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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.  

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

Separation Anxiety

What can a parent do when their child has separation anxiety?I received an email via our iPhone App from a mother who was concerned because her toddler son was crying when they left him at day care.  They were “alarmed” as he had not previously cried when they dropped him off and wondered if this was “normal” or a sign of a problem.

Actually, this phenomenon should be quite reassuring to a parent as this is a sign that your child is developmentally on track, and has developed a healthy attachment to his parents. All children go through periods developmentally when they are more prone to separation anxiety.  As a new parent you are often concerned about “leaving” your child under the care of someone other than a parent. But, in actuality, it is far easier to leave a newborn or an infant than it is to leave a 8-9 month old. By the time a child reaches this age they are beginning to show signs of stranger anxiety. In other words, they now recognize the faces and voices of their parents, routine caregivers, siblings etc. But, when a new person (and face) reaches out for a 9 month old it is not uncommon for that child to suddenly panic and burst into tears. This is not because the “stranger” has done anything at all, but because the child now understands being separated from their parent and may fear that the parent is leaving forever. The bond between parent and child has been successfully established, which is quite healthy. This is the beginning of teaching a child that a parent may leave for work, school or even a trip, but that they will return.  Just because a parent leaves for awhile, they are not gone forever. This first stage of separation anxiety can provoke feelings of anxiousness in both child and parent, but it is an essential part of normal development. Separation anxiety, like almost all behaviors, varies from child to child. While some childen are more clingy than others, some may just be “wired” in a certain way and are more vulnerable to  separating from a parent. Regardless, it is important for a child to begin to deal with healthy separation. During the ages of 12 – 24 months separation anxiety seems to peak, and the period of crying or anxiety when a parent drops a child at day care or Sunday school, or even at a grandparents house may escalate. While a child may cry after being dropped off, most children will then calm down and may be distracted and will begin playing soon after the parent has left. Again, some children just seem to take longer to adjust, so don’t be alarmed if  one child cries for 2 minutes, while another may take up to 20-30 minutes to settle down. Toddlers do not understand the concept of time, and therefore each one may react differently.  While happily playing while the parent is gone, it is not uncommon for the child to cry again upon seeing their parent when being picked up.  For the toddler, the return of the parent may remind them of how they felt when the parent left earlier in the day. For most children separation anxiety decreases between 2 -4 years of age as you can explain,  and a child can understand,  where you are going, how long you will be gone etc. For children who have rarely been left with others, it may be more difficult at this age.  Remember, healthy separations are important for both parent and child, and the idea that no one will “babysit” or care for your child other than a parent is not realistic nor does it teach your child to build trust in others. The more experience a child has had with earlier normal periods of separation the easier different transitions will be.  Remember, they will all be going to school one day and you want to prepare them for that separation. Lastly, every child has good days and bad days and almost every child will have a phase when it is harder to separate than others. Just remember to hang in there, be re-assuring to your child when you leave them, do not prolong the departure, and be understanding about their anxiety. As with so many experiences in parenting, “this too shall pass”. That's your daily dose for today. We'll chat again tomorrow. Send your question or comment to Dr. Sue now!

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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