Toddler Lessons

Pinworms (fancy name: Enterobius vermicularis) are small parasitic worms that set up shop in our intestines. Per the Centers for Disease Control and Prevention (the CDC), they’re the most common type of worm infection in the U.S.¹

By unintentionally swallowing their eggs.

Uh, Come Again? Yup, when kids swallow the pinworm eggs, the eggs hatch in their intestines. The larvae then grow into mature pinworms in the gut. At night, the mature female pinworms crawl out of the intestines through the anus and lay more eggs.

If your child is constantly scratching their hiney and having trouble sleeping because of the discomfort, the doctor will suspect pinworms.

To confirm the diagnosis, the doctor will probably do a “scotch tape test.”

How Does That Work? For the scotch tape test, the doctor will ask you to take a piece of scotch tape and stick it to the skin around your child’s anus before they go to sleep (or first thing in the morning before bathing).

Kids under 7-8 years of age don’t have a great sense of time. Therefore, telling them they’ll get a toy in 3 weeks for a chore they just completed is like telling them they’ll fly to the moon one day. Kids need instant gratification to keep the reward chart interesting.

Protect your bank account by keeping the rewards small and inexpensive. For example, you can give your child a sticker for each completed task. Your child can then cash in 20 stickers for a small toy at the end of the week.

If your child does something naughty, you may be tempted to take away a sticker or a toy they’ve already earned. This undermines the system, however, and will just make your child see red.

Why’s That? Because natural consequences make the most sense to your child. Your kiddo, therefore, won’t understand why you’re taking a sticker away for hitting you with a toy truck when they earned that sticker for brushing their teeth. Because these two things are unrelated, your “unjust” punishment will leave your child feeling bewildered and angry. The natural consequence of hitting you with a toy truck should, instead, be to put the truck in “time-out” until your kiddo has cooled down and is ready to apologize.

Giving edible treats as a reward can unnecessarily complicate your child’s relationship with food and lead to emotional eating. Stick with non-food prizes.

Parents can first introduce the concept of being a “helper” around the house during the toddler years (starting around age 1). In the beginning, you’ll mostly be showing your child how to do the tasks and guiding them through the process. As their motor skills and cognitive abilities improve, your little one will become more independent and will be able to do the tasks on their own. This usually occurs around 2-3 years of age. Praise the effort and keep your expectations low in terms of how “perfectly” the chore has to be executed.

One of the main mosquito-causing diseases that we worry about in the U.S. is West Nile Virus.

It’s a virus that causes brain inflammation (fancy name: encephalitis) and meningitis in kids and adults.

Through mosquito bites. Mosquitos get infected with the West Nile Virus when they feed on infected birds.

Insider Info: People with West Nile virus look and act sick.

The Not So Good News: West Nile Virus cannot be treated with antibiotics (because it’s a virus) and there aren’t any anti-viral medications to combat it. Therefore, hydration, rest, and fever reducers (such as Tylenol) are the mainstays of treatment.

The Zika virus disease is caused by mosquitos infected with the Zika virus. The Zika virus is transmitted to humans by a specific species of mosquito – the Aedes species – which thrives in tropical and subtropical places.

Zika virus infections are predominantly a problem in pregnant women because they can lead to birth defects in the fetus (think: smaller-than-normal heads). However, a few cases of Guillain-Barré syndrome (a nervous-system disorder characterized by muscle weakness and, at times, paralysis) have been reported in children with Zika.

Reality Check: This is super rare, though, and the symptoms of Guillain-Barré syndrome are often reversible.

The Good News: Although the Zika virus has received a ton of media attention in recent years, it’s basically nonexistent in mosquitos in the U.S. The Zika cases in the U.S. are primarily due to travel abroad to high-risk countries. Go here for the CDC’s updated map of Zika-infected countries.

Now we’ll turn our attention to two infections that are caused by ticks: Lyme Disease and Rocky Mountain spotted fever.

Lyme disease is caused by the bacterium, Borrelia burgdorferi, which infects certain types of ticks. If the infected tick bites a human, it can pass this bacterium to them, causing Lyme disease.

Insider Info: Not ALL ticks carry Lyme disease. The ticks responsible for causing Lyme Disease are members of the Ixodes species. They include the Ixodes scapularis tick (aka the deer tick) which can be found in the northeast, mid-Atlantic, and north-central parts of the United States and the Ixodes pacificus tick (aka the western blacklegged tick) which can be found on the West Coast.

The Ixodes scapularis tick likes to hang out with (and on) deer (hence its nickname, the deer tick). It looks like this:

Image Source: TickEncounter

The Ixodes pacificus tick (the western-blacklegged tick) has slightly different features and looks like this:

Image Source: TickEncounter

Image Source: CDC

If left untreated, Lyme disease can progress and spread to other parts of the body (think: the joints, the heart, and the nervous system). If caught early enough, though, this later stage of Lyme Disease can be avoided. 

1. A warm, red, and swollen knee (which makes the child limp). 

2. Bell’s palsy – the temporary paralysis of one side of the face (i.e. one side doesn’t move well and looks droopy).

Go here to see the full article on Lyme Disease. In the section of the article entitled “The Top 5 Facts to Know About Lyme Disease,” you’ll get the inside scoop on how long the tick has to be attached to transmit the bacteria (think: at least 36-48 hours), who gets the classic bull’s eye-rash (80% of people), and how to remove a tick (hint: grab the tweezers).

No. There’s no evidence of that.

Yes! Lyme disease can be treated with antibiotics. The annoying thing about the treatment, though, is that it takes a while to complete (10 to 28 days depending on the severity of the symptoms).

The two antibiotics most commonly used to treat Lyme disease in kids are Amoxicillin and Doxycycline.

Insider Info: Back in the day, Amoxicillin was used to treat Lyme Disease in children under 8 and Doxycycline was used to treat it in kids 8 & over. Doxycycline was avoided in kids under 8 because it was found to permanently stain their teeth. Since then, studies have shown that Doxycycline doesn’t have this side effect in kids under 8 as long as the treatment course is 21 days or less.² 

I only bring this up because you may find conflicting info about the treatment of Lyme Disease in kids on the web. Don’t stress about it, though, your child’s doctor should have you covered.

Back in the day, it was thought that children should be “seen and not heard.” Today, the pendulum has swung to the other extreme, and parents’ lives tend to revolve around their children’s over-packed schedules. Praise and participation awards are in, while shaming and spanking are (thankfully) out.

Although everyone likes praise, experts have found that certain types of praise are more effective and meaningful than others. Helpful praise should be used somewhat sparingly and is specific, honest, and focused on the process.

1. Be Specific: For example, let’s say your child draws a picture that looks like a giant blob. Instead of saying, “Great job. I love your picture, you’re the next Picasso,” you can focus on a detail that you like. For example, you could say, “I like the colors that you chose,” or you can ask a question, like, “What’s your favorite part?”

2. Be Honest: If your child tries to throw a ball and it literally goes nowhere, you don’t have to clap and say, “Great job.” Your child will innately know the throw was garbage and be skeptical of your praise in the future. Be authentic when it comes to praise. You don’t have to say the throw was crap, just don’t throw a fake compliment at it.

3. Applaud the Process: We want our kids to enjoy the process rather than focus on the end result. Instead of saying, “Nice picture,” you can praise the effort and say, “You worked really hard on that” or “that was fun to watch you draw.”

4. Put Down the Gradebook: As parents, we tend to have a running commentary on how things are going. But we don’t always have to evaluate how our kids are doing. Don’t feel pressure to fill the void. Silence can be golden.

When it comes to sharing, apologizing, and offering praise, teach your child to go for authenticity over insincerity. 

“No matter which kids’ book I read
to my screaming baby on an airplane,
the moral of the story is always
something about a vasectomy.” 

~Thanks for Keeping it Real, Ryan Reynolds!

And…That’s a Wrap!

Studies show that roughly two-thirds of young children have an imaginary friend by age 7.¹ That’s more than half the pediatric population! Imaginary friends tend make their debut around 2.5-to 3-years of age (but may show up later) and usually disappear by adolescence. They’re most prevalent in only children and firstborn kids.

Although parents often worry about imaginary friends, they’re actually a healthy expression of a child’s imagination and creativity. Having an imaginary friend doesn’t mean your child doesn’t like people, won’t have “real” friends, or is a “weirdo.” In fact, research shows the opposite: children with imaginary friends tend to be more outgoing, have more empathy, and smile and laugh more often.²

The Answer: Yes! Although it may feel a bit strange to “play along” and set a place at the table for your child’s imaginary friend, this is actually the way to go.

In fact, take it a step further by asking your child questions about their imaginary friend and including the imaginary friend in your games. This will stimulate your child’s imagination even more and strengthen your bond.

Imaginary friends not only provide a window into your child’s imagination but can also help your child work through their problems. For example, your child may feel more comfortable talking about their fears and challenges through their imaginary friend.

PediaTip: Kids with imaginary friends often pin the blame on their fictitious pals when they, themselves, make a mistake. For example, if your child spills paint on your white carpet and blames it on their imaginary friend, ask your kiddo to be a “good friend” and help the imaginary friend clean it up. The imaginary friend shouldn’t be exempt from the rules just because they’re made up.

The death of a beloved person or pet, while all too real, can send a young child’s imagination into overdrive, as well. Death is always a difficult concept to explain to toddlers. It’s especially difficult because, we, ourselves, often struggle to make sense of it and to process our feelings around it.

This euphemism will just make your child scared when anyone goes to sleep.

Why? Because the softer terms for death are lost on toddlers and will only confuse them.

Young children don’t fully grasp what it means to die and often hold onto the belief that the person or the pet will come back.

When kids sense that something serious is going on, they’ll often say something unexpected out of stress or try to lighten the mood by being silly.

You don’t have to hide your tears from your child. It’s ok to let them see that grieving is a hard and complicated process with its ups and downs.

This is a less direct (and therefore less threatening) way to discuss the topic of loss with your child and to answer any questions they may have about it.

PediaTip: These books can be a bit advanced for toddlers. If the story is flying over your child’s head, show them the pictures and make up your own, truncated narrative.

This is, of course, a personal decision. You toddler might not be on their best behavior at the funeral, which could interfere with your own grieving process. On the flip side, it’s important for our kids to to say goodbye and to see us honoring our loved ones. In the end, there’s no right answer. Just do what feels right for you and your family.

Just found out the kid I thought was my daughter’s imaginary friend is actually real. Whoops.

My 5-year-old has an imaginary friend named ‘No-one’ … which gets confusing. Who are you playing with? ‘No-one’ Who made the mess? ‘No-one.’

Just walked in on my daughter eating a pat of butter. She pinned the blame on her imaginary friend.

My son wrote a story at school today about his imaginary friend, Wino. I assume questions about his home life have been raised.

Kinda wish my 5-year-old told me before he invited all of his buddies to his imaginary friend’s birthday party this weekend.

And…That’s a Wrap!

Unless you’re Buddha himself, you’re probably going to get emotionally triggered by your child’s public tantrums. This is because they rattle the primitive parts of our brain and trigger feelings of shame, embarrassment, frustration, and anger.

Although it may seem paradoxical, you need to soothe yourself first before you can effectively parent your child. So, take a deep breath, give yourself a mental hug, and comfort the reptilian part of your brain that’s screaming “danger.” Once you’re calm(ish), you’ll be less tempted to feed the tantrum fire with your own emotions.

For example, you can say, “If you continue to be this upset, then we have to leave. If not, we can stay. What’s your choice?” Don’t offer an option that you’re not willing to honor, though. For example, if you’re in a grocery store and you have a full cart, you may not want to leave for good. In this case, your child can chill out in the car with you for a bit (if an option), before returning to the store.

Reality Check: While going somewhere private sounds great in the moment, sometimes the act of getting to the private location causes additional problems. For example, are you going to have to drag your kid across the floor to get to the private spot? Just something to think about. How well the “relocation” process goes depends on your child’s temperament and the intensity of the tantrum.

Parents tend to feel like their child’s tantrums are a reflection of their parenting skills, which they’re not. Instead, treat the tantrum as a sign that your child needs help regulating their emotions in the moment.

Try to figure out what’s causing the tantrum and say it out loud. For example, if you think your child is hungry, you can say, “I wonder if you’re hungry? Let’s find some food for you.” This helps your child put a name to what they’re feeling and offers a solution to the problem. Over time, your child will internalize this practice and will learn to identify their emotions and solve problems independently.

There’s no stopping some tantrums. Runaway tantrums tend to occur when kids are overly tired or just need to blow off steam. As a parent, you may have to ride out this type of tantrum (while saying a mantra to yourself, like, “we’re ok”).

Tantrums are a normal phenomenon during the toddler years (and beyond). Our goal as parents is not to have “perfectly” behaved children (who are repressing their feelings of anger, frustration, and fear), but to teach our kids how to regulate their emotions and express them in a “healthy” way.

“When my kids act up in public,
I like to yell ‘Wait till I tell your mom!’
and pretend they’re not mine.”

~QUOTElicious

And…That’s a Wrap!

If you Google “fevers in toddlers,” you’ll get a long list of things that cause them (fancy name: the differential diagnosis). The problem with these lists is they don’t tell the full story or indicate the probability of having each condition.

Although rectal temperatures provide the most accurate reading (for all ages), doctors don’t have to know a toddler’s temperatures to the 10th of a degree (like they do for infants).

Caregivers can, therefore, take a toddler’s temperature in the ear, under the arm, or across the forehead. The ear and under-the-arm methods are the most reliable. The temperature readings that you get with these alternative methods will be lower than those of the rectal temperature (often by a degree or so). That being said, you don’t have to subtract a degree from the temperature that’s registered on the thermometer. Just tell the doctor what your child’s temperature is and how you took it. For really high fevers, the doctor may ask you to confirm the number with a rectal temperature.

Once your child can hold the thermometer under their tongue, you can take their temperature orally. This typically occurs around 4 years of age (or around 3 years if your kiddo is precocious).

Fevers are a common occurrence in toddlers and are usually due to viruses that resolve on their own. Call the doctor if your child’s fever is high (102.2°F or above), persistent, caused by an unclear source, or is associated with other concerning symptoms (such as lethargy).

“Raise your words, not your voice.
It is rain that grows flowers, not thunder.”

~Rumi

And…That’s a Wrap!

“Infantile masturbation” doesn’t usually mean that kids are putting their hands down their pants. Instead, parents may find their toddler humping a teddy bear or rubbing up against a piece of furniture until they climax. (Note: Even though boys and girls have orgasms at this age, the boys don’t ejaculate). I know it sounds a little crazy to use the words orgasm and toddler in the same sentence, but remember this isn’t a sexual thing, it’s just something that feels good to them.

Some toddlers will do the deed once a week while others will do it multiple times a day. Because toddlers are toddlers, they’re not embarrassed to masturbate at the grocery store, during a play date, or on the carpet in front of their grandparents!

Blast From the Past: Back in the day, orgasms were often misdiagnosed as seizures in infants and young kids.

1. Normalize the Behavior: The most important thing parents can to do when they see their kids masturbating is not to shame them. Instead, they can send them the message that it’s normal for kids to explore their bodies.

2. Set Boundaries Around the Behavior: Being accepting of a behavior, doesn’t mean that you can’t set boundaries around it. For example, a parent can say, “I know rubbing against your teddy bear feels good. It’s okay to do that but you need to do it in the privacy of your own room.” Remember, too, that the more we tell our children not to do something, the more they’ll want to do it.

3. Slowly Introduce the Concept of Body Boundaries & Consent: Even though infantile masturbation is typically born out of curiosity rather than out of something sinister (like sexual abuse), it’s never too early to start dialoguing about body boundaries and consent (in age-appropriate language).

4. Watch Out for Red Flags: If your child starts to say mature sexual words or begins to exhibit inappropriate sexual behavior (such as simulating adult sex acts) let the doctor know. Why? Because these are potential signs of sexual abuse.

Reality Check #1: Most masturbation in toddlers is normal and is not a sign of sexual abuse.

Reality Check #2: The topic of body boundaries and consent will probably fly right over your toddler’s head, but it doesn’t hurt to get comfortable with the language early on.

While it might sound kind of boring, the research shows that it’s best to refer to private parts by their anatomical names (such as penis, vagina, and testicles) when talking to kids.

Why? Because saying things like “hoo-ha” and “wee-wee” are confusing to toddlers. Moreover, using the correct anatomical terms has been found to enhance kids’ “body image, self-confidence, and openness. It also discourages their susceptibility to molesters.”³ Three cheers for boring!

“If John Lennon was right that life is what
happens when you’re making other plans,
parenthood is what happens when
everything is flipped over and spilling
everywhere and you can’t find
a towel or a sponge
or your ‘inside’ voice.”

~Kelly Corrigan

And…That’s a Wrap!