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Daily Dose

Toddler Milestone

1:30 to read

I love doing 12 and 15 month check ups and seeing all of the “tricks” that a child that age has learned. While we routinely have parents fill out developmental questionnaires prior to their check up, I am still old school and like to ask lots of questions and have them demonstrate things that their children have learned while I  am in the exam room and can observe them

 

I sometimes have to laugh as I ask, “can they wave bye bye?”, or “can they point to their body parts?”, and the poor parents are desperately trying to get their child to demonstrate their newest milestone (trick) but alas, the child is just not interested in “performing” at that minute!! I now how frustrating that is for the parent…but it is just cute to me. We parents sometimes act like our children (and grandchildren) are circus acts…and have to perform on cue. But they are smarter than we are and will decide when they want to show off!! 

 

But there are a few times when I am watching a child whose parents have filled out the developmental questionnaire and it seems all is normal…but when I am in the room I have a few concerns that the child may have not reached a milestone yet…despite what the parents say. Again, I am only in the room with the child for 15-30 minutes, but in that time you do get a lot of both non- verbal and verbal communication. In those cases, if my concerns are not great I make a “note to self” in the chart to re-visit the milestone at the next check up. I also know when parents are concerned that I did not see “the trick” and within the next days or weeks they send me the video of their child waving or saying bye-bye or pointing to their nose!!  

 

Remember, we too do not always “perform’ on command and do not to worry if your child picks their pediatric visit as the time to go on a performance strike. There are other days that “the show will go on” and I get to see the cute trick..often just as I am walking out the door.

 

Daily Dose

Early Talkers

1.15 to read

Is your child a precocious talker?  Most children start to acquire words around 12-15 months, but that means 5-10 words and building. By the time a child is 18 months old they are often mimicking when you ask them to say a word, and some are putting 2 words together. This is all very normal development. But there are few children who are just “early talkers” who are speaking in full sentences by the time they are 18-24 months! 

I think having such a verbal child during the early toddler years is both a “blessing and a curse”. I know that from raising my own children, where my oldest was quite verbal by 20 months, and was “bossing us around” before age 2!!  I also see this same dilemma in my little patients.  While some parents are worried that their 2 year old does not put 3-4 words together, others want to know how you can stop the chatter.  Parents.....we always have issues. 

Example:  When I come into the exam room for a 2 year old check up, the precocious talker looks up and says, “Hi Dr. Sue...what took you so long?”.  Or they may tell their parent that they “don’t need any help” as I ask them to climb on the exam table. Recently a little boy looked right at his mother and said, “I’ve got this”, when I asked him to take off his shoes.  

On another day a little girl was impatient to leave and kept asking her mother if they could go to the park after they left my office.  The mother kept telling the little girl, “maybe” . Finally, exasperated, the 2 year old said, “what’s the answer, yes or no?””  How do you keep a straight face? 

A verbal child can bring you to your knees, both laughing and sometimes wanting to cry.  How can a 2 year old know just what to say to make a parent feel inadequate?  Is it inborn? This seems to be especially true if you have had another child and the 2 year old is instructing you on how to parent “their baby”.   

So, if your child is a talker write down all of those clever sentences they blurt out......one day you will look back and laugh.  I often saw myself in my 2 year old as he told complete strangers , “my mommy says my baby brother cries all of the time, and he has colic!”  Out of the mouth of babes, and I still remember it.  Bittersweet.

Daily Dose

Ear Tubes

1:00 to read

I had been seeing a 3 year old VERY verbal patient for several months as he would intermittently complain to his mother that his “ears were ON?”.  He would tell her this off and on but could not explain what he meant by this statement. He did not say his ears hurt, he did not have a fever, he was sleeping well….but he seemed to be bothered enough to talk about it from time to time.

 

His mother brought him in to see me a few times and his exam was normal…but one day when she brought him in I noticed that he had clear fluid behind his ear drum(serous otitis). His eardrum was not inflamed and his exam was otherwise normal.  When a child has fluid behind their ear drums it is not always a sign of infection, and in this case you watch and see if the fluid goes away on its own. 

 

Well, he continued to talk to his mother about his “ears being ON”, and he even told his teachers a few times.  Because he continued to talk about it ( over about 3 months) I sent him to see a pediatric ENT.

 

When the ENT saw him he also noted that he had some fluid behind one of his ear drums. Because he had had persistent fluid it was decided to place ear tubes….

 

And guess what? Once he had ears tubes placed he told me his “ears had turned off”!!  I guess he sometimes felt funny or heard sounds differently and that was his way to express his ear issue - on and off! What took me so long?

Children continue to amaze me. 

Daily Dose

Toddler Constipation

1:30 to read

I get so many questions about toddlers and constipation.  Constipation relates to stool frequency and consistency.  It is important to understand that everyone has different bowel habits and not all children will have a stool every day.  While some children will have several stools a day another may have a stool every 2 -3 days. Both of these scenarios may be normal and not an indicator of problem.  At the same time, stool consistency is important. If your child has  hard, dry, pebble like stools ( rocks rather than softer snakes or blobs ) this may be an indicator of constipation. Everyone will occasionally have a hard stool, but this should not occur consistently. Lastly, it should not be painful to pass the stool. While toddlers may grunt or push, or even start to “hide” to poop, it should not cause real pain.

With all of that being said, it is not uncommon for toddlers to become constipated as they often are also becoming picky eaters. Due to this “phase”,  some young children will drink too much milk in place of eating meals and this may lead to constipation. Your toddler should be drinking somewhere between 12 -18 ounces of milk per day.  Many children also load up on other dairy products like cheese, yogurt and cottage cheese, which while healthy, may also lead to too much dairy intake and contribute to constipation.

Water intake is also important to help prevent constipation. If your child is drinking too much milk, substitute some water as well.  It is a balancing act to make sure your child is getting both milk and water. If necessary I will also put the smallest amount of apple or prune juice in the water. By the age of 1 year, your child should no longer have a bottle as their main source of nutrition is no longer in the liquid form!

Fiber is also important so offer plenty of whole grains and limit the “white foods” that toddlers love (yes, the bread, cereal, pasta). If you always buy whole wheat pasta and whole grain breads your children will never know the difference. Stay away from processed white foods whenever possible.  It is also easy to throw flax seed or bran into muffins or smoothies (disguising fiber). I also sometimes use Metamucil cookies (they are pre made) and may even resort to dot of icing smeared on it and offer it as a cookie for snack, along with a big glass of water.

Fruits and veggies are a must…even if you think your child won’t eat them! Your toddler needs 2 servings of fruits and veggies every day and rotate what you offer them.  You will be surprised at how one day they may refuse something and they next they will eat it. Don’t give up on fruits and veggies,  it may literally take years for your child to eat peas…but if they aren’t offered a food repetitively they will probably never it eat. I know a lot may get thrown to the floor but just clean it up and persevere.  Not only will this help their stools but their long term healthy eating habits as well.

Movement is also important to help keep the bowels healthy and “moving”.  Making sure that your toddler is moving seems crazy, as they are on the go all of the time.  But with an older child make sure they are getting plenty of time for play and exercise outside or in…and not just sitting in front of a screen.

Lastly, for short term issues with constipation it is also okay to try using milk of magnesia (MOM) or even Miralax….but ask your doctor about dosing in toddlers.   

Your Toddler

High Chair Recall Due to Fall Danger

1:30

Nuna Baby Essentials has recalled eight models of their baby high chairs because the arm bar can bend or detach during use, posing a fall hazard to children.

Nuna has received 50 reports of the arm bar detaching, including six reports of children falling from the high chair. Four incidents resulted in injuries, including bruising and a cut on the forehead.

This recall includes ZAAZTM high chairs in eight models: HC-07-004 (pewter), HC-07-005 (carbon), HC-07-006 (plum), HC-07-009 (almond), HC-08-004 (pewter), HC-08-005 (carbon), HC-08-006 (plum) and HC-08-009 (almond). ZAAZ and the model number are printed under the high chair seat on a white sticker. These high chairs look like a regular kitchen table chair and have removable trays, arm bars footrests, seat pads and harnesses so that they can convert into toddler chairs. “Nuna” is printed above the footrest of the unit.

The high chairs were sold at Albee Baby, Giggle, Magic Bean, Nordstrom and other specialty stores nationwide and online at www.nuna.eu and www.wayfair.com and other online retailers from February 2013 through November 2015 for about between $250 and $300. 

Consumers should immediately stop using these recalled high chairs and contact the firm to receive a free new arm bar and instructions on how to replace it.

For more information, Nuna Baby Essentials has a toll-free number at 855-686-2872 from 8:30 a.m. to 4:30 p.m. ET Monday through Friday. Or consumers can go online at www.nuna.eu/usa/ and click on “Product Recall” under the “Support” section on the sidebar of the homepage for more information.

Source; http://www.cpsc.gov/en/Recalls/2016/Nuna-Baby-Essentials-Recalls-High-Chairs/

Daily Dose

Toddlers & Tantrums

1.15 to read

I see toddlers for check ups nearly every day and for both the 15 month and 18 month visit, there are many challenges for parents and the pediatrician (and of course the child). Toddlers are not at what I would call an EASY age.

As you know if you have a toddler, they are quite moody (just wait for teenagers) and they can “stop, drop and roll” into a tantrum in the blink of an eye.  So while I was examining an 18 month old this week ( she is one of three adorable girls), she suddenly became infuriated (her mother and I were really clueless as to what triggered this) and she jumped off of her mother’s lap and fell to the floor kicking and screaming. 

Now, for a first time parent this might be alarming behavior, but for a seasoned mother of three it was really no big deal. Appropriately, we all just ignored her as she laid on the floor and screamed (no, the mother was not worried about germs on the floor either) and we continued our conversation about her child’s less than stellar sleep habits.

After a few minutes her daughter calmed down, the older sisters got her a sticker and she left without a fuss. Her mother had already learned, like we all do, that the best way to stop tantrums is by ignoring them and letting your toddler have some time to “express her emotions” with age appropriate (although inappropriate for older children) behavior.  

Several days later, her mother sent me an email with another picture attached of the same child having yet another tantrum after she found her in her diaper with a sharpie pen happily marking all over herself (the photo above). Of course, the minute she took the marker away her daughter fell to the floor again to express her outrage! So funny that her mom thought to document it and send me another picture.

By the way, she also told me that she had taken practical advice and was working on having her daughter cry herself to sleep and it was working well!  Both the tantrums and sleep were improving by just ignoring her behavior. Back to those laws of natural consequences.  

Your Toddler

Noisy Homes May Influence Toddler’s Vocabulary

1:00

Have you ever had a hard time understanding someone speak in a noisy restaurant? Imagine if you were trying to learn a new language. That’s just what toddlers are trying to do, learn a language. According to a new study, toddlers learn new words quicker when their environment has less background noise.

"Modern homes are filled with noisy distractions such as TV, radio and people talking that could affect how children learn words at early ages," said study leader Brianna McMillan.

"Our study suggests that adults should be aware of the amount of background speech in the environment when they're interacting with young children," said McMillan, a doctoral student in psychology at the University of Wisconsin at Madison.

Researchers from the university assessed the ability of 106 children, aged 22 to 30 months, to learn new words. They found they were more successful when their surroundings were quiet than when there was background noise.

However, researchers noted that providing the children with additional language cues helped them overcome the detrimental effects of a noisy location.

"Hearing new words in fluent speech without a lot of background noise before trying to learn what objects the new words corresponded to, may help very young children master new vocabulary," said study co-author Jenny Saffran, a professor of psychology.

Sometimes, you simply can’t avoid a noisy environment- especially if there are other children around. Saffron says there is a way to overcome that.

“… When the environment is noisy, drawing young children's attention to the sounds of the new word may help them compensate," she added.

Story source: Robert Preidt, https://consumer.healthday.com/kids-health-information-23/child-development-news-124/noisy-homes-slow-toddler-s-vocabulary-713013.html

 

 

Daily Dose

Toddler Behavior

1.30 to read

Do you have a toddler? If so you are in the throes of some difficult, albeit sometimes funny, yet inappropriate behavior. It happens to every parent...suddenly their precious child turns into Dr. Jekyll and Mr. Hyde.  Somewhere around 15-18 months, you will most likely see this change in behavior. Although most books refer to the “terrible twos” I really think it is the “me no wanna” 18-30 month old. 

“Me no wanna” is the phrase we often used around our house, and it was coined when the boys were toddlers. It just seemed like the best line when our sweet toddler would rather have a tantrum than do the simple task that we wanted him to do. Example: please put your toy back in the box. “Me no wanna”, I would prefer to fall to the floor and scream.   

How is it that your typically sweet 20 month old child can be in middle of playing nicely and then suddenly seems possessed as they fling themselves to the floor kicking and screaming?  What is the matter?  Are they having a seizure? Or is it that “something” just didn’t seem right to them and they are angry and frustrated???  How can they change behavior so quickly.?   (hint, foreshadowing for those teen years). 

You never know with a toddler what kind of answer you will get when you say something as easy as “let’s get on your shoes to go outside”. Sometimes they happily run get the shoes, bring them to you, sit down and the shoes go on licitly split.  The next time they get the shoes, throw them across the room, lay on the floor and look at you like “me no wanna”. 

Trust me, you are not a “bad” parent, you are just living through some really challenging parenting. It is exhausting at times, but while this age is typically difficult it is some of your most important parenting. This is really the beginning of behavior modification.  Your brilliant toddler is testing you, this may be the first time you the parents understand why everyone talks about boundaries and consequences. 

Some children also express their “me no wanna” by acting out with hitting, biting and kicking. Again, very inappropriate behavior. Your job is to change that behavior by using time out, or taking away a toy or even putting the child to bed early.. There are so many ways to start letting your toddler know that there are consequences for misbehaving, and that tantrums don’t work. 

I am in throes of “me no wanna” again, only this time it is with a puppy! Seems very similar to me.

Daily Dose

Car Seat Safety

1:30 to read

As a pediatrician, I remind parents from the time they leave the hospital for the first ride home with their newborn, until their child is at least 4 years of age that their child needs to be well secured in a car seat!! I have written articles with updated guidelines for car seat safety, including the recommendations that a child remain in a rear facing car seat until at least 2 years of age. I have done TV segments on how to install a car seat…..but I had not installed a car seat in my own car. 

 

So last week I found myself with my husband perusing the aisles of our local “baby store” for a car seat for our now toddler granddaughter.  We arrived with lists of questions and Consumer Report rankings trying to figure out the “best and safest” car seat. It was certainly a lesson in knowing that there is not a “one size fits all” when choosing a car seat. We left the store over an hour later, with a large box and several hundred dollars “poorer”, but confident that we had made a good choice.

 

Next, time to put the car seat in the back seat of my car so that we could pick up our grand daughter for an event. We got out the instructions and I assured my husband that I had observed car seat installations numerous times…key word “observed”.  We started reading page after page of instructions to try and begin the “easy” installation.

 

Well….we did manage to get it in the middle of the back seat of the car and even figured out the latching system (that took us about 30 minutes and two different trials). But that was just the first of the installment issues.  We had to thread the seat belt through the car seat over and over again with each of us on opposite sides insisting that the other was not threading the belt correctly or pulling tight enough….. as we worked to make sure the seat was tight and stable. Once that was complete we realized that we should have figured out the car seat straps before we had latched the car seat….and did we really have to take it out again?

 

It seemed like you needed a degree in physics and engineering (not medicine and business) to safely install a car seat.  We finally figure it out….but it was not always a “friendly” exchange between a long married couple who are now grandparents. How could our many years of parenting seem easy in comparison?

 

My advice, go to a car seat installation in your area…which is what we did with the rear facing car seat we had for our infant granddaughter. Somehow, they made it look like it was not that difficult and it was certainly installed correctly and safely!

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DR SUE'S DAILY DOSE

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