Toddler Lessons

Welcome to Month 23 (Week 2) of Parenting Your Toddler!

As your child gets deeper into toddlerhood, you may notice that they’re developing quite the potbelly. The “potbelly look” usually has more to do with a toddler’s funky center of gravity than their weight. Because toddlers are still working on their balance, they often assume a wide stance, which makes their bellies poke out. In addition, their abdominal muscles are fairly weak (no six-pack abs here) and are, therefore, unable to keep everything sucked in. As toddlers find their balance and develop stronger abdominal muscles, their bellies pull inward.

Less commonly, potbellies can signal a medical problem or a “weight issue.” Get Wise below about red flags to look out for. We’ll also say a word about childhood obesity & the pitfalls of diet culture. In addition, we’ll offer tips to help your toddler develop a positive relationship with food and with their body.

1. Constipation: Constipation can lead to bloating, abdominal pain, and hard, infrequent stools.

2. A Chronic Gastrointestinal Disease: If your child’s belly sticks out prominently (even when they’re lying down) and they suffer from major gas, bloating, or chronic diarrhea, let the doctor know.

Why? Because these can be signs of celiac disease (a gluten allergy) or lactose intolerance (the inability to fully digest the sugar in milk).

3. An Infection: Abdominal infections can cause children to develop a firm belly and abdominal pain. They’re almost always accompanied by additional symptoms such as a fever, vomiting, and diarrhea.

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Welcome to Month 30 (Week 1) of Parenting Your Toddler!

Once toddlers get the hang of walking and running, they look for additional ways to satisfy their need for speed. Ride-on “vehicles” like tricycles, balance bikes, and scooters become coveted items. If you’ve ever seen a toddler whiz merrily by on a scooter or a balance bike, you know that these modes of transportation bring independence, joy, and a bit of risk, too.

Note: A ride-on toy is any toy that a child can sit on and ride. Get Wise(r) about them below.

With so many different ride-on toys on the market, it can be hard for parents to know which ones are suitable for their child’s age. Have no fear. Below, I’ll walk you through the United States Consumer Product Safety Commission’s guidelines to help you make sense of it all. In addition, I’ll provide several PediaWise Picks so you can get an idea of the different ride-on toys available and what they look like. The PediaWise Picks are toys that either my kids have liked or that I’ve heard good things about.

PediaTip: Before buying a ride-on toy make sure to note the age range for it and read the reviews & safety profiles associated with it.

Welcome to Month 33 (Week 3) of Parenting Your Toddler!

We’re going to switch gears a bit this week and talk about age-appropriate books for toddlers and my Top 5 Favorite Books About Parenting Toddlers.

1. “Are You My Mother?” by P.D. Eastman: This book is about a baby bird who hatches out of an egg, falls out of his nest, and goes searching for his Mama.

Spoiler Alert: The ending is a happy one.

2. “Where the Wild Things Are,” by Maurice Sendak: You may remember this one from your childhood. Max, the protagonist, is being naughty and is sent to bed without dinner. He falls asleep and finds himself in a jungle where the “Wild Things” live. He tames the Wild Things (while also curbing his own “wild” behavior). When he wakes up, his mom, who is no longer mad at him, has his supper ready and waiting.

3. “The Very Hungry Caterpillar,” by Eric Carle: This story is about a caterpillar who starts binge-eating everything in sight and, after stuffing his face, eats a green leaf to cleanse his palate.

4. “Green Eggs and Ham,” by Dr. Seuss: You all know this one. It’s about Sam-I-Am, a cute little guy who tries to get the (unnamed) main character to eat green eggs and ham even after they’ve been on a train, in a tree, and submerged in water (a tough sell!). This book may get your kiddo to try the broccoli they’ve been avoiding (which, you can point out, is also green).

5. “Corduroy,” by Don Freeman: This classic is about a teddy bear named Corduroy who lives in a department store. Every day, he waits for someone to buy him, but no one does because he’s missing a button on his overalls. One day, a little girl named Lisa scoops Corduroy up and takes him home (after convincing her judgy mom that he’s up to snuff, despite the missing button).

6. “Brown Bear, Brown Bear, What Do You See?” by Bill Martin Jr. and Eric Carle: This is a picture book that asks Brown Bear (the main character) what he sees (think: a red bird, a purple cat, etc.). It’s a good book for naming animals and colors. Plus, the repetitive rhyming structure helps little ones “read” along with the text.

7. “The Feelings Book,” by Todd Parr: This book helps young kids identify their feelings. Being able to name and sort out one’s feelings is a skill that many adults are still working on. This book will help your child get a head start in that department.

8. “Hands Are Not for Hitting,” by Martine Agassi: This book teaches kids that their hands can be used for more positive things than whacking people.

9. “First 100 Board Book Box Set,” by Roger Priddy: This 3-book box set is a nice way to teach your child some basic everyday vocabulary. It includes: “The First 100 Words,” “The First 100 Animals,” and “Numbers, Colors, and Shapes.”

10. “Guess How Much I Love You,” by Sam McBratney: In this book, a dad and his baby bunny get competitive about who loves the other more. This is a sweet book about a parent’s love for his child and a helpful story if you’re sending a reluctant toddler off to school.

Interactive Books: Interactive books are typically a big hit with toddlers. They include: lift-the-flap books, coloring books, and felt activity books.

The Bottom Line: Reading with your child is both a brain-building activity and a bonding activity. Find books that you love and read them together over & over again.

1. “The Whole Brain Child,” by Daniel J. Siegel: This book offers 12 strategies to help manage day-to-day parenting struggles. At the heart of this book is a discussion about kids’ developing brains and how they’re divided into 2 parts: the primitive (“downstairs”) brain and the more evolved (“upstairs”) brain. Before kids can access higher levels of thought (i.e. reasoning), they need to soothe their more reactive, primitive brain.

What Does All of This Fancy Language Mean for Parents?

It means hold off on the lectures while your child is having a meltdown. During the meltdown, your child’s primitive brain is firing on all cylinders and they can’t think straight. Once your child has calmed down, they’ll be able to use their more rational “upstairs” brain to process what you’re saying. At this point, a lecture may not even be necessary. Instead, a few moments of silence or a simple word or phrase may be able to help your child get back on track.

2. “The Yes Brain,” by Daniel J. Siegel: As you can probably tell (by the fact that I have two books in a row by him), I’m a huge fan of Dan Siegel and his parenting philosophy. Although there’s a bit of an overlap between this book and “The Whole Brain Child,” they’re both worth the read. “The Yes Brain” focuses on how to help your child get into a positive headspace and build empathy.

3. “Transforming the Difficult Child: The Nurtured Heart Approach,” by Howard Glasser: This book urges parents to be selective about where they put their energy. It’s built on the premise that kids love ALL types of attention and will do naughty things just to get a big reaction out of their parents. If parents refuse to give their child’s negative behavior a lot of energy, their kiddo will often try a more positive approach. This book is helpful even if your little one isn’t all that difficult.

4. “Parenting With Love & Logic,” by Foster Cline and Jim Fay: This book encourages parents to use “natural consequences” as way of disciplining their children. For example, if your child is dawdling and running late for the zoo, instead of taking away their dessert (which has nothing to do with the zoo), let them know that the zoo trip will be cut short as a result. This method is fairly simple and makes a lot of sense (even to kids!). Moreover, the “natural consequences” approach mirrors the way the world actually works.

5. “Raising Lions,” by Joe Newman: Although the advice given in this book is geared toward older children with behavioral issues, Joe Newman’s philosophy is what’s key. He believes that children inherently know right from wrong and urges parents to give their kids the space to solve their own problems. For him, over-parenting gets a big thumbs down.

If you like Joe Newman’s approach, you can take a course on his website to learn more about his method and how to implement it.

Check out the Empowering Parents website. Here, you’ll find online learning programs and parent coaching (for a fee), plus hundreds of free articles. I’m a fan of “The Calm Parent AM & PM” program by Debbie Pincus.

Need a Good Laugh? Check out the book “Home Game: An Accidental Guide to Fatherhood,” by Michael Lewis. Although this book isn’t as well-known as his other books (think: “Liar’s Poker,” “The Big Short,” “Moneyball,” and “The Blind Side”), it’s a hilarious, open, and honest real-life story of parenthood for both Moms and Dads.

“My kids throw a lot of shade for tiny people
completely dependent on me for survival.”

~Huffpost (@PonyMartini)

And…That’s a Wrap!

Welcome to Month 34 (Week 2) of Parenting Your Toddler!

Getting lice is basically a rite of passage for kids. Although some children are lucky enough to avoid lice, lice outbreaks are a common occurrence in daycares and schools. It’s the gift that keeps on giving, and kids tend to share the love with each other AND with their family members.

The good news is lice aren’t dangerous, they’re just gross. The bad news is lice can be a bit of a pain to get rid of (think: labor intensive) and they tend to get passed around classrooms like candy. Once you experience a case of lice in your home, you’ll be armed and ready (with a nitpicker and a lice shampoo) for the next one.

Get Wise below about how to identify (and avoid) lice. While we’re at it, we’ll also talk about another type of undesirable guest on our skin: mites. We’ll focus on two types of mites: mites that cause scabies and dust mites (a common childhood allergen).

You have to hand it to lice – they’ve been around since the beginning of time. In fact, it’s thought that human lice evolved from chimpanzee lice about 5.5 million years ago.¹ Around 107,000 B.C., lice started to specialize, splitting into 2 groups: head lice and body lice.

Head lice is still going strong today and loves to hang out in daycares and elementary schools. Body lice (aka clothes lice) and pubic lice (sorry, I had to go there!) have survived, as well. This week we’ll concentrate on the dreaded head lice.

Is Your Scalp Starting to Itch, Yet? I Feel Ya!

Head lice are wingless insects that live on the human scalp and feed on human blood. An adult louse is roughly the size of a sesame seed. A nit (a louse egg) is about the size of a flake of dandruff.

Although adult lice and nits are tiny, they can be seen with the naked eye if you’re looking for them.

Check Out the Visuals Below:

Here’s a Picture of What an Adult Louse Looks Like…

See the 2 brown insects in the hair that look like sesame seeds?

And…Here’s a Pic of Nits:

See the white eggs that look like dandruff?

Head lice are open-minded. If you have hair, they’re into it. They don’t discriminate between dirty hair and clean hair. Getting head lice, therefore, has nothing to do with hygiene.

Because of this, lice like to travel across “hair bridges” and are pros at walking onto a person’s scalp from a hairbrush or a hat.

What in the Heck is a “Hair Bridge?” A “hair bridge” is a “bridge” that’s made between one person’s hair and another person’s hair when their heads are close together.

Reality Check: Your child can’t get lice by “fur” bridging with a dog or a cat. Why Not? Because dogs have lice that feed only on dog blood and cats have lice that feed only on cat blood. The reverse is also true: dogs and cats can’t get lice from your child because a human head louse feeds only on human blood.

Head lice don’t live for more than 24 hours on a non-human surface. They can, however, live on a human scalp for up to 30 days.

They’re actually fairly benign little creatures, simply looking for their next meal, which happens to be human blood.

PediaTip: To help you identify the lice, you’ll want to have a special lice comb (aka a nitpicker) and a magnifying glass (I like the round ones) at the ready. Without these tools, you might confuse random dirt, lint, and dandruff for lice or nits.

The itching from lice is often more intense at night. Why? Because lice are more active later in the day.

Insider Info:

You can, but it isn’t necessary.

The current recommendation is to treat additional family members only if you see lice in their hair. Check everyone’s hair every 2-3 days for lice and nits (for a total of 2-3 weeks).

If it makes you feel better, though, you can go ahead and treat everyone.

Insider Info: Want to outsource the whole lice thing? There are businesses that will come to your home, sell you their lice products, and methodically comb through your child’s hair.

This is actually a hotly debated topic. In the past there was a blanket “no-nit” policy at schools. Under this policy, kids diagnosed with lice at school were sent home and told to return only when they were totally nit free.

The American Academy of Pediatrics (the AAP) and the National Association of School Nurses no longer support this policy.² Instead, they recommend that kids be allowed to stay in school for the remainder of the day and start treatment when they get home. The child can return to school the next day as long as they’ve been treated with a lice shampoo and their parents have started the nit-picking process.

The Bottom Line: Most schools have junked the “no-nit” policy, but there are still a few schools that stand by it. Find out which side of the debate your child’s school falls on.

Now we’ll turn our attention to Scabies, an infestation of the skin by another parasite, the Sarcoptes scabiei mite. Mites are a type of arthropod (not an insect) and are closely related to spiders and ticks.

When Sarcoptes scabiei mites find their way onto humans, they burrow beneath the top layer of their host’s skin to lay their eggs (ugh!). Sarcoptes scabiei mites (unlike lice & nits) are nearly invisible to the naked eye and are best seen under a microscope. Without a microscope these mites look like tiny black dots on the skin.

Insider Info: When a person is infested with scabies mites for the first-time, the symptoms may not show up for 4-8 weeks.

Why Does That Matter? Because even though the infected person doesn’t have any symptoms, they can still spread the scabies to other people.

If it’s not the patient’s first-time having scabies, the symptoms will show up sooner (1-4 days after being exposed to the mites).

Scabies is diagnosed clinically — i.e. based on the telltale rash and burrows in the skin.

The most popular medication to treat scabies is Permethrin 5% cream which kills the scabies mites and their eggs. This medication cream is “prescription only” (i.e. you can’t buy it over-the-counter).

Note: The 5% version of Permethrin cream is used to treat scabies, whereas the 1% version (which IS over-the-counter) is used to treat lice.

Insider Info:

After treating your child and the rest of your family with Permethrin 5% cream, the next step is to rid your home of scabies. This can be a pain in the you-know-what. Fortunately the scabies mites only live on non-human surfaces for 2-3 days. Take advantage of this and vacuum every room in your home. In addition, wash clothes, bedding, and towels in hot water. As with lice, there are companies that will come to your home and help you get rid of the scabies-causing mites.

If I had to choose between getting scabies or lice, I would go with lice. Hopefully that’s not a decision you’ll ever have to make.

Now that we’re past the point of no return in our discussion of creepy crawlies, let’s forge ahead and talk about dust mites.

Dust mites are microscopic bugs that feed on dead skin cells shed by humans and animals. Dust mites, unlike lice and scabies-causing mites, are NOT parasites. They do eat our dead skin (yuck!), but they don’t bite us, suck our blood, or burrow under our skin.

The Bad News: Dust mites are basically everywhere. Reports show that 80% of homes in the U.S. have “detectable levels of dust mite allergen in at least one bed.”³

To make matters worse, humans shed enough skin in a 24-hour cycle to feed a million dust mites each day.

Before You Freak Out and Put Your House on the Market, Here is Some GOOD News: 90% of the population lives in harmony with dust mites.

What About the Other 10% of the Population? The other 10% has either an allergy or a “sensitivity” to dust mites. The allergy is mainly to the dust mites’ feces. Kids who are allergic to dust mites often sneeze, cough, and itch when they’re exposed to them. Dust mites are also a common trigger of asthma symptoms in asthmatics.

Dust mite covers are zippered covers that enclose your mattress, box spring, or pillow (depending on the type you get). Fitted sheets that are dust-mite proof are also a good investment.

PediaTip: Take your dust mite covers with you when you travel.

Dust mites thrive in hot, humid environments. Therefore, keep your thermostat below 70 degrees Fahrenheit and the humidity level below 50% (with the help of a dehumidifier) to prevent the dust mites from proliferating in your home.

Try to do this once a week.

PediaTip: Another option is to use a special laundry detergent that kills dust mites in all water temperatures (i.e. even in cold water).

PediaWise Pick: Mite-y Clean All-Natural & Allergy Free Laundry Detergent.

Dust, mop, sweep, and vacuum often.

PediaTip: Invest in a HEPA vacuum. Why? Because they (claim to) trap 99.9% of the dust mites they suck up.

Carpets tend to collect dust mites. If your child has a dust mite allergy, skip the wall-to-wall carpeting and keep your floors as bare as possible.

Congrats! You’ve survived our lice, scabies, and dust mites discussion. Although the mere mention of these critters may make your skin crawl, remember the following: lice are annoying (but don’t carry diseases), the scabies mite is even more annoying (but doesn’t carry diseases either), and dust mites don’t bother most people.

If you think your child has lice, scabies, or a dust mite allergy, let the doctor know.

“Parenting is a delicate balance of convincing
your child [that they] can do anything
in life while simultaneously screaming
‘Don’t Do That!’ every three minutes.”

~One Funny Daddy

And…That’s a Wrap!

Welcome to Month 36 (Week 4) of Parenting Your Toddler!

Imagine you’re at a noisy and high-energy birthday party for a 3-year-old and 3 toddlers walk through the door. One toddler immediately covers their ears, the second strolls in nonchalantly, and the third runs towards a friend and tackles them excitedly. These 3 reactions illustrate the different ways kids process and interact with the world around them.

Our brains constantly take in new information through our 5 senses (taste, touch, sight, hearing, and smell). In fact, studies show that the human body relays 11 million bits of information to the brain per second.¹ Our conscious mind processes only a tiny fraction of this information (50 bits of information per second), but it does so in the blink of an eye. No wonder we’re so tired at the end of the day!

Some kids have trouble organizing the information their brain receives from their senses. Kids who struggle with this may have a “sensory processing disorder.” Kids with sensory processing disorders fall into two main camps: (1) Sensory Avoidant and (2) Sensory Seeking.

Sensory-avoidant children get overwhelmed by the information bombarding their brains and they either shut down (the child who covers their ears at the party) or they become hyper.

At the other end of the continuum are kids who are underwhelmed by the sensory information coming into their brains. They need more stimulation to be able to process the information. These are the types of kids who don’t mind loud noises and who enjoy hugging their friends and family tightly.

Think: The child who tackles their friend at the birthday party in the scenario above.

Reality Check: All children (and adults) have moments of feeling either overstimulated or understimulated in various situations. This is normal. If these feelings persist in one direction or the other, however, then a sensory processing disorder may be present.

Sensory processing disorders can be found on their own or as part of another disorder (such as Obsessive-Compulsive Disorder, Attention Deficit Hyperactivity Disorder, or Autism Spectrum Disorder).

Get Wise below about how doctors identify and treat Sensory Processing Disorders.

As mentioned above, kids with sensory processing disorders may be “sensory-seeking” or “sensory-avoidant.”

Note: Some kids engage in both types of behaviors. For example, a child may hate loud noises but love tight hugs.

Sensory-seeking children and sensory-avoidant children have different ways of responding to the sensory information coming into their brains through the 5 senses.

1. “Proprioception” (body awareness)

AND

2. “Vestibular Sense” (where their body is in space relative to other people and objects).

Insider Info: Because kids with sensory processing disorders are frequently overstimulated or understimulated (translation: uncomfortable), they tend to have more anxiety, tantrums, meltdowns, and social issues than other kids.

The Bottom Line: If your child consistently exhibits one or more of the symptoms above, reach out to their doctor. The key word here is “consistently” (since ALL humans get overwhelmed or underwhelmed at times).

The Good News: “Occupational therapy” can work wonders for children with sensory processing disorders.

What’s Occupational Therapy? It’s a type of therapy that teaches kids different skills that enable them to function in the world more easily. In the context of Sensory Processing Disorders, occupational therapy helps kids:

There are certain activities that you can do at home, as well, if your child has a sensory processing disorder (see below).

FYI: These activities benefit ALL kids (and adults) because they teach them how to self-soothe when they’re riled up and how to get energized when they’re feeling sluggish.

Get Wise About Them, Below…

Sensory-avoidant kids do NOT like too much input coming into their brains at once. The trick, therefore, is to help them limit their sensory input when they’re overstimulated.

Double Take: Even though watching TV might seem like a passive activity, blue screens can be “activating” for kids. Therefore, avoid screen time during the 2 hours before bedtime.

Sensory-seeking children need extra physical and sensory input to feel satisfied.

PediaTip: Build a “sensory toolkit” by throwing some of the above tools (think: stress balls, Play-Doh, Slime, etc.) into a bag. You can then whip the bag out when your child is having a meltdown.

Note: A sensory toolkit is a good thing for ALL kids to have!

Sensory-seeking kids love to be on the move and are often bouncing off the walls.

Note: This hyperactivity can either mimic or be present alongside Attention Deficit Hyperactivity Disorder (ADHD).

Both sensory-seeking and sensory-avoidant kids can benefit from understanding their emotions. All humans can. Tools such as the Zones of Regulation can help your child better identify and express their emotions.

How Do the Zones of Regulation Work? The Zones of Regulation “visually” separate emotions into 4 zones (blue, green, yellow, and red) as shown in the image below:

Image Source: The Zones of Regulation Website

Print out the Zones of Regulation chart so your child can point to the emotion they’re feeling in the moment.

PediaTip: It helps if ALL family members (not just the kids) share what zones they’re in throughout the day.

If interested, check out the Zones of Regulation website to learn more.

The symptoms of a Sensory Processing Disorder can improve with the right tools and a good occupational therapist. All children (and adults) benefit from learning how to recognize their needs, regulate their emotions, and express themselves in healthy ways.

“You know your life has changed when…
going to the grocery store by yourself
is like taking a vacation.”

~IFunny

And…That’s a Wrap!

Welcome to Month 36 (Week 1) of Parenting Your Toddler!

You may have grown up with the mantra “leaves of three, let them be,” and become an expert at avoiding poison ivy. Or you may have learned about poison ivy the hard way — by getting a super-itchy rash and having calamine lotion slathered all over you. Whatever the case, Get Wise about the symptoms and management of the poison ivy rash below. We’ll also take a look at two other rash-inducing plants (poison oak and poison sumac) and talk about how to be a rash detective.

Poison ivy is a plant that can cause an allergic skin reaction when people come into contact with the oil that it produces.

Insider Info:

Exception: Your child’s skin may not react to urushiol with the first exposure. This is because the human body has to “see” an allergen more than once before it builds up an immune response to it.

1. The unsuspecting victim brushes up against the poison ivy plant (or against an animal that’s come in contact with the plant) and touches the plant oil. 

2. Then they touch other parts of their body, spreading the plant oil around. 

3. An itchy raised red rash appears 4-96 hours later.

Poison ivy rashes are red, blistering rashes that look like this:

The rash is itchy and may ooze fluid if the blisters break open.

A Word of Caution: Don’t pop your child’s blisters.

Why Not? Because doing this can lead to an infection (and it won’t speed up the healing process anyway).

The rash itself is not contagious, but the plant oil is. If your child comes in contact with the plant oil on another person’s skin or on a pet’s fur, they can get poison ivy, too.

PediaTip: If your child develops poison ivy, have them take a shower (or a bath) to wash the plant oil off (and to prevent the rash from spreading further).

The poison ivy rash will eventually dry up and go away on its own (usually within 2 weeks). In the meantime, the itching may be intense. Here are some products and medications to help alleviate the itching:

Double Take: The poison ivy plant can be a bit of a chameleon, though, and isn’t always easy to identify.

For example, in the fall, poison ivy leaves turn red and look like this:

Image Source: Michigan State University

In the spring, the poison ivy plant produces clusters of small white berries:

Image Source: Oral Ivy

At times, poison ivy will even crawl up trees as a vine. For instance, the poison ivy plant in the pic below looks dark and hairy and has no leaves:

Image Source: Michigan State University

Caution: Resist the urge to burn poison ivy leaves on your property. When burned, poison ivy leaves release chemicals that can irritate the eyes, nose, and lungs. 

Here’s a Fun Children’s Book About Poison Ivy: “Fancy Nancy: Poison Ivy Expert,” by Jane O’Connor. Even though this book is geared towards children 4-8 years of age, the pictures (along with an abbreviated version of the story) can appeal to toddlers, as well.

Poison ivy isn’t the only plant that produces the plant oil, urushiol. Poison oak and poison sumac do too. Like poison ivy, these plants grow in wooded and marshy areas in the U.S.

Poison oak and poison sumac produce the same red, blistering rash that’s seen with poison ivy (because the body is reacting to the same plant oil). However, the poison oak and poison sumac plants look different from poison ivy and can be harder to spot.

Image Source: WebMD

Rashes come and go during childhood. Fortunately, most rashes don’t cause serious or long-term problems (unless your child has a known chronic skin condition, like eczema). Determining the cause of a rash can be tricky, though, and sometimes doctors never figure it out.

Insider Info: If the rash continues to stump your child’s doctor, they may decide to throw everything but the kitchen sink at it (think: antibacterial creams, antifungal creams, and steroid creams), hoping to find the magic bullet. If the rash disappears, the doctor may wonder if the medication helped or if the rash simply resolved on its own. If the mystery rash lingers, the doctor will refer your child to a dermatologist.

Rashes from poison ivy, poison oak, and poison sumac are common during childhood. If you notice that your child has an itchy, red rash (especially after walking in the woods or playing with a dog), take a picture of it and let the doctor know. These types of rashes can usually be managed at home (with the doctor’s approval). If the rash gets infected, though, or is taking a while to heal, the doctor will want to see it in person.

“I want the confidence of a toddler
who picked out her own outfit.”

~@mommajessiec

And…That’s a Wrap!

Welcome to Month 35 (Week 4) of Parenting Your Toddler!

Give yourself a pat on the back. You’ve survived the newborn days, the infant ups & downs, and the Terrible Twos. You deserve a medal!

Next Up: The “three-nage” years. As your child’s speech improves and they get better at expressing their wants and needs, the Category 5 hurricane tantrums tend to diminish (a bit).

The 3-year-old, though more mature and independent, is still prone to meltdowns, defiance, picky eating, and nightmares. If your child is in preschool, they’re learning how to coexist with other children and how to regulate their emotions in a group setting. If your kiddo isn’t in school, this is a good time to get them involved in social activities like Mommy & Me classes and informal music or art classes.

Why? Because kids are sponges at this age, absorbing everything.

If you’re in the throes of potty training and need a refresher on how to do it, go here. 

Reality Check: Girls tend to get the hang of potty training earlier than boys.

Coming Up: The 3-year checkup is just around the corner. This visit tends to be fairly low-key since it’s typically free of shots and bloodwork. During the visit, the pediatrician will focus on your child’s growth, diet, sleep, dental hygiene, and development. Get Wise about the developmental milestones for 3-year-olds below (and remember, there’s a range of normal and every child is different).

Insider Info: Doctors use the following trick to remember the tricycle milestone: a 3-year-old pedals a bike with 3 wheels (a tricycle).

Insider Info: Your toddler will most likely continue to need a pull-up diaper during sleep. Although most kids in the U.S. achieve full daytime bladder and bowel control by 24-48 months of age, doctors give them a bit longer (until age 5) to stop wetting the bed at night.

Your child’s unique personality is making itself known more & more every day. Encourage their development by reading books together and talking up a storm. In addition, set aside some “connect time” each day. This is time when you get on your child’s level and let them dictate the play. Connect time doesn’t have to be long (it can be as little as 10-15 minutes), as long as you’re a present and engaged participant.

Looking for Fun, Safe, and Educational Toys for Your Toddler? Get Wise About the Top 20 Types of Toys Toddlers Enjoy.

Mary Poppins Voice:
“Ok, Children! Time to Go!”

[15 Min Later]

Batman Voice:
‘I Said Let’s Go.’”

~@LurkaAtHomeMom

And…That’s a Wrap!

Welcome to Month 35 (Week 3) of Parenting Your Toddler!

As you’ve probably noticed, the pediatrician listens to your child’s heart with a stethoscope at every checkup. Listening to the heart isn’t the only component of the cardiac exam, however.

1. Measuring the heart rate.

2. Feeling the pulses.

3. Asking the parents if the child has any symptoms that could be related to the heart. For example, do they have:

Insider Info: The doctor will then put all of this info together to get an overall picture of the child’s “heart” health.

In the Hot Topics section, we’ll talk about how pediatricians perform the pediatric cardiac exam and what they look for during the exam. In addition, we’ll do a deeper dive into the topics of heart murmurs, high blood pressure, high cholesterol, and chest pain in the pediatric population. 

As mentioned above, the cardiac exam involves measuring the heart rate, feeling the patient’s pulses, listening to the heart, and asking the parent if the child has any heart-related symptoms or a family history of heart problems. Get Wise(r) about the different components of the cardiac exam below:

The heart rate refers to how many times the heart beats in 60 seconds. It can be measured with a machine (such as a “vital signs device”), by feeling the pulse, or by listening to the heart with a stethoscope.

A toddler’s heart rate is faster than an adult’s, but slower than a newborn’s. The normal heart rate for toddlers is 90-150 beats per minute, whereas the average adult heart rate is 60-100 beats per minute.

A child with a persistently slow heart rate, is said to have “bradycardia.” A fast heart rate, on the other hand, is called “tachycardia.”

Bradycardia is often a benign finding. For example, athletes tend to be “bradycardic” by nature (i.e. to have a low resting heart rate).

In some cases, though, bradycardia is a sign that there’s an issue with the heart itself. For instance, a problem with the “electrical conduction system” of the heart can cause an abnormally slow heart rate. 

Note: The electrical conduction system of the heart tells the heart when to squeeze and pump blood to the rest of the body.

Medical conditions such as hypothyroidism (a slow-running thyroid gland) can also cause bradycardia in children.

If the pediatrician is worried about bradycardia in a child, they’ll get an EKG (an electrocardiogram) to measure the electrical activity of the heart. If the EKG is concerning, the child will be referred to a cardiologist.

Symptom Alert: Children with bradycardia often feel tired, light-headed, and may even faint.

Tachycardia, like bradycardia, is usually a benign finding.

Non-Worrisome Causes of Tachycardia Include:

If the tachycardia continues and is present, even at rest, the doctor will want to investigate it further in the form of an EKG.

Why? Because tachycardia, like bradycardia, can be a sign that there’s a problem with the heart itself or that another disease (such as hyperthyroidism—an overactive thyroid gland) is causing it.

Supraventricular tachycardia (SVT) is a heart condition that causes random bouts of tachycardia in kids.

Children with supraventricular tachycardia have an extra pathway in their heart that the electrical signal occasionally travels down. When the electrical impulse goes down this “accessory pathway” (which is essentially a short cut), the heart starts to beat super fast (like 200-300 beats per minute fast).

Kids can learn different techniques to slow down their heart rate when they “flip into SVT.” Medications can be given as well, and in some cases, a minor surgery—an “ablation”—is performed to eliminate the extra pathway.

Wolff-Parkinson-White Syndrome (WPW), a special form of SVT, is a condition that doctors are always on the lookout for in patients with episodes of tachycardia.

Why? Because WPW is more worrisome than your run-of-the-mill SVT.

The Good News: WPW can be diagnosed with a simple EKG and fixed with surgery. Note: WPW is often found “incidentally” (DocTalk for out of the blue) on EKGs.

Symptom Alert: If a child’s heart is beating fast enough, they may feel sweaty or light-headed (and even faint). As kids get older, they get better at verbalizing when their heart is racing.

The Bottom Line: The pediatrician will evaluate your child’s heart rate at every visit. If the doctor finds any abnormalities, they’ll let you know. If you notice that your child seems light-headed or abnormally fatigued at home, call the doctor. In addition, give the doctor a heads up if bradycardia, supraventricular tachycardia, Wolff-Parkinson-White, or any other heart abnormalities run in the family.

The vast majority of heart murmurs are benign & nothing to worry about. In fact, most children develop an “innocent murmur” at some point in their lives.² Innocent murmurs are most commonly heard between 1-5 years of age. They do NOT signify an underlying heart defect and resolve on their own with time.

Examples of innocent murmurs (aka “functional murmurs”) include “flow murmurs” (which occur in kids with viruses or anemia) and “Still’s murmurs.” Still’s murmurs are the most common type of innocent heart murmur. They produce a classic “vibratory” sound that helps doctors make the diagnosis.

Insider Info: Doctors vary in whether they tell parents about innocent-sounding heart murmurs. I always give parents the heads-up in case their child ends up in the ER and the ER doctor scares them by telling them their child has a heart murmur. Some doctors don’t mention it, though, especially if they think the parents are going to go down a rabbit hole of worry.

Doctors “grade” the murmur (from Grade 1 to Grade 6) based on its intensity. 

A Grade 1 murmur is a nothing burger, whereas a Grade 6 murmur is serious. If your child has a moderately loud Grade 3 (or higher) murmur, the pediatrician will probably refer them to a cardiologist.

In this case, the cardiologist may order an echocardiogram (an ultrasound of the heart). The echocardiogram is a noninvasive test that looks for structural abnormalities of the heart.

Reality Check: If a child has a significant structural problem with their heart, it will most likely be detected during the newborn period or during infancy (possibly with the help of the “critical congenital heart defect screen,” which is performed on ALL babies prior to discharge from the hospital).

If the critical congenital heart defect screen doesn’t pick up the heart defect, the pediatrician or the parent will probably realize something is wrong.

Why’s That? Because when a major heart defect is present, patients typically have multiple symptoms. These symptoms vary depending on the type of heart defect, but may include a heart murmur, poor growth, trouble breathing with feeding, fatigue, episodes of fainting, and periods of cyanosis (i.e. turning blue).

Exception: Hypertrophic cardiomyopathy (HOCM), a rare disease that runs in families, tends to show up later in life and is harder to detect (because it has fewer associated symptoms).

What Causes HOCM?  An overly thick heart muscle.

During the cardiac exam, the pediatrician will also feel your child’s pulse. Doctors typically feel the pulse on the inside of the wrist.  

When evaluating the pulse, pediatricians want to make sure that it feels “regular” (i.e. that it beats in a regular fashion) and is strong. A weak pulse suggests the blood from the heart isn’t being distributed effectively to the rest of the body.

Pediatricians may also feel a child’s femoral pulses by pressing down on either side of their groin. Some doctors only evaluate the femoral pulses of newborns and infants, while others continue this practice in toddlers, as well.

Doctors feel the femoral pulses to rule out something called coarctation of the aorta. In coarctation of the aorta, the big blood vessel that carries blood to the rest of the body is constricted, reducing blood flow to the lower half of the body. If coarctation of the aorta is present, the femoral pulses in the groin will beat weakly or won’t be felt at all (depending on the severity of the coarctation).

Reality Check: Coarctations of the aorta are fairly rare.

Pediatricians don’t usually measure kids’ blood pressure until age 3. When a child turns 3, the pediatrician will start measuring their blood pressure at every checkup.

Exception: If your child has a chronic medical condition or was born prematurely, the doctor may routinely check their blood pressure before age 3.

Normal blood pressures in kids vary by age, height, and gender. These factors will determine where your child’s blood pressure falls on the pediatric blood pressure chart.

Children whose blood pressures are above the 95^th percentile for their age, gender, and height at 3 separate office visits are diagnosed with “high blood pressure” (aka hypertension).

Insider Info: Automatic blood pressure cuffs are notoriously finicky in the pediatric population and can produce inaccurate readings if the cuff is too tight or if your child is wriggling around too much. If the blood pressure machine continues to spit out erratic numbers, the doctor will most likely revert to measuring your child’s blood pressure the old-fashioned way (with a blood pressure cuff and a stethoscope).

1. Kidney Disease & Heart Problems: In younger kids, hypertension is often due to a “secondary cause” such as kidney disease or a heart defect.

2. Obesity: As children get older, obesity becomes a more prevalent cause of hypertension. For example, studies show that obesity is responsible for 50% of hypertension cases in 7-year-olds. This number jumps to 85-95% during the teen years.³

If your child is found to have consistently high blood pressure, their doctor will embark on a relatively extensive workup to determine the cause.

This will include a review of your child’s family history and growth chart plus a detailed physical exam. Lab work, imaging of the kidneys, and an ultrasound of the heart (an echocardiogram) may also be done. Once the underlying cause is pinpointed, it will be treated. Anti-hypertensive medications (to lower the blood pressure) are usually part of the treatment plan.

High cholesterol (fancy word: hypercholesterolemia) isn’t super common in kids, but it does exist. Therefore, doctors screen ALL children for hypercholesterolemia (with a blood test) between 9-11 years of age and again between 17-21 years.

If high cholesterol runs in a child’s family, the screening may occur earlier (between 2-8 years).

The initial screening blood test for hypercholesterolemia is typically done via a finger prick. This test looks at a child’s non-fasting total cholesterol and their HDL cholesterol (the “good” cholesterol). HDL cholesterol is protective against heart disease, so you want it to be high (ideally over 45 mg/dL).

If the “non-HDL cholesterol” (the total cholesterol minus the HDL cholesterol) is borderline (120-144 mg/dL) OR high (145+ mg/dL), the child will be asked to return for a more detailed blood test (namely, a “lipid panel”). Blood for the lipid panel is drawn from the vein, rather than through a finger prick. In addition, kids must “fast” (i.e. not eat or drink anything except water) for the 12 hours leading up to the lipid panel.

PediaTip: If your child needs a fasting lipid panel, schedule it for early in the morning so they don’t get “hangry” during the day.

Total Cholesterol = LDL cholesterol + HDL cholesterol + 20% of the triglycerides

Double Take: A high HDL level (which is a good thing) can make the total cholesterol level erroneously elevated. This is why doctors also pay close attention to the LDL and triglyceride values on the lipid panel. If a child has an abnormal LDL level (of 130 mg/dL or higher) or an abnormal triglyceride level (which depends on their age), they’ll be asked to repeat the fasting lipid panel.

A diagnosis of high cholesterol can only be made when 2 abnormal lipid profiles are obtained on 2 separate occasions, 2 weeks to 3 months apart.⁴ If this criteria is met, the child will be referred to a cardiologist for further evaluation.

Note: Doctors often refer kids with a low HDL to the cardiologist, as well, and have stricter parameters for kids with a family history of hypercholesterolemia.

Unless there’s a major inherited cholesterol problem in the family, cardiologists typically encourage kids with high cholesterol to follow a low-cholesterol diet (rather than take medication) for the first 6 months or so. If that doesn’t work, a cholesterol-lowering medication is the next step.

Insider Info: Statins, a type of cholesterol-lowering medication, are generally the first choice when treating high cholesterol in kids (and adults). Children who take statins must undergo regular blood tests to ensure their liver function hasn’t taken a hit (since this can be a side effect of statins).

Reality Check: This side effect isn’t usually a big deal, but it’s something doctors like to keep an eye on.

When children complain of chest pain, their parents often fear they’re having a heart attack. Fortunately, chest pain in kids is rarely caused by a heart problem (think: only 2% of the time).⁴ Chest pain in kids is more likely to be caused by:

Costochondritis is a common cause of chest pain in kids.

It’s a condition in which the cartilage joining the ribs to the breastbone (aka to the sternum) gets inflamed. It’s often caused by lifting heavy objects or coughing repeatedly.

Nope. It’s a benign condition that goes away with time.

You can apply an ice pack or a heating pad to the affected area and give your child ibuprofen (as long as the doctor is sure of the diagnosis and says it’s OK).

The pediatrician will assess your child’s cardiac health at every visit. They’ll evaluate your child’s heart rate and rhythm and listen for murmurs. Heart murmurs are common findings during the cardiac exam in kids and are mostly “innocent.” If your child has a heart murmur the doctor will either follow it closely OR they’ll refer your child to a cardiologist if they’re worried about it. Blood pressure screening typically starts at age 3, and cholesterol screening usually begins at age 9 (or earlier if the child has risk factors that increase the likelihood of these conditions). Remember too, that the majority of chest pain in kids is NOT related to the heart. That being said, let the doctor know if your child complains of chest pain, at any point.

“My kids always ask for things like,
‘Can I have four cookies because I’m four?’
By that logic, can I have 30 million
dollars because I’m thirty?”

~@MetteAngerhofer

Sneak Peek: There are a few things that occur at age 3 (in addition to starting the blood pressure checks at every visit). They include (but aren’t limited to):

And…That’s a Wrap!

Welcome to Month 35 (Week 2) of Parenting Your Toddler!

This week, we’re going to talk about a cringe-worthy topic: sexually provocative behavior in toddlers. Although this topic can be triggering, it’s important to discuss. Most of the time, sexually provocative behavior in toddlers is benign and is merely a sign of toddler exploration (e.g. as with toddler masturbation). Less commonly, there’s a more sinister cause at play, such as sexual abuse.

Get Wise below about the signs to watch out for when it comes to sexually provocative behavior in kids and what to do if you fear the worst.

Sexually provocative behavior in kids is a sensitive topic, and one that comes up from time to time in the pediatrician’s office.

A child may make an offhand comment or exhibit an odd behavior that will stop a parent in their tracks and make them wonder if their child is being sexually abused. For example, a child may hump a pillow or want to kiss a parent in a romantic way. Most of these behaviors are the result of (normal) curiosity or mimic things kids have seen on TV, while others are red flags.

So, How’s a Parent to Know? Although there’s no surefire answer to this question, here are some signs to look out for:

1. Appear Depressed, Anxious, and Withdrawn. Most children who are victims of abuse undergo a personality change. They may:

2. Use Surprisingly “Grown-Up” Language. For example, they may use overtly sexual language that seems beyond their years.

3. Steer Clear of Certain People or Make Excuses to Avoid Being Around Them.

4. Refuse to Change Their Clothes in Front of Others.

Reality Check: Some kids are naturally shy about changing in front of people. In isolation, this is probably nothing to worry about, but when paired with other signs, it becomes a red flag.

5. Act Overtly Sexual. For example, the child may try to engage in sexual behaviors with other kids (modeling behavior they’ve either seen or experienced).

As mentioned before, toddler masturbation is common and is usually nothing to worry about. If toddler masturbation is combined with any alarming signs, though, let the doctor know.

6. Regress. The child may whine more, want to sleep with a blankie again, or wet the bed (even though they’re fully potty-trained).

Insider Info: Children aren’t usually fully potty-trained (during the day and night) until 5 years of age.

7. Have Nightmares. Sleep is often affected in victims of sexual abuse. Kids may be afraid to go to bed alone or may wake up with nightmares. Again, this is a pretty normal finding on its own, but when it’s seen in conjunction with other worrisome symptoms, it can be a sign of a problem.

8. Contract a Sexually Transmitted Disease or Have Signs of Trauma to Their Private Parts (Such as Irritation and Bleeding).

9. Change Their Eating Habits. The eating behaviors of toddlers are naturally all over the map. That being said, if your child has a significant change in their appetite (in either direction), in combination with other concerning symptoms, let the doctor know.

10. Try to Run Away From Home.

11. Have Worsening Grades in School (When Older).

Although we can’t 100% prevent sexual abuse, there are certain steps that we can take to protect our kids from becoming a victim of it. Get Wise about 7 of these tips below.

Reality Check: Some of these concepts will fly right over your toddler’s head but it doesn’t hurt to be aware of them and introduce them early on:

1. Teach Your Child About Thumbs Up & Thumbs Down Touch: Let your child know that certain parts of the body are private and only trusted doctors, parents, and caregivers can look “down there” with their consent.

“Thumbs down” touch is any type of touch that feels uncomfortable or violates these private areas. Teach your child to speak up if a touch is unwanted.

2. Don’t Force Intimacy: Resist the urge to force your child to hug, kiss, or go towards people they’re skeptical of in the moment.

To make things less awkward, you can teach your child alternative (yet polite) ways to greet someone. For example, at my daughter’s elementary school, they encouraged kids to greet the teachers with an “H, H, or H” — a hug, handshake (knuckles work, too), or a high-five.

I would throw in two non-touching options as well: just saying “hi” or waving. By offering your child various ways to greet people, you’re teaching them to honor their inner voice while still being courteous.

3. Avoid Secrecy: Parents will often tell their kids to “keep it a secret” when they’ve eaten the last cookie in the cookie jar or hidden a birthday present. Even though these “secrets” are pretty innocuous, they promote an air of secrecy within the family. Be mindful of your language around the word “secret” and substitute the phrase “let’s make it a surprise” when you can.

4. Know the Signs of Sexual Abuse: Educate yourself about the signs of sexual abuse (as discussed above).

5. Be Open About What’s “Ok” and What’s “Not Ok”: Toddlers often look to their parents to determine what’s “normal.” Let your child know early on that having another person (other than a trusted doctor, parent, or caregiver) touch their private parts is not “ok” but exploring their own bodies is.

6. Listen Well: Give your child the space to confide in you and they’ll be more likely to do so.

7. Stay Involved: Get to know your child’s teachers, coaches, and the parents of their friends.

Later On: Monitor your child’s online activities.

Although most “sexually provocative” behavior in toddlers is benign, don’t hesitate to sound the alarm and to seek help from your child’s pediatrician if you see any of the red flags signs mentioned above.

“When your mother asks,
‘Do you want a piece of advice?’
it’s a mere formality.
It doesn’t matter if you
answer yes or no.
You’re going to get it anyway.”

~Erma Bombeck

And…That’s a Wrap!

Welcome to Month 35 (Week 1) of Parenting Your Toddler!

Parents (and grandparents) often reminisce about the “good old days” when kids played unsupervised in the neighborhood and walked to school on their own. However, today’s world feels scarier and more out of control. Kidnappings, school shootings, and Amber Alerts dominate the headlines.

But is the world really a more dangerous place for our kids? A Washington Post article written in 2015 and entitled “There’s Never Been a Safer Time to Be a Kid in America” says no. In fact, as the headline implies, things are reportedly safer than ever. The article says child mortality rates are down and there’s been a significant decline in homicides in children. There’s also been a dramatic (66%) drop in kids hit by vehicles while crossing the street. Moreover, missing children reports have decreased by 40% since 1997.¹

British author Warwick Cairns puts things in perspective even more with this hypothetical question: “if you actually wanted your child to be kidnapped and held overnight by a stranger, how long would you have to keep her outside, unattended, for this to be statistically likely to happen?”

His Answer: “About seven hundred and fifty thousand years.²”

The Bottom Line: The constant barrage of fear-inducing headlines and images in the media is giving us a skewed perspective about the safety of our world today.

Many parents think the reassuring stats mentioned above prove that “helicopter parenting” has created a safer world for our kids and, as a result, are becoming even more overprotective.

Another subset of parents feel liberated by the numbers and have abandoned “hovering” in favor of building grit and independence in their kids.

How much leeway you end up giving your child is a personal decision based on your comfort level. Regardless of your approach, it doesn’t hurt to teach your little one the basics of how to move around safely in the world.

Get Wise below about how to teach toddlers about social safety rules and when to bring up the phrase “stranger danger” (hint: this is a trick question — the answer is never). We’ll also revisit the concept of “body bubbles.”

Infants (as you may remember) tend to develop “stranger anxiety” (a fear of strangers) and “separation anxiety” (a fear of being separated from their caregivers) around 9 months of age. Even though these are normal developmental milestones, you may have been slightly annoyed if your child cried every time they saw a distant relative or became hysterical when you tried to leave the house for a date night.

Fast-forward a year or two, and you may be wishing that your toddler was more aware of their surroundings and more discerning about “strangers.”

1. Set the Ground Rules: Between 1-4 years of age, the concept of “stranger danger” flies over kids’ heads. Moreover, this term has lost its luster over the years (see below). Instead of focusing on “strangers,” teach your child how to stay safe with these tips:

How Do I Do This?

First, Kick the Concept of “Stranger Danger” to the Curb.

What! Why? The term “stranger danger,” is out for three reasons.

1. Not every stranger is a threat. In fact, most strangers aren’t.

2. Most children who are abducted are taken by someone they know (i.e. not by a stranger).

3. The phrase “stranger danger” conjures up the image of a hulking monster lurking in shadows. In reality, “strangers” with bad intentions are often smiling and offering kids candy, toys, and other seductive treats.

So, What Can I Say Instead of “Stranger Danger:”

I personally like the way the Berenstain Bears book “Learn About Strangers” presents the topic. Even though this book is best for kids 4 years & up, its lingo is applicable before then. This book compares new people (i.e. strangers) to a barrel of apples. Most apples in the barrel are “good” but there are always a few “rotten apples” in the mix.

The Problem? You can’t always tell the good apples from the bad ones just by looking at them. It’s the same with people.

1. Role-Play It: Practice different scenarios in which you’re the “stranger” or even a family member. During the game, make an odd request (such as “I will give you candy if you get in my car”) and see how your child reacts. Don’t be surprised, though, if they initially say “YES!” when offered the “candy” while role-playing. Turning down candy is hard, especially when it’s in the context of a game.

2. Come Up With a Plan: Take some time to develop a strategy that you and your child can use in case they get lost. You can start by pointing out the “safe” adults in new locations (think: the cashier at a store, a police officer on the street, etc.). Teach your child your phone number and your “real” name, too. Children are often surprised to learn their parents’ given names aren’t “Mommy” and “Daddy.”

3. Make Secrets a Faux Pas: Parents commonly say things like “you can have that treat, but don’t tell Daddy” or “you can stay up for 5 more minutes, but let’s keep it between us.” Even though these “secrets” are innocuous, they promote the secret-keeping habit.

The Solution? Ditch the secret-keeping and repeat the mantra “we don’t have secrets in our family” every so often. If you want to keep something on the down-low, use the term “let’s make it a surprise” rather than “let’s keep it a secret.”

4. Teach Your Child That It’s Okay to Be “Rude” in Certain Situations: Encourage your child to listen to that “small, still voice” inside of them as they get older. This is a phrase used by Marie Forleo in the Goop podcast, “Why Fear Can be Magical.” ³

Let your child know that if they feel a strange energy with another person, it’s okay to ignore that person or run for help.

5. Reinforce the Idea of a “Body Bubble”: Use this concept to teach your child about personal space.

What’s a “Body Bubble” Again? “Body bubble” is a term used to help kids visualize their personal space. Ask your child to spin around with their arms outstretched and tell them that the space inside the imaginary circle is their own personal “body bubble.” If your child needs a more concrete visual, you can have them step inside a hula hoop or stand on a large bathmat. 

Once your child has an understanding of their “body bubble,” play games in which they give you a thumbs up or a thumbs down when you ask to enter it.

Body bubbles fluctuate in size based on our mood, our surroundings, and the people we’re interacting with. Sometimes we want to be cozy and sometimes we need space. Encourage your child to honor their changing body-bubble size by asking if they want a hug rather than assuming they want one.

Reality Check: Asking for permission for affection will probably feel a bit stilted in the beginning (and doesn’t have to happen all of the time), but it’s a helpful practice for teaching kids about personal space.

Even though none of us wants to think about our children coming face-to-face with sketchy strangers—or inappropriate family members or friends—it’s important to teach them how to navigate uncomfortable situations and trust the “small, still voice” inside them.

You feel like you’re an okay parent
winging it as best as possible and
then you ask your almost 4yo what
her favorite number is, and she says ‘A’”.

~@SnarkyMommy78

And…That’s a Wrap!

Welcome to Month 34 (Week 4) of Parenting Your Toddler!

Some babies are born with a full head of hair, while others look more like a cue ball. Most infants lose all of their primary hair (no matter how luscious it is) during their first 6 months of life, while new hair takes its place. The new hair that comes in may be an entirely different color and texture than the original hair.

By the time kids reach toddlerhood, they usually have a nice mane going (although some are thicker than others). Many parents breathe a sigh of relief at this point, thinking they’ve left the issue of “bald patches” in the dust. Some parents are, therefore, surprised to see areas of hair loss develop on their child’s head. Although this isn’t very common, it does happen.

The 3 main causes of bald spots in kids are: tinea capitis (ringworm of the scalp), alopecia areata (an autoimmune disorder), and trichotillomania (a hair-pulling disorder). We’ll also briefly talk about “traction alopecia” which occurs when braids and ponytails are pulled too tight.

Get Wise about these strange-sounding conditions and their management below.

As mentioned in last week’s PediaGuide article, tinea capitis is an infection of the scalp caused by a fungus. Although tinea capitis can occur in kids of any age, it’s most common in children 2-10 years.

The classic finding of tinea capitis is a bald patch that contains small black dots (where the hair has broken off the scalp). The bald patches often look red and scaly (as in the pic below).

Insider Info: Some patients with tinea capitis develop a “kerion,” which is a tender, pus-filled area that develops over the initial ringworm rash. This is caused by a hypersensitivity to the ringworm.

Heck Yeah! If your child develops tinea capitis, put the kibosh on sharing hairbrushes, pillows, and hats until it’s cured.

Insider Info: Ringworm can be spread from cats & dogs to humans, as well.

Ringworm of the scalp (tinea capitis) must be treated with an oral medication for a whopping 6-8 weeks. It’s annoying, but worth it. In addition, doctors often recommend that kids with tinea capitis use an antifungal shampoo.

Insider Info:

Alopecia areata is another cause of bald spots in children, although it’s much less common than tinea capitis. In fact, the general lifetime risk of getting alopecia areata is only 2%. Roughly 60% of people who develop alopecia areata have their first episode before age 20.¹

PediaMedia: You may have already heard of alopecia areata in the media.

For instance, in the tearjerker show, “This is Us,” Deja (the adopted daughter of Beth and Randall) is found to have alopecia areata.² And more recently, a spotlight was turned on Jada Pickett’s alopecia areata when her husband, Will Smith, slapped Chris Rock across the face at the 2022 Oscars for making a “bald joke.”

Alopecia areata, also known as “spot baldness,” causes the hair to fall out in round or oval patches.

The hair will often fall out in clumps, much to the dismay of the patient.

Unlike tinea capitis, the bald spots in alopecia areata are mostly smooth and bare, except for some scattered “exclamation point” hairs dotting the skin.

What are Exclamation Point Hairs? They’re short broken hairs within the bald patch. The skin of the bald spot remains unaffected, though (i.e. it doesn’t adopt the red and scaly look we see with tinea capitis).

Insider Info: 

Insider Info: Alopecia areata isn’t contagious but it does have a genetic component and can, therefore, be passed down within families.

A diagnosis of alopecia areata can usually be made based on the patient’s symptoms & physical exam. In rare cases, a biopsy of the scalp is needed to make the diagnosis.

The Good News: Roughly 50% of patients with mild alopecia areata have their hair grow back spontaneously within 1 year.⁴

The Not So Good News: Most patients with alopecia areata experience more than 1 episode of the disease during their lifetime.

Heads Up: Although alopecia areata is technically a “benign” disease, it can take a psychological toll on children because of its unpredictable nature and the cosmetic issues that it causes.

Kids with alopecia areata lose patches of hair and don’t know when the hair is going to grow back. And when it does grows back, it’s not always there to stay. This begins a cycle of uncertainty and stress. The stress, unfortunately, makes the problem worse, leading to a vicious cycle.

Although “Trichotillomania” might sound like a type of spider, it’s actually an obsessive-compulsive disorder that causes kids to pull their own hair out.

Kids with trichotillomania have an overwhelming urge to repeatedly pull out their hair. To relieve this urge, they twist, rub, or pull out their hair by the roots.

While ripping one’s hair out might not sound all that soothing, it can be calming for some children. In fact, some kids do it so much that they develop bald spots.

Although most kids with trichotillomania pull out the hair on their scalp, some kiddos prefer to pull out their eyelashes or the hair on their eyebrows, instead. And certain kids do both. A small minority of kids with trichotillomania find comfort in chewing or swallowing the hair they’ve pulled out.

The bald spots contain hairs of varying length (as shown in the pic below):

Image Source: Pediatrics in Review

Clue: The bald areas are typically on the same side as the child’s dominant hand.

The best initial course of action is to ignore the behavior (even if it makes you want to pull your own hair out). Why? Because Trichotillomania is a compulsive behavior that will only get worse if you call attention to it. Children can’t help it, so yelling at them doesn’t work, either.

If the habit leads to bald patches or interferes with your child’s daily life, psychotherapy (namely cognitive behavioral therapy) can help. As with other compulsive behaviors, kids can learn tools to help them control the urge to pull out their hair.

In rare cases, medications such as antidepressants and anti-anxiety medications are used (alongside cognitive behavioral therapy) to treat trichotillomania.

Traction alopecia occurs when braids or ponytails are pulled so tight that it causes the hair to fall out at the hairline.

The child will complain of pain or tell the parent they’re pulling too tightly when they’re putting their hair up. There may also be redness or irritation around the hairline.

PediaMedia: Back in the day, JoJo Siwa, the American singer, dancer, and YouTube sensation, was known for rocking a tight blonde ponytail with a big bow, and had a history of traction alopecia because of it.⁵

The Good News: Traction alopecia can be reversed if the caregiver stops pulling the hair back so tightly early on. 

The Not So Good News: If no changes are made, the hair loss can become permanent over time. 

Bald spots aren’t a super common finding in children. That being said, if you notice that your child has bald patches or is pulling out their hair, let their doctor know. 

“Before becoming a parent,
I didn’t realize I could ruin
someone’s life by just asking
them to put pants on…”

~Someecards (by Julie3347897)  

And…That’s a Wrap!

Welcome to Month 34 (Week 3) of Parenting Your Toddler!

Fungal infections are common in kids. If your child has ever had thrush (white spots in the mouth) or a particularly red and angry-looking diaper rash, then they’ve had a fungal infection.

Different types of fungi cause different types of fungal infections. For example, “tinea” infections are a group of fungal infections caused by dermatophytes. Dermatophytes are fungi that need keratin (a protein found in our hair, skin, and nails) to grow.

As mentioned above, Tinea Corporis (aka Ringworm of the Body) is a type of fungal infection caused by dermatophytes (keratin-loving fungi).

Insider Info: In addition to being passed between people, body ringworm can spread from one part of the body to another (on the same person). Therefore, kids with ringworm should wash their hands frequently.

Tinea corporis presents as a red & itchy circular rash with a clear center. The edges of the rash are raised and scaly (as in the pic below):

Note: The rash may start off as a simple red bump before it expands.

Ringworm has such a distinctive appearance that the circular red rash is usually all doctors need to make the diagnosis. If the diagnosis is unclear, however, the doctor will gently scrape the patient’s skin and look at the skin scrapings under a microscope to see if any fungi are present.

Severe fungal infections and fungal infections that don’t respond well to topical anti-fungal creams may need to be treated with an oral medication, such as Griseofulvin.  

Insider Info: Although tinea corporis responds well to anti-fungal medications, it can take a while to get rid of. The average treatment length for tinea corporis is 1-3 weeks. Fungal infections tend to reoccur, so the treatment may need to be repeated.

Topical Nystatin, which is often used on diaper rashes caused by yeast (another type of fungus), is not effective against tinea infections (fungal infections caused by dermatophytes).

Invasive fungal infections (i.e. fungal infections inside the body) can occur and are often severe. However, this type of infection is usually only seen in immunocompromised patients (patients with weakened immune systems).

Tinea corporis (ringworm of the body) is a fairly common skin rash in kids. While it’s not the prettiest thing to look at and can take some time to clear up, it’s relatively benign overall. If you notice an itchy, red circular rash on your child, think about ringworm and call the doctor.

“Do not compare your dog problems
to parenting. Your dog cannot say
your name 3,427 times a day.”

~Rookie Moms

And…That’s a Wrap!