of promoting breastfeeding and
protecting against SIDS. None of
the reported studies is able to tell if pacifier use is a signal of
breastfeeding difficulties leading to early weaning, or the cause of such
difficulties. There is some new, perhaps more definitive research.
New Findings A 2012 Cochrane Review of more recent and stronger
evidence from randomized trials reached this opposing conclusion: For mothers who are motivated to breastfeed
their infants, pacifier use before or after breastfeeding was established did
not significantly affect the prevalence or duration of exclusive or partial
breastfeeding for up to four months of age. The authors warn that this finding may not apply to mothers
who are less motivated; so the chicken-or-egg question about pacifiers and
early weaning remains.
At least one author contends the Review is severely
flawed. So the longer, final answers to these good questions depend on who you
ask and how you interpret the evidence.
Editors’ Conclusion SIDS is rare before age one month, (highest risk is 2-4
months); so there is little risk in waiting to offer a pacifier to a
breastfeeding baby. Recent research on the highly protective value of
pacifiers, along with new evidence that pacifiers interfere with breastfeeding
less than previously believed warrants a recommendation to offer a pacifier to
both breast fed and formula fed babies at all sleep times during the SIDS risk
period (age 1 to 6 months). You’ll see the change in the new 2012 edition to say about the new Review. Stay tuned.
References Jaafar SH, Jahanfar S, Angolkar M & Ho JJ. (2012).
Pacifier use versus no
pacifier use in breastfeeding infants for increasing
duration of
breastfeeding (Review). The Cochrane Collabortion. Wiley &
Sons.
Abstract free online:
Jenik AG & Nestor V. (2009). The pacifier debate. Early Human Development 85; S89-S91.
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Sandra Smith, PhD: Posted on Tuesday, February 21, 2012 5:38 PM
Lead
is a toxic metal that is harmful if inhaled or swallowed.
Lead is found in air, soil, dust,food
and water. The greatest
exposure to lead is swallowing or breathing lead paint
chips
and dust. Another risk is drinking water contaminated by lead
plumbing or
water lines. Blood lead levels in the US dropped
dramatically after 1978 with
the ban on lead in gasoline.
Blood
lead levels continue to drop, but no safe threshold has
been identified.
Current efforts and recommendations focus
on primary prevention.
Lead
is especially dangerous to infants and toddlers because
they live close to
the ground with their hands in dust and soil;
and their favorite way to explore
anything is to put it in their
mouths.
Also, growing bodies absorb more lead and growing brains and nervous
systems are more sensitive to harmful
effects.Blood lead levels peak around
age 2 when most toddlers
stop chewing on everything in reach; then they decline
without
treatment unless exposure continues.
Here’s
the big worry: harmful effects are long lasting, perhaps
permanent,
potentially including brain and nervous system
damage resulting in lower IQ and
behavior problems (reduced
ability to pay attention and follow instructions,
hyperactivity,
aggression, reading disabilities, hearing and balance problems).
These symptoms can occur even with low exposures.
The
source of most lead poisoning in children is dust and chips from lead paint
on interior surfaces. Lead paint was taken off
the market in the 1970s. But it
is still present in homes built before
1978. In most cases, lead paint in good
condition is not a hazard.
But when it chips, peels, or flakes; and when it is
sanded or
otherwise disturbed, it’s highly toxic. U.S. water sources are lead free, but old plumbing can be toxic. (The Latin word for
plumbing translates literally as lead.) Children
living in poverty are most at risk. The American
Academy of Pediatrics
recommends that all Medicaid-eligible children be tested for lead at age1 and
again at age 2.
Medicaid covers the two
tests and requires one at age 2,
which may be too late to prevent
damage. Other children should be
tested if their living conditions or parents’
occupations warrant.
Beginnings
Parents Guide first addresses lead poisoning on a
page 26 (Book 1, 2-12
weeks).. The text focuses on avoiding
Baby’s exposure to lead carried on the
shoes, clothes and skin
of parents/caregivers in certain occupations. The new
2012
edition will add content to aid parents in assessing and ensuring
the
safety of their home, particularly the presence of lead paint and lead
plumbing.
Test
all Medicaid eligible children at age 1 and 2. The current
edition suggests a lead test at six months, and
includes a self-test for parents to determine if their chid needs a lead test.
This
information will be revised and relocated to reflect the policy
of testing
all Medicaid eligible children at age 1 and 2 years,
and other at-risk
children, including those who spend time in a
home built before 1978.
New
Resources on this Beginnings Guides website. Find out about lead in
drinking water in your area. National Hotlines and the
National Lead Info
Center. Info for families renting, repairing or
References: American
Academy of Pediatrics, Committee on Environmental Health. (2005) Policy
Statement. Lead Exposure in Children: Prevention,
Detection, and Management. Pediatrics 116 (4) p1036-1046
Note,
this policy was reaffirmed in 2009
National Lead Information
Center 1-800-424-LEAD
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Sandra Smith, PhD, MPH: Posted on Thursday, February 16, 2012 9:05 AM
Part of health literacy is
understanding information. But it is using
information that makes
a difference in outcomes. Last time in this space we
discussed new federal regulations from the Consumer Products Safety Commission
that aim to improve crib safety.
That’s good information for health promoters and healthcare professionals,
but how can we offer this information to parents in a way they can use it?
To use information, we first
personalize it using interactive and reflective skills. When a
mother
personalizes health info, she reflects on: What
does this mean for me, in my
situation,in my family with my income,
experience, education, values and living conditions?
And then: Now that I have this information, how do I
want to respond? What do I want to do?
Information is
most easily personalized and applied in context when it uses familiar words
that do not require judgment or background knowledge.
For example, if the info says,
“Slats should be less than 3” apart”, it will pass the readability tests, but
the learner must know the meaning of slats,
know that the symbol “ means inches,
and know or how to use a ruler to measure. And s/he must judge whether should means the
distance between the slats is a vital concern or
just a suggestion, so that she can judge
whether it worth the trouble to go
find the ruler or someone who knows how to measure.
I found few parents used the word slats. More parents used – and nearly
all understood bars.
If the info uses
something familiar and handy as a measure, no one needs to understand inches or use measuring devices to
check the space between bars.
Further, info is easier to
personalize and put into action when it contains only what the
learner needs to
know to take appropriate action. For example, a mother does not need to
know
that the Consumer Product Safety Commission sets crib safety standards. She
needs to know how to tell if her crib
is safe for her baby
Crib Safety Checklist If you can check Yes for all these statements,
you have a
safe crib.
·The bars are
close together so the baby cannot get stuck between them. The space between
bars is no wider than four adult fingers.
[ ] Yes [ ] No
©Practice Development Inc |
Beginnings
Parents Guide makes crib safety info easy to use with a Crib Safety Check
List.
Ideally, the checklist is
the focus of a reflective
conversation on sleep safety, or it may be
used in
self-directed learning. The checklist is interactive and reflective; it
requires the
learner to think and check Yes or No to three
statements. This
takes the learning deeper faster by using muscles in addition to the
brain. In the process, the learner
teaches herself
to determine whether the crib is safe and what
makes it safe or
not.
Here’s
the part about distance between slats. No rulers or knowledge of measurement
needed.
No polysyllabic words. The
text sounds like something a person would actually say in
conversation. See the
full Checklist here (choose Parents Guide and go to page 22).
The
2012 edition will add this item to reflect new safety standards: ·
The sides of the crib do not fold down…. |
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