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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!

Your Toddler

Seven Tips For Toddler Discipline

2.15 to read

Toddler-hood is a particularly vexing time for parents because this is the age at which children start to become more independent and discover themselves as individuals. Yet they still have a limited ability to communicate and reason. "They understand that their actions matter -- they can make things happen," says Claire Lerner, LCSW-C, child development specialist and director of parenting resources for the organization Zero to Three. "This leads them to want to make their imprint on the world and assert themselves in a way they didn't when they were a baby. The problem is they have very little self-control and they're not rational thinkers. It's a very challenging combination." So how do you deal with a child who screams every time you try to give him or her a bath, and whose vocabulary seems to consist of just one word -- "no"? Here are a few simple toddler discipline strategies to help make life easier for both you and your child. Toddler Discipline Secret No. 1: Be Consistent Order and routine give young children a safe haven from what they view as an overwhelming and unpredictable world, says Lerner. "When there's some predictability and routine, it makes children feel much more safe and secure, and they tend to be much more behaved and calm because they know what to expect." Try to keep to the same schedule every day. That means having consistent nap times, mealtimes, and bedtimes, as well as times when your toddler is free to just run around and have fun. When you do have to make a change, it helps to warn your child in advance. Telling your child, "Aunt Jean is going to watch you tonight while Mommy and Daddy go out for a little bit" will prepare her for a slightly different routine, and will hopefully prevent a scene at bedtime. Consistency is also important when it comes to discipline. When you say "no hitting" the first time your child smacks another child on the playground, you also need to say "no hitting" the second, third, and fourth times your child does it. Toddler Discipline Secret No. 2: Avoid Stressful Situations By the time children reach the toddler stage, you've spent enough time with them to know their triggers. The most common ones are hunger, sleepiness, and quick changes of venue. With a little advance planning, you can avoid these potential meltdown scenarios and keep things relatively calm. "You have to anticipate, which means you don't go to the grocery store when your child needs a nap," says Lisa Asta, MD, a pediatrician in Walnut Creek, Calif., and associate clinical professor of pediatrics at the University of California, San Francisco. Try to make sure your child is home at naptimes, bedtimes, and mealtimes. If you are out, always keep food on hand in case of a sudden hunger attack. Keep excursions short (that means finding another restaurant if the one you've chosen has an hour-long wait, or doing your grocery shopping at times when the lines are shortest). Finally, plan ahead so you don't have to rush (particularly when you need to get your child to preschool and yourself to work in the mornings). You can ease transitions by involving your child in the process. That can be as simple as setting an egg timer for five minutes, and saying that when it rings it's time to take a bath or get dressed, or giving your child a choice of whether to wear the red shirt or the blue shirt to school. Toddler Discipline Secret No. 3: Think Like a Toddler Toddlers aren't mini-adults. They have trouble understanding many of the things we take for granted, like how to follow directions and behave appropriately. Seeing the scenario from a toddler's perspective can help prevent a tantrum. "You might say, 'I know, Derek, you don't like getting into the car seat ... but it's what we have to do,'" Lerner explains. "So you're not coddling, but you're validating their feelings. You have to set the limit, but you do it in a way that respects the child and you use it as an opportunity to help them learn to cope with life's frustrations and rules and regulations." Giving choices also shows that you respect your toddler and recognize the child's feelings. Asking your child if he or she wants to bring a favorite book in the car, or take along a snack, can make the child feel as though he or she has some control over the situation while you remain in charge, Lerner says. Toddler Discipline Secret No. 4: Practice the Art of Distraction Make your toddler's short attention span work for you. When your child throws the ball against the dining room wall for the 10th time after you've said to stop, it's pretty easy to redirect your child to a more productive activity, like trading the ball for a favorite book or moving the game outside. "Parents need to create an environment that is most conducive to good toddler behavior," advises Rex Forehand, PhD, the Heinz and Rowena Ansbacher Professor of Psychology at the University of Vermont and author of Parenting the Strong-Willed Child. "If they're into something they're not supposed to do, the idea is not to punish them but to get another activity going or pick them up and put them in another room." Toddler Discipline Secret No. 5: Give Your Child a Break Time-outs are one of the foundations of child discipline, but they may not be the best approach for the toddler stage. The negative implication of being sent away can teach kids that they're bad, rather than promote good behavior. If you do give your child a time-out, limit it to just a minute or two at this age. Instead of calling it a time-out, which can be confusing to children under 3, refer to it as something more positive. Lerner suggests creating a "cozy corner," a safe place, free from distractions and stimulation, where your child can just chill out for a few minutes until he or she can get back in control. That time away can help you regroup, as well. Correct bad behaviors, but also take the time to praise good behaviors. "If you don't tell your child when they're doing the right thing, sometimes they'll do the wrong thing just to get attention," Asta says. When you tell your toddler he or she has done something good, there's a good chance your child will want to do it again. Toddler Discipline Secret No. 6: Stay Calm When you're standing in the middle of the mall, looking down at your child who's screaming on the floor, and trying to ignore the stares of the shoppers around you, it's easy for your blood pressure to reach the boiling point. It's hard to stay calm, but losing control will quickly escalate an already stressful situation. Give yourself some time to cool off, advises Forehand. "Otherwise, you're venting your own anger. In the end that's going to make you as a parent feel worse and guilty, and it's not going to do your child any good." "I call it the "Stepford Wife" approach," Lerner says. As your child screams, say, 'I know, I know,' but stay completely calm as you pick him up. Don't show any emotion. Sometimes the best tactic is to ignore the behavior entirely. "You just literally act like they're not doing what they're doing. You ignore the behavior you want to stop," Lerner says. When your child realizes that his screaming fit is not going to get him a second lollipop or your attention, eventually he'll get tired of yelling. Your child may drive you so close to the breaking point that you're tempted to spank him, but most experts warn against the practice. "When we spank, kids learn that physical punishment is acceptable. And so we are modeling exactly what we don't want our kids to do," says Forehand. At the toddler stage, redirection and brief breaks are far more effective discipline tactics, Forehand says. Toddler Discipline Secret No. 7: Know When to Give In Certain things in a toddler's life are nonnegotiable. She has to eat, brush her teeth, and ride in a car seat. She also has to take baths once in a while. Hitting and biting are never OK. But many other issues aren't worth the headache of an argument. Pick your battles. "You have to decide whether it's worth fighting about, and about half the time it's not worth fighting about," Asta says. That means it's OK to let your son wear his superhero costume to the grocery store, or read The Giving Tree 10 times in a row. Once he gets what he wants, you can gradually get him to shift in another direction -- like wearing another outfit or picking out a different book to read. Finally, know that it's OK to feel stressed out by your toddler sometimes. "Realize that none of us as parents is perfect -- we do the best we can. There are going to be days that we're better at this than other days," Forehand says. "But if we parent consistently and have consistent rules, then we're going to see more good days than bad days."

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

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

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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If your child snores, is this a sign of something more serious?

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