PREFACE                                                                                                                Page 1 of 2

(Beside the acknowledgements, I wanted the Arab reader to realize that the book came as a result of a project on which there was a lot of consultation, research, and cooperation. This in itself is a novelty to the Arab reader.)

          The idea for the guidebook came about from an awareness of the importance of the first five years of life in the development of the human being, especially his personality; also from an appreciation of the big role that the family, especially the mother, plays in this stage of development.

          The development of the human element is the basis and objective of any socioeconomic development. The development of this element structurally and actively depends a great deal on what he receives and what influences him in the home. The role of the mother stands out here in the development of the personality of the human being and citizen. Therefore, the Arab woman should be aware of her important responsibility in bringing up her children according to available scientific information and proper knowledge. This book is a humble attempt to contribute in that direction.

          It was not put together to be the last word on the subject. We hope to get all the comments that both mothers and specialists have for future effort.

          This book was prepared especially for the Arab woman, that is, relevant to her needs and in harmony with her environment. As such, we had to know the prevailing custom s and practice s in Arab society, in an effort to tie what is good and useful from it with modern scientific knowledge while eliminating misconceptions and harmful practices. We do find differences in local customs between one Arab country and another but if we look at basic attitudes in childrearing, we find one Arab culture! Therefore our book addresses the Arab woman wherever she may be.

          How was this book produced?

          In order to know the prevailing customs in Arab society and the specific problems of this stage of development (from pregnancy to five years), library research was carried out to collect information on the physical, mental and social growth characteristic of this period.

          Then we interviewed people who have been working with mothers and children: doctors, midwives, social workers, and nursery school teachers in the cities of Beirut and Tripoli and some villages in Lebanon. We learned some of the pressing problems they felt in working directly with mothers and children.

          After writing the chapters, we took parts of them to mothers with no higher than elementary education, to read and comment on. This gave us an idea of the extent of the mothers understanding of the book and the comprehensiveness of the book on the topics under discussion.

          The last stage was putting the book in draft form and sending it to WHO, UNESCO, FAO and specialists in various Arab countries. Their valuable comments were incorporated into the final draft.

          This book was able to come out as a result of a UNICEF Project, as part of its total efforts in the service of the Arab child. UNICEF gave me the opportunity to work full time on this project and build it on a basis of research, and consultations with doctors and specialists. The Ford Foundation cooperated by giving UNICEF a grant for the project that provided us with research assistants and consultants.

          I would like to extend special acknowledgements to Mr. James McDougall, Regional Director, UNICEF, and to Mr. Courtney Nelson, Ford Foundation Representative for the Middle East, for their personal concern for the project, and for providing it with the necessary support to complete it.

          My acknowledgements to all who helped realize this project, especially:

1.       Dr. Jamal K. Harfouche: for reviewing the manual in parts and as a completed draft, and for her valuable comments.

2.       Dr. Ali El-Hassan and Dr. M. Selim for their comments on some chapters.

3.       Misses Fakhury, R. Madi, and H. Hallab for their valuable contribution as research assistants, collecting information and interviewing pediatricians, midwives, and social workers and teachers.

4.       Dr. Afif Demechkiey for editing the book.

5.       Mrs. S. Khoury and Mrs. S. Shaloohy for typing drafts and manuscript.

6.       Mr. Farid Haddad for illustrating the manual and designing it.

          May I be permitted to thank my husband Ali Othman for being unusually patient in discussing endless questions about Arab society.

          In closing, the most this cooperative effort hopes to achieve is to realize its objectives and become one stone in the new Arab structure.

Chapter 1.            Why the Guidebook?

(I tried to explain why the guidebook has been written and to relate it both to national pride and to personal needs and motives. Here is a translation.)

          You might be expecting your first child or maybe you have just become a mother very recently. In both cases, you are so happy with the fact of your motherhood that you have decided to shower your baby with all the love and tenderness in the world.

          However, you know that love and tenderness are not enough to bring a baby up and you are anxious to know the best possible ways of providing your baby with good health and security. You feel apprehensive about the colossal responsibility that will be yours. Perhaps an awareness of this feeling provided our primary motive in trying to put this manual within your reach, to help you in caring for your child.

          The objectives of the guidebook are basically threefold:

1.                  First, to emphasize the importance of the early years of life in relation to the development of a human being in general, and his future abilities, skills, attitudes and values, specifically. Doctors, psychologists, and educators believe that what happens in this early period influences to a great extent the future growth of the individual physically, mentally, and socially, and may lead to patterns and traits that are difficult to change later in life.

2.                  Second, to indicate the importance of the role of the mother in the child’s growth. It is a role that starts with conception. Her uterus is the natural environment where the embryo forms and grows until birth. After birth, she is feeding her child with her milk. This organic biological relationship ends with weaning, but the child is still dependent on her for its needs: feeding, cleanliness, clothing and protection from diseases and dangers, as well as giving the child the opportunity to develop mentally. Also, her responsibility is to teach him good habits and various skills such as language and thought, self-reliance, and values that will influence his future ability to learn both outside the school and inside it. Every Arab mother should be aware that the child who is not given enough opportunities to develop mental abilities and acquire good habits early in life will lose its chance to become a creative person able to contribute to the building of a better Arab society.

3.                  Third, we belong to an ambitious nation that boasts a glorious past, but we are aware that it is a developing nation highly motivated towards evolution and modernization. We do have a good heritage that has been passed from one generation to the other. This heritage has many good traditions that we must retain but it does also have some harmful practices that are obstacles to progress and, therefore, we must try to leave them behind.

          If we look into the area of childcare, we find that we love children. The child’s ties with the mother are strong, but so are they with all the members of the family: the father, the older siblings and the grandparents. The harmful practices are the result of traditional misconceptions, such as not cleaning the babies’ faces, and especially their eyes, so that they will not be beautiful and, therefore, will he protected from the evil eye. Such practices are starting to disappear as a result of education and the spread of knowledge. Fear of vaccination, viewing obesity as a sign of health, or using fear-provoking situations to control the child’s behavior are some other traditional misconceptions about childrearing.

          We don’t want to copy blindly from the West, the rationale being that they have reached the peak of modernization; but, at the same time, we don’t want to fossilize our traditions and not make use of the good results of modern science in the fields of nutrition and education, for example.

          The woman on the threshold of motherhood today is in conflict between the old and the new. She asks herself, “Shall I follow the advice of my mother and grandmother literally? Or shall I refuse everything that comes from them just because it is traditional?” To her, we hope that this manual will be a help in her ambivalence.

          In the manual itself after discussing pregnancy and some of its major problems, we have divided the period of birth to 5 years as follows:

1.                  The child in its first year;

2.                  The child from one to three;

3.                  The child from three to five.

          This is followed by chapters on First Aid, Nutrition, and Children’s Diseases, as reference chapters for the mother who would like to know more about these topics.

          The first five years that we have dealt with in this manual are the important years of the pre-school period. Though each age group has its own characteristic problems and issues, a number of important issues repeatedly come up in every one of the three stages. We have stressed concern for protection from disease, malnutrition, and accidents, keeping in mind that infant mortality in developing countries could reach between 40 to 50% of total deaths, as compared with 5% for developed countries.

Chapter 2.             Pregnancy

          An introductory page discusses the sex of the future child, touching on the preference for boys in Arab countries and the tradition of condemning “mothers of girls.” An attempt is made to clear up misconceptions about the mother’s responsibility in determining the sex of the child. It also discusses the changing attitude toward women in Arab countries and the new opportunities for women to work and have vocations plus the unchanging fact that girls will be the mothers of future generations and, therefore, have double responsibilities and opportunities.

Conception:

-         How it occurs;

-         The fertilized ovum already has the determined characteristics of the individual, those that are inherited;

-         The individual’s personality and development are the result of both heredity and environment;

-         Environment is responsible for socially learned traits and characteristics, hence, the importance of the family in the early years.

Stages of Pregnancy:

-         Conception and 3 months

-         3 months to 6 months

-         6 months to 9 months

-         What the pregnant mother should do to protect herself and her child.

-         What the pregnant mother should avoid.

Chapter 3.            The Child in its First Year

A General Introduction to the First Year of Life

          How it is characterized by rapid growth: from an immobile, relatively helpless creature to a creature with specific abilities and a definite awareness of the physical and social world around him, and with certain likes and dislikes.

          Do parents, and especially the mother, have a role to play during this period besides providing the child with nutritive food and protection from disease and accidents? Does the intellect or mind grow during this period? How is this manifest and what can be done to stimulate growth and development?

          Three basic principles about growth are briefly discussed.

-         That a healthy body is the right vehicle for the development of a healthy mind, especially in the early years.

-         That a child becomes ready to learn as the result of maturation, so teaching tasks and skills before the child is ready becomes a futhe frustrating exercise.

-         Every child has his own rate of development. Though this book presents different stages of development and corresponding average ages, what is important for each individual child is not the specific age, but the sequence. Symptoms of extreme retardation, however, should be acknowledged and an effort made to find out what is wrong.

The Newborn and Its Mother

          This subject is given a lot of attention, not just because of the novelty of the situation for the new mother but because we found that there is a high percentage of infant mortality during the first month of life in Arab countries. This is often due to ignorance and unhealthy traditional practices related mainly to treatment given to eyes, umbilical cord, and nipples, as well as to the use of pillows and over-bundling the child. The mother who has just delivered is also bound by many traditional practices, some of them very useful, but some quite harmful. Harmful practices would include not moving for 40 days and not bathing during this period. Useful practices would include feeding with high-protein foods such as chicken and chicken soup and sweets and nuts, even in the poorest homes. The new mother is also spared bad news or anger during this period, but could suffer from over-visiting. It is traditional for women to come in at any the to have coffee and chatter in the same room with the mother and the baby, even if the visitors or their accompanying children are sick.

          Therefore, correct information is given along with an explanation of the traditional practice, whether useful or harmful, on the following topics. Special stress is given all through the chapter on the value of breast-feeding.

1)     Care of the mother who just delivered, mainly hygiene (bath and clean nipples) and diet.

2)     Care of the newborn:

a)     Warmth: excessive heat is as bad as cold (traditional fear of cold results in overclothing and overbundling)

b)     Eyes- wipe eyes with pre-boiled water or cold tea (traditional practice of Kohl is not in itself harmful, but its application can be a source of infection)

c)     Umbilical cord - clean with alcohol (traditional practices vary from use of talcum power to ground coffee applied in an effort to dry it; such practices often cause infection)

d)     Nipples - leave swallowed nipples of newborn that have milk untouched. (Traditional practice is to squeeze milk out to relieve baby -- another source of infection.)

e)     Bath - Traditional practice of “salting’” -- rubbing salt for 3 days over babies’ bodies is not necessary and may lend to skin chafing. Steps in bathing a child:

i)        How often?

ii)      Do not use powder, but olive oil, which is found in most Arab homes.

f)       Clothes - swaddling: the traditional practice of tying the baby, though it has become more tolerable, is still widely practiced. The physical disadvantages of swaddling are discussed.

g)     Clothes should be made from washable cotton

h)     Diapers

i)        How to diaper

ii)      How to clean diaper area

iii)     How diapers should be cared for

i)   Sleep

i)        Amount of sleep typical and needed, during this period

ii)      How essential it is for growth

iii)     Role of mother in timing sleep

(a)  a separate cot for the child to avoid cases of strangulation when an exhausted mother could sleep over child

(b)  some sort of regularity in feeding and bathing helps both mother and child

iv)    Shaking or rocking child to sleep is very traditional, to the point where children never sleep unless carried or shaken to sleep

v)      Position during sleep: the practice of putting a child on its stomach and not on its back is encouraged and advantages discussed.

Feeding

          The preferable way to feed is to breast-feed and not bottle feed (bottle feeding became very fashionable recently because of a false belief that western babies are healthy (fat) because they are bottle fed).

-         Why mother’s milk is better

-         Advantages of breastfeeding to mother herself (there is a widespread belief among middle class mothers that breastfeeding spoils the beauty of their breasts)

-         Conditions that are conducive to breastfeeding

-         How to breastfeed

-         Timing breastfeeding to establish some schedule that the baby is encouraged to follow. A happy medium between giving the breast at every cry and turn of the baby and a rigid time schedule.

-         Night-feeding: breastfeed the child at night until it starts sleeping through, a sign that it isn’t needed anymore.

-         Conditions that prevent breastfeeding.

Bottle Feeding is discussed as an alternative when breastfeeding is not possible. Stress on method, mainly sterilization, choice of milk (kinds of milks available discussed), left-over milk (a source of intestinal trouble in our countries).

Introducing Solids

          This is discussed at length - - both the why and the how. Research reports show that the most critical period of growth for Arab children is from 6 months to 2 years where malnutrition and infections form the two components of a vicious circle. The problem is the result of improper feeding during the period of transition between milk diet, weaning, and regular family diet. A schedule of feeding is suggested built around local foods with inexpensive mixtures as alternatives to expensive high proteins.

Weaning

          The advantages of the gradual method of weaning, both physical and psychological, are stressed as an alternative to the traditional. The traditional is abrupt weaning by using bitter substances on the breast or separating the child from its mother by sending it to relatives. Gradual weaning becomes a simple and healthy process if the child has been introduced to solids.