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Toddler Lessons

Welcome to Month 19 (Week 1) of Parenting Your Toddler!

In This Week’s PediaGuide, We’ll Discuss:

Get Wise About It All Below…

At 19 months, your child continues to hone their motor skills, language skills, and social skills. Your toddler is probably walking at this point, even running, and climbing the stairs one at a time. Your little one may also have 6-10 words in their vocabulary (in addition to Mama & Dada).

Around 2 years of age, your child will start to put 2 words together to form a rudimentary sentence (such as “That mine” or “No, mine”).

Insider Info: As kids near the 24-month mark, the word “mine” becomes almost as popular as the word “no.”

This week’s PediaGuide article focuses on abdominal pain in toddlers. A wide variety of things can cause abdominal pain in this age group, from good old constipation to more worrisome (and rarer) ailments like appendicitis.

Get Wise below about what doctors worry about when it comes to abdominal pain in toddlers and the questions they ask to determine what’s causing it.

Abdominal Pain in Toddlers

Abdominal pain in toddlers is typically caused by gas, heartburn (reflux), constipation, or a GI virus. Although most abdominal pain is benign and self-limiting, doctors are always on high alert for a “surgical” abdomen. What’s That? As the name implies, a “surgical” abdomen is a gastrointestinal problem that requires immediate attention and (usually) surgery. Examples of a surgical abdomen include:

  • Appendicitis – an infection of the appendix that leads to “right lower quadrant pain” – i.e. pain in the right lower side of the abdomen. Get Wise(r) about appendicitis below.
  • A Bowel Obstruction – such as a blocked intestine due to Meckel’s diverticulum (an abnormal “outpouching” of the lower part of the small intestine).
  • Intussusception – when one part of the intestine telescopes into another part.
  • A Strangulated Inguinal Hernia or Umbilical Hernia. “Strangulated” means the blood supply to the hernia has been cut off.

Insider Info: Not all abdominal pain originates in the GI tract. Conditions such as pneumonia, kidney infections, bladder infections, abdominal migraines (i.e. migraines that manifest as stomach pain), and strep throat can cause abdominal pain, as well.

The Top 10 Questions Doctors Ask About Abdominal Pain

Doctors Want to Know the Following Info When They’re Evaluating Abdominal Pain and are Trying to Rule Out a Surgical Abdomen: 

1. Is the Pain Acute or Chronic?

Did the pain come on suddenly or has it been going on for a while? When did it start and what was your child doing when it started?

2. Is the Pain Severe (ER-Worthy)?

Fortunately, most abdominal pain doesn’t require a trip to the ER. That being said, here are a few pain-related symptoms that do require a call to the doctor and (typically) a visit to the ER:

  • Your child looks sick and isn’t interested in eating or playing with their favorite toys.
  • Your kiddo is crying because the pain is so intense.
  • The pain seems to be getting worse and is showing no signs of letting up (e.g. it’s been bad for 2+ hours).
  • Your child refuses to walk because of the pain.

3. Where’s the Pain?

The Location of the Abdominal Pain Can Provide Clues About What’s Causing It. 

  • Unfortunately, younger children (under 3 years) are notoriously unreliable when it comes to identifying the location of their belly pain. Toddlers will usually just point to the middle of their abdomen when asked where it hurts.
  • Older kiddos are better at pinpointing their pain.

PediaTip: Your child may be better able to localize their pain if you push on different parts of their abdomen. For example, they may wince or say “Ow” when you press on a tender area.

Doctors Divide the Abdomen Into 4 Sections (aka Quadrants) When Describing a Patient’s Pain:

Here’s a Quick Anatomy Lesson to Help You Make Sense of These Quadrants and What They Contain:

  • The Left Upper Quadrant: The left upper quadrant houses the stomach and spleen.
  • The Left Lower Quadrant: The left lower quadrant contains part of the colon.
  • The Right Upper Quadrant: The liver and gallbladder live in the right upper quadrant.
  • The Right Lower Quadrant: The appendix and the upper part of the colon are located in the right lower quadrant.

4. Does Anything Make the Pain Better or Worse?

Does the pain change when your child eats, has a bowel movement, or takes medicine? What about when they move around or lie down in a certain position (such as on their back)?

5. Is the Pain Constant or Does it Come and Go?

In the medical world, abdominal pain that “comes and go” is described as “colicky.”

6. Are There Any Other Symptoms Besides the Abdominal Pain? 

Examples of additional symptoms include vomiting, diarrhea, blood in the poop, pain with urination, a poor appetite, a sore throat, a rash, a cough, and a runny nose.

7. When Was the Last Time Your Child Pooped? Was the Stool Hard or Soft?

Constipation and gas can cause pretty significant abdominal pain in kids (and in adults too). Therefore, it’s not uncommon for parents to rush their child to the ER worried about appendicitis and sheepishly return home with a diagnosis of constipation.

8. Has There Been Any Exposure to Animals?

In this case, doctors are looking for possible parasites in the gastrointestinal tract.

9. Have There Been Any Recent Stressors at Home or at School/Daycare?

Anxiety and depression can manifest as physical symptoms (such as stomach pain or fatigue).

Insider Info: Doctors will often ask school-aged children if their abdominal pain is present on the weekends, too.

Why? Because kids who have anxiety about going to school may say their stomach hurts during the week, but not on the weekend.

10. Have There Been Any “Sick Contacts?”

This is the fancy way of asking whether a child has been around anyone with similar symptoms (e.g. at home or at daycare).

When the Doctor Examines the Patient, They’ll Be On the Lookout for the Following Red-Flag SIGNS:

  • A child with abdominal pain who looks sick (not just nauseated).
  • Abdominal pain that starts in the middle of the abdomen, then localizes to the right lower quadrant (docs worry about appendicitis in this case).
  • Vomiting bile (green stuff).
  • Lethargy.
  • Poor feeding and dehydration.
  • Bloody poop.
  • A tense, bulging belly.
  • Abdominal pain that won’t go away.
  • A high fever (think: 102.2ºF and above for this age group).
  • A child who refuses to walk or play because of their abdominal pain.

Plus, Anything Else the Parents are Worried About!

A Word About Gastrointestinal Ulcers

Peptic ulcers, which include ulcers in the stomach (fancy name: gastric ulcers) and ulcers in the first part of the small intestine (fancy name: duodenal ulcers) can also cause abdominal pain in children. Although peptic ulcers aren’t very common in kids, they’re something doctors think about, especially when the abdominal pain is chronic. 

A bacterium called Helicobacter pylori (more commonly known as H. pylori) is the No. 1 cause of peptic ulcers. Doctors can check their patients for H. pylori with a blood test, stool study, or “breath test.” 

A GI doctor may also want to confirm the presence of the ulcer with an upper endoscopy. This procedure requires sedation and involves putting a tube with a camera on the end of it down the child’s throat to visualize the stomach and small intestine.

Ulcers caused by H. pylori can be treated with a combo of antibiotics and antacids. 

The 411 on Appendicitis

Appendicitis is the No. 1 cause of emergency abdominal surgery in children (although it’s not commonly seen in kids under 5).1

What is Appendicitis? It’s when a person’s appendix becomes inflamed or infected.

Quick Anatomy Lesson: The appendix is a finger-like pouch that projects out from the colon. It’s generally thought to be a “vestigial” organ, meaning it doesn’t serve a purpose but is evidence of our evolution. However, some researchers think the appendix may actually be useful and help protect the “good bacteria” in our gut.2

PediaTrivia:

Other vestigial body parts include tailbones, male nipples (sorry, guys!), and wisdom teeth. In addition, goosebumps are considered a vestigial reflex.3

What are the Symptoms of Appendicitis?

The Following Symptoms are Suggestive of Appendicitis:

  • Abdominal Pain. Appendicitis pain starts around the belly-button area (fancy name: the periumbilical region), then migrates to the right lower quadrant a few hours later.
    • Appendicitis pain hurts!
    • If your child tenses up when you press on their abdomen or refuses to walk because it hurts so much, they may have appendicitis.
  • A Poor Appetite.
  • A Fever.
  • Vomiting.
  • Irritability.

Insider Info: The symptoms of early appendicitis are often vague, but as the disease progresses, they get worse and more obvious.

How is Appendicitis Diagnosed?

Appendicitis can be tricky to diagnose, especially in younger kids who can’t verbalize what they’re feeling. If a doctor suspects that a child has appendicitis, they’ll send the child to the ER for lab work and imaging (an abdominal ultrasound or a CT scan).

In young, thin children, an abdominal ultrasound may be all that’s required to make the diagnosis. If the appendix can’t be visualized on the ultrasound, then an abdominal CT scan is needed.

How is Appendicitis Treated?

Appendicitis can be cured by taking the appendix out. Although an “appendectomy” is a major surgery, general surgeons are well-versed in this procedure and can usually do it laparoscopically (without opening the patient up). One of the benefits of laparoscopic surgery is that the scars are barely visible once healed.

Insider Info: Recent studies suggest that uncomplicated cases of appendicitis in older patients may be managed with antibiotics and IV fluids rather than surgery.4 This is not the norm, though, and more research is needed—especially in kids.

PediaWise Book Club

If you’re ever looking for a classic read about a child with appendicitis, check out the first book of the popular children’s book series, “Madeline.” In this book, the star character, Madeline, comes down with appendicitis and goes to the hospital to have her appendix removed. After seeing her enviable scar and all the gifts she receives for being in the hospital, Madeline’s “frenemies” burst into jealous tears, wishing they could have their appendices out too!

The Bottom Line

Abdominal pain is a common pediatric complaint. Fortunately, most cases of abdominal pain aren’t due to a serious medical problem. Call the doctor, though, if you’re worried about your child’s abdominal pain or if they develop any of the red flag symptoms above.

“My friend asked me recently
what the most difficult
part of being a parent is.
‘Without a shadow of a doubt,
it’s the kids,’ I replied.”

~Baby Berry

The Reminders for This Week are the Same as Last Week’s. Get Wise About Them Below…

  • Limit Your Child’s Whole Milk to 16-24 Ounces Per Day.
  • Feed Your Child What You Eat, But Cut into Small Pieces.
  • Steer Clear of Choking Hazards. Get Wise About the Top 10 (Food) Choking Hazards Here.
  • Brush Your Child’s Teeth Twice a Day (Especially After the Last Meal of the Night) and Have Them Visit the Dentist Every 6 Months (Unless the Dentist Says Otherwise).
  • Call the Doctor If Your Child Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).
  • Continue to Give Your Child a Daily Vitamin D Supplement (600 International Units Per Day).
  • Keep Your Child in a Rear-Facing Car Seat Until (At Least) 2 Years of Age.

And…That’s a Wrap!

Welcome to Month 18 (Week 4) of Parenting Your Toddler! 

In This Week’s PediaGuide, We’ll Discuss:

Get Wise About It All Below…

Now that your child is 18 months old, “NO!” may have become their favorite word. Toddlers love to brandish this word in different settings (think: at the dinner table, at bedtime, on the changing table, or while being strapped into a car seat). Toddlers get a kick out of being oppositional and aren’t the best at regulating their emotions. So, this week we’ll discuss how to: set boundaries, discipline in a positive way, and put down the (self) judgment.

Self-Care & Putting Down the (Self) Judgment

Being a parent is a full-time job that’s strictly volunteer (read: unpaid). Parenting isn’t easy and can make the most confident of people doubt themselves at times. The tough thing about parenting is that it’s always changing. When one problem is solved, another one pops up in its place. If you have more than one child, this means you’re probably putting out multiple fires a day (and hopefully not literal ones). So, be gentle with yourself and try not to judge other parents either. We’re all in this together, doing the best we can.

Discipline & Setting Boundaries

Discipline has become a bad word in our society. For many parents, the idea of discipline is emotionally charged, and elicits memories of being spanked, reprimanded, and being told “NO!”

In reality, the word discipline derives from the Latin word “disciplina,” meaning “instruction and training.” Discipline is, therefore, not about punishment, but about teaching.

As parents we strive to teach our children life skills, emotional regulation, boundary-setting, and how to thrive in this ever-changing, ever-challenging world.

With this in mind, you may want to know when and how to start “disciplining” (i.e. guiding) your child.

Timing Is Everything:

Children don’t understand the word “No” until about 9 months of age. After 9 months, you can start planting the seeds of discipline. 

Below are 8 Tips for How to Do This:

1. Parent Intentionally, Rather Than Reactively. Have a game plan for how you’re going to react in tough situations.

Why? Because it helps to get your emotions under control before addressing those of your child.

2. Pick Your Battles. Make a short list of rules (the non-negotiables) that are important to you, and discipline around them.

3. Make Sure That Your Expectations are Developmentally Appropriate. Don’t expect your toddler to resist the urge to push over a crystal vase that’s sitting on the coffee table. Keep it out of reach instead.

4. Put Natural Consequences Front & Center. Teach your child lessons that revolve around the principle of cause and effect. For example, if your child hits you with a toy, take that toy away for a few minutes.

If you take something unrelated away from your child in this situation (such as their favorite dessert), the consequence won’t make sense to them. Instead, it sends the message that when they hit you with a truck, you’ll be a jerk for no reason and take something random away.

5. Be Mindful of Where You Put Your Energy. Children, like celebrities, believe that any publicity is good publicity. Kids love to see their parents react, especially if their reactions are full of fireworks.

If you compare the energy that we give to the negative with the energy that we give to the positive you’ll understand why kids relish negative attention. They’re not sociopaths, they just like powerful energy. Therefore, if your child does something “bad,” be relatively businesslike and matter-of-fact about it, as if to say, “I’m not going to reward your behavior by giving it my energy.”

6. Remember That You’re a Model …With Flaws.

Kids like to mimic what their parents do, so unfortunately the whole “do as I say, not as I do” thing doesn’t work. If you tell your child not to hit you and then you turn around and spank them, they won’t know what to believe.

This does not mean that you have to be perfect. It’s actually better if you’re not, because no kid can live up to those expectations. So, if you lose your cool with your child (or with your significant other), try to model what an apology looks like. It’s important for our kids to see how we respond to our mistakes and return to calm after flipping out.

7. Minimize Conflicts. Many parents (especially first-time parents) underestimate the sheer number of daily conflicts they’ll have with their kids. I know I did. While some conflicts are unavoidable, many can be anticipated and side-stepped. For example, if you know that your child is going to freak out at the grocery store because they want a certain treat, skip the sweets aisle. Or allow one treat and that’s it. Or go to the store after your child has had something to eat (since shopping while hungry is never a good look for anyone).

8. Pay Attention to Your “Positive to Negative Ratio.” Humans tend to focus more on what’s going wrong than on what’s going right. This stems from our cavepeople ancestors, who had to constantly scan the horizon for threats. The worriers and Negative Nancies had an evolutionary advantage and kept our species going.

It takes discipline to go against the primitive parts of our brains that look for the negative. So, take a few moments to notice how often you “correct” your child vs. how frequently you make supportive comments. Go for a 4:1 ratio (at least) — 4 positive comments for every negative comment. This is a good ratio to follow with your partner as well.

A Word About Positive Comments

When I talk about increasing our number of positive comments, I’m not saying that you should spew rainbows and unicorns every time you speak. Kids can see through fake, empty, and shallow praise, and will call you on it.

So, if your kid tries to kick a ball and whiffs, don’t jump up and down and say, “Great job!” They know it wasn’t a great job and will think you’re an idiot. “You’ll get it next time” or “Keep at it” are positive, non-BS things that you can say instead. Or just don’t say anything at all. We often feel compelled to fill the silence but in reality, we don’t have to be our children’s constant cheerleaders. Our kids need to be able to experience that grounded feeling that comes with positive self-talk. Kids today often rely on external praise for their self-worth, and that can be a slippery slope. You don’t have to be perfect or censor everything you say, but it helps to be mindful of your parenting commentary. 

Common Question: Is Spanking Still a Thing?

Spanking used to be all the rage (no pun intended) until studies showed that it teaches children the opposite of what we want to teach them. For instance, spanking teaches kids to:

  • Hit people when they’re angry (rather than step back and solve problems peacefully).
  • Fear their parents.
  • Feel shame.

For these reasons, spanking is out, and positive, non-physical discipline is in.

A Word of Caution: Be Careful Not to Replace Spanking with Yelling.

Everyone raises their voice at their kids at times but pay attention to your tone and try not to say anything degrading (such as “You’re always getting in trouble. Why can’t you be more like your brother?!”). If you do say something you regret, simply apologize. It’s important for kids to learn that even if they say something they don’t mean, they can usually get back on track if they own their mistakes.

Tips for How NOT to Yell:

Amy McCready, founder of Positive Parenting Solutions, says, “screaming is the new spanking,”1 and it can be almost as damaging. Here are some tips to curb yelling:

  • Create space between your emotions and your reactions. For example, take a deep breath (or ten) before responding.
  • Take care of yourself first.

    Why? Because it will be easier for you to help your child get their emotions under control if your emotions are under control.
  • Walk away while you cool down.
  • Squeeze a stress ball.
  • Count to 10.
  • Meditate (to reduce overall stress levels). Try apps like Headspace and Insight Timer.
  • Say a mantra to yourself (such as “Breathe”).

PediaWise Book Club: Want more info on how to cut down on yelling? Check out the book “Yell Less, Love More” about one mom’s quest to leave yelling in the dust. The author’s (Sheila McCraith’s) website has good tips, too.

The Bottom Line

Raising kids can be frustrating. As you navigate the ups and downs of parenting, remember to take care of yourself first, loosen your grip on perfection, and look for the humor in the chaos.

“Just when you think you might be feeling good
about your Mommy skills, a trip to the store
with your kids can put you back in your place
really quick.”

~Someecards

The Reminders for This Week are the Same as Last Week’s. Get Wise About Them Below…

  • Limit Your Child’s Whole Milk to 16-24 Ounces Per Day.
  • Feed Your Child What You Eat, But Cut into Small Pieces.
  • Steer Clear of Choking Hazards. Get Wise About the Top 10 (Food) Choking Hazards Here.
  • Brush Your Child’s Teeth Twice a Day (Especially After the Last Meal of the Night) and Have Them Visit the Dentist Every 6 Months (Unless the Dentist Says Otherwise).
  • Call the Doctor If Your Child Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).
  • Continue to Give Your Child a Daily Vitamin D Supplement (600 International Units Per Day).
  • Keep Your Child in a Rear-Facing Car Seat Until (At Least) 2 Years of Age.

And…That’s a Wrap!

Welcome to Month 18 (Week 3) of Parenting Your Toddler! 

In This Week’s PediaGuide, We’ll Discuss:

Get Wise About It All Below…

Although we want our kids to speak their truth and explore their creative side, sometimes their “self-expression” ends up as scribbling on the walls, interrupting, or wearing the same outfit for a month straight. Get Wise below about how to manage the “clothes horse,” the “graffiti artist,” and the “interrupter.”

The Clothes Horse

Some kids insist on dressing themselves in the craziest outfits. For example, when my son was a toddler, he refused to go anywhere without a superhero costume on. This lasted a solid 6 months. We were so used to him being in costume that we’d forget about it until someone would ask if he was on his way to a dress-up party. Nope, it was just a regular day for us. Below are some tips on how to manage the defiant clothes horse:

  • Pick Your Battles and Set Your Boundaries. For example, allow your child to wear whatever they want at home (or to the park), but let them know that only certain outfits are allowed at daycare, school, or church, etc.
  • Have Your Child Pick Out Their Outfit the Night Before in Case You Need to Make a Few Edits. This is to avoid locking horns in the morning when you’re in a rush.
  • Know That It’s Just a Phase. Focus on the long game. Although you may not love that your child wears their ratty Wolverine costume everywhere, remind yourself that they (probably) won’t go off to college in it.
  • Remember the Big Picture. People, in general, like to express themselves through clothes. By allowing this freedom of expression, you’ll encourage your child’s creativity.
  • Read the Pressure Gauge. Parents often feel pressure to have their kids look spiffy and spotless at all times. If this sounds familiar, think about where this pressure comes from and whether you believe in it. Let your inner voice, rather than external influences, be your guide.

The Graffiti Artist

White walls often look like beautiful blank canvases to budding Picassos. Here are some tips to help you keep your kids’ art on the page:

  • Praise Your Child When They Draw on Paper.
  • Practice Natural Consequences. If your kiddo draws on the walls, take away their drawing materials for the day and have them help you clean the wall.

    PediaTip: If your child is a graffiti artist, invest in some Mr. Clean’s Magic Erasers. They really are magic.
  • Don’t Give the Habit Too Much Energy or Your Child Will Want to Do it Even More.

Another Option:

If you can’t beat ‘em, join ‘em. Hang a big dry erase board on one of your walls OR consider painting a wall with dry erase paint (this is actually a thing-e.g. IdeaPaint).

PediaMedia: If your child has a flair for drawing on the walls, they may be destined for graffiti greatness, like this super-cool graffiti artist from Season 14 of “America’s Got Talent.”

The Interrupter

Kids love to interrupt, especially when their parent is on the phone. This is attention-seeking behavior and is often due to lack of awareness, as well.

Tips to Help Diminish This Behavior Include:

  • Set the Expectation Early. Let your child know that you’ll be on the phone for a few minutes and they need to let you finish your conversation before you can help them.
  • Keep Your Expectations Low. Toddlers can be patient for only so long, so don’t expect your little one to quietly twiddle their thumbs while you take a 20-minute call.
  • Reward Patience With Attention. If your child is patient while you’re on the phone or when you’re speaking with another adult in person, reward them with one-on-one time afterward.
  • Role Play Different Ways to “Politely” Interrupt. Teach your child that squeezing your hand or saying “excuse me” are better ways to get your attention than whining and repeatedly tugging on your sleeve.

The Bottom Line

All toddlers get into some undesirable habits, whether it be drawing on the walls, interrupting, or refusing to wear anything but superhero costumes. Pick your battles and try to be consistent about how you “fight” them.

Celebrities Are Just Like Us!

“Like all parents, my husband and I
just do the best we can, and hold our breath,
and hope we’ve set aside enough money
to pay for our kids’ therapy.”

~Michelle Pfeiffer

The Reminders for This Week are the Same as Last Week’s. Get Wise About Them Below…

  • Limit Your Child’s Whole Milk to 16-24 Ounces Per Day.
  • Feed Your Child What You Eat, But Cut into Small Pieces.
  • Steer Clear of Choking Hazards. Get Wise About the Top 10 (Food) Choking Hazards Here.
  • Brush Your Child’s Teeth Twice a Day (Especially After the Last Meal of the Night) and Have Them Visit the Dentist Every 6 Months (Unless the Dentist Says Otherwise).
  • Call the Doctor If Your Child Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).
  • Continue to Give Your Child a Daily Vitamin D Supplement (600 International Units Per Day).
  • Keep Your Child in a Rear-Facing Car Seat Until (At Least) 2 Years of Age.

And…That’s a Wrap!

Welcome to Month 18 (Week 2) of Parenting Your Toddler! 

In This Week’s PediaGuide, We’ll Discuss:

Get Wise About It All Below…

As your child nears the 2-year mark, you may feel like things are getting a bit more chaotic. This is especially true if you have more than one child. Sibling rivalry may be rearing its ugly head as your older child realizes that not only is your toddler here to stay, but they’re getting more annoying by the minute.

In addition, other habits may spring up or intensify in your toddler, such as ripping off their diaper or refusing to get in the car seat. Get Wise about how to manage these challenges below.

Sibling Rivalry

Sibling rivalry is common, especially between siblings who are close in age and of the same sex. Here are a few tips to help you minimize the conflict between your little ones:

  • Sidestep the Comparison Trap: Avoid openly comparing your children and labeling them. Phrases like “why can’t you be more like your sister?” or “he’s my wild one” will just pit your kids against each other and intensify their sibling rivalry. 
  • Spend “Connect” Time With Each Child Every Day. “Connect” time is one-on-one time that you spend with your child, during which your little one gets to dictate the play. The connect time doesn’t have to be long (it can be 10 minutes or less) but it should be long enough for your child to feel seen and heard.

    PediaTip: Put your phone away during this time and get on your child’s level (i.e. down on the floor).
  • Don’t Police Their Every Move. You want your kids to learn to solve problems. If you’re constantly hovering and interfering, they won’t get the chance to work things out themselves.
  • Avoid Being the Judge & Jury. Avoid the he-said-she-said game. You’ll probably never know exactly what went down during a conflict and that’s ok. Have both children “reset” whenever there’s fighting and don’t waste your time trying to figure out the details.
  • Give the Toy a Timeout: Although I’m not a big fan of timeouts for kids (I prefer “pauses” and “resets”), I am a fan of giving toys timeouts.

    What Does That Look Like? If your kids are fighting over a toy, you can take the toy away and put it on a shelf in “timeout” for 5 minutes while the dust settles. The toy can be brought back into play after the timeout is over as long as your children take turns playing with it. More often than not, kids forget about the toy altogether and move onto something else.
  • Don’t Force Apologies.

    Why? Because you don’t want your kids to get in the habit of “fake” apologizing. Instead, help your children brainstorm ways to make amends (when they feel ready).
  • Have Designated Places That Your Kids Can Retreat To. Every child needs downtime and a quiet place to escape to.

The Diaper-Ripper Offer

Some kids love to rip off their diapers and fling them across the room. With a pee diaper, this is a small annoyance. When they’re tossing a poop-filled diaper around, though, it can feel like a major calamity.

How Can I Stop This Behavior?

  • Don’t Give it Too Much of Your Energy. If your child knows that ripping off their diaper gets a rise out of you, they’ll want to do it again and again.
  • Buy Pull-Up Diapers. Pull-up diapers can be pulled down, of course, but this requires more coordination than ripping off a non-pull-up diaper.
  • Use Duct Tape to Secure the Diaper. This strategy works but it can be a pain to get the diaper off.
  • Set Up a Positive Reward Chart. Give your child a sticker each day they don’t rip off their diaper. Get Wise about how to make an effective reward chart here.

The Car-Seat Refuser

While some kids don’t mind their car seats, others view them as tiny prisons. Because car seats are non-negotiable, you don’t want to have a battle on your hands every time you strap your child into one. Although there’s no quick or surefire fix for the car-seat resister, here are some tips to improve the situation:

  • Give Your Child Options. For example, you can say “should I lift you into the car seat or do you want to climb into it yourself?” This gives your child the illusion they’re in control of the situation.
  • Let Your Child “Help” You Buckle Them Into the Car Seat. When your child is an active participant in the buckling, it makes them feel like it’s a concerted effort.
  • Try To Avoid Wrestling Your Child Into the Car Seat. Forcing your kiddo into the car seat will just make them resist the process even more.
  • Accessorize. Set aside a few fun toys that can only be used in the car and put a favorite drink or snack in the cup holder.
  • Appeal to Your Child’s Vanity. Purchase a car-seat mirror that allows your child to gaze at themselves and look at you, as well.

Bonus Tips for the Car-Seat Refuser

  • Tell Your Child Where You’re Going If It’s a Fun Place. If it’s a dreaded destination (like the doctor’s office), feel free to keep it on the down low until you get there. If your child asks you where you’re going, though, don’t lie or they won’t trust you.
  • Make a Game Out of It. For example, make up a silly song that you sing only when your child is getting into the car seat. Or bring toy binoculars and pretend you’re both explorers during the drive.
  • Try a Reward Chart and Give Your Child a Sticker Every Time They Buckle Up Without a Fight. Remember, toddlers have no sense of time, so stash the stickers in the car and dole them out once your kiddo is successfully buckled.

The Bottom Line

Refusing to get in the car seat, ripping off the diaper, and fighting with a sibling, are common behaviors seen in toddlers. These behaviors improve as kids mature and learn to better regulate their emotions. In the meantime, try the tips above and accept that there will probably be some ups & downs along the way.

“The easiest way to shop with kids is not to.”

~@relaxingmommy 

The Reminders for This Week are the Same as Last Week’s. Get Wise About Them Below…

  • Limit Your Child’s Whole Milk to 16-24 Ounces Per Day.
  • Feed Your Child What You Eat, But Cut Into Small Pieces.
  • Steer Clear of Choking Hazards. Get Wise About the Top 10 (Food) Choking Hazards Here.
  • Brush Your Child’s Teeth Twice a Day (Especially After the Last Meal of the Night) and Have Them Visit the Dentist Every 6 Months (Unless the Dentist Says Otherwise).
  • Call the Doctor If Your Child Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).
  • Continue to Give Your Child a Daily Vitamin D Supplement (600 International Units Per Day).
  • Keep Your Child in a Rear-Facing Car Seat Until (At Least) 2 Years of Age.

And…That’s a Wrap!

Welcome to Month 18 (Week 1) of Parenting Your Toddler! 

In This Week’s PediaGuide, We’ll Discuss:

Get Wise About It All Below…

Over the next several weeks, we’ll discuss different behavioral issues that tend to crop up during the toddler years. Even though your child probably won’t have all of them (or possibly any of them), it never hurts to be prepared. For this Week’s Hot Topics we’ll discuss “runners” and “bath-time protesters.”

Diet

Continue to offer your toddler cut-up solid foods (while avoiding choking hazards) and limit the whole milk (or the cow’s milk alternative) to 16-24 ounces per day.

PediaTip: Offer water with meals (vs. whole milk). 

Why? Because whole milk tends to fill kids up, reducing the amount of “growing” food they eat at mealtimes.

Now, Let’s Take a Look at the Hot Topics…

The Runner

Kids can be deceptively quick at this age. Some will use this to their advantage and run off. These children often flee as part of the “flight” response when they’re stressed or frustrated. They may also think it’s funny to have their parents chase after them. “Runners” often take off without notice, completely freaking their parents out.

The Good News: Kids outgrow this behavior.

The Not-So-Good News: It can take a while for kids to kick the “running off” habit.

In the Meantime, Try the Following:

1. Verbalize Your Expectations: Kids need boundaries and thrive with rules (even if they don’t seem to like them). Before you go to a public place, spell out your expectations. For example, say “you need to hold my hand on the sidewalk and when we cross the street. When we get to the park you can run around on the playground without holding my hand.”

2. Give Your Child Opportunities to Run Around Safely: Toddlers have a ton of energy and need to burn it off. If your child is fond of running off, let them run free in an enclosed space. Teach them the difference between “hand-holding places” vs. “free to run” places.

3. Set Up Natural Consequences and Stick to Your Guns: Because running off can be a high stakes situation, it’s important to set up consistent consequences to try to reduce the behavior. For example, if your child takes off, tell them the outing is over and return home. Toddlers have no sense of time, so make the consequence immediate to highlight the connection between the action and the loss of the privilege.

4. Try to Keep Your Reaction Small Even If Your Heart is Beating Out of Your Chest: It can be terrifying to see your child run off. Try to “appear” calm when you catch up to them.

Why? Because kids love big reactions. If you give the situation too much energy, your child might run off again, just for attention.

5. When Your Child Gets a Little Older, Role-Play Different “Going Out” Scenarios to Educate Them About the Dangers of Running Off: For example, have your child pretend they’re a parent who’s worried their child is going to run into the street. This type of role-playing will help nurture the seeds of empathy, as well.

Common Question: Should I Put My Runaway Child on a Leash?

Child leashes are a controversial topic in the pediatric world. The American Academy of Pediatrics isn’t a fan of them, and many pediatricians think they’re degrading to children. Some doctors, however, think they’re a useful safety tool, especially for kids with autism spectrum disorder or other conditions that may make them a “flight risk.” Ask your child’s pediatrician for their advice on “child leashes” before using one. If you do end up using one, invest in a harness or a backpack-style leash that goes around the torso (vs. one that straps to the arm).

The Bath-Time Protester

Some kids look forward to their baths, while others consider them a form of torture.

Here are 5 Tips to Help Make Bath Time More Fun for ALL Toddlers

1. Keep It Short and Sweet: Your child doesn’t have to turn into a prune for bath time to be effective. Set a timer if they tend to count down the minutes until bath time is over.

2. Play Music: Reserve a favorite playlist for bath time. The more positive associations your child has with bath time, the better.

3. Upgrade Your Bath Toys: The rubber ducky isn’t the only game in town now. Try the following as well:

4. Offer Choices: Bath time doesn’t have to happen every day. Give your child a choice of when they want to take a bath while setting boundaries around that choice. For example, you can say, “do you want to take a bath today or tomorrow?”

5. Try a Bath Visor. Some kids don’t like baths because they’re afraid to get water or shampoo in their eyes. If this is the case for your child, try a “bath visor.”

Reality Check: Parents report mixed success with these. Some say they work like a charm, while others think they’re hard to keep on.

Bonus Tip:

Partner Up: Offer to take a bath with your child. This is particularly helpful for children who are scared of the bathtub. Some kids think they’re going to get sucked down the drain, so having a parent (or a sibling) in the tub with them can help quell their fears.

PediaTip: If your kiddo gets hooked on the idea of you getting in the tub with them every time they take a bath, set parameters around it. For example, you can say, “I’ll take a bath with you but only once a week.” This will be an easier concept for your toddler to understand when they get a bit older and have a better sense of time. It may help to mark the day on a calendar, since visual cues tend to be more effective than verbal cues at this age.

What About Offering Up a Bubble Bath to Make Bath Time More Fun? Kids love bubble baths! Unfortunately, they’re pretty irritating to the genitals (especially for girls’ private parts) and can make dry skin and eczema worse. Therefore, think twice about bubble baths, and consider using a hypoallergenic soap, instead.

The Bottom Line

Running off and resisting bath time are popular past times for some kids. Fortunately, most kids outgrow these behaviors. In the meantime, try the tips above (if needed).

“If you want your children to be intelligent,
read them fairy tales.

If you want them to be more intelligent,
read them more fairy tales.”

~Albert Einstein

The Reminders for This Week are the Same as Last Week’s. Get Wise About Them Below…

  • Limit Your Child’s Whole Milk to 16-24 Ounces Per Day.
  • Feed Your Child What You Eat, But Cut into Small Pieces.
  • Steer Clear of Choking Hazards. Get Wise About the Top 10 (Food) Choking Hazards Here.
  • Brush Your Child’s Teeth Twice a Day (Especially After the Last Meal of the Night) and Have Them Visit the Dentist Every 6 Months (Unless the Dentist Says Otherwise).
  • Call the Doctor If Your Child Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).
  • Continue to Give Your Child a Daily Vitamin D Supplement (600 International Units Per Day).
  • Keep Your Child in a Rear-Facing Car Seat Until (At Least) 2 Years of Age.

And…That’s a Wrap!

Welcome to Month 17 (Week 4) of Parenting Your Toddler!

In This Week’s PediaGuide, We’ll Discuss:

Get Wise About It All Below…

Wahoo! Your child has almost reached the year-and-a-half mark. It’s crazy to think that your little one has transformed from a wriggling newborn into a walking, (somewhat) talking force of nature. In this PediaGuide article, we’ll go over the developmental milestones at this age. But first, a word about sleep and the toddler diet.

Sleep

Your toddler (hopefully) sleeps through the night and takes 2 naps a day (although they may be toying with the idea of dropping one of them). If your toddler is in a “family bed,” you may have the distinct pleasure of getting kicked in the face every now and then at night.

The Toddler Diet

Continue the cut-up table foods. Work on adding extra fruits and veggies to your child’s diet if they’re a carb fanatic. Avoid choking hazards and remember to give your kiddo 600 international units of supplemental vitamin D every day. Limit the whole milk (or cow’s milk alternative) to 16-24 ounces per day and offer your child cheese and yogurt to beef up their calcium intake (if they’re not dairy-free).

As a Reminder, the Hot Topic for This Week Is: The 18-Month Developmental Milestones. Get Wise(r) About Them Below.

The Gross Motor Milestones

Gross Motor Skills are Skills That Require Large Muscle Groups to Work Together. When it Comes to Gross Motor Skills, 18-Month-Olds are Usually Able To:

  • Walk independently and even run.
  • Climb steps one at a time while holding onto a caregiver’s hand. This means the child will climb a step with one foot, then bring the other foot next to it, before tackling the next step.
  • Sit in a small chair.
  • Carry a toy while walking. You have a multitasker on your hands!

Fine Motor Skills

Fine Motor Skills are Skills That Require Small Muscle Groups to Work Together. From a Fine Motor Skills Perspective, 18-Month-Olds May Be Able To:

  • Throw a small ball underhand while standing.

    Reality Check: The ball will probably go only a few feet at first. The pro baseball-type throws come later. You can build up to the underhand throw by rolling a ball back and forth with your child.
  • Scribble spontaneously.

    Insider Info: At this age, most kids will continue to hold the crayon in their fist (i.e. with a “crude grip”) while drawing.

Expressive Language Skills

Expressive Language Refers to the Words and Sounds That a Child Can Generate. At 18-Months, Kids are Usually Able To:

  • Say 6-10 words (other than “mama” and “dada”).
  • Name at least 5 familiar objects.

Receptive Language Skills

Receptive Language Skills Center Around a Child’s Ability to Understand Language and Follow Commands. At 18-Months, Kids Can Usually:

  • Shake their head “no” if they’re asked to do something they don’t want to do. This will quickly become a favorite gesture.
  • Point to at least 1 body part (when asked).

    PediaTip: Play the “name game” with body parts to help your child master them.

Social-Emotional Skills

Social-Emotional Skills Refer to How Kids Interact With the World Around Them. On Average, 18-Month-Olds are Able To:

  • Hand objects to caregivers.
  • Use words and gestures to ask for help.
  • Point to pictures in a book.
  • Point to objects of interest to get others interested in them as well.
  • Look to their caregivers for reassurance if something new happens.

Insider Info: Kids don’t typically initiate play with other kids until they’re older (think: 3.5 years or so). Get Wise (Again) about the 6 Stages of Play that occur during childhood.

The Bottom Line

When it comes to development, there’s a range of normal and every child is different. Therefore, try not to judge your child’s milestones based on what other kids are doing. If you’re worried about your 18-month-old’s development, let their doctor know and consider booking a separate appointment to discuss your concerns in more detail.

“I love to clean up messes I didn’t make,
so I became a mother!”

~Someecards (created by dlux)

Sneak Peek: After the 18-month visit, the next checkup isn’t until 2 years of age.

The Reminders for This Week are the Same as Last Week’s. Get Wise About Them Below…

  • Limit Your Child’s Whole Milk to 16-24 Ounces Per Day.
  • Feed Your Child What You Eat, But Cut into Small Pieces.
  • Steer Clear of Choking Hazards. Get Wise (Again) About the Top 10 (Food) Choking Hazards Here.
  • Brush Your Child’s Teeth Twice a Day (Especially After the Last Meal of the Night) and Have Them Visit the Dentist Every 6 Months (Unless the Dentist Says Otherwise).
  • Call the Doctor If Your Child Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).
  • Continue to Give Your Child a Daily Vitamin D Supplement (600 International Units Per Day).
  • Keep Your Child in a Rear-Facing Car Seat Until (At Least) 2 Years of Age.

And…That’s a Wrap!

Welcome to Month 17 (Week 3) of Parenting Your Toddler! 

In This Week’s PediaGuide, We’ll Discuss:

Get Wise About It All Below…

The 18-month checkup is coming up. As a quick review, this visit is typically free of shots and bloodwork (unless your child’s doctor follows a different schedule or your kiddo is behind on their vaccines or labs).

The main event at the 18-month visit is completing the M-CHAT (the screening questionnaire for autism spectrum disorder). The doctor will either ask you the questions directly or request that you fill out the questionnaire on your own (so the two of you can review the answers together during the visit).

Another topic the pediatrician may raise at the 18-month visit is potty training. In the U.S., potty training is often introduced to kids between 18-36 months of age. This rite of passage is a big deal for both children and their parents. For toddlers, wearing “big kid” underwear is a sign that they’ve “arrived.” For parents, ditching the diapers means freedom from lugging around overstuffed diaper bags and cleaning up gag-inducing messes.

Potty training, however, is often easier said than done. Some children (boys, I’m looking at you!) take their sweet time to get the hang of potty training, while others get the pee part down but refuse to poop in the potty. A small percentage of kids even develop a fear of toilets and start to withhold their poop.

To help you navigate the potty training waters, this Week’s Hot Topic will focus on: Potty-Training Readiness, Commonly-Asked Questions About Potty Training, Tips for Potty Training, and Pitfalls to Avoid.

Potty-Training Readiness

The first step in potty training is assessing your child’s “potty-training readiness.”

Insider Info: Potty-training readiness varies between cultures and households.

Here are the Top Signs That Your Child is Ready to Start Potty Training:

They:

  • Tell you when they have to go to the bathroom. This signals that your child is beginning to “sense” when they have to “go.”
  • Ask to use the toilet. This is a sign that your kiddo is into the whole toilet thing.
  • Want to try big-kid underwear.
  • Stay dry for several hours at a time.
  • Want to be changed right away when they have a wet or dirty diaper.
  • Hide in a corner when they poop. This suggests that your child is becoming aware of the need for a diaper change and isn’t super psyched about it.
  • Are able to follow simple directions and are getting the hang of pulling their pants down.

The Nuts & Bolts of Potty Training

Common Potty-Training Questions

How Long Does Potty Training Take?

On average, it takes kids 6 months to achieve daytime bladder and bowel control.

What About the Potty-Training Programs That Claim Success in Just 3 Days?! Although kids can get the concept of potty training down in 3 days, it usually takes longer than that to fully potty train a child during the day.

How Long Does It Take for Kids to Be Potty Trained at Night, Too?

Staying dry during the night comes more slowly than staying dry during the day. Because of this, the two are considered separate developmental milestones.

While most kids in the U.S. achieve full daytime bladder and bowel control by 24-48 months, doctors give kids at bit longer (until 5 years of age) to stop wetting the bed at night.

PediaTrivia: Bedwetting remains a problem in 15% of 5-year-olds.1

PediaTip: When you first start potty training your toddler, you can float the idea of “nighttime underwear” and use a pull-up until they gain more bowel and bladder control at night.

I’ve Heard That Boys are Harder to Potty Train Than Girls. Is That True?

Pretty much. When it comes to potty training, boys tend to lag behind girls by 2-3 months. In addition, first-born children take longer (on average) to master potty training than their younger siblings.

Now, Let’s Turn Our Attention to the Top 10 Tips for Potty Training Success. Here We Go…

1. As Mentioned Above, Make Sure That Your Child is Ready to Start Potty Training.

Potty training takes longer if it’s started too early.

2. Choose a Low-Stress Time to Introduce Potty Training.

For example, think twice about initiating potty training right before a sibling is born or when a parent is away on a business trip.

3. Slowly Introduce the Concept of Potty Training By Announcing When YOU Have to Go to the Bathroom and By Reading a Book (or Two) to Your Toddler About Kids Learning to Use the Toilet.

PediaWise Picks Include:

4. Buy a Bunch of Loose-Fitting Big-Kid Underwear Plus a Potty Seat (To Go on the Toilet) OR a Portable Potty (That You Have to Dump Out After Each Use).

PediaTips:

  • Have your child pick out the underwear and choose their own potty seat. The more involved your child is in the process, the more invested they’ll be in it.
  • If you decide to go the portable potty route, invest in one that makes music or does something cool when your child pees or poops. Positive reinforcement is always a plus!
  • If your child is potty training during the summer, you can have them run around diaper free and not bother with the underwear. You may feel like you’re playing Russian roulette when you do this, but kids love being naked at this age. Plus, it bypasses the whole pulling-the-underwear-up-and-down thing (which can be tricky for toddlers).

5. Plan for Frequent Potty Breaks (About 10 Times a Day) and Some Messes Along the Way.

6. Have Your Child Sit on the Toilet When They Wake Up, After They Eat, and Right Before Bed. Limit the Potty Sitting to 5-10 Minutes at a Time (Any Longer and it Will Start to Feel Like a Chore).

Distract your child with a book or a fun toy that’s reserved for potty training.

7. Offer Praise, a Sticker, or a Small Toy If Your Child Does Their Business in the Potty. If They Don’t Do Anything, Just Say, “No Worries. We’ll Try Again, Later.”

A Word of Caution:

Parents often use candy (think: M&Ms) to reward their children for using the potty. When it comes to potty training, reward systems and reward charts work well, but I often caution parents about rewarding behaviors with edible treats. Why? Because this practice can complicate a child’s relationship with food (think: future emotional eating).

Try This Instead: Fill a box with cheap toys and let your child choose a “prize” each time they use the potty. Or use a reward chart in which your child earns a sticker each time they successfully use the toilet. Once they collect a certain number of stickers, they can select a toy. Get Wise(r) about how to set up an effective reward chart here.

8. Make the Process Fun and Pressure-Free.

When it comes to eating, sleeping, and potty training, your child is the one in control. You can’t make your child eat their broccoli, fall asleep at the snap of your fingers, or use the potty, no matter how much you want to. So be cool, keep it light, and know that potty training takes time and practice.

9. Keep Tabs on Your Child’s Stool.

Constipation can complicate potty training and undermine a child’s success. Kids with hard stools often try to withhold them and don’t want to poop in the potty because it hurts. This can lead to a vicious cycle of refusing to poop, becoming more constipated as a result, and then REALLY not wanting to poop in the potty. Signs that your child is “withholding” include:

  • Denying they need to poop even though it looks like they have to.
  • Trying to hold the poop IN by crossing their legs, walking on their tiptoes, grunting, turning red, and squatting in the corner.

If Your Child Has Constipation Issues, Try to Get Their Stools SOFT Before You Attempt to Potty Train Them. You Can Do This By:

  • Increasing the fiber in your child’s diet by serving them more fruits, veggies, and whole grains.
  • Decreasing the amount of milk your child drinks if they’re chugging more than 24 ounces a day.
  • Giving your kiddo a stool softener (like Miralax) if their pediatrician says it’s OK.

10. Try the Cheerios Trick With Boys.

When your son practices standing up to pee, help him improve his accuracy by throwing a couple of Cheerios in the toilet and having him hit them with his urine stream.

Note: This works for husbands who need a little work in the “aim” department, as well.

The Bottom Line

Have fun and good luck. If the potty training doesn’t go well, consider shelving it for a few weeks (or more), and reintroducing it when your child is a bit older. Although potty training does take some work, it shouldn’t be torture. If your child is really struggling with it or is developing “withholding behavior,” ask their pediatrician to weigh in on the situation.

Celebrities Are Just Like Us!

“Usually the triumph of my day is, you know, 
everybody making it to the potty.”

~Julia Roberts

The Reminders for This Week are the Same as Last Week’s. Get Wise About Them Below…

  • Limit Your Child’s Whole Milk to 16-24 Ounces Per Day.
  • Feed Your Child What You Eat, But Cut into Small Pieces.
  • Steer Clear of Choking Hazards. Get Wise About the Top 10 (Food) Choking Hazards Here.
  • Brush Your Child’s Teeth Twice a Day (Especially After the Last Meal of the Night) and Have Them Visit the Dentist Every 6 Months (Unless the Dentist Says Otherwise).
  • Call the Doctor If Your Child Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).
  • Continue to Give Your Child a Daily Vitamin D Supplement (600 International Units Per Day).
  • Keep Your Child in a Rear-Facing Car Seat Until (At Least) 2 Years of Age.

And…That’s a Wrap!

Welcome to Month 17 (Week 2) of Parenting Your Toddler!

In This Weeks’ PediaGuide, We’ll Discuss:

Get Wise About It All Below…

As your child nears the 18-month mark, you’re probably paying close attention to their social development, as well as their overall development. At the 18-month visit, your child’s doctor will administer the M-CHAT, a parent questionnaire that screens for “autism spectrum disorder” (the medically correct term for “autism”).

M-CHAT stands for the “Modified Checklist for Autism in Toddlers.” Although the M-CHAT is a subjective screen (based on parental responses), it does a pretty good job of identifying children who need to be referred to a developmental-behavioral pediatrician.

Get Wise below about the signs of Autism Spectrum Disorder, which children are most at risk for it, and how vaccines and ASD became a hot-button issue in the news.

The 411 on Autism Spectrum Disorder

Autism Spectrum Disorder (ASD) is a Neurodevelopmental Disorder That Causes Children to Struggle in the Following 3 Areas:

1. Social Skills.

2. Communication.

3. Behavior.

Because ASD Cases Vary in Severity, a Bunch of Different Terms Have Been Used to Describe It Over the Years. Prior Terms You May Have Heard Include:

  • Asperger’s Syndrome.
  • Pervasive Developmental Disorder, Not Otherwise Specified (PDD-NOS).
  • And plain old “Autism.”

Today, Simplicity is King, and Doctors Use the Umbrella Term “Autism Spectrum Disorder” to Describe This Condition.

In This Week’s Hot Topic, We’ll Do a Deep Dive Into Autism Spectrum Disorder and Discuss:

What are the Symptoms of Autism Spectrum Disorder?

Below, is a review of the early signs of autism spectrum disorder. Don’t hang your hat on any one sign, though. Children with ASD typically exhibit all of these signs (to varying degrees), especially if the ASD is severe.

Here are the Common Characteristics of a Child With ASD. They:

  • Don’t Smile Back at People.

    Children with autism still smile but they often smile in response to something internal, rather than in response to the people they see.
  • Don’t Mimic (Copy) What Others Do.
  • Fail to Initiate Social Interactions – i.e. They Don’t Wave Hello or Point at Objects of Interest.
  • Don’t Make Eye Contact.

    Infants and toddlers don’t make great eye contact in general. It’s a red flag, though, if a child rarely makes eye contact when a caregiver tries to get their attention.
  • Are Hypersensitive to Loud Noises and Bright Lights.
  • Aren’t Babbling By 1 Year or Saying Single Words By 15 Months of Age.
  • Don’t Respond to Their Name (Making Their Parents Wonder If They’re Deaf).
  • Ignore Attempts to Engage Them.

    For example, they don’t look up when a parent points at an airplane overhead.
  • Consistently Prefer Not to Be Cuddled.

    This is a soft-ish sign since some kids like to cuddle more than others.
  • Seem to Be Living in Their Own World (i.e. They Appear Disconnected From the Rest of the World).
  • Have Repetitive Behaviors Such as Rocking, Spinning, Repeating Random Words Said by Others (Fancy Name: Echolalia), and “Head Banging” (i.e. Banging Their Head Against the Wall or the Floor).
  • Don’t Seem Interested in Other Kids (By a Certain Age).

    Babies and toddlers often look like they’re “ignoring” each other. This is actually normal. In fact, kids don’t actively “play” together until about 3.5 years of age. Starting at 2 years, they watch each other play (“onlooker play”) and then at 2.5 years they play next to each other without directly interacting with one another (“parallel play”). These types of play are part of normal development. Failing to progress through these stages of play or not being interested in playing with other kids when older, are potential signs of ASD.

Insider Info: Autism spectrum disorder is often accompanied by other conditions. These conditions include, but aren’t limited to: ADHD (Attention Deficit Hyperactivity Disorder), anxiety, depression, feeding issues, sleep problems, and epilepsy (a seizure disorder). Kids with ASD may develop symptoms of these other conditions as they get older.

Common Questions That Parents Have About Autism Spectrum Disorder 

My Child Bangs Their Head Against the Crib on Purpose But Has No Other Signs of Autism Spectrum Disorder. Should I Be Worried?

As mentioned above, children with autism spectrum disorder often exhibit repetitive behaviors, such as consistently banging their heads against the wall, the floor, and the sides of their crib. “Head banging” in babies and toddlers is fairly common, though, and doesn’t always mean that a child is autistic. Kids also bang their heads to self-soothe (oddly enough) and to see how their parents will react.

If your child is a “head banger,” look for additional signs of autism spectrum disorder. If the head banging seems to be an isolated habit that’s not associated with other ASD red flags, then it’s probably not the result of autism. Still, it doesn’t hurt to let the doctor know about it.

My Child Likes to Line Their Toys Up in a Certain Way. Could This be a Sign of ASD or Early OCD (Obsessive Compulsive Disorder)?

Kids often like to organize their toys in a specific way. This doesn’t mean they have ASD or OCD, though. It also doesn’t mean their rooms will be neat when they’re teenagers.

If the process of lining up the toys interferes with your child’s daily functioning, however, let the doctor know. For example, if your child would consistently prefer to line up their toys rather than play with you, that could be a red flag.

The Bottom Line: Head banging and being particular about one’s toys aren’t a big deal in isolation. If they’re combined with other red-flag symptoms, however (like not making eye contact), let the doctor know.

How Common Is Autism Spectrum Disorder?

Because there’s so much talk about “autism” in medicine and in the general community, parents tend to overestimate their child’s risk of developing it. While doctors and parents alike should be on the lookout for ASD, it only affects 1-2% of the population.1 

Reality Check: Since the 1990s, the number of cases of ASD has increased significantly. Although there may have been a small bump in the actual prevalence of ASD, most experts attribute the jump in cases to better detection, greater acceptance of the condition, and the adoption of a broader diagnostic criteria. In general, the risk that any one child will develop ASD, remains low.

What Causes Autism Spectrum Disorder?

No one knows for sure what causes ASD, but researchers have identified several risk factors.

The Main Risk Factors for ASD Include:

  • Being a Boy: ASD is 4x more common in males than in females.2
  • Having a Sibling With ASD: Parents who already have one child with ASD, are thought to have a 4-14% greater chance of having a second child with ASD.3
  • Advanced Maternal and/or Paternal Age: Parents who conceive later in life have an increased risk of having a child with ASD. For instance, a 2006 study showed that men in their 30s are 1.6x more likely than men in their 20s to have a child with ASD. In keeping with this trend, men in their 40s have an even higher risk (a 6-fold risk) of having a child with ASD.4

    Exception: ASD rates have been found to be higher in teen Moms (vs. in Moms in their 20s).5

    Reality Check: The majority of kids born to older parents do not develop ASD.
  • Specific Chromosomal Abnormalities: There are certain diseases (such as Fragile X Syndrome and tuberous sclerosis) that are caused by chromosomal abnormalities and lead to ASD.

    Insider Info: A few of these rare diseases (such as Rett Syndrome in girls) can cause kids who seem to be on track with their development to suddenly regress in their milestones. This is not common, though. If your child is reaching their developmental milestones on time, they’ll most likely continue to do so.
  • Exposure to Certain Environmental Toxins (Including Medications) and Infections During Pregnancy, Especially During the Early “Critical Window” (5-10 Weeks of Pregnancy) When the Baby’s Brain is Developing.
  • Prematurity: Babies who were born early have a greater chance of developing ASD. For example, babies born before 28 weeks gestational age are 4x more likely to have ASD than babies born at term.6

Do Vaccines Cause Autism Spectrum Disorder?

You’ve probably heard about the controversy surrounding vaccines and “autism.” If not, I’ll refresh your memory. In 1998, a study came out that said vaccines, namely the MMR (the measles, mumps, and rubella) vaccine, cause autism. The news media got a hold of these results and fanned the flames of anxiety in parents.

The Problem? The results of the study turned out to be bogus (read: falsified). Since then, multiple studies have shown no link between vaccines and autism spectrum disorder.7 Still, it’s hard to unring a bell, and many parents who choose not to immunize their children still believe that vaccines cause autism spectrum disorder.

It doesn’t help that ASD is often diagnosed shortly after the MMR vaccine has been given at 1 year. Even though people are born with autism spectrum disorder, the signs don’t usually become clear until after 1 year (typically between 18-24 months). The proposed link between ASD and the MMR vaccine is thought to be an example of “correlation without causation” — i.e. even though the vaccine is given around the same time the ASD diagnosis is made, the two are unrelated.

How is Autism Spectrum Disorder Diagnosed?

ASD is a “clinical diagnosis,” meaning that it’s made based on a patient’s symptoms, rather than on diagnostic tests. 

Exception: Docs will usually order bloodwork if an underlying genetic disorder is suspected.

Questionnaires Like the M-CHAT (the Modified Checklist for Autism in Toddlers) Help Doctors Screen for ASD.

A Few Words About the M-CHAT

  • Doctors typically use the M-CHAT to screen for ASD at both the 18-month and 24-month checkups.
  • As mentioned above, the MCHAT is a questionnaire that parents fill out. Here’s a copy of it if you’re interested.

    Insider Info: One of the questions on the M-CHAT that often trips parents up is “Does your child play pretend or make-believe?” If your child picks up your cellphone and pretends to listen to it or pretends to use a pan for cooking, then the answer is yes.
  • An M-CHAT score of 0-2 is considered low risk for ASD and no further workup is needed. If your child scores a 3 or above, the doctor will ask you to complete an additional screening questionnaire. If the follow-up questionnaire is also positive (i.e. it yields a score of 2 or higher), then a referral to a developmental-behavioral pediatrician will be made.

Is There a Cure for ASD?

There’s currently no cure for ASD, but there are different therapies that can help autistic children reach their potential and function better in the world.

Get Wise About How Doctors Manage Autism Spectrum Disorder.

The Bottom Line

Although the topic of autism spectrum disorder is all over the news, ASD only affects a small percentage of the population (1-2%). The pediatrician will screen your child for autism spectrum disorder at their 18-month and 24-month visits.

And Now For Some Inspiration…Check out this video of Kodi Lee, who won Season 14 of “America’s Got Talent.” Kodi is blind and has ASD.

PediaTip: Have a box of tissues at the ready!

“Encourage don’t belittle,
embrace their individuality.
And show them that no matter
what they will always have value
if they stay true to themselves.”

~Solange Nicole

The Reminders for This Week are the Same as Last Week’s. Get Wise About Them Below…

  • Limit Your Child’s Whole Milk to 16-24 Ounces Per Day.
  • Feed Your Child What You Eat, But Cut into Small Pieces.
  • Steer Clear of Choking Hazards. Get Wise About the Top 10 (Food) Choking Hazards Here.
  • Brush Your Child’s Teeth Twice a Day (Especially After the Last Meal of the Night) and Have Them Visit the Dentist Every 6 Months (Unless the Dentist Says Otherwise).
  • Call the Doctor If Your Child Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).
  • Continue to Give Your Child a Daily Vitamin D Supplement (600 International Units Per Day).
  • Keep Your Child in a Rear-Facing Car Seat Until (At Least) 2 Years of Age.

And…That’s a Wrap!

Welcome to Month 17 (Week 1) of Parenting Your Toddler!

In This Week’s PediaGuide, We’ll Discuss:

Get Wise About It All Below…

Did you know that sneezing is an important defense mechanism against germs? Both children and adults sneeze to clear unwanted stuff from their noses. When foreign matter (such as pollen, dust, bacteria, viruses, and smoke) flies into our noses, it tickles our nose hairs and irritates our skin, leading to a sneeze. When a person sneezes in twos or threes, it means the unwanted guests are taking their sweet time to leave.

PediaTrivia:

It’s thought that saying “bless you” after a sneeze may have originated during the Plague of Justinian (541-542 A.D). The history books reveal that Pope Gregory I urged people to say “God bless you” after a sneeze to protect the sneezer from the plague.

Another theory is that people used to think their hearts stopped when they sneezed. They would say “Bless You” to thank “the powers that be” for starting their tickers back up again.

Get Wise Below About a Common Cause of Sneezing in Kids: Environmental Allergies.

Environmental Allergies

Unlike food allergies and eczema, environmental allergies are rare in children under 1 and aren’t commonly seen in kids under 2, either. This is because the body has to see an allergen several times before it (over) reacts to it.

So, Why Are You Telling Me About Environmental Allergies When My Kiddo is Probably Too Young to Have Them?

For 4 Reasons:

1. Even though environmental allergies aren’t frequently seen in this age group, they can occur.

2. Caregivers often blame runny noses and coughs on environmental allergies, without realizing these symptoms are more likely to be due to the common cold in kids under 2.

3. Parents often have questions about this topic, especially if there’s a family history of allergies.

4. When you learn things early on, you know what to look out for down the road.

The 411 on Environmental Allergies

Environmental Allergies Include:

1. Perennial Allergies: Year-round allergies (think: dust mites and cat dander).

2. Seasonal Allergies: Allergies that show up in different seasons. Seasonal allergies are often caused by something outside the home (like pollen).

Keeping It in the Family

There’s a strong genetic component to environmental allergies. When one parent suffers from allergies, their child has a 30-50% chance of developing allergies as well. When both parents have allergies, the risk of allergies in their offspring jumps to 60-80%.1

Insider Info: Drug allergies are not inherited, although most people mistakenly assume that they are. This means that if you have a penicillin allergy, your child does not have an increased risk of developing one, too.

What are the Signs of Environmental Allergies?

Doctors Typically See the Following Symptoms With Environmental Allergies:

  • Nasal congestion and a chronic runny nose.
  • A cough. 
  • Sneezing.
  • Red, watery, and itchy eyes.

Additional Allergy Symptoms May Be Present as Well. These Include:

  • Allergic Shiners: Dark, puffy circles under the eyes that resemble bruises. Kids with allergic shiners look TIRED.
  • Allergic Salute: A temporary horizontal line that forms across a child’s nose. It’s due to the child frequently pushing their nose up when rubbing it. 
  • Cobblestoning: A bumpy appearance at the back of the throat that’s caused by chronic postnasal drip (i.e. snot running down the back of the throat).
  • Pale and Boggy Nasal Turbinates: When a child has allergic rhinitis (aka hay fever), the nasal turbinates (i.e. the soft tissue on the inside of the nose) may appear pale and boggy (i.e. swollen). Pediatricians and allergists use a special tool to look up kids’ noses to visualize the nasal turbinates.

Can Environmental Allergies Cause Any Other Problems?

Yes. They Can:

  • Trigger Asthma Attacks in Kids With Asthma OR Trigger Reactive Airway Disease Attacks in Children With Reactive Airway Disease. Reactive airway disease typically refers to asthma symptoms in kids under age 5. This is why many kids with asthma or reactive airway disease are followed by an allergist (in addition to a pulmonologist – a lung doctor). Getting the allergies under control can help get the asthma (or the reactive airway disease) under control, as well.
  • Lead to Sinus Infections. Allergies produce a lot of mucus in the nose and sinuses. If the mucus sits there too long, it can become infected and lead to a sinus infection. If your child’s clear snot becomes green or they develop a fever or fussiness (due to facial pain and pressure), visit the doctor.

What Can I Do About Environmental Allergies If My Child Develops Them?

  • Talk to Your Child’s Doctor. At this age, your child is more likely to have a cold than allergies. However, if the doctor diagnoses your child with environmental allergies, they may recommend the following:
    • A daily antihistamine during allergy season (or year-round if the allergies are perennial). Doctors usually recommend that children with seasonal allergies start taking an antihistamine a month before the season starts. Why? So the medication has time to build up in their bodies and can work its magic from the get-go.
    • A nasal spray with a steroid in it (to reduce the inflammation in the nose) plus nasal rinses with distilled water (to wash out the snot that’s sitting in the nose).
  • Avoid the Allergen: If you know which allergen is triggering your child’s symptoms, do your best to avoid it. If your child’s allergen is a prevalent type of pollen, this can be a little trickier. Use the National Allergy Bureau’s Website to stay up to date on pollen counts in your area. On the days when your local pollen count is high, your child can do more indoor activities.
  • Wash Off the Allergen: Have your child wash their hands regularly during the day and stick your little one in a bath at night.
  • See an Allergist: If your child has moderate to severe allergies, they’ll probably be referred to an allergist. The allergist can do skin prick testing to pinpoint what your child is allergic to and devise a plan of attack based on the results.

Sneak Peek: For kids 5 years & older with severe allergies, the allergist may recommend regular allergy shots (to decrease the child’s sensitivity to the offending allergen). Although allergy shots are a (literal) pain to get, they can be a game changer.

Insider Info: Studies show that the early exposure of kids to dogs and cats can actually help prevent allergies and asthma down the road. So, if you’re on the fence about getting a furry friend, this info may push you into the “yes” column.

A Word About Latex Allergies

Allergies to latex (i.e. to latex gloves and latex balloons) are on the rise. If your child is allergic to latex, ask the doctor to use non-latex gloves when examining them and choose Mylar balloons (the shiny balloons made out of foil) over latex balloons, for parties.

Need Another Reason to Choose Mylar Balloons for B-Day Parties?

Popped and deflated latex balloons are a choking hazard for kids under 8 years. Mylar balloons are a safer alternative.

The Bottom Line

Although environmental allergies aren’t common in toddlers, they’re not unheard of. If your child has a chronically runny nose, itchy eyes, and sneezes a lot, let the doctor know. 

Celebrities Are Just Like Us!

“It’s not difficult to take care of a child;
it’s difficult to do anything else
while taking care of a child.”

~Julianne Moore

Sneak Peek: The next checkup is at 18 months. Make an appointment for it (if you haven’t already).

The Reminders for This Week are the Same as Last Week’s. Get Wise About Them Below…

  • Limit Your Child’s Whole Milk to 16-24 Ounces Per Day.
  • Feed Your Child What You Eat, But Cut into Small Pieces.
  • Steer Clear of Choking Hazards. Get Wise About the Top 10 (Food) Choking Hazards Here.
  • Brush Your Child’s Teeth Twice a Day (Especially After the Last Meal of the Night) and Have Them Visit the Dentist Every 6 Months (Unless the Dentist Says Otherwise).
  • Call the Doctor If Your Child Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).
  • Continue to Give Your Child a Daily Vitamin D Supplement (600 International Units Per Day).
  • Keep Your Child in a Rear-Facing Car Seat Until (At Least) 2 Years of Age.

And…That’s a Wrap!

Welcome to Month 16 (Week 4) of Parenting Your Toddler!

In This Week’s PediaGuide, We’ll Discuss:

Get Wise About It All Below…

Now that you’re nearing the year-and-a-half mark of parenting your child, you’ve probably seen your fair share of ailments come and go. In addition to colds, rashes, and stomach bugs, many children at this age have gotten at least one ear infection. If not, you’ve dodged a (fairly benign) bullet thus far.

In this PediaGuide article, we’ll revisit the topic of middle ear infections (in the context of toddlerhood) and say a word about “swimmer’s ear.” As you can imagine, swimmer’s ear is often a hot topic during the summer months and middle ear infections are particularly prevalent during cold & flu season, although both can be seen year-round.

Get Wise About These Two Ear Issues Below.

Middle Ear Infections (Fancy Name: Acute Otitis Media)

As discussed in the Baby PediaGuide, a middle ear infection is an infection of the space behind the eardrum. Although this space is normally filled with air, it gets filled with germy fluid when infected. The fancy name for a middle ear infection is “acute otitis media.”

What Causes Middle Ear Infections?

Middle ear infections are typically caused by viruses or bacteria (that infect the fluid behind the eardrum). These viruses and bacteria are the same pathogens that cause colds.

Insider Info: If you want to impress your baby’s doctor, nonchalantly rattle off the Top 3 bacteria that cause middle ear infections. They are:

  • Streptococcus pneumoniae.

    Insider Info: The vaccine, Prevnar-13, protects against 13 strains of this bug.
  • Moraxella catarrhalis.
  • Non-typeable influenzae B. This bacterium is different from both Influenza A & B (viruses known for causing the flu) AND Haemophilius influenzae B (which the Hib vaccine protects against).

Common Question: Are There Any Risk Factors That Make Middle Ear Infections More Likely?

Yes! Here are 10 of Them:

1. Being a Kid. Kids are more prone to ear infections than adults because their ear canals (fancy name: Eustachian Tubes) are smaller and more horizontal than ours. This makes it harder for fluid to drain out of their ears (and escape infection).

2. Exposure to Secondhand Smoke.

3. Going to Daycare.

4. Sleeping With a Bottle. If your toddler has kicked the bottle habit, then you can disregard this risk factor. If not, do your best to make sure that your kiddo doesn’t go to bed with a bottle. Try a transitional object (such as a blankie) for comfort instead.

5. Anatomic Abnormalities Such as Malformed Ears or a Cleft Lip.

What’s a Cleft Lip? It’s a deformity in which a baby is born with a split in their upper lip.

6. Immune Deficiencies. Immune deficiencies weaken the immune system and make kids more susceptible to infections in general (including ear infections).

7. A Family History of Ear Infections.

8. A Cochlear Implant – a surgically implanted electronic device that partially restores hearing.

9. Pacifier Use. Pacifiers are thought to slightly increase the risk of ear infections.

10. Having a Cold.

Why? Because the fluid from the nose drains into the ears and sits there, waiting to get infected.

Extra Risk Factor: Being of Native American, Alaskan, or Canadian Inuit descent. Studies show that these ethnic groups are more prone to ear infections than the general population.

4 Tips for Decreasing Your Toddler’s Risk of a Middle Ear Infection

1. Don’t Smoke or Try to Quit If You Do. Ask your toddler’s other caregivers to quit as well (since secondhand smoke is a risk factor for ear infections).

2. Keep Your Child Up-to-Date on Their Immunizations. As mentioned above, the Prevnar-13 vaccine protects against 13 strains of Streptococcocus pneumoniae – one of the major bacterial causes of acute otitis media.

3. Practice Good Handwashing, Especially During Cold and Flu Season.

4. Say Goodbye to the Pacifier and Bottle.

How Will I Know If My Child Has an Ear Infection?

Signs of an Ear Infection in Toddlers Include:

  • A Fever (especially one that occurs in the context of nasal congestion). Ear infections aren’t always accompanied by a fever, but if a fever is present, it can signal that an ear infection is brewing.
  • Fussiness: If your toddler has a runny nose and seems extra emotional, they may be developing an ear infection.
  • Ear Pain: As kids get older, they become better at localizing their pain and verbalizing that their ear hurts. 

Insider Info: The ear pain peaks when the infected eardrum bulges out. This always seems to happen at night (just to stress parents out). You can give your child Tylenol or ibuprofen if this occurs and call the doctor. In the past, doctors also recommended giving kids a numbing ear drop called Auralgan to help with the pain, but the FDA has pulled this medication off the market. 

Double Take: Throat pain and referred pain from the teeth can also cause ear pain.

Your Child’s Doctor Will Confirm the Ear Infection By Looking Into Your Little One’s Ear With an Otoscope.

Here’s what the doctor sees when they look at an infected ear. Picture A shows a normal eardrum, whereas pics B, C, and D show ear infections of progressively worsening severity.

Image Source: AAP News, “Understanding Otitis Media in 2018.”

How Are Middle Ear Infections Treated?

The management of an ear infection depends on the child’s age and the severity of the symptoms. Back in the day, ALL ear infections were treated with antibiotics, but now a “watch and wait” approach is often encouraged in older children.

Why? Because studies showed that 80% of ear infections clear up on their own without antibiotics.1

What Are the Current Guidelines for Treating Middle Ear Infections?

  • Babies under 6 months of age are treated conservatively because of the concern for complications. As a result, they’re given antibiotics right away when an ear infection is suspected. This is usually the case for children under 2 years, as well, although the American Academy of Pediatrics (the AAP) says mild and uncomplicated ear infections in kids 6 months to 2 years may be watched for a bit.
  • Children over 2 years have more wiggle room, and doctors will often take a “watch and wait” approach (for 48-72 hours) with them as long as the ear infection isn’t severe and the child’s temperature is less than 102.2ºF. If the ear infection doesn’t improve with watchful waiting, it will be treated with antibiotics.

PediaTrivia: Despite the above guidelines, ear infections remain the #1 reason doctors prescribe antibiotics to kids.  

Which Antibiotics are Used to Treat Ear Infections in Kids?

Ear infections are typically treated with high-dose amoxicillin (although alternatives exist for children who are allergic to penicillin). The standard treatment length is 10 days.

Why is “High Dose” Amoxicillin Used (vs. Regular Dose Amoxicillin)?

Because the bacteria that cause ear infections have become increasingly resistant to amoxicillin. Therefore, higher doses of amoxicillin are needed to eradicate them.

Insider Info: Some doctors will give parents a prescription for an antibiotic and tell them to fill it only if the ear infection worsens during the “watch and wait” period. This isn’t 100% above board but it happens and may spare the child a return visit.

Frequently Asked Questions About Middle Ear Infections:

Is Ear Tugging a Reliable Sign of an Ear Infection?

Kids with ear infections tend to pull on their ears. Therefore, ear tugging may be a clue that your child has an ear infection IF it’s seen in the context of a cold or a fever.

However, ear tugging (on its own) isn’t a reliable sign of an ear infection, because kids love to tug on their ears for other reasons too (for example, when exploring their bodies, teething, or trying to self-soothe). Many children find ear tugging comforting and will do it when they’re tired.

At First, the Doctor Said My Child Didn’t Have an Ear Infection, But Now, He Says My Child DOES Have One. What Gives?

When it comes to acute otitis media, the ear exam can change over the course of a day. The eardrum may go from normal-looking to bulging in a matter of hours.

Translation: Don’t yell at the doctor if your child’s eardrum suddenly looks infected on the repeat exam.

Does My Toddler Need a Follow-Up Ear Check After Being Treated With Antibiotics?

Some doctors request that kids return for an ear recheck.

Why? To make sure the infection has resolved and to look for lingering fluid in the ears (fancy name: serous otitis media).

Help! My Child Has an Ear Infection and We’re Going on a Plane. Is That Okay?

Yup. Just make sure your little one has something to suck on or chew on (such as a teething toy or a snack) to help alleviate the pressure in their ears during takeoff and landing.

Yikes, The Doctor Just Told Me That My Child’s Eardrum Ruptured! Now What?

A “ruptured” or “perforated” eardrum sounds worse than it is. It happens when the middle ear infection worsens, causing a build-up of pressure in the ear. This increased pressure makes the eardrum burst.

Don’t worry, though, a ruptured eardrum is more like a cut in the eardrum (vs. an explosion in the ear).

Insider Info: The ear actually feels better after it ruptures because the pressure has been released. Most ruptured eardrums heal on their own, leaving a small scar behind. If your child’s doctor has any concerns, though, they’ll refer your little one to an ear, nose, and throat doctor (an ENT).

Can I Stop the Antibiotics Early? My Toddler Seems Back to Normal.

Although it can be a nuisance to give a child medicine for 10 days straight, it’s best to complete the full course of antibiotics. Why? To prevent the ear infection from returning or from getting worse and causing complications (such as hearing loss, meningitis, etc.).

A Word About Recurrent Ear Infections

Some children are more prone to ear infections than others.

Is This a Problem?

It can be. Recurrent ear infections can lead to:

  • Scarring of the eardrum. 
  • Speech delays.

    Why? Because persistent fluid behind the eardrum can impair a child’s hearing which, in turn, can affect their language development. Fortunately, most speech delays due to recurrent ear infections can be overcome with speech therapy and by clearing the fluid out of the ears.

Get Wise About Recurrent Ear Infections and How They’re Managed (think: Ear Tubes).

The Bottom Line: Middle ear infections are common in kids. Pediatricians are, therefore, always on the lookout for them, especially in kids who’ve had a runny nose for a few days and suddenly spike a fever.

Now, on to Swimmer’s Ear (Fancy Name: Otitis Externa)

Swimmer’s ear is an “outer ear infection” in which the skin lining the ear canal gets infected.

What Causes It?

Bacteria. When water gets trapped in the ear or there’s minor trauma to the ear canal (e.g. from a Q-tip), bacteria can collect in the ear canal, leading to otitis externa.

Swimmer’s ear, as the name implies, is most commonly seen during swim season.

What Does Swimmer’s Ear Feel Like?

Swimmer’s ear causes ear pain and itching and may lead to a white or clear discharge in the ear canal. It’s especially painful when the outside of the ear is pulled up and back. Note: This is a common physical exam maneuver that doctors use to diagnose swimmer’s ear.

How is Swimmer’s Ear Treated?

Unlike middle ear infections, otitis externa can be treated with antibiotic drops (vs. oral antibiotics). 

PediaTip: If your kiddo is prone to swimmer’s ear, take the following steps to prevent it from reoccurring:

1. Dry their ears with a towel after swimming or bathing.

2. Put ear drops in your child’s ears after they take a dip. These can be purchased over the counter or made at home by combining white vinegar and rubbing alcohol in a 1-to-1 ratio. Get the green light from the doctor before using them, though.

3. Consider ear plugs.

A Word About Earwax & How to Manage It

Did you know that Q-tips are out when it comes to cleaning the inside of the ears?

Why? Because Q-tips can cause trauma to the ear canal and push the wax towards the eardrum. If the Q-tip is pushed too far in, it can even puncture the eardrum.

Doctors Aren’t the Only Ones Who Caution Against Q-Tips IN the Ear: Even Q-tip boxes contain a warning that reads: “Do not insert swab into ear canal. Entering the ear canal could cause injury. If used to clean ears, stroke swab gently around the outer surface of the ear only.2”

So, What Should I Do About My Kid’s Earwax?

Although parents (and people in general) don’t usually love the look of earwax, it actually serves a purpose. Earwax has antibacterial and antifungal properties that help keep the ear canal lubricated and clean. I know that sounds kind of gross, but it’s true. So, the best way to manage ear wax is to leave it alone. The ear is “self-cleaning,” meaning the earwax should fall out on its own.

If you can’t help yourself, though, use a damp washcloth to clean around your child’s ear to capture any wax that has migrated out of the ear canal.

Insider Info: At times, earwax can become “impacted,” which means that it builds up, hardens, and blocks the ear canal. This can happen naturally or if you push the wax further into the ear canal with a Q-tip (which is a no-no anyway). For impacted earwax, pediatricians usually recommend one or both of the following:

  • Instill Debrox drops in the ear. Remember Colace, the medication that helps with constipation? Well, Debrox is essentially Colace for the ear. It softens the earwax and is sold over-the-counter.
  • Take your child to the doctor for an “ear irrigation.” During an ear irrigation, the doctor squirts water under high pressure into the ear to get the wax out. This isn’t the most comfortable thing in the world, but it often does the trick. BTW, don’t try this at home!

Note: Docs will often instruct parents to put Debrox drops in their child’s ear, then come to the clinic 1-2 days later for the ear irrigation.

Another option that some doctors pursue is to scoop out the earwax in the office with a special tool, using an otoscope as their guide.

The Bottom Line

Ear pain is a fairly common problem in toddlers and warrants a call to the doctor.

If your child has nasal congestion and spikes a fever, the doctor will look for a middle ear infection. If your little one develops ear pain after hanging out at the pool, the doctor will be on lookout for swimmer’s ear. If there’s pus draining from one ear and your child complains of pain in that ear, they may have a foreign body (such as a toy) stuck in there (since kids love to put objects in their ears AND up their noses).

To determine the cause of the ear pain, the doctor will want to see your child in the office and examine the affected ear with an otoscope.

“Oh, you ran a 5k today? That’s cool. 
I buckled a toddler into a car seat twice,
so we both burned the same amount of calories.”

~Stephanie Ortiz (@Six_Pack_Mom)

The Reminders for This Week are the Same as Last Week’s. Get Wise About Them Below…

  • Limit Your Child’s Whole Milk to 16-24 Ounces Per Day.
  • Feed Your Child What You Eat, But Cut into Small Pieces.
  • Steer Clear of Choking Hazards. Get Wise About the Top 10 (Food) Choking Hazards Here.
  • Brush Your Child’s Teeth Twice a Day (Especially After the Last Meal of the Night) and Have Them Visit the Dentist Every 6 Months (Unless the Dentist Says Otherwise).
  • Call the Doctor If Your Child Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).
  • Continue to Give Your Child a Daily Vitamin D Supplement (600 International Units Per Day).
  • Keep Your Child in a Rear-Facing Car Seat Until (At Least) 2 Years of Age.

And…That’s a Wrap!

Welcome to Month 16 (Week 3) of Parenting Your Toddler!

In This Week’s PediaGuide, We’ll Discuss:

Get Wise About It All Below…

Parents often wonder when they should switch their toddler to a big bed, especially if their little one has tried to hurl themselves out of the crib. Believe it or not, most doctors recommend keeping toddlers in a crib for as long as possible. We’re not saying until college, but until about 3 years of age OR until they start consistently climbing out of the crib (whichever comes first). 

Why Keep Kids In a Crib For So Long?

Because once a child moves to a toddler bed, all bets are off, and they have the potential to roam around at night (think: visiting their parent’s room or heading to the kitchen in search of a midnight snack).

Get Wise below About Tips for Safe Toddler Sleep and How to Transition Your Child to a Big Bed (When the Time is Right). 

The Top 5 Tips for Safe Toddler Sleep

1. Lower the Mattress.

Make sure the crib mattress is set to the lowest level to make it harder for your child to climb out (or fall out). Install a soft carpet in the room, as well.

2. Let Your Child Pick Their Sleep Position.

Now that the SIDS risk is over, your toddler can sleep in whichever position they’d like (i.e. on their stomach, back, side, etc.). You may even notice that your kiddo completely spins around while asleep. That’s normal and something they’ll eventually grow out of.

3. Watch Out for Choking Hazards on “Transitional Objects.”

Transitional objects (such as teddy bears, blankies, and pillows) are allowed now. Just make sure they don’t have pieces that could be pulled off and swallowed. Also, make sure there’s nothing in the crib (like a thick pillow) that can be used as a step stool to help your child climb out.

4. Clear Away Mobiles, Electrical Wires, and Window-Blind Cords.

Now that your toddler excels at grabbing things, the mobile definitely needs to go (if it hasn’t already). In addition, make sure there aren’t any electrical cords (e.g. from the baby monitor) or window-blind cords within reach.

5. Skip the Crib Tent.

Avoid crib tents, which are designed to keep crib jumpers inside their cribs. Why? Because they can pose a suffocation hazard.

How to Transition Your Child to a Big Bed When the Time is Right

As mentioned above, pediatricians like to keep children in their cribs for as long as possible because it’s safer for the kids and easier on the parents. However, once your child starts getting cramped in their crib (around age 3) or is consistently doing flips out of it, it’s time to switch them to a big bed. 

Below are the Top 5 Tips for Moving Your Child to a Big Bed:

1. Pick a Time When There are No Big Life Changes Happening.

Parents commonly transition their child to a “big bed” when they’re about to have another baby. The thought behind this move is twofold:

  • They want to use the crib for the newborn,

    AND
  • They want to give their older child a sense of pride and independence.

This always sounds like a good idea at the time, but do you really want your toddler wandering around at night while you’re tending to an infant? Plus, toddlers tend to regress in their behavior when a new baby shows up. If your toddler isn’t a fan of the new bed, they may end up in YOUR bed (which can make the late-night newborn feeds a bit crowded). 

That’s not to say the switch can’t be done at this time, just think about this plan before you commit to it. If you do decide to take the plunge, switch your child to a new bed several months before the new baby arrives.

2. Put the New Bed in the Same Place as the Crib.

Why? Because kids like familiarity.

3. Let Your Child Pick Out the Sheets and the Comforter.

Why? Because kids like control.

4. Lay the Ground Rules Early On.

For example, let your child know that there’s no getting out of the bed or leaving the room until morning. If your child is potty training, at the time, ask them to give you a shout when nature calls (if they aren’t wearing a pull-up diaper overnight). In addition, make sure that your child’s room is safe in case they don’t follow the rules. For example, plug up the electrical sockets, tie up loose electrical wires and window-blind cords, hide choking hazards, and put doorknob covers on the doorknobs.

5. If Your Child is Skeptical About the Whole Bed Thing, You Can Put a Mattress on the Floor and Start There.

Bonus Tips:

1. Avoid Toddler Beds With Side Rails.

Why? Because they’re not safe.

2. Introduce Your Child to the Idea of Moving to a “Big Bed” by Reading Them a Book on the Subject.

PediaWise Pick: Big Bed for Giraffe by Michael Dahl.

3. Try a “Sleep Trainer” Alarm Clock.

These alarm clocks use pictures and/or different colored lights to let kids know when they can get out of bed (and when they need to stay put).

PediaWise Pick: Hatch Baby Sound Machine, Night Light & Time-to-Rise Alarm Clock.

Common Toddler Bed Questions

Does My Child Really Need a Toddler Bed, or Can They Go Straight to a Real Bed?

If you’re looking to save money, your child can move straight to a real bed (or you can put the mattress on the floor if the bed seems too high).

Does My Toddler Need a Pillow For Their Toddler Bed?

You can put a pillow on the toddler bed, but don’t expect your child’s head to stay on it. Most toddlers turn around in their sleep and jettison the pillow off the bed at some point during the night.

The Bottom Line

Don’t feel pressure to ditch the crib any time soon (unless your child regularly jumps out of it). When your child is ready to move to a toddler bed, make sure their room is childproofed and be intentional about how and when you make the switch.

“A child is a curly, dimpled lunatic.”

~Ralph Waldo Emerson

The Reminders for This Week are the Same as Last Week’s. Get Wise About Them Below…

  • Limit Your Child’s Whole Milk to 16-24 Ounces Per Day.
  • Feed Your Child What You Eat, But Cut into Small Pieces.
  • Steer Clear of Choking Hazards. Get Wise About the Top 10 (Food) Choking Hazards Here.
  • Brush Your Child’s Teeth Twice a Day (Especially After the Last Meal of the Night) and Have Them Visit the Dentist Every 6 Months (Unless the Dentist Says Otherwise).
  • Call the Doctor If Your Child Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).
  • Continue to Give Your Child a Daily Vitamin D Supplement (600 International Units Per Day).
  • Keep Your Child in a Rear-Facing Car Seat Until (At Least) 2 Years of Age.

And…That’s a Wrap!

Welcome to Month 16 (Week 2) of Parenting Your Toddler!

In This Week’s PediaGuide, We’ll Discuss:

Get Wise About It All Below…

Every daycare and preschool has a biter and every parent secretly hopes that it’s not their child. Kids bite, not because they’re “bad,” but because they’re either trying to fulfill a need, are having trouble regulating their emotions, or they tried it once for kicks and got a big reaction. Whatever the reason, we’ve got you covered, on both sides of the equation, in the Hot Topics below.

The Biter & The Bitee

Tips If Your Child Is the Biter

1. Know That It’s a Phase and It’s Not the End of the World. Also know that it’s pretty common.

2. Give It Your Attention (But Not Too Much): Kids will often bite for the first time on a whim. If they get an intense reaction when they do it, they’ll want to do it again. Instead of going ballistic, make your response short, low energy, and simple. You can say, for example, “No biting,” then distract your little one with something more exciting. As your child gets older, offer alternatives to biting. For example, you can say, “It’s okay to be upset, but if you feel like you need to bite, hold your doll, squeeze a stress ball, or tell the teacher.”

3. Don’t Bite Back: Back in the day, parents were encouraged to bite their children back to show them what it felt like to be bitten. Needless to say, this practice has fallen out of favor.

4. Don’t Scream: Doctors also used to advise parents to scream “OUCH!” at the top of their lungs so their child would know that biting HURTS. Kids unfortunately LOVED this dramatic response, so this advice fell by the wayside, too.

5. Read Your Child a Book About Biting: If you teach your child about biting in a less direct way (like through a book), they may feel less defensive about it.

PediaWise Pick: Teeth are Not for Biting by Elizabeth Verdick.

6. Make Sure That Your Kiddo is Getting Enough Sleep: It’s harder for kids (and adults, for that matter) to regulate their emotions when they’re overtired.

7. Practice Makes Perfect: Role-play with your child and act out positive ways to manage conflict.

8. Identify Your Child’s Triggers: Observe your child and try to figure out when they tend to bite and why. Then intervene (if you can) before they get triggered.

9. Talk to the Teacher (If Your Child is in School or Daycare). Biting is often a one-off, but it can become a pattern of behavior if it’s not addressed quickly. Develop a plan with the teacher to prevent it from becoming “a thing.”

10. Apologize to the Bitten Child’s Parents. Feel out the situation first, but know that it usually helps to apologize to the parents of the bitten child. A mea culpa can prevent things from spinning out of control.

Bonus Tip:

Teach Your Child How to Make Things Right

Ask your child what they can do to make it up to the child that was bitten. Can they draw a picture, give a gift, or apologize in person to make amends? This concept can be a bit much for toddlers, but it’s important for kids to learn how to “right a wrong” early on.

The Bottom Line: Most kids outgrow their biting behavior by age 3-3.5 years. If your child continues to bite other children or the behavior gets worse, let their doctor know. In this case, the doctor may be able to offer additional tips or provide a referral to a developmental-behavioral pediatrician.

Tips if Your Child is the Bitee (the One Who Was Bitten)

1. Let Your Child’s Doctor Know (Especially If the Biter Drew Blood). Human bites are considered “dirty,” (i.e. full of bacteria), so you’ll want to minimize the risk of infection if the teeth broke through the skin.

2. If Your Child is in Daycare or Preschool, Ask the Teacher (Or the Principal) How They Plan to Handle the Situation.

3. Let Your Child Know That It’s Not Okay to Bite and That the Other Child is Having Trouble Managing Their Emotions.

4. Try to Have Compassion for the Biter. When another child injures your child, it’s tempting to go all mama or papa bear on the perpetrator. However, resist the urge to vilify the other child and to gossip about them. Biters tend to get labeled quickly, and labels never help. Understand that biters are not “problem” kids, they just need to work on expressing themselves in healthier ways.

A Word About Hitting

Hitting, like biting, can be an exhilarating pastime for kids. Kids love to see the reactions that hitting elicits, too. As with biting, the less energy you give hitting, the better. For example, you can say, “No hitting,” and then move on to something else. 

If your child hits a playmate with a toy, take the toy away (as a natural consequence). In addition, teach your child better ways to deal with frustration, such as taking a breath or verbalizing their feelings.

The Bottom Line

Hitting, biting, and other unsavory childhood behaviors typically resolve as kids mature and gain better impulse control.

“You can learn many things from children.
How much patience you have, for instance.”

~Franklin P. Jones

The Reminders for This Week are the Same as Last Week’s. Get Wise About Them Below…

  • Limit Your Child’s Whole Milk to 16-24 Ounces Per Day.
  • Feed Your Child What You Eat, But Cut into Small Pieces.
  • Steer Clear of Choking Hazards. Get Wise About the Top 10 (Food) Choking Hazards Here.
  • Brush Your Child’s Teeth Twice a Day (Especially After the Last Meal of the Night) and Have Them Visit the Dentist Every 6 Months (Unless the Dentist Says Otherwise).
  • Call the Doctor If Your Child Spikes a Fever Above 102.2°F OR If They Develop Any Other Worrisome Symptoms (Such as Lethargy or Poor Feeding).
  • Continue to Give Your Child a Daily Vitamin D Supplement (600 International Units Per Day).
  • Keep Your Child in a Rear-Facing Car Seat Until (At Least) 2 Years of Age.

And…That’s a Wrap!

Pediatric Wisdom for Parents
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