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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

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.   

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.

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

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!

Daily Dose

Language Development

1.30 to read

When talking to parents about language development there are two things that need to be considered: expressive and receptive language. 

While many parents worry that their children “need” to have 10-20 words by the time they reach 15 months, I am just as interested in a toddler’s receptive language. In other words, does their 15-18 month old child understand what they are saying to them (when they want to?). 

It is very important for this age child to understand simple statements and to be able to follow a one step direction.  Examples being, “where is your nose?”, “go get me the ball”, “point to the picture of the moon in the book”.  As a parent you are doing this all day long, probably without even realizing how much they are understanding (when they want to). Observing your child develop  receptive language shows you that your child’s brain is working away at developing language and comprehension. 

Some children will have later expressive language than others. There are 1 year olds that have 8-10 words and there are 15 month olds that are just acquiring that many words. But, just like you will someday help teach your child to read, you are teaching your toddler language by talking to them, reading to them and then suddenly your realize that they are saying a few words. You can’t “make” them say bye-bye, or thank-you but you can say these things over and over and know that they may comprehend before they actually talk. Most children have jargon or chatter as well as words and that too is a good sign of language development. 

Language acquisition is fascinating, and there is a wide range of normal.  It is true that boys are often later talkers than girls. I also think 2nd, 3rd, 4th children may also have later expressive language, but earlier receptive language...it seems the older sibling gives them commands that the younger child follows, but the older child also “talks” for the younger sibling. Those first children just can’t stand not to be the boss (birth order, another fascinating topic). 

So, remember just to keep reading to your child, talking to them about everyday life and magically language evolves.  Remember too, receptive language is an important milestone in your child’s development so give them some “things to do” and see what happens....you may be amazed at all of the things they do know how to do and how much they comprehend as well.

Daily Dose

Holiday Pictures: When Your Child Is Afraid Of Santa

1.30 to read

Over the past several weeks, I have been talking with all of my patients about what they want from Santa Claus, and asking them if they have been to sit on Santa’s lap. It is such fun to hear all of their responses, and it also keeps me abreast of the newest toy choices.

This is the best time of year to chat with the 2–5 year old set. They have those wonderful wide eyes and they are so cute when they start listing the things they want from Santa. It is such a wonderful age. But the toddler set is a different story as they are just beginning to understand the concept of Santa, and are still a little unsure of that “jolly old man” with the long beard and white hair.

How many parents have stood in long lines with their toddler who “has to sit on Santa’s lap” only to finally get to the front of the line and guess what, the cute, precious toddler suddenly does not want to sit on Santa’s lap!!  You must be kidding right?

It is a common occurrence, and looking back I have to laugh!  Me, (mom/pediatrician) knew that it was at this age a child's imagination begins to take shape and some concepts like Santa, sound great in books and stories, but in person…..no way!  Even armed with that knowledge, I dressed all of my boys in the cutest matching outfits and headed to the mall for that magical Christmas card picture with all three of them on Santa’s lap.

I know we stood in line for over 30 minutes, trying to entertain everyone, but at the same time trying to keep their outfits pristine.  That meant no food or drinks in line, just a mother and father entertaining and distracting the boys while we inched our way toward Santa.  It was going to be perfect; a “Kodak Moment”. Well, you probably guessed what happened next.

We finally get to the front of the line and head for Santa’s lap.  The 6 year old and 4 year old  just hop right up  but the 1 year old starts to let out horrific cries as I try to put him in Santa’s lap with his brothers.  The perfect Christmas card photo is actually a picture of the older two boys, holding the 1 year old brother down while he screams and Santa looks like he is not sure what to do.

At the time, I couldn’t believe that this was happening. We had been in line forever!  But the picture hanging on the wall is priceless, and will actually be a “Kodak Moment” forever.  It makes me smile to just look at those precious faces, with the perplexed Santa in the background.  Just like their first day of school pictures, the toddler screaming while sitting on Santa’s lap is priceless. Remember, this is a common event. Santa is a stranger with a big beard, a red suit and a deep voice.

If your child doesn’t want to sit on Santa’s lap, even after telling you how excited they are, do not despair. The “crying with Santa picture” may become one of the family favorites.  Within a couple more years, a toddler’s imagination matures, and they realize that Santa’s lap is actually a great place to sit and discuss all of their many wishes, without any tears!

I would love to hear your holiday photo horrors! Please share (comments below) and we'll all have a good laugh together!

Daily Dose

Play It Safe While Playing on the Slide

Do you remember the first time your child went down a sliding board? Or do you have a toddler who is about ready to make their first trip down the slide?

I remember watching my child climb the ladder up a sliding board, and then looking back and saying, “Mommy, you come with me.” So, up the ladder you go, putting your child in your lap for that first sliding board experience. Isn’t that the safest and easiest way to teach your child about a sliding board? What a sense of accomplishment, for both parent and child. Such a fun day at the park!! Well, I was reading a study by Dr. John Gaffney in an issue of the Journal of Pediatric Orthopedics. Dr. Gaffney noted that he was seeing fractures of the tibia (shin bone) in toddlers, many of whom had a history of being on a slide. I must admit, I haven’t ever seen a fractured tibia from a sliding board accident, but he looked at medical records for all tibia fractures he treated over an 11- month period. Of the 58 tibia fractures he studied, eight (13.8%) were sustained while playing on a playground slide. The age range of these patients was 14 – 32 months, and the average age of the eight patients in the study was 20.7 months. All of the tibia fractures associated with playing on a slide were sustained while going down the slide on the lap of an adult or an older sibling. None of the eight children studied had been on the slide alone. Dr. Gaffney states, “if a toddler is riding by himself and gets his leg stuck against the side of the slide, he can stop himself fairly easily, but with a parent’s weight added in you have greater velocity and momentum and it is harder to stop and the leg may get wedged and subsequently break.” He advises that if a child cannot use a sliding board independently, you should look for another age appropriate piece of playground equipment. I guess that would mean the sandbox. Thank goodness that I was lucky enough that all of my children made it safely down the slide with their parents, as I know both my husband and I were on the slide numerous times. I am sure I have pictures of that event, but I will be telling my patients about this interesting study. Like many things, there are risks involved, so find a smaller slide that your child can handle alone, or just wait until they are bigger. It ironic that something that we think will make our children safer might actually cause more injury. That’s your daily dose, we’ll chat again tomorrow. Send your question to Dr. Sue right now!

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