Evaluating the functional state of pulmonary clinicians recently received much attention. Lung function (LF) are important for the diagnosis and determine the severity of the disease, and for the selection of treatment programs. Dynamic monitoring of patients with repeated studies FVD can make changes in treatment, to predict the course and even the outcome of respiratory diseases in children.
The main objective of the study ERF in most patients is to establish violations of pulmonary ventilation capacity, dominated obstructive, that is caused by changes in air flow to the tracheobronchial tree. Rarely diagnosed restrictive or restrictive disorders that occur due to changes in elasticity of lung tissue. Unlike adult children continued growth and development of bronchopulmonary structures. This explains the fact that even in the presence of chronic respiratory diseases due to high compensatory capacity in lung function are often missing. Children with asthma often have normal functional characteristics, not only in remission, but even in the acute stage of the disease.
The most complete characterization of pulmonary ventilation capacity is possible when studying the structure of total lung capacity. Method bodipletizmografii simultaneously with the study of total lung capacity to evaluate bronchial resistance, which is enough to diagnose the nature and extent of violations. The most popular and affordable method for studying the ERF is to record the flow-volume curve of forced expiratory vital capacity (FVC). The brevity of the study, visual inspection of the forced expiratory maneuver, the computer processing of results, including comparative analysis of different time of the study parameters make this method is indispensable in carrying out functional tests with bronchodilators, bronhokonstriktorami and physical activity.
Evaluation of the indicators is the deviation from the brand name viagra proper value, that is theoretically the most probable value of the indicator set in healthy children, which is calculated by regression equation. To estimate the boundaries of normal values used persentilnoe distribution, as in groups of healthy children is usually different from the normal distribution [1].
Analysis of indicators of flow-volume curve (PAC) expiratory forced vital capacity allows you to identify violations of bronchial conductance, the severity of these disorders, as well as the level of damage: impaired patency of small (or peripheral), the bronchi, large (or central), bronchial disorders or generalized. The initial part of flow-volume curve characterizes the permeability of the central airways. The decline in FEV1 (forced expiratory volume in 1 s), PEF (peak expiratory flow rate) and MOS25 (maximum volume flow rate at exhalation 25% FVC), with good reproducibility of the curve indicates a violation patency large bronchi. Decrease in flow at 50 and 75% of exhaled lung volume (MOS50 and MOS75) and velocity parameters (average speed in the area of 25-50% and 75-85% of FVC: SOS25-50% and SOS75-85%) typical for impaired patency of peripheral respiratory tract. Generalized obstruction characterized by a decrease of all indicators, a decrease in area under the curve, increasing exhalation time, and in pronounced cases - and a decrease in the FVC.
Conducting tests with inhaled bronchodilators solves the problem of reversibility of airway obstruction is detected. These tests are widely used in children with bronchial asthma and chronic nonspecific lung pathology. According to our records, more than half of children with chronic pneumonia and the clinical syndrome of bronchial obstruction give reliable increase in the value of FEV1 bronchodilator inhalation. For proper implementation and evaluation of the test must cancel prior to the study conducted therapy: ?2-agonists, short duration - 6 hours, ?2-agonists, long-lasting - up to 12 hours, prolonged theophylline - 24 hours. When the original study of lung function in children is important to pay attention to the reproducibility of performance: the difference between the maximum and minimum parameters FEV1 and FVC should not exceed 5%. In the case of poor reproducibility of flow-volume curve further evaluation of growth performance is difficult and biased. Re-running the forced expiratory volume makes it possible to identify bronchial obstruction caused by spirometry, ie deterioration of bronchial obstruction in the performance of repeated forced expiratory maneuvers. The existence of this phenomenon is a contraindication for bronhoprovokatsionnyh tests and tests with physical exercise.
Existing methods of assessing pharmacological tests with bronchodilators: the increase in FEV1, expressed as a percentage of the initial value [^ FEV1 ref.]%, The ratio expressed as a percentage of the absolute gain to proper value of [^ FEV1 should.%] - Are unsuitable for pediatric practices because of their significant variability. In pediatric practice, the proposed increase in FEV1 of 12% or more compared with the baseline values assessed as a positive response to inhaled bronchodilator. However, children gain in 12% and can equal 120, and 250, and 360 ml. Therefore, we propose to assess the response to inhaled bronchodilator in the absolute increase in FEV1 values. Commonly used 95-percent confidence interval (1.96 sigma repeatability) was, according to our findings in children and adolescents 190 ml. Therefore, the growth rate in FEV1 of 190 ml or more [^ FEV1] can be regarded as a positive response to inhaled bronchodilator. In some cases, with minimal bronchial obstruction all the indices after bronchodilator inhalation reach the limit of normal, and the increase in FEV1 of less than 190 ml. Then, if established cooperation patient and physician, and a satisfactory reproducibility of flow-volume curve during the initial investigation of such a test can be assessed as positive.
Airway inflammation accompanied by bronchial hyperreactivity, which are used for the diagnosis of provocation tests with histamine and methacholine. To study bronchial hyperreactivity (SAB), there are several methods, the choice of which depends on the equipment: Adjust gradually increased doses of methacholine (histamine) occurs by inhalation of a constant volume of air and varying the aerosol concentration or increase the dose by increasing the inhaled Viagra help with premature ejaculation volume at a constant concentration. At the last method of action is based device "Pariprovotest-2" (company "Pari, Germany). As the gun is used a nebulizer, as shown by studies with labeled with radio-labeled aerosols aerosol particles less than 2.3 microns in diameter reach the lower respiratory tract. In "Pariprovoteste-2, unlike the first model, the solution is applied methacholine (histamine), one concentration (0.33%), which not only cost effective but also reduces the time of the study. After each inhalation spend-control study of forced expiratory flow, test terminated when the fall in FEV1 of 20% or more of the basic values for which the accepted value of FEV1 after inhalation of the solvent provocative agent (in the case of methacholine - saline). Calculate the cumulative dose of substance, ie dose (PD20), resulted in a decline OFV1na 20% [3]. The evaluation bronhoprovokatsionnyh samples to identify the degree of hyperresponsiveness, hypersensitivity accounting and comparing the results with other studies it is important to calculate the PD20, although ecological studies allowed the use of PD10.
You should not assign bronhoprovokatsionnye tests to differential diagnosis: today there is no inflammatory agents, allowing to clearly differentiate asthma and other chronic lung diseases that occur with bronchoobstructive syndrome. Conducting tests with methacholine provocation (histamine) is usually shown in children with long-term remission of asthma, in some cases (in normal parameters of ERF) - to establish the severity of the disease, since there is relation between the degree of bronchial hyperresponsiveness to the severity of the disease. Change a positive response to inhalation of a provocative agent to negative after treatment, or reduction in the degree of bronchial hyperreactivity, of course, indicates the effectiveness of prescribed therapy. In chronic nonspecific inflammatory lung diseases, as shown by our study, almost half of the patients is determined by bronchial hyperreactivity, but its degree is usually low, much less - an average, a high degree of SAB, we have not seen once.
Test with dosed physical exercise is widely used in children with bronchopulmonary diseases. Testing is conducted on a bicycle ergometer at the rate of 1 watt per 1 kg of body weight at 60-70 cadence of 1 minute, you can also use the treadmill, in this case, the load is determined depending on the child's age [1]. Most researchers evaluate the test as positive at lower values of FEV1 by 10% after exercise. Studies have shown that there is a direct correlation between the frequency of occurrence poslenagruzochnogo bronchospasm and severity of asthma. In addition, poslenagruzochny bronchospasm often diagnosed in patients who complained of shortness of breath during physical activity [4]. Significant correlation between the detection poslenagruzochnogo spasm and bronchial hyperreactivity available evidence does not exist [5]. In this regard, the choice of the complex functional studies is determined not only with appropriate equipment, but also the terms of the problems that have to solve the practical physician.
Frequently ill child
Joy and worries
الأربعاء، 29 ديسمبر 2010
الاثنين، 27 ديسمبر 2010
Road to the pot
Watching a child, comparing it with other children, talking with friends, girlfriends, normal loving parents are constantly looking for evidence of the fact that "we are not worse than others." And that's why life is normal loving parents is a huge number of experiences.
Problems and causes for unrest gradually replace each other. Will keep the crown? Vylezut whether your teeth? Closes a fontanel? When, finally, he will sit down, get up, crawl, go? Is he still will repel the spoon? Did he or did not speak - have since turned a year, and besides "mama" and "give" any meaningful sounds is not observed?
The crucial feature is our way of life is an ongoing discussion of the problems concern not only the family but also take away their (problems) on public display in the process of communicating with friends, girlfriends, neighbors and colleagues.
As soon as some birthday you proudly claim that, say, "our Peter at 10 months he has gone," as prenepremenno among those present will show more "lucky" parent whose Vasya went to 9.5. A detailed study of the issue probably will expand the list of discussion of relatives and friends. The main outcome of the evening will be the unchallenged statement of Aunt Clara's neighbors about the fact that her great-nephew Arturchik walked alone in 8 months.
Left alone with yourself, you could not help wondering transformation of his own thoughts. During some hours of your favorite, most talented and best-developed boy Peter from the object of unswerving parental pride was transformed into the most common and most undistinguished child. Whether business Arturchik!
The next morning, calmed down, you'll find that eight plemennik Aunt Clara went on their own, mostly for themselves ...
And this is the subject of a separate discussion.
Theme of 'going under him, to which we came "a simple logical way" in the whole spectrum of children's issues stand out.
*
Ability to independently without the help of relatives, defecate is so obvious attribute of "maturity" that the desire to quickly see your child proudly sitting on the pot and no less proudly draw the then completely dry underpants is just unbearable.
Add fuel to the fire again, street information. It is easy to learn about the outstanding achievements of a young mother Oksana from the third entrance: her daughter and three months urinates on command "writ-pis. It is unlikely that you will be informed that the phrase "writ-pis" Oksana says for 30-40 minutes at a time, but it's done. Seed of doubt in a vulnerable parent fuse soul. And, taking off with a dry and cheerful Petit heavy morning diaper, you firmly decide: enough to be a little!
From that moment, your child's road to the pot (optional toilet). But, going on a journey, should be clearly understood: the mere kid is not coming soon to the target. You will have to be near him. Are you ready for this journey?
So let's sit down in front of the road and think.
And, above all, that's what.
Do you know many kids who went to school, unable at this self-defecate?
The answer is unequivocal - a little, or rather, do not know. At least when it comes to a child who went to mainstream schools.
You strongly need to be aware that if the child has severe congenital or acquired pathology, then sooner or later he will learn to control their own needs and become a full member of society.
But that means in this context the phrase "sooner or later"?
Early, when it is - in six months or a year? Late, is when - three years or four?
And the simple answer is no and can not be.
Because everything is determined, at least, should be defined, namely your personal views about the timeliness and appropriateness. I emphasize again - personally yours!
No opinion grandmother, which clearly states that all her five children one year of age themselves wiping their own ass and have not been spoiled by the harmful and worthless diapers;
Not saying assertive neighbor Oksana, estimated that brand name viagra over the past six months she was able to save on diapers amount equal to 20 packages of washing powder;
Not definitive statements of major "professional" that diapers are harmful and you should be ashamed and do the time has come. "
You must clearly define the immutable rule: it's your child, it is you spend money on his clothes and diapers, this is you must in your child anything to organize or not organize. When and how your child will defecate, it is an internal affair of your family.
From the above rules is an obvious exception. Processes trucking physiological needs are internal matters for your family only on condition that this does not affect the existence of other families. The situation where a child urinates at the door at the neighbors, is not normal. But cited an exception only confirms the general rule.
So you've decided that really it's time.
The first thing you should know: something you know is not necessary. If you never got acquainted with the rules of habituation to the pot, if you've never opened the book with wise instructions, if not theory, you immediately decide to become a practitioner - success will come to you prenepremenno. Yes, there are problems, disappointment in myself and in a child, several scandals and tantrums, but the end result is predetermined.
Limit the amount of practical failures and misunderstandings by using the time of the theoretical information.
In this way we are going to do, perhaps.
*
From the moment of birth - and it's an obvious fact - the processes of urination and defecation child is not supervised. That is, these processes are subject to an unconditional reflexes - actions that do not require the participation of the cerebral cortex. Elementary task habituation to the pot in terms of clever terminology is given to the nature of the unconditioned reflex to make conditional - to subdue his will a particular young individual.
The success of retraining is determined by three factors:
1.
State (development) of the bodies directly involved in the processes of urination and defecation: the bladder, urethra, rectum, abdominal muscles, sphincters of the rectum and bladder (the sphincter - a special circular muscle, compressing the hollow body or closing out of it ).
2.
State (development) of the nervous system, primarily the cerebral cortex.
3.
Intensity of external influences or, more simply, the pedagogical activity relatives.
Three of these components are closely interlinked, but at this stage can make a very important conclusions, which, however, are quite obvious:
The sooner you start the process of habituation to the pot, the more effort is required of you.
Schooling to the pot the more successful, painless and easier than the higher level of physiological development of the child.
Practical experience confirms the above: the road to a pot full of tears, screaming children, work and disappointments, but only if you set off too early.
Very much patience and active parents can achieve excellent results even in the first year of life. Quite often uttered the proud declaration that the child is 10, 9, 8, even at 7 months empties the bladder by the command "pee-pee", and walks by and large only after the "ah". And this is not entirely surprising. Multiple pipikanem and aakanem difficult to achieve emergence of a conditioned reflex, but this reflex is not quite what we need.
Why? Yes, because this is the relationship between the process of emptying the bladder and the sound of "pee-pee." And if the sound is often pronounced and long, and if still does not get away until help because this connection is established sooner or later.
But the chain should be different: not "wee-wee" - filling the bladder - urinary, and filling the bladder - a pot - urination. That is an incentive to the pot should be a physiological process (filling of the bladder), and not a sound stimulus ("pee-pee").
Retribution for the early successes came in the second year of life. Supposedly capable and development, the child from 9 months of sitting on the pot, suddenly, for some "unknown" reasons, no longer do this and actively fight for their freedom with anxious relatives. And the reasons are very understandable, even - comes the time of formation of the very normal and natural control over the discharge of which we have already spoken. Bladder empty, and they immediately climb with his "pee-pee" ...
What would be "astounding success" you may have, but before 1.5 years of success, these will be temporary, but the episodes promashek - frequent. And this must include a very philosophical. No nothing at all wrong with that, you can save a certain number of diapers Lucky and to acquaint the child with such an interesting thing, as a pot. But this acquaintance, at least from the standpoint of medical science, it will be superficial, and develop skills not persistent.
However, the timing of formation of individual reflections, conscious fellowship with the pot can also occur as age one, but a situation where up to 3 years old "well it does not work" - is also not uncommon.
Therein lies the big problem. Concerned that not, parents are trying to actively influence the process. Potential impacts will certainly include elements of violence - to get to sit down, do not give up, to punish a puddle in the hallway. Consequence - a tantrum, the antipathy of the child in the process as a whole to the pot and relatives in particular.
Hence an important rule: if you can not - wait. Close the topic for 1-2 months, return to the familiar for the whole family diapers, do not bother wasting your and the child's psyche.
There are established experts physiological norms.
1.
Natural transition to the control of discharge begins after a year and actively "ripen" in the second year of life.
2.
The average age of a more or less stable "pot" of skills ranges from 22 to 30 months.
3.
Persistent conditioned reflexes are formed by age three.
All of the above - the theory that precedes the subsequent practical recommendations. But before moving on to specific advice, I would like to stress once again: trying to accustom the child to the pot to one year of age can only lead to savings of diapers (not least), but no relation to the formation of conscious control over excretory functions, these attempts have not.
Thus, the recommended time of accustoming the child to the pot varies in a wide age range - from 1 year to 3 years.
To make the process went as smooth as possible, you should know some signs of a mental and physiological readiness of the child's toilet to the knowledge of science.
These signs include:
*
establishment of a more or less stable regime stool;
*
the ability of a 1,5-2 hours to keep diapers in a dry condition;
*
knowledge of body parts and names of clothing;
*
knowledge or understanding of the words "pee" and "pokakal;
*
demonstration of negative emotions as a consequence of stay in the dirty (wet) diapers;
*
desire (ability) to undress themselves;
*
desire (ability) on their own input-output from the toilet.
And finally, the most reliable feature: the ability in any way - in short, antics, concrete sounds, gestures - to convey to parents the word "want".
*
Thus, all prerequisites are present. Desire to eat. Begin.
1. In addition to the child's readiness and willingness to be adults. Obviously, the transition from diaper to potty time spent on direct contact with the child significantly increased. You can not make toilet training only on Sundays, or only on days when expected to visit his grandmother.
2. The child, as, indeed, and every adult person is prone to changes in mood. Early stage of toilet learning is best done when all family members are healthy and cheerful.
3. Best time - summer. It is easier to get rid of clothes, fewer items to be washed in case of misses. Yes, and dries much faster than everything.
4. Acquainted with the potty. Offer it to the child when the probability of a "process" maximum - after sleeping, after eating, when the behavior of realized - it's time.
5. In case of success - a very, very praise. In case of failure - with all his might try not to grieve, if grieve - do not show grief.
6. We fix attention not only on the pot, but also on actions immediately prior to the hearing from the pot and parting with him: how to get a pot, as it is open, how to remove the pants, how to dress pants, and how and where to pour the contents of the pot as the pot wash how to close the pot and put it into place. Implementing all the above can easily converted into an interesting game. Wonderful if, after each successful implementation of the parents do not skimp on the praise - the whole process in this case is accompanied by positive emotions, and this is perhaps the most important transition.
7. Gradually organize meetings with the pot, not only when it is time to child, and if this requires a daily routine. For example, mandatory sits at bedtime, before taking a stroll.
8. Part from nappies irrevocably should not be. It is quite handy for travel in vehicles, at night, walk in cooler times of the year, initially and during daytime sleep. But every time when I woke up dry and quickly sat down on the pot - pay attention to what we are good fellows, and to confirm this obvious fact demonstrate a dry diaper.
9. The form of the pot, the color and the number of "gadgets" (musical accompaniment, twist-off pieces, painted eyes and protruding ears) have no fundamental significance. Importantly still, the pot was perceived not as a toy, but as a subject quite a specific purpose. And in this context should not be encouraged simply playing with the pot. "This is a chair. Sit on it "- and, by analogy, -" This is a pot to piss him and cocoa ". Preferably, however, that the pot was made of environmentally friendly plastics, was easy - the size corresponded to the pope, was not cold. The presence of the back (the pot in a chair) was not hurt.
10. Not fundamentally: a pot or bowl (assuming the existence of a special child seat). At this point as you prefer. Given the fact that, especially at first, the process can drag on, a pot handy, since the chat in a room better than in the close dressing area. Combining the pot with a toilet - a perfectly acceptable option, especially for boys. Special stool in the toilet, and with her help - there is simply fun and informed introduction to the world of adults. And if my father finds the time to show how it's done ...
*
The final observation of the practice.
Honestly, over two decades of a pediatrician, I have never encountered a situation where the parents of the normal four children go to the doctor about the fact that the child does not know how to use the potty.
But the sobbing mother whose two offspring pees in his pants - a fairly typical phenomenon. In this case, the main cause of regret is not the fact that our pants wet, and that all other long walk to the pot.
- And where did you get the idea that everyone else go?
- You say themselves!
On this occasion, remember a wonderful anecdote about how the pensioner Ivan complains sexologist: "Neighbours Pyotr Petrovich, like me, 70, and he says he can 3 times, and I generally can not!". A doctor advises: "So you say" ... I hope the analogy is clear.
Problems and causes for unrest gradually replace each other. Will keep the crown? Vylezut whether your teeth? Closes a fontanel? When, finally, he will sit down, get up, crawl, go? Is he still will repel the spoon? Did he or did not speak - have since turned a year, and besides "mama" and "give" any meaningful sounds is not observed?
The crucial feature is our way of life is an ongoing discussion of the problems concern not only the family but also take away their (problems) on public display in the process of communicating with friends, girlfriends, neighbors and colleagues.
As soon as some birthday you proudly claim that, say, "our Peter at 10 months he has gone," as prenepremenno among those present will show more "lucky" parent whose Vasya went to 9.5. A detailed study of the issue probably will expand the list of discussion of relatives and friends. The main outcome of the evening will be the unchallenged statement of Aunt Clara's neighbors about the fact that her great-nephew Arturchik walked alone in 8 months.
Left alone with yourself, you could not help wondering transformation of his own thoughts. During some hours of your favorite, most talented and best-developed boy Peter from the object of unswerving parental pride was transformed into the most common and most undistinguished child. Whether business Arturchik!
The next morning, calmed down, you'll find that eight plemennik Aunt Clara went on their own, mostly for themselves ...
And this is the subject of a separate discussion.
Theme of 'going under him, to which we came "a simple logical way" in the whole spectrum of children's issues stand out.
*
Ability to independently without the help of relatives, defecate is so obvious attribute of "maturity" that the desire to quickly see your child proudly sitting on the pot and no less proudly draw the then completely dry underpants is just unbearable.
Add fuel to the fire again, street information. It is easy to learn about the outstanding achievements of a young mother Oksana from the third entrance: her daughter and three months urinates on command "writ-pis. It is unlikely that you will be informed that the phrase "writ-pis" Oksana says for 30-40 minutes at a time, but it's done. Seed of doubt in a vulnerable parent fuse soul. And, taking off with a dry and cheerful Petit heavy morning diaper, you firmly decide: enough to be a little!
From that moment, your child's road to the pot (optional toilet). But, going on a journey, should be clearly understood: the mere kid is not coming soon to the target. You will have to be near him. Are you ready for this journey?
So let's sit down in front of the road and think.
And, above all, that's what.
Do you know many kids who went to school, unable at this self-defecate?
The answer is unequivocal - a little, or rather, do not know. At least when it comes to a child who went to mainstream schools.
You strongly need to be aware that if the child has severe congenital or acquired pathology, then sooner or later he will learn to control their own needs and become a full member of society.
But that means in this context the phrase "sooner or later"?
Early, when it is - in six months or a year? Late, is when - three years or four?
And the simple answer is no and can not be.
Because everything is determined, at least, should be defined, namely your personal views about the timeliness and appropriateness. I emphasize again - personally yours!
No opinion grandmother, which clearly states that all her five children one year of age themselves wiping their own ass and have not been spoiled by the harmful and worthless diapers;
Not saying assertive neighbor Oksana, estimated that brand name viagra over the past six months she was able to save on diapers amount equal to 20 packages of washing powder;
Not definitive statements of major "professional" that diapers are harmful and you should be ashamed and do the time has come. "
You must clearly define the immutable rule: it's your child, it is you spend money on his clothes and diapers, this is you must in your child anything to organize or not organize. When and how your child will defecate, it is an internal affair of your family.
From the above rules is an obvious exception. Processes trucking physiological needs are internal matters for your family only on condition that this does not affect the existence of other families. The situation where a child urinates at the door at the neighbors, is not normal. But cited an exception only confirms the general rule.
So you've decided that really it's time.
The first thing you should know: something you know is not necessary. If you never got acquainted with the rules of habituation to the pot, if you've never opened the book with wise instructions, if not theory, you immediately decide to become a practitioner - success will come to you prenepremenno. Yes, there are problems, disappointment in myself and in a child, several scandals and tantrums, but the end result is predetermined.
Limit the amount of practical failures and misunderstandings by using the time of the theoretical information.
In this way we are going to do, perhaps.
*
From the moment of birth - and it's an obvious fact - the processes of urination and defecation child is not supervised. That is, these processes are subject to an unconditional reflexes - actions that do not require the participation of the cerebral cortex. Elementary task habituation to the pot in terms of clever terminology is given to the nature of the unconditioned reflex to make conditional - to subdue his will a particular young individual.
The success of retraining is determined by three factors:
1.
State (development) of the bodies directly involved in the processes of urination and defecation: the bladder, urethra, rectum, abdominal muscles, sphincters of the rectum and bladder (the sphincter - a special circular muscle, compressing the hollow body or closing out of it ).
2.
State (development) of the nervous system, primarily the cerebral cortex.
3.
Intensity of external influences or, more simply, the pedagogical activity relatives.
Three of these components are closely interlinked, but at this stage can make a very important conclusions, which, however, are quite obvious:
The sooner you start the process of habituation to the pot, the more effort is required of you.
Schooling to the pot the more successful, painless and easier than the higher level of physiological development of the child.
Practical experience confirms the above: the road to a pot full of tears, screaming children, work and disappointments, but only if you set off too early.
Very much patience and active parents can achieve excellent results even in the first year of life. Quite often uttered the proud declaration that the child is 10, 9, 8, even at 7 months empties the bladder by the command "pee-pee", and walks by and large only after the "ah". And this is not entirely surprising. Multiple pipikanem and aakanem difficult to achieve emergence of a conditioned reflex, but this reflex is not quite what we need.
Why? Yes, because this is the relationship between the process of emptying the bladder and the sound of "pee-pee." And if the sound is often pronounced and long, and if still does not get away until help because this connection is established sooner or later.
But the chain should be different: not "wee-wee" - filling the bladder - urinary, and filling the bladder - a pot - urination. That is an incentive to the pot should be a physiological process (filling of the bladder), and not a sound stimulus ("pee-pee").
Retribution for the early successes came in the second year of life. Supposedly capable and development, the child from 9 months of sitting on the pot, suddenly, for some "unknown" reasons, no longer do this and actively fight for their freedom with anxious relatives. And the reasons are very understandable, even - comes the time of formation of the very normal and natural control over the discharge of which we have already spoken. Bladder empty, and they immediately climb with his "pee-pee" ...
What would be "astounding success" you may have, but before 1.5 years of success, these will be temporary, but the episodes promashek - frequent. And this must include a very philosophical. No nothing at all wrong with that, you can save a certain number of diapers Lucky and to acquaint the child with such an interesting thing, as a pot. But this acquaintance, at least from the standpoint of medical science, it will be superficial, and develop skills not persistent.
However, the timing of formation of individual reflections, conscious fellowship with the pot can also occur as age one, but a situation where up to 3 years old "well it does not work" - is also not uncommon.
Therein lies the big problem. Concerned that not, parents are trying to actively influence the process. Potential impacts will certainly include elements of violence - to get to sit down, do not give up, to punish a puddle in the hallway. Consequence - a tantrum, the antipathy of the child in the process as a whole to the pot and relatives in particular.
Hence an important rule: if you can not - wait. Close the topic for 1-2 months, return to the familiar for the whole family diapers, do not bother wasting your and the child's psyche.
There are established experts physiological norms.
1.
Natural transition to the control of discharge begins after a year and actively "ripen" in the second year of life.
2.
The average age of a more or less stable "pot" of skills ranges from 22 to 30 months.
3.
Persistent conditioned reflexes are formed by age three.
All of the above - the theory that precedes the subsequent practical recommendations. But before moving on to specific advice, I would like to stress once again: trying to accustom the child to the pot to one year of age can only lead to savings of diapers (not least), but no relation to the formation of conscious control over excretory functions, these attempts have not.
Thus, the recommended time of accustoming the child to the pot varies in a wide age range - from 1 year to 3 years.
To make the process went as smooth as possible, you should know some signs of a mental and physiological readiness of the child's toilet to the knowledge of science.
These signs include:
*
establishment of a more or less stable regime stool;
*
the ability of a 1,5-2 hours to keep diapers in a dry condition;
*
knowledge of body parts and names of clothing;
*
knowledge or understanding of the words "pee" and "pokakal;
*
demonstration of negative emotions as a consequence of stay in the dirty (wet) diapers;
*
desire (ability) to undress themselves;
*
desire (ability) on their own input-output from the toilet.
And finally, the most reliable feature: the ability in any way - in short, antics, concrete sounds, gestures - to convey to parents the word "want".
*
Thus, all prerequisites are present. Desire to eat. Begin.
1. In addition to the child's readiness and willingness to be adults. Obviously, the transition from diaper to potty time spent on direct contact with the child significantly increased. You can not make toilet training only on Sundays, or only on days when expected to visit his grandmother.
2. The child, as, indeed, and every adult person is prone to changes in mood. Early stage of toilet learning is best done when all family members are healthy and cheerful.
3. Best time - summer. It is easier to get rid of clothes, fewer items to be washed in case of misses. Yes, and dries much faster than everything.
4. Acquainted with the potty. Offer it to the child when the probability of a "process" maximum - after sleeping, after eating, when the behavior of realized - it's time.
5. In case of success - a very, very praise. In case of failure - with all his might try not to grieve, if grieve - do not show grief.
6. We fix attention not only on the pot, but also on actions immediately prior to the hearing from the pot and parting with him: how to get a pot, as it is open, how to remove the pants, how to dress pants, and how and where to pour the contents of the pot as the pot wash how to close the pot and put it into place. Implementing all the above can easily converted into an interesting game. Wonderful if, after each successful implementation of the parents do not skimp on the praise - the whole process in this case is accompanied by positive emotions, and this is perhaps the most important transition.
7. Gradually organize meetings with the pot, not only when it is time to child, and if this requires a daily routine. For example, mandatory sits at bedtime, before taking a stroll.
8. Part from nappies irrevocably should not be. It is quite handy for travel in vehicles, at night, walk in cooler times of the year, initially and during daytime sleep. But every time when I woke up dry and quickly sat down on the pot - pay attention to what we are good fellows, and to confirm this obvious fact demonstrate a dry diaper.
9. The form of the pot, the color and the number of "gadgets" (musical accompaniment, twist-off pieces, painted eyes and protruding ears) have no fundamental significance. Importantly still, the pot was perceived not as a toy, but as a subject quite a specific purpose. And in this context should not be encouraged simply playing with the pot. "This is a chair. Sit on it "- and, by analogy, -" This is a pot to piss him and cocoa ". Preferably, however, that the pot was made of environmentally friendly plastics, was easy - the size corresponded to the pope, was not cold. The presence of the back (the pot in a chair) was not hurt.
10. Not fundamentally: a pot or bowl (assuming the existence of a special child seat). At this point as you prefer. Given the fact that, especially at first, the process can drag on, a pot handy, since the chat in a room better than in the close dressing area. Combining the pot with a toilet - a perfectly acceptable option, especially for boys. Special stool in the toilet, and with her help - there is simply fun and informed introduction to the world of adults. And if my father finds the time to show how it's done ...
*
The final observation of the practice.
Honestly, over two decades of a pediatrician, I have never encountered a situation where the parents of the normal four children go to the doctor about the fact that the child does not know how to use the potty.
But the sobbing mother whose two offspring pees in his pants - a fairly typical phenomenon. In this case, the main cause of regret is not the fact that our pants wet, and that all other long walk to the pot.
- And where did you get the idea that everyone else go?
- You say themselves!
On this occasion, remember a wonderful anecdote about how the pensioner Ivan complains sexologist: "Neighbours Pyotr Petrovich, like me, 70, and he says he can 3 times, and I generally can not!". A doctor advises: "So you say" ... I hope the analogy is clear.
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