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Toddler Lessons

Welcome to Month 16 (Week 1) of Parenting Your Toddler! 

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

Get Wise About It All Below…

It’s basically a parenting rite of passage to get barfed on by your toddler, so this week’s Hot Topic will focus on vomiting. 

But, First, Let’s Do a Quick Review of Eating & Sleeping at This Age:

Your toddler can continue to eat cut-up table foods and drink 16-24 ounces of whole milk per day. They’re ideally getting 11-14 hours of sleep per day (including 2 naps, although many kids drop the second nap between 14-18 months of age).

The Vomiting Toddler

As you may remember from the Baby PediaGuide, vomiting is the forceful throwing up of stomach contents.

The Most Common Cause of Vomiting in Toddlers is a Stomach Virus. Less Common Causes Include:

  • Food poisoning.
  • Intense coughing that leads to vomiting (fancy name: post-tussive emesis).
  • Bladder infections.
  • Intestinal blockages (such as from an intussusception – the telescoping of one part of the bowel into the other).
  • Increased pressure inside the skull (due to head injuries, brain tumors, etc.) – this is super rare, though!

Vomiting, Though Gross, Isn’t Usually a Big Deal In and of Itself. Doctors Have 2 Main Goals When it Comes to Vomiting.

1. To figure out what’s causing it.

2. To make sure the “puker” doesn’t get dehydrated (although toddlers are less likely to get dehydrated than infants).

Making the Diagnosis

To determine the underlying cause of the vomiting, the doctor will examine your child and ask you a series of questions. 

The diagnosis is usually a clinical one (based on your child’s symptoms). If any red flags show up, the doctor may order labs or imaging (such as an X-ray or, more rarely, a CT scan or an MRI). Get Wise about a few important vomiting red-flag symptoms below.

The Top 5 Vomiting Red Flag Symptoms

Although vomiting is typically benign and self-limiting, there are some red flags to look out for. They include:

1. Vomiting Bile

  • If the vomit is green or dark yellow, it may include bile.
  • Bile is a red flag because it signals a blockage in the intestines.

Double Take: Sometimes it’s hard to distinguish bile from gastric juices just by looking. Gastric juices are yellow, like yellow Gatorade. If you’re not sure what you’re looking at, take a picture and call the doctor. Parents often say their child is vomiting bile when they’re really just spewing gastric juices.

The Bottom Line: Green vomit is always a concern! Yellow vomit can be a red flag (especially if it’s dark) and should be relayed to the doctor as well.

2. Vomiting Blood

When a child is vomiting blood, the color of the blood helps determine where it’s coming from.

  • Bright-red blood suggests the blood is coming from higher up in the gastrointestinal tract (such as from the esophagus or even from the nose – as with a bloody nose).
  • Dark-red blood, on the other hand, is a sign that the blood is originating from a place lower down in the gastrointestinal tract. Dark blood in the vomit often looks like coffee grounds.

The Bottom Line: Any blood in the vomit requires a call to the doctor. If your child vomits blood, either make a note of the color (bright red vs. dark red) or take a picture of the vomit.

PediaTip If Your Child Has Red Vomit: Before you panic about blood in the vomit, try to remember if your child had anything “red” to drink before they started vomiting. For instance, if your child drank cranberry juice or fruit punch, they may vomit red.

3. Prolonged Vomiting (for 24+ Hours)

  • Prolonged vomiting makes pediatricians worry about dehydration. It also makes doctors wonder if something more worrisome than a run-of-the-mill virus is causing the upchuck.

4. A Distended and Tender Belly

While an “upset stomach” isn’t comfortable for anyone, it shouldn’t lead to excruciating pain or to a bloated-looking belly (fancy name: abdominal distension).

If your child’s belly is distended and super tender (i.e. they cry out in pain when you touch it or refuse to even let you touch it), call the doctor.

Why? Because these symptoms suggest an “acute” abdomen, which is a medical emergency. An acute abdomen is often the result of a concerning pathology (such as an intestinal obstruction or appendicitis) and may require surgery.

5. Middle-of-the-Night Vomiting or Morning-Only Vomiting

Call the doctor if the vomiting wakes your child up at night or occurs repeatedly every morning (but not at any other time).

What Do Docs Worry About in This Case? Increased pressure in the skull (for instance, because of a brain tumor).

Before you freak out, know that this is incredibly rare. Most vomiting is caused by stomach bugs, not scary stuff.

A Word About Fevers and Vomiting: Fevers are commonly seen with stomach bugs and don’t always warrant a call to the doctor right away (assuming your kiddo looks ok). That being said, if your child’s fever goes sky-high (i.e. above 102.2°F) or persists for more than a few days, call their doctor to be on the safe side.

How to Manage Vomiting at Home

1. Call the Doctor If Your Child Has Any of the Red Flag Symptoms Mentioned Above OR If You’re Worried.

2. Push Fluids, Not Food.

  • Vomiting kids don’t want to eat or drink because both activities make them vomit more.
  • Don’t worry about the food part — your child will eat when they’re ready. Prioritize fluids instead. Offer your child Pedialyte if they’re not drinking much. 

Insider Info: Pedialyte (the equivalent of Baby Gatorade) helps replenish electrolytes. Note: Don’t give your toddler actual Gatorade, though. Why Not? Because the electrolyte ratio in Gatorade is designed for grownups, not kiddos.

Get Wise About How to “Push Fluids” to Prevent Dehydration.

3. Watch Out for Signs of Dehydration. Get Wise About the Top 10 Signs of Dehydration in Toddlers.

If there’s a concern for dehydration, the doctor may send your child to the ER.

What Would Happen There?

In the ER, the Doctor Would Probably Do the Following:

  • Ask about red-flag symptoms (such as vomiting blood).
  • Give your child an anti-nausea medication (like Zofran).
  • Offer your kiddo water, Pedialyte, or a popsicle (i.e. do a “popsicle challenge”) after the vomiting has subsided and your child looks better.
    • If there are no freaky red flag symptoms and your child keeps the liquids and the popsicle down, the doctor will probably send them home. 
    • If your child vomits the liquids and the popsicle back up or shows signs of moderate to severe dehydration, the doctor may start IV fluids. 

The Bottom Line

Vomiting is a common occurrence in kids and is often due to a benign cause (such as a self-limiting virus). If your child starts vomiting, push fluids to keep them hydrated, look out for any red-flag symptoms (such as vomiting bile), and call the doctor if you have any concerns.

“I feel very blessed to have
two wonderful, healthy children
who keep me completely grounded,
sane and throw up on my shoes just
before I go to an awards show
just so I know to keep it real.”

~Reese Witherspoon 

Sneak Peek: The next checkup will be at 18-months. Book your child’s appointment 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 15 (Week 4) of Parenting Your Toddler!

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

Get Wise About It All Below…

Unless your child is living in a bubble, they’re going to get some bumps and bruises along the way. As toddlers explore, they often run into things, fall down, then get back up and do it all over again.

In theory, we want our children to take risks and develop grit and resilience. In reality, it can be hard to watch. Know that some of these bumps and bruises will happen no matter how much you hover. What you want to guard against are the high-risk injuries — for example, running into traffic, falling down a marble flight of stairs, and catapulting from a dangerous height. Prioritize preventing these types of injuries and do your best with the rest.

The Hot Topic for this week focuses on injuries, including ones that lead to bruises, leg pain, cuts, and splinters. We’ll also provide tips on how to stock your first-aid kit. Get Wise about these topics below.

Bruises

Most bruises in kids are normal and are nothing to worry about. Kids are always bumping into things and taking tumbles, so we expect a certain amount of bruising, especially in “high trauma” areas like the forehead, shins, knees, and elbows. 

What Docs Worry About: In rare cases, bruising can be caused by a low platelet count (which leads to blood-clotting issues) or another bleeding disorder. Doctors also worry about “non-accidental trauma” (the PC word for child abuse) in certain situations.

Red Flags: The Following Signs Tend to Get the Doctor’s Attention When it Comes to Bruising:

1. Bruising in Non-High-Trauma Areas (Such as on the Ears, the Neck, and the Cheeks).

2. A Ton of Bruising in Various Places (More Than Normal).

Insider Info: It can be hard to tell what a “normal amount” of bruising is, so ask your child’s doctor what they think.

3. Nosebleeds and Bleeding Gums in Addition to the Bruising. This may be a coincidence or indicate an underlying bleeding disorder.

4. Petechiae – small round pink or purple dots (see pic below).

Why Do Doctors Care About Petechiae? Because they signify bleeding under the skin.

Here’s a Clue That the Dots are Petechiae: Petechiae don’t blanche (i.e. turn white when you press on them).

5. Bruising in a Child With a Family History of a Bleeding Disorder (Such as Hemophilia).

6. Bruising in an Infant Who’s Not Yet Mobile (This Can Be a Sign of Non-Accidental Trauma).

7. Any Bruising That You Find Worrisome.

Why? Because it never hurts to be on the safe side.

The Bottom Line: Call the doctor if you see any of the red flag signs above.

Finger & Toe Injuries

Below are a few classic finger and toe injuries seen in toddlers.

Slammed Fingers 

Slammed fingers are common in kids.

Here’s a Classic “Slammed Finger” Scenario: A parent accidentally slams their child’s finger in a car door. The child screams bloody murder and the parent wants to crawl under a rock.

The Management? Years of guilt and therapy for the parent (JK!) and ice for the injured finger.

Signs That a Doctor May Need to Get Involved Include:

  • The finger is bruised and excessively swollen. In this case, an X-ray may be needed.

    Note: It’s a good sign if the child can wiggle their injured finger.
  • There’s a cut that may need stitches. In this case, the parent can clean the cut, then call the doctor.

The Bottom Line: Most injuries caused by slammed fingers don’t require a trip to the doctor. Call the doctor, however, if you have any concerns.

A Blood Blister Under the Fingernail (Fancy Name: Subungual Hematoma)

Subungual hematomas can result from accidental finger slamming too. Subungual hematomas occur when blood pools under the fingernail. A doctor may need to drain the blood blister to relieve the pressure.

Broken Fingers & Toes 

Broken fingers often require splinting (rather than casting), whereas broken toes are often “buddy taped” (i.e. taped together).

A child with a broken toe may have to wear a boot as well. Why? To prevent them from putting too much pressure on the toe.

Insider Info: Stubbing a toe is a fairly common way for a child to break their toe. Who Knew? So if your child continues to fuss about their toe a day or two after stubbing it, don’t assume they’re being overly dramatic (like I did with my son — eek!).

Leg Injuries After a Fall

Toddlers fall a lot. This is a normal part of life and a sign that they’re curious and practicing new skills. Fortunately, most falls don’t result in an injury (although they can cause a few crocodile tears).

Below are Some Red Flags to Watch Out For If Your Child Falls and Appears to Have a Leg Injury:

  • Your Child Refuses to Stand or Walk After the Initial Shock Has Worn Off. 

    After a fall, kids will often cry and refuse to bear weight on the affected leg. However, once they’ve settled down and gotten distracted by something else, they usually forget about the fall. If your child continues to resist standing or walking despite your attempts to divert their attention, call the doctor.
  • Your Child Continues to Be Inconsolable. Crying hysterically after a fall is not uncommon and is usually a reaction to the pain and the surprise of the fall. Once the shock wears off and the pain dissipates, however, your child should calm down. If this isn’t the case, let the doctor know.
  • There’s an Obvious Deformity. If your child’s leg looks like it’s at a weird angle after the fall, it might be broken. In this case, call the doctor and be prepared to go to the ER.

Insider Info: 

A simple X-ray is usually enough to diagnose a lower extremity fracture. Fractures aren’t always picked up on the initial X-ray, however, which can be frustrating. Sometimes there’s a lag. If your child continues to complain of pain or has a persistent limp despite a negative X-ray, let the doctor know. In this case, the x-ray may need to be repeated.

Because children are still growing, they’re at risk for “growth plate” fractures.

What are Growth Plates? Growth plates are areas of cartilage found at the ends of bones. Growth plates are important because they allow bones to grow longer. After a child goes through puberty, their growth plates fuse, signaling they’re done growing.

If a growth plate breaks, the bone may grow abnormally. Because of this, the early diagnosis of fractures (through imaging) is critical.

Cuts & How to Manage Them

Most cuts and scrapes are minor and heal on their own.  

If Your Child Gets a Cut and It’s Bleeding, Do the Following:

1. “Hold pressure” (with a tissue or a piece of toilet paper) to stop the bleeding.

2. Clean the cut with soap and water.

3. Inspect the cut. 

4. After you’ve examined the cut, it becomes a choose your own adventure story based on what the cut looks like: 

Option #1: If the cut is minor, apply an anti-bacterial ointment (such as Neosporin) to the affected area and cover it with a Band-Aid.

Insider Info: Back in the day, doctors recommended “drying out” cuts, thinking they healed better and faster when left exposed to the air. Now, studies show that keeping cuts moist and covered is the way to go.1

PediaTip: Check the cut daily to make sure that it’s not getting infected.

Option #2: If the cut looks worrisome, your child may need stitches. In this case, call the doctor.

Medical Attention is Usually Needed for the Following:

  • The Cut is Deep and Gaping. These types of cuts often require stitches.

    Insider Info: The depth of a cut can be hard to assess, so err on the side of caution and call the doctor if you’re not sure. If you see globs of fat oozing out of the cut, you know that it’s deep.
  • The Cut Won’t Stop Bleeding Even Though You’ve Been “Holding Pressure” for 10-Plus Minutes.
  • The Wound is in a Tricky Location. Lacerations in the following areas may need to be sutured by a plastic surgeon for cosmetic reasons (i.e. so they look pretty when they heal) and to prevent complications.
    • Cuts in the upper part of the ear.
    • Cuts through the upper or lower borders of the lip (fancy name: the vermilion borders). Cuts ON the lip itself don’t usually require stitches.
    • Cuts at the hairline.
    • Cuts that run across the eyebrow.
    • Cuts in the nasal septum (the cartilage that divides the two nostrils).
    • Eyelid cuts.

      Insider Info: It’s rare to need stitches on the tongue or the gums. Why? Because these areas tend to heal well without stitches (unless the tongue is cut all the way through, which it’s usually not).
  • The Wound Starts to Get Infected (i.e. it starts to ooze pus, turns red, becomes painful, or your child spikes a fever).
  • The Cause of the Cut (i.e. the Mechanism of Injury) Makes It More Likely That the Cut is Going to Get Infected (i.e. That It’s a “Dirty” Wound). Animal bites, human bites, and cuts from a rusty nail are all considered “dirty” wounds. 
  • Your Child’s Immunizations Aren’t Up To Date. In this case, your child may need a tetanus booster.
    • For “clean” wounds, a tetanus booster is recommended if the child has gotten fewer than 3 doses of the tetanus vaccine OR if the most recent tetanus shot was given 10+ years ago.
    • For “dirty” wounds, a tetanus booster is needed if the child has gotten fewer than 3 doses of the tetanus vaccine OR it’s been 5+ years since the last tetanus shot.

Not Sure if Your Child’s Tetanus Series is Current (or Adequate)? Ask their doctor. Know too, that kids usually get tetanus shots at 2 months, 4 months, 6 months, 15 months, and again at 4 years. They get an additional tetanus booster shot between 11-12 years and a tetanus booster every 10 years after that.

PediaTip: If you’re concerned about your child’s cut, don’t wait to seek treatment. Why Not? Because it’s best to get stitches within 12 hours of the injury, ideally within 6-8 hours. After that, the risk of infection goes way up.

If the doctor thinks your child needs stitches based on the clues above, they’ll tell you where to go.

The Options Are: The doctor’s office, a plastic surgeon’s office, the ER, or an urgent-care center with doctors well-versed in pediatrics.

Insider Info: Stitches Aren’t the Only Game in Town.

  • Glue (e.g. Dermabond) and Steri-strips (butterfly bandage closures) can be used for small, straightforward cuts.
  • Staples are commonly used for cuts on the scalp. Although head wounds tend to bleed a lot, only a few staples are usually needed to close them. Don’t worry, the doctor isn’t pulling out their office stapler for this; a fancy staple gun is used instead. Although putting staples in a child’s head sounds kind of barbaric, they go in fast and do the job well.

Get Wise About Additional Questions That Parents Tend to Have About Stitches.

The 411 on Human Bites & Animal Bites

Animal bites and human bites can get infected and must be taken seriously even if they don’t look all that bad.

PediaTrivia:

  • Human bites are the dirtiest type of bite (i.e. they have the highest concentration of bacteria).
  • Cat bites are more likely to get infected, though, because they go so deep.
  • Dog bites have the potential to get infected, as well, and tend to vary in their severity.

How are Bites Managed?

All injuries from bites need to be irrigated (washed out with water). If the teeth break your child’s skin, call the doctor. Minor bites can probably be managed at home (with thorough cleaning of the wound), but more significant bites need to be seen in the doctor’s office or in the ER. Why? Because doctors can more thoroughly irrigate the wound and start antibiotics if needed.

Insider Info: An animal bite may not be stitched up immediately (or at all) because of the high risk of infection.

A Word About Rabies

What is Rabies?

It’s a disease caused by the rabies virus. Humans contract it when they’re bitten or scratched by a rabid animal.

What’s So Bad About Rabies?

Rabies is super rare, but it can be fatal if it’s not treated promptly or properly.

Which Animals Carry Rabies?

The most common rabies-carrying culprits in the U.S. are bats, raccoons, skunks, and foxes.

Why Aren’t Dogs On This List? 

Because most dogs in the U.S. get the rabies vaccine. It’s a different story abroad, however, so be extra careful if you or your child gets bitten by a dog in a foreign country.

Insider Info:

  • Bats are particularly worrisome carriers of rabies because their bite is so soft that a parent might not even realize their child had been bitten. Therefore, doctors advise parents to seek care even if their child is merely in the same room as a bat.

    Although there are only 1-3 human rabies cases reported in the U.S. each year, 70% of rabies deaths in the U.S. are caused by bats.2
  • Chipmunks, gerbils, guinea pigs, hamsters, mice, rats, rabbits, moles, and gophers rarely carry rabies and haven’t been known to cause any human rabies cases in the U.S. Squirrels are almost always rabies-free, as well. If a crazed squirrel bites your child, though, call the doctor, just to be safe. Most squirrels won’t come near you, however, and are happily burying their nuts and forgetting where they put them.

PediaTrivia:

Gray squirrels find only 26% of the nuts they bury.3 

What are the Symptoms of Rabies?

For the rabies virus to cause symptoms, it needs to travel from the site of the bite to the brain. If treatment is sought early enough, medication may be able to stop the virus in its tracks. Once the symptoms appear, though, it’s often too late. 

Rabies Symptoms Include (But Aren’t Limited To):

  • Flu-like symptoms 
  • Anxiety
  • Confusion
  • Agitation
  • Insomnia
  • Strange behavior
  • Hallucinations
  • Hydrophobia (a fear of water)

If Your Child is Bitten By a Potentially Rabid Animal, Take the Following Steps:

1. If the animal is a pet, ask the owner if their furry friend’s shots are up to date. If the animal isn’t a pet, call animal control to see if it can be captured and observed for rabies.

2. Call the doctor. If the doctor is worried, they’ll send your child to the ER.

3. If the ER doctor is concerned about rabies, they’ll recommend rabies “PEP,” which stands for “post-exposure prophylaxis.” Although rabies PEP isn’t fun to get, it can be lifesaving. With rabies PEP, kids receive 5 shots over 14 days. One of the shots is a dose of immune globulin, while the other 4 are single doses of the rabies vaccine.

Reality Check: It’s much more likely that an animal bite will get infected than lead to rabies.

The Bottom Line: Reach out to the doctor if your child is bitten by a human or an animal.

Splinters & How to Remove Them

Now, let’s downshift to a less intense topic: splinters.

Splinters are common in kids and can often be managed at home. Here are the steps to safely remove a splinter at home:

1. Clean the area with soap and water.

2. Grab one end of the splinter with tweezers and pull gently.

3. If you can’t get the splinter out, that’s okay. Don’t go digging around for it. Probing the area will only increase the risk of infection. Plus, it will make your child mad! Remember, your child’s body sees splinters as foreign objects and wants to get them out as much as you do.

4. If the splinter isn’t budging OR an infection seems to be brewing (e.g. there’s redness, pain, or pus at the site of the splinter), have the pediatrician remove it.

The Bottom Line

Cuts, scrapes, and falls are an inevitable part of growing up. To help you prepare for them, here are the Top 15 items to include in your first-aid kit:

  • Band-Aids.
  • Elastic Wrap Bandages.
  • Athletic Tape.
  • An Instant Cold Compress (aka an ice pack).
  • Alcohol Wipes (to clean cuts and remove residue from Band-Aids and athletic tape).
  • Hydrogen Peroxide (you can pour hydrogen peroxide onto cuts to disinfect them).
  • Eyewash Solution.
  • Vaseline.
  • Neosporin (an anti-bacterial ointment for cuts and scrapes).
  • Calamine Lotion.
  • Tylenol and ibuprofen.
  • Benadryl. Benadryl is typically reserved for children 2 years and older when it’s used for (minor) allergic reactions and is often limited to kids 6 years and older when it’s used as a decongestant (unless the doctor recommends otherwise). If your child has an Epi-Pen, add it to the kit as well.
  • 1% Hydrocortisone cream (a steroid cream).
  • A Thermometer.
  • Scissors and Tweezers.

For serious falls and injuries that require more than what’s in your first-aid kit, call the doctor.

Whew…That Was a Lot of Info. And Breathe….

And Now for a Quote…

“Even when freshly washed and relieved of all obvious confections, 
children tend to be sticky.”

~Fran Lebowitz

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 15 (Week 3) of Parenting Your Toddler! 

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

Get Wise About It All Below…

If you’ve ever seen a toddler expertly work a smartphone, you know that we’ve entered a new era. While babies are mesmerized by the blue light, older kids focus more on the content. For this week’s Hot Topic, we’ll review the American Academy of Pediatrics’ (the AAP’s) screen-time guidelines and provide tips on how to develop a “media plan” for your family.

Glued to the Screen

Many Parents Ask When Their Children Can Start Using Screens. Here’s a Rundown of the AAP’s Recommendations (Until Age 5):

1. Under 18 Months:

The AAP discourages the use of screens in children under 18 months.1

Exception: Video-chatting (e.g. FaceTiming) gets the thumbs-up because it’s an interactive way for kids to keep in touch with long-distance relatives and family friends.

2. 18-24 Months:

The AAP says parents who want to give children in this age group limited amounts of screen time should choose high-quality programs (such as PBS Kids) and view them with their child.

3. 2-5 Years:

The AAP suggests limiting screen time to 1 hour or less per day for kids 2-5 years. Again, it’s best to choose legit programs and watch them with your child so you can monitor the content and make the experience more interactive.

“Your Lips Move But I Cannot Hear What You’re Saying.”

Despite the AAP’s recommendations, 90% of children under 2 years of age watch some form of electronic media (many of whom are younger than 18 months). In addition, 1/3 of kids have a TV in their bedroom by age 3.2

Reality Check:

We all know (docs included) that TV can be a useful babysitting tool when you want to cook dinner, fold laundry, or take a break. Remember, it doesn’t have to be perfect, and you don’t have to beat yourself up for turning on the tube every once in a while.

Here Are Some Tips to Help Your Child Develop a Healthy Relationship With Screens:

1. Have a Plan.

Intentional parenting is always more productive than reactive parenting. Discuss a media plan with your partner and think about:

  • How old you want your child to be when you introduce screens.
  • What programs you’ll allow.
  • What the family rules are re: cellphones (for ALL family members). Remember, kids model what they see.

Examples of Potential Screen-Time Rules After 18 Months, Include:

  • Allow screen time only on the weekends for morning cartoons or only during travel. Or don’t allow screen time at all.
  • Limit screen time to 1 hour per day (for kids 2-5 years).
  • Put your cellphone in a bin after work.

PediaTip: Choose rules that feel right for your family and know that you’ll probably have to tweak them as your child gets older.

2. Keep Screens Out of Your Child’s Bedroom.

Screens in the bedroom are the kiss of death. Once a TV enters a child’s room, it’s hard to get it out. Consider making the bedroom a screen-free space.

3. Make Mealtimes Sacred and Screen-Free.

4. Watch Together.

Make screen time a family affair so that it’s more social.

5. Watch Adult Programs (Such as the News) AFTER Your Child Has Gone to Bed.

6. Skip the Commercials, If Possible.

Thank you, Roku and Apple TV!

7. Find Another Option.

Seek out fun alternatives to screen time that the whole family can enjoy.

Interested in Drawing Up a Formal Media Plan? Check Out This Link Provided by the AAP Website, HealthyChildren.org.

The Bottom Line

Screens are everywhere, so it’s pretty much impossible to shield our kids from them forever. But that’s ok! As parents we can work on teaching our children how to use screens responsibly and mindfully from the get-go.

“Based on the amount of laundry I do each week
I’m going to assume that there are people
who live here that I haven’t met yet.”

~Pinterest (uploaded by Leanne Cooke)

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 15 (Week 2) of Parenting Your Toddler!

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

Get Wise About It All Below…

As your child samples new foods, you may notice they’re sensitive to certain ingredients or outright allergic to them. When kids first start solid foods, it’s easier to identify what’s causing an allergic reaction because the ingredients are offered one at a time. Now that your child is eating all sorts of foods, the waters can become muddied.

In addition, kids won’t necessarily react to a food the first time they eat it. It often takes a few passes at a food for the body to build up the allergy-producing substance (histamine) that’s released during allergic reactions. In this week’s Hot Topic, we’ll revisit food allergies in the context of toddlerhood.

Disease Spotlight: Food Allergies Revisited

As you may (or may not) remember from the Baby PediaGuide, nearly 8% of children develop food allergies.1 The majority of food allergies occur in the first 2 years of life and many kids outgrow them by age 5.

Kids typically outgrow allergies to milk, eggs, soy, and wheat. Food allergies that tend to stick around for life include allergies to peanuts, tree nuts, fish, and shellfish.

To put a number to it, 80-90% of egg, milk, wheat, and soy allergies resolve by 5 years of age, whereas only 20% of children outgrow their peanut allergies.2 Even fewer outgrow their tree nut and seafood allergies.

Who Gets Food Allergies?

Although any child can develop a food allergy, there are certain risk factors that make some kids more prone to them than others. Such risk factors include:

  • A personal history of severe eczema, asthma or hay fever.
  • Having a parent or a sibling with an allergic condition such as a food allergy, hay fever, eczema, or asthma.

Remind Me of the Food Allergy Symptoms Again:

Food allergies can declare themselves in different ways. A true food allergy is caused by the release of histamine. The body releases histamine when it encounters something “foreign” (and doesn’t like it).

The Histamine Release Can Cause the Following:

  • Hives. Hives are itchy red welts with raised borders. They may last a few days or longer (weeks) and tend to disappear and then reappear in different places. Get Wise(r) about Hives and How They’re Managed.
  • Other Non-Hive Rashes.
  • Vomiting.
  • Diarrhea.
  • Blood or Mucus in the Poop.
  • Tongue and/or Lip Swelling.
  • Trouble Breathing.

Tongue swelling, lip swelling and trouble breathing suggest a severe allergic reaction called anaphylaxis. Call 911 if your child develops any of these symptoms.

The Good News: Anaphylaxis doesn’t usually occur the first time a child is exposed to a food they’re allergic to. Why Not? Because it takes a while for the histamine to build up in the body and create a big reaction. You’ll often see less dramatic symptoms (such as a rash, diarrhea, or vomiting) with the initial exposure.

How Long After Eating a Food Does It Take for Allergy Symptoms to Develop? Not long! Food allergy symptoms typically show up within 2 hours after the exposure (often within minutes).3 In rare cases, a “biphasic reaction” occurs, in which a second wave of symptoms follows the first wave. In most cases, this second reaction takes place 6-10 hours after the first reaction. Although biphasic reactions are uncommon, they’re the reason doctors urge patients to stay in the hospital for observation after an anaphylactic reaction.

Double Take: Certain Skin Findings and GI Complaints Can Mimic the Symptoms of a Food Allergy (But are Caused by Other Phenomena).

Here are Some Examples:

  • Irritation From Acidic Foods: Acidic foods like berries, oranges, and tomatoes can cause redness around a child’s mouth. This redness is often due to irritation (rather than to a food allergy).
  • Eczema Flare-Ups: Children with eczema may develop a rash on their face when food touches their skin. This rash is usually a sign of an eczema flare-up (not of a histamine-releasing allergic reaction).

    PediaTip: If your child has eczema, slather Vaseline or Aquaphor on their cheeks and around their mouth before meals to protect the skin against irritants in the food.
  • Food Intolerances: A food “intolerance” means a child has trouble tolerating a specific food but isn’t necessarily allergic to it (i.e. no histamine is released when they ingest the food). Food intolerances can cause stomach cramps, flatulence, and bloating. For example, some kids develop a milk intolerance. They don’t feel great when they drink milk, but they’re not technically allergic to it either.

How Will the Doctor Figure Out If My Child Has a True Food Allergy?

If your child develops symptoms of a food allergy, their doctor will probably recommend “allergy testing.”

The most commonly used allergy test is the “skin-prick test.” The skin prick test is performed at an allergist’s office and involves pricking the child’s skin with different allergens to see if any of them trigger a local reaction (such as a red, itchy bump). The pricks are annoying but aren’t super painful. Get Wise(r) About Skin Prick Testing and Other Types of Allergy Testing here.

Want to Do an Even Deeper Dive Into Food Allergies? 

Get Wise (Again) About:

The Bottom Line

If you suspect that your child has a food allergy, call the doctor. If your child develops lip swelling, tongue swelling, or trouble breathing after ingesting a known allergen, call 911 and administer their EpiPen (if they have one). If you don’t have injectable epinephrine at home, don’t worry, the paramedics will have some on hand.

And Breathe…

Sneak Peek: The next checkup is at 18 months. At this visit, the doctor will (probably) screen your child for Autism Spectrum Disorder, using the M-CHAT (a parent questionnaire). The 18-month visit is usually free of shots and bloodwork. Wahoo!

 “There are no seven wonders of the world
in the eyes of a child. 
There are seven million.”

~Walt Streightiff

The Reminders for This Week are Essentially 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 15 (Week 1) of Parenting Your Toddler! 

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

Get Wise About It All Below…

At this point, your toddler is probably walking independently, adding a few more words to their repertoire, and busily exploring the world. Their diet includes cut-up pieces of table food, water, and whole milk or a cow’s milk alternative (limited to 16-24 ounces per day). Skip the juice if possible (or at least limit it to 4 ounces per day) and don’t forget to give your little one a daily vitamin D supplement. (The daily dose of vitamin D for kids over 1 year is 600 international units per day.)

This week’s disease spotlight focuses on eczema, a common pediatric skin condition that we touched upon in the Baby PediaGuide. Although most toddlers with eczema have a mild form of it, some kids have moderate to severe cases that drive them AND their parents crazy. 

Get Wise (Again) About Eczema Below.

Disease Spotlight: Eczema (Fancy Name: Atopic Dermatitis)

Eczema is a chronic, inflammatory skin condition that’s commonly seen in children (and some adults). Eczema causes recurrent rashes, known as “flare-ups.” These flare-ups can be triggered by certain foods, detergents, and soaps, as well as temperature changes, sweating, stress, and outdoor allergens. Everyone’s triggers are different.

Eczema Flare-Ups are Characterized By:

  • Dry, itchy, and scaly red patches on the skin. These patches tend to congregate on the “flexor surfaces” (think: the backs of the knees and the insides of the elbows).
  • Toddlers can also get eczema on their cheeks, especially in the wake of a few messy meals (as if there’s any other kind). The food, in this case, sits on the skin and irritates it, leading to red cheeks and small bumps.

    PediaTip: Rub Vaseline or Aquaphor on your child’s face before meals to form a barrier against the food.
  • At times, eczema shows up as round circles of irritated skin. This is called nummular eczema. 

Who Gets Eczema?

Although any child can develop eczema, certain risk factors make it more likely. Such risk factors include:

  • A Personal History of Seasonal Allergies or Asthma: Eczema, seasonal allergies, and asthma tend to flock together and are called the atopic triad. Children with seasonal allergies and/or asthma, are, therefore, more likely to develop eczema.
  • A Family History of “Atopy”: Eczema runs in families. About 70% of kids with eczema have a parent or a sibling with eczema, asthma, or seasonal allergies.1

    Insider Info: Eczema is NOT contagious – your child can’t get it from touching another child’s eczema rash.

Tips for Preventing & Treating Eczema Flares

Prevention Tips

  • Moisturize: When it comes to eczema, you’ll hear dermatologists chant “Moisturize! Moisturize! Moisturize!” The goal with eczema is to keep the skin moist and supple (not dry). If your child is prone to eczema, rub lotion on their skin at least 2 times a day even when there are no flare-ups in sight.

    PediaTip: Use a dermatologist-recommended moisturizer and lube your child up after baths to lock in the moisture.

    PediaWise Picks for Moisturizers Include:
  • Avoid Bubble Baths.

    Why? Because they can irritate your child’s skin.
  • Don’t Make the Bath Too Hot (Which You’re Probably Not Doing Anyway).
  • Be Mindful of the Detergents You Use: Choose perfume-free and dye-free options. Avoid fabric softeners.
  • Keep Your Child’s Nails Short to Break the Itching and Scratching Cycle. Kids who are old enough to scratch tend to claw at their eczema rashes because they’re so itchy. Unfortunately, this irritates the rash even more.
  • Identify Triggers: As mentioned above, eczema flares can be triggered by different things (such as detergents, a change in weather, allergies, and certain foods). If your child’s eczema flare-ups intensify with particular foods or during specific seasons, consider having them see an allergist.

Treatment Tips

If the preventative measures above don’t work and your child develops an acute flare-up, try the following (with the doctor’s blessing):

  • Moisturize Often (2-3 Times a Day).
  • Apply a Steroid Cream: Your child’s doctor will most likely recommend a steroid cream for flare-ups. A popular treatment for flare-ups is Triamcinolone 0.1% cream, a prescription steroid cream. It’s usually applied daily for 5-7 days.

    Insider Info: Topical steroids can really help with the inflammation, but you don’t want to use them for too long because overuse can lead to thinning of the skin. The goal is to treat the eczema flare-up with the lowest potency steroid for the shortest amount of time possible.
  • Ask the Dermatologist If They Have Any Special Lotions: If your child has moderate to severe eczema, the pediatrician may refer them to a dermatologist. Dermatologists have all sorts of fancy lotions & creams (such as Elidel and Protopic) that they can prescribe for bad cases of eczema.
  • Make Sure the Eczema Patches Aren’t Getting Infected: Call the doctor if the affected skin is tender, draining pus, or turning yellow and crusting.
  • If Your Kiddo is Having Trouble Sleeping Because of the Itching, Ask the Doctor About Giving Them an Oral Antihistamine at Night. 

    Heads Up: Antihistamines are usually reserved for kids 2 years & older, so make sure to get the green light from your child’s doctor before giving one.

The Silver Lining: Many kids “outgrow” their eczema by age 4 or 5.2 Oddly enough, the earlier your child gets eczema, the more likely they are to outgrow it.

The Bottom Line

Most kids have mild to moderate cases of eczema. If your child has a particularly tough case of eczema, don’t hesitate to ask the pediatrician for a referral to a dermatologist.

“Every time I say, ‘no,’ my kid hears,
‘ask again, she didn’t understand the question.’”

~Housewife Plus (via the Proud Mummy website)

The Reminders for This Week are Essentially 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 14 (Week 3) of Parenting Your Toddler! 

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

Get Wise About It All Below…

The 15-month checkup is around the corner and it’s a pretty tame one. Your child will receive a few booster shots, but no new vaccines. Bloodwork ISN’T needed (assuming the bloodwork at the 1 year checkup was normal).

PediaTip: If the doctor hasn’t told you about the lead and hematocrit results from your child’s 1-year visit, make sure to ask about them at the 15-month visit. Docs don’t usually call when the results are normal. On rare occasions, though, abnormal lab results get missed or overlooked. It doesn’t happen often, but it’s worth double checking, just to make sure.

Below is a List of the Standard Vaccines Typically Given at the 15-Month Visit. They’re Administered as Individual Shots (vs. in Combination With One Another).

Disclaimer: Remember, there’s some variation between pediatric practices re: which vaccines are given and when.

  • The Diphtheria, Tetanus, and Pertussis (DTaP) Vaccine.
  • The Haemophilus influenzae type B (Hib) Vaccine.
  • The Prevnar-13 (Pneumococcal) Vaccine.

Get Wise (Again) About What These Vaccines Protect Against.

As a Reminder, the Hot Topic for This Week Is: Diarrhea in Toddlers. Get Wise About It Below.

Diarrhea in Toddlers

Diarrhea, as you probably already know (and have experienced), is the frequent passage of loose, watery stools. Acute diarrhea is fairly common in toddlers. Diarrhea that lasts more than 4 weeks (but feels like 100 years) is considered “chronic diarrhea.”  Although chronic diarrhea is less prevalent than acute diarrhea, it’s also seen in toddlers, especially in those who drink a ton of juice and develop “toddler’s diarrhea” (see below).

What Causes Diarrhea in Toddlers?

There are a bunch of causes of diarrhea in this age group. Below are the Top 10:

1. Viruses: No surprise here. Viruses are once again the No. 1 culprit when it comes to causing trouble. Viruses can cause stand-alone diarrhea OR diarrhea plus vomiting (which docs call gastroenteritis).

2. Bacteria: Bacteria run a close second to viruses and can also cause the “back-door trots” in toddlers (think: food poisoning). Get Wise about Food Poisoning here.

3. “Toddler’s Diarrhea”: As mentioned above, toddler’s diarrhea is the result of too much juice intake. It can lead to seemingly never-ending diarrhea in kids and is another reason to think twice about giving your child juice.

4. Food Allergies: Children with food allergies may develop diarrhea (as well as stomach pain and hives) when they have an allergic reaction. Kids who have a severe allergic reaction to a food (fancy name: anaphylaxis), will have throat swelling and need a dose of injectable epinephrine (e.g. via an EpiPen), followed by a trip to the ER.

5. Lactose Intolerance (Especially Following a Stomach Virus): Stomach viruses can disrupt the “good bacteria” in the GI tract and lead to diarrhea. For this reason, doctors often tell parents to give their child a probiotic during (and right after) a stomach virus to restore the healthy bacteria in the gut. Probiotics come in the form of certain yogurts (think: kefir) and capsules. Kids can also switch to a lactose-free milk (such as Lactaid) for a bit until their gas and bloating have resolved.

6. Overflow Diarrhea From Chronic Constipation: Overflow diarrhea usually shows up as big skid marks in the diaper (or underwear). Overflow diarrhea occurs when a child who is chronically constipated has a massive stool stuck in their gastrointestinal tract and poop flows around it. This signals the need for a “bowel clean-out” (with laxatives and an enema).

Note: Small skid marks are usually due to improper wiping (vs. overflow diarrhea).

7. Celiac Disease: Kids with celiac disease (a gluten allergy) can develop chronic diarrhea. The diarrhea resolves when gluten is removed from their diet.

Get Wise about Celiac Disease here.

8. Parasitic Infections: Parasitic infections are most commonly seen in kids who travel abroad.

9. Inflammatory Bowel Disease (Think: Crohn’s Disease and Ulcerative Colitis): Crohn’s disease and ulcerative colitis are chronic diseases that cause inflammation of the bowel and lead to recurrent abdominal pain and diarrhea.

These diseases are typically seen in teens and young adults but can, occasionally, affect younger kiddos as well.

10. Medications (As a Side Effect): Certain medications used in the pediatric world (think: amoxicillin) can cause diarrhea as an unwanted side effect. Doctors will often encourage parents to give their child a probiotic during the treatment period to prevent (or reduce) the diarrhea.

How Do Doctors Discover the Cause of a Child’s Diarrhea?

Doctors can usually figure out the cause of the diarrhea by taking a thorough history (i.e. by asking the parents a bunch of questions) and doing a physical exam.

If the diarrhea has been going on for a while or the cause of the diarrhea is unclear, the doctor may order “stool studies.” These lab tests look for bacteria, parasites, and other substances (such as blood and mucus) in the poop. 

The Next Steps If Your Child Has Diarrhea:

1. Practice good handwashing to prevent the infection (if there is one) from spreading to other people.

2. “Push fluids” and don’t stress too much about your child’s food intake. Offer Pedialyte to help restore your child’s electrolyte balance and avoid juice, soda, and milk-containing products, which can make the diarrhea worse. 

Insider Info: Pedialyte tastes a bit salty. Some kids don’t mind it, while others flat out reject it. Try to find a flavor that your child likes. Pedialyte popsicles (“freezer pops”) are another option, as well.

3. If your child is having copious amounts of diarrhea and you’re concerned about dehydration, call the doctor. Your little one may need to be seen in the doctor’s office or in the ER (if IV fluids are in order).

Get Wise about what the doctor will want to know about the diarrhea.

Blast From the Past: 

Back in the day, the “BRAT” diet was recommended for people with vomiting and diarrhea. BRAT stands for bananas, rice, applesauce, and toast (or sometimes tea). Since then, studies have shown the BRAT diet doesn’t really work and is unnecessarily restrictive. 

Even though the BRAT diet gets the thumbs-down, that doesn’t mean you should give your child a 5-alarm chili when they become interested in eating again after a bout of diarrhea. Slow and steady wins the race. Start your child back slowly with bland-ish foods even if they’re ravenous and want pizza and fries.

In addition, know that the diarrhea may get worse when your child starts eating again. This is because the bowels get stimulated when food hits the gut. That’s okay. It’s just the nature of the diarrhea beast. Keep track of the diarrhea and look for an improving trend overall.

A Common Question: Can I Give My Child a Medicine (Like Imodium or Pepto-Bismol) to Stop the Diarrhea?

No. These Medications are Frowned Upon for 3 Reasons.

1. You want your child to keep pooping, so they can get the “bad stuff” out of their system.

2. Products containing Imodium (Loperamide) have been known to cause bad side effects in the pediatric population (and have even led to death in a very small number of kids).

3. In addition, products containing bismuth subsalicylate (e.g. Pepto-Bismol) can cause Reye’s syndrome (a liver and brain disease) when they’re used during a viral illness.

For These Reasons, the American Academy of Pediatrics (the AAP) Advises Against the Use of Anti-Diarrheal Medications in Children.

The Bottom Line

Diarrhea is a common complaint in the pediatric population. Most cases of diarrhea are due to viruses and are self-limiting. If your child develops diarrhea, “push fluids” to keep them hydrated, be on the lookout for red flag symptoms (such as blood in the stool), and call the doctor if you have any concerns.

“They say women speak 20,000 words a day.
I have a daughter who gets that done by breakfast.”

~Country Living

The Reminders for This Week are the Same as Last Week’s (Plus a Reminder to Book Your Child’s Next Checkup). Get Wise About Them Below…

  • Schedule Your Child’s 15-Month Checkup (If You Haven’t Already).
  • 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 14 (Week 2) of Parenting Your Toddler! 

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

Get Wise About It All Below…

Naptime is a precious commodity for kids and parents alike (especially for stay-at-home parents). It gives adults a break and allows kids to recharge their batteries. However, between 12-24 months, many toddlers begin to drop their second nap, much to their parents’ dismay.

Get Wise below about dropping naps, what a one-nap schedule looks like, and how to institute “quiet time” (the nap loophole for parents).

Dropping the Second Nap

If your toddler wants to “drop a nap,” they’ll be pretty clear about it.

How So? Your kiddo will simply refuse to sleep during naptime.

For example, your child may cry or scream when you put them in their crib. Or your little one may diddle around (i.e. talk to themselves or play) when they should be asleep.

If your child fights sleep for more than 2 weeks in a row, you may be headed towards a one-nap system.

Additional Clues That Your Child is Ready to Drop a Nap:

They:

  • Snooze for only a short period of time (e.g. under 20 minutes) during one of the naps.
  • Have one legitimate nap, while the other is a disaster (think: tears and tantrums).
  • No longer fall asleep in the car seat when you’re out and about.
  • Are (relatively) cheerful after missing a nap.

The One-Nap Schedule

Just because a toddler wants to drop a nap doesn’t mean they automatically know how to do it. The transition from 2 naps to 1 nap can be a bit rocky in the beginning and may take a little while for your child to get used to.

Below Are Some Tips for How to Drop the Second Nap: 

  • Work on “dropping” the nap that your child is resisting. For example, if your kiddo conks out for the morning nap but rejects the afternoon nap, focus on dropping the afternoon nap (and vice versa).
  • The goal is to end up with ONE consolidated nap.
  • Instead of dropping the morning or afternoon nap cold turkey, start by moving the nap that you’re dropping either up or back (depending on which one is getting the boot).
    • For example, if you’re dropping the morning nap, push it back 30 minutes each day until it merges with the afternoon nap, creating one midday or early afternoon nap.
    • If you’re dropping the afternoon nap, move it up by 30 minutes each day until it runs into the morning nap, creating one midday or late morning nap.

Reality Check: Don’t expect the “dropping-a-nap” process to be pretty (even though your kiddo is the one who started it). Your child will most likely be fussy for a few weeks while they settle into their new routine and you’ll probably have to adjust their bedtime and mealtimes as you adapt to the one-nap-a-day schedule. If your child seems overly tired in the morning or in the afternoon, consider instituting a “quiet time” so they can get some rest.

The Gift of “Quiet Time”

Even if your child refuses the second nap, they still need extra downtime during the day. A “quiet time” period (if feasible) can prevent your child from getting overstimulated. Plus, it gives BOTH of you the chance to rest and reset without formally sleeping.

Here are Some Ground Rules for “Quiet Time”:

  • During quiet time, your child doesn’t have to sleep, but they should play quietly, look at a book or listen to music.
  • As with naptime, try to keep the quiet time consistent. Do it at the same time (more or less) each day for the same amount of time (about 30-60 minutes).
  • To signal that quiet time is starting, dim the lights, play soft music, and speak in hushed tones.

If You’re Able to Pull Off Quiet Time, It’s Something Your Family Can Continue to Do As Your Child Gets Older.

Common Questions About Naps

How Long are Naps Supposed to Be?

Individual naps typically last anywhere from 30 minutes to 2 hours (depending on the child).

When Do Kids Usually Stop Napping Entirely?

Kids often drop their naps completely when they go to a school that doesn’t have naps or when they lose interest in them (whichever comes first). This typically occurs around 3-5 years of age.

How Does the Nap System Work If I Have Multiple Children?

Ideally, you’ll be able to find at least one designated time of day when your toddler can squeeze in a nap in their crib. But because we live in reality, this isn’t always possible. Toddlers with older siblings often catch their naps whenever and wherever they can (think: in the car or their stroller).

That’s okay. Do what you need to do and focus on maintaining a healthy bedtime routine at night (while still encouraging your toddler to get some sleep during the day).

The Bottom Line

Some children love to crush naps, while others can’t be bothered. Encourage two naps a day during the toddler years but follow your child’s lead if they want to drop a nap. And don’t forget to try out “quiet time”- it can be a game changer.

“Why don’t kids understand that their nap is not for them but for us?”

 ~Alyson Hannigan 

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 14 (Week 1) of Parenting Your Toddler! 

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

Get Wise About It All Below…

While many parents think flying with an infant is a nightmare, air travel with a toddler is actually worse.

Why? Because toddlers are in constant MOTION. For example, toddlers love to run up and down the aisle of the plane, visit the bathroom to play with the sink water, kick the seat in front of them, and cry when they don’t get their way.

So, What’s a Parent to Do? Try the Plane Travel Tactics below.

In addition, Get Wise about another Hot Topic – Speech Delays in Toddlers.

The Top 10 Tips for Plane Travel With Your Toddler

1. Bring a Bunch of Toys, Board Books, and Crayons on Your Trip.

Mix-in some old favorites with a few new toys that your child hasn’t seen before.

2. Travel During Off-Peak Hours, When the Airport Isn’t Super Crowded.

This isn’t always an option, but it’s worth a try.

3. Consider the Flight Time As It Relates to Your Toddler’s Nap Schedule.

4. Bring Food and Drinks.

5. Get Your Toddler Their Own Seat (If Finances Allow).

Although kids under 2 years of age have historically been allowed to fly for free in the arms of a parent, they’re better protected when they’re restrained in a FAA-approved safety seat next to their caregiver (starting around 6 months of age).1

The FAA recommends that children under 40 pounds use a safety seat. Check to see if your car seat has an FAA-approved safety sticker. Children under 20 pounds should travel in the rear-facing position, whereas kids 20 pounds and older can ride in the forward-facing position.

6. Try Not to Care (Too Much) About the Eye Rolls From Your Fellow Passengers.

Most people are understanding. The rest can fly private next time.  

7. Offer Your Toddler a Drink During Takeoff and Landing to Help Equalize the Pressure in Their Ears (Especially If They Have a Cold or an Ear Infection).

8. Bring Hand Sanitizer and a Blanket to Protect Your Little One From Germs. 

It doesn’t hurt to clean the tray table and the hard surfaces of the seat with a disinfectant wipe, too.

9. Send as Much Stuff Ahead as Possible.

Thank you, Amazon Prime! 

10. Bring Earplugs and Order a Cocktail for Yourself. Just Kidding (Sort of)!

Ok, Let’s Switch Gears, and Talk About Another Toddler Topic – Speech Delays.

Speech Delays in Toddlers

Language development, like motor development, occurs in a sequential manner. If your child continues to make forward progress in the language department, that’s a good sign. 

What are the Signs of a Speech Delay?

Three Red Flags That Suggest a Speech Delay Include (But Aren’t Limited To):

1. No babbling, pointing, or gesturing by 1 year of age. Remember, we hope for 1 word plus “Mama” and “Dada” at 12 months.

2. No words by 15 months of age.

3. Not being able to follow simple (one-step) commands by 18 months.

The Bottom Line: If your child isn’t reaching their language milestones on time, the doctor will want to follow them closely and may want to investigate further.

Here Are 8 Things to Know About Language Development and Speech Delays

1. There are 2 Main Types of Language Delays:

  • Receptive Language Delays: Delays in understanding what’s being said.
  • Expressive Language Delays: Delays in being able to express what you want to say.

Insider Info: Some kids have both types of language delays (fancy name: a mixed expressive-receptive language disorder).

2. The First Step in Evaluating a Language Delay is to Test the Child’s Hearing.

Why? Because kids need to hear well for receptive AND expressive language to develop properly.

Insider Info: I typically provide a referral to a speech pathologist along with the referral for the hearing test.

Why Both? Because even if the hearing screen is abnormal and we’ve identified the cause of the speech delay, speech therapy is still needed.

3. Recurrent Ear Infections Can Cause a Chronic Buildup of Fluid in the Ears and Lead to Temporary Hearing Loss and Language Delays.

If your child suffers from chronic ear infections and has a language delay, the pediatrician will refer them to an ear, nose and throat doctor (an ENT). In this case, the ENT will probably recommend ear tubes to drain the existing fluid from the ear and to prevent fluid from building back up again.

4. Babies Tend to Understand and Know More Than They Can Express.

This is one reason for the frustration seen during the Terrible Twos.

PediaTip: As mentioned in previous PediaGuide articles, sign language can help kids who are having trouble (verbally) expressing what they want to say. Even learning a few signs can be empowering and cut down on the tantrums. Common first signs include “more,” “milk,” “eat,” “drink” and “thank you.” 

Image Source: BabySignLanguage.com

Get Wise(r) about Baby Sign Language and Learn Additional Signs here. If you’re interested in reading a book about baby sign language with your toddler, check out “Nita’s First Signs” by Kathy MacMillan.

5. There’s Usually a Big Explosion in Language Between 18-24 Months of Age.

At 15 months, children are expected to say only 3 words (in addition to “mama” and “dada”). However, by 2 years, kids are typically able to say 50-200 words and put 2-word sentences together (e.g. “That mine!”). Toddlers with a questionable language delay at 15 months are often jabbering away at their 18-month or 2-year checkups.

6. Many of Us Docs Have Seen Mild INITIAL Speech Delays In Children Who Are Trying to Master 2 Languages at Once. However, Studies Suggest That Bilingual Households Do NOT Experience More Speech Delays in the Long Run.

In fact, the research shows that kids who learn a second language before 10 years of age are able to speak it more fluently than those who learn it later in life.2 Kids’ brains are like sponges. The adult brain, not so much.

PediaTip: Consider introducing your child to a second language before age 10 but don’t stress if your little one isn’t fluent in Mandarin by kindergarten.

7. Twins (Especially Identical Twins) Tend to (Temporarily) Lag Behind in Their Language Development Because They Like to “Talk” to Each Other in a Made-Up Language.

Don’t worry, though, they catch up eventually as long as there are no underlying developmental issues. 

PediaTrivia: The made-up language that twins create has a name: cryptophasia.

8. Kids Like to Mimic Their Caregivers, So the More You Talk to Your Child, the More They’ll Try to Talk to You.

Remember, imitation is the sincerest form of flattery.

The Bottom Line

If you have any concerns about your child’s language development, let their doctor know. But don’t be mad if the doctor doesn’t do anything about it right away. Unless there’s a clear delay, doctors will often take a watch-and-wait approach to see if their patient suddenly starts talking a blue streak. If this doesn’t happen, a hearing test and speech therapy are the next steps.

“Wake up extra early so that you and your kids
can still be 20 minutes late wherever you go.”

~MEME (by @cray_at_home_ma)

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 13 (Week 4) of Parenting Your Toddler!

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

Get Wise About It All Below…

Many parents think their sleep-training woes will be put to bed (no pun intended) by the time their child is a toddler. New sleep issues, however, tend to crop up during the toddler years (think: nightmares, fear of the dark, and not wanting to go to sleep).

Get Wise about how to handle bedtime battles at this age in the Hot Topics section below. We’ll also talk about how to manage fevers in toddlers and how to take a toddler’s temperature (hint: the up-the-bum method isn’t the only game in town now. Yay!).

Toddler Sleep

Although many toddlers stay the course when it comes to sleep, others decide that sleep is optional. Below are 10 Tips to get your toddler to sleep. Some of these tips echo the infant sleep tips, while others address new challenges that arise during the toddler years.

The Top 10 Toddler Sleep Tips

1. Find Your Child’s Sleep “Sweet Spot.”

What’s That? It’s the time of night when your toddler seems drowsy but isn’t overly tired or undertired. The sleep sweet spot for toddlers is usually between 6-7:30 p.m.  

2. Keep Up the Routine.

Nighttime rituals are sacred and soothing to kids. Why? Because children find comfort in the expected. The routine doesn’t have to be long, though, (or even include a bath), it just needs to be consistent and predictable. Dim the lights and play some music to let your child know things are winding down.

3. Offer One Last Request (But Only One).

Some toddlers have classic FOMO and think they’re going to miss a late-night party if they go to bed. They’ll often stall by asking for another book, a drink, a snack, or a snuggle. The first few requests are often endearing, but by the 10th ask, you may be seeing red. By way of compromise, allow your toddler to ask for one final request before you turn off the lights. But That’s It! 

4. Drop the Midnight Snack.

Some kids wake up and want to eat in the middle of the night. This is usually a residual habit from babyhood. At this age, your child shouldn’t need any extra calories overnight (unless they have an underlying medical issue). Work on breaking the midnight snack habit. The dentist will thank you for this, as well, since it can be tough to remember to brush you child’s teeth after a middle-of-the-night nibble.

5. Don’t Skip the Nap If Your Child Needs One.

It may seem logical to start skipping your child’s afternoon nap in an effort to move bedtime up and to get your little one to sleep through the night. This, oddly enough, has the opposite effect. If your child gets overly tired, they may actually get “punch drunk,” and not want to sleep at all. 

6. Put a Lovey in the Crib.

Many kids (over the age of 1) enjoy having a “transitional object” in their crib. This is an object that brings them comfort during the night. Examples include a stuffed animal or a blankie.

PediaTip: Make sure the stuffed animal doesn’t have any hard parts that can be chewed (or pulled off) and swallowed.

7. Have a Plan.

Figure out (with your partner) how to manage nighttime awakenings. Remember, toddlers (like babies and adults) sleep in cycles. They stir every 90 minutes as they enter a lighter phase of sleep, then naturally settle back into a deeper phase of slumber. 

The key is not to rush to your child’s side every time they whimper or cry out in their sleep. Instead, see if your child settles on their own. It’s important for them to learn self-soothing skills. If you do go into the room, give your child a quick pat and a hug. Try not to pick them up or rock them back to sleep (no matter how tempting it might be).

8. Power Down.

Turn off all screens at least 1 hour before bedtime. Although TV might seem like a relaxing pastime, the blue light that emanates from the screen activates and energizes the human brain. Plus, the American Academy of Pediatrics discourages screen time in kids under 18-months.1

9. Consider a Night-Light.

Some toddlers have vivid imaginations and develop recurring nightmares. A night-light may provide comfort if your child is “afraid of the dark.” 

10. Try a Reward Chart (When Your Toddler Gets a Bit Older).

Toddlers enjoy completing tasks and tracking their progress. When your toddler reaches 2.5-3 years, they may be able to understand the concept of a reward chart. To create a reward chart, write out the top 3-5 things included in your little one’s bedtime routine (such as taking a bath, brushing their teeth, reading a book, playing music, turning off the lights, etc.). Every time a task is completed, put a sticker next to it. Once your child earns a certain number of stickers, let them pick out a prize (such as a bigger sticker or a small toy).

Insider Info: If your child continues to have trouble falling asleep or wakes up at night (despite the tips above), you may have to go back to the drawing board and do some sleep training.

Get Wise (Again) About the Ferber Method and Other Sleep Training Programs.

Common Question: My Toddler Keeps Gnawing on the Sides of Their Crib. What Should I Do?

Some toddlers find the act of chewing on the sides of their crib soothing. Cribs nowadays don’t contain lead paint, so this shouldn’t be a major concern. Still, you may want your child’s beaverlike behavior to stop. 

One solution is to throw a safe, chewable toy in the crib as a diversion. Another popular option with parents is a crib rail guard. They attach to the top rails of the crib but can be dangerous if the ties come loose. If you decide to purchase a crib rail guard, avoid ones with buttons (because they can be a choking hazard) and make sure the ties are secure and can’t be undone. 

Ok, Let’s Switch Gears and Talk About Fevers in Toddlers…

Fevers Revisited

Doctors are more relaxed about fevers during the toddler years than they are about fevers during the newborn period.

For children 3-36 months, pediatricians would like a call when the fever reaches a temperature of 102.2°F (or greater). Doctors also want a call if your child is having any other concerning symptoms (such trouble breathing or lethargy), regardless of the number on the thermometer.

Insider Info: Remember, kids can look pretty wiped out when they have a fever. When the fever goes down, however, they may suddenly look fit as a fiddle. So, don’t feel bad if you call the doctor in a panic, only to have your child perk up after the fever reducer (i.e. the Tylenol or ibuprofen) kicks in.

A Word About Taking Temperatures in Toddlers

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

Caregivers can, therefore, take a toddler’s temperature in the ear, under the arm, or across the forehead. The ear and under-the-arm methods are the most reliable. The temperature readings that you get with these alternative methods will be lower than the ones you get with a rectal temperature (often by 1 degree or so). That being said, you don’t have to subtract a degree from the temperature that you get on the thermometer. Just tell the doctor what your child’s temperature is and how you took it. For really high fevers, the doctor may ask you to confirm the number with a rectal temperature.

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

The Bottom Line

Sleep issues may resurface during the toddler years and require a sleep training refresher. Stay the course and try to keep the nighttime ritual consistent. In addition, remember that there’s a bit more latitude when it comes to fevers in toddlers, and there are other acceptable ways (besides the rectal method) to take their temperature. Hooray!

“I’m not a parenting expert. In fact, I’m not
sure that I even believe in the
idea of ‘parenting experts.’

I’m an engaged, imperfect parent and
a passionate researcher.
I’m an experienced mapmaker
and a stumbling traveler.

Like many of you, parenting is by far
my boldest and most daring adventure.”

~Brené Brown


Sneak Peek: Your child’s next checkup will be at 15 months. Book this appointment if you haven’t done so 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 13 (Week 3) of Parenting Your Toddler! 

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

Get Wise About It All Below…

Although your little one has come a long way socially, they may seem oblivious when it comes to “playing” with other kids. Don’t worry, that’s normal. 1-year-olds tend to engage in “solitary play” rather than group play with their peers. They will, however, “play” with their family members and other caregivers.

In addition to being fans of “solitary play,” kids at this age are big fans of TOYS and start to use them appropriately. For example, they may hold a toy phone (or a real one) up to their ear or bang on a toy piano.

Get Wise below about the different stages of play during childhood and the best toys for toddlers.

How Children Learn to Play

Play isn’t all fun and games for kids, it’s work. Through play, children learn to solve problems, manage conflicts, be creative, and take risks. Free, unstructured play is critical to their development, yet it’s being replaced by more structured activities at younger and younger ages.

Per sociologist Mildred Parten Newhall, there are six stages of play that kids progress through early on in life. The age ranges for these stages are not set in stone, however. Some kids (especially those in daycare and those with older siblings) pass through the stages at an accelerated rate, while others take their time.

Here are the 6 Stages of Play…

1. Unoccupied Play: 0-3 Months

  • Between 0-3 months, babies make a lot of random movements with their arms and legs. Although these movements don’t look like much, they actually set the stage for future play.

2. Solitary Play: 3 Months-2 Years

  • During this stage, children like to play on their own. Envision a toddler pretending to cook by themselves in a toy kitchen.
  • Children don’t typically initiate play with other kids during this stage.

3. Onlooker Play: 2-3 Years

  • During Onlooker Play, children watch other children play but they don’t engage in play with them. They’re students of play at this point. This stage overlaps with the next stage, Parallel Play.

4. Parallel Play: 2.5-3.5 Years

  • During parallel play, kids play side by side but they don’t interact with one another.
  • They ARE paying attention to the other kids, however, even if it seems like they’re ignoring them.

5. Associative Play: 3.5-4.5 Years

  • As kids emerge from the toddler phase, they become more interested in playing with other children.
  • They begin to “share” (with varying degrees of success) and play within groups (e.g. to stack blocks together). They do not, however, set ground rules or try to organize their play.

6. Cooperative Play: 4.5 Years and Up

  • Cooperative play is more sophisticated than associative play.
  • During this stage, kids play imaginary games, make up rules, and assign roles in their games. As you can see, a lot of important skills develop during cooperative play.

Play Isn’t Just for Kids: Play is also good for adults! It’s something we tend to forget about, though, as life gets more serious. As R.C. Ferguson says, “a man is getting old when he walks around a puddle instead of through it.”1 The good news is that our children tend to bring out our playful side once again.

As I’ve mentioned in the past, there’s a great book called “Playful Parenting” by Lawrence J. Cohen that discusses the importance of playing with our kids. For those of you who aren’t in the mood to play “family” for 5 hours, know that you’re in the majority. Luckily, this book espouses quality over quantity. Ten minutes a day of free, unstructured play can do wonders for your family bonds. Get physically down to your child’s level (i.e. sit on the floor) and let them dictate the play.

Common Question: What Types of Toys Do Children Like at This Age? 

There are so many toys on the market nowadays that it can make parents’ heads spin. Below are the types of toys and games that usually appeal to toddlers.

  • “Cause & Effect” Toys: These are toys that do something in response to your child’s action. For example, the siren of a toy fire engine goes off when your child presses a button.
  • Push-Pull Toys: As the name implies, your child can either push or pull these toys. Note: Push-pull toys differ from walkers, which are OUT.
  • Blocks (for Stacking).
  • Balls (of Different Sizes).
  • Play-Doh.
  • Picture Books (Namely Board Books).
  • Sand or Water Tables.

    PediaTip: Observe your child while they play with these types of tables. Why? Because it’s not uncommon for toddlers to try to eat the sand or drink the water.
  • Toy Telephones (Before Your Child Takes Your Real One).
  • Stuffed Animals and Dolls.

    PediaTip: if your child sleeps with a stuffed animal or a doll, make sure that it doesn’t have parts that can be chewed (or pulled) off, and swallowed.
  • Dress-Up Play Clothes.

In Addition to the Toys Listed Above, Toddlers Love to Experiment With “Object Permanence.”  

That Sounds Fancy. What is It?

Object permanence is when a child understands that an object still exists even when it disappears from sight. 

While this might seem obvious, newborns and infants don’t know about object permanence and assume that an object is gone for good if it’s no longer in view. For example, an infant will often lose interest in a toy when they can no longer see it. 

Toddlers, however, are well-versed in object permanence and get a kick out of playing peek-a-boo and finding objects hidden under napkins and behind pillows. 

The Bottom Line

As your child gets older, they’ll naturally move through the 6 stages of play and learn to socialize with others. Enjoy the process and try to spend some “connect” time with them each day. 

“Play is often talked about as if it were a relief
from serious learning.

But for children, play is serious learning.
Play is really the work of childhood.”

  ~Fred Rogers

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 13 (Week 2) of Parenting Your Toddler!

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

Get Wise About It All Below…

As you settle into your child’s second year of life, constipation issues may develop, continue, or resurface, especially if your little one likes to crush milk.

Get Wise about constipation and how to manage it in the Hot Topics Section below.

Constipation in Toddlers

Constipation refers to infrequent and “hard to pass” bowel movements. When it comes to constipation, doctors worry more about the consistency of the stools (vs. their frequency).

The stooling patterns of toddlers vary greatly. Many toddlers poop 1-2 times per day, while others go several days without pooping. Doctors are happy as long as the poop is soft, the child seems content, and their belly isn’t distended or firm. 

If the poop is hard, looks like pellets, and the child is straining to go to the bathroom, they might be constipated.

PediaTip: To be on the safe side, let the doctor know if your toddler hasn’t pooped for 3+ days (disclaimer: doctors vary in terms of when they want to be called about constipation). If your child is super cranky, starts vomiting, or develops a firm and bloated belly along with the constipation, call the doctor regardless of when your little one pooped last.

Did You Know That Constipation Can be a Literal Pain in the *ss and Is Known to Cause Abdominal Pain and Bloody Stool?!

Learn More About These 2 Symptoms Below…

  • Abdominal Pain: Constipation is the No. 1 cause of abdominal pain in kids. It can get so uncomfortable that it mimics appendicitis (especially if the pain is localized to the right lower part of the abdomen).

    A classic scenario is a child who ends up in the ER with intense abdominal pain and a concern for appendicitis. After the ER doctor asks the parents a bunch of questions and does an abdominal x-ray, a diagnosis of constipation is made. The parents then head home with their little one, feeling sheepish, but relieved.
  • Bloody Stool: Constipation is also the No. 1 cause of blood in a toddler’s poop. Why? Because kids can get a small cut around their anus (fancy name: anal fissure) when they strain to get a hard poop out. Anal fissures produce bright red blood on the toilet paper, the baby wipe, or the outside of the stool. They hurt too!

    The Good News: Anal fissures heal quickly on their own. That being said, call the doctor if you see blood in your toddler’s poop (just to be on the safe side).

    Get Wise(r) about anal fissures here.

    In addition, go here for a review of weird-colored poops and which ones doctors worry about.

How is Constipation Diagnosed?

Constipation is typically a clinical diagnosis (based on the child’s symptoms). Some doctors will confirm their suspicions, however, with a simple abdominal x-ray.

What Causes Constipation?

The Top 4 Causes of Constipation in Toddlers Are:

1. Too little fiber in the diet.

2. Not drinking enough water.

3. Drinking too much whole milk (more than 16-24 ounces per day).

4. “Withholding” poop:

Note: The “withholding poop” behavior tends to rear its ugly head during potty training (around 2.5-3 years of age) because kids don’t want to poop in the potty. A vicious cycle can develop in which the child refuses to poop, becomes constipated because of it, and then really doesn’t want to “go” for fear that it will hurt on the way out.

Children withholding stool often look like they have to go to the bathroom, but instead of pooping, they cross their legs, dance around, squeeze their butt cheeks together, turn red, and slink off into a corner. 

PediaTip: Practice “NO pressure” potty training when the time is right (around 2.5-3 years). Why? Because the more stressed out a child gets about pooping in the potty, the more likely they are to withhold their stool.

Insider Info: Although constipation is usually related to a diet issue (i.e. not getting enough fiber), a drinking issue (ingesting too much milk and not enough water), or a behavioral issue (withholding poop), it can, in rare cases, be caused by an underlying medical problem.

If your child has chronic constipation, their doctor may want to investigate the problem further and look for other, less common, reasons for it. For example, the doctor might order special lab tests or imaging studies to make sure the intestines are functioning as they should.

Rare Causes of Chronic Constipation Include:

  • Hirschsprung Disease: This is a condition in which individuals are born with missing nerve cells in the lower part of their colon. It’s hard for kids to poop when they don’t feel the urge to poop. Newborns with Hirschsprung disease often fail to poop within the first 24 hours after birth. That’s why doctors are always on “poop watch” during a baby’s first day of life.
  • Intestinal Obstruction: This means there’s a blockage in the intestine. An intestinal obstruction will cause a child to become acutely constipated, vomit bile (green stuff), and look acutely ill.
  • Hypothyroidism: Hypothyroidism causes the thyroid gland to “run slow,” leading to low levels of thyroid hormone in the body. Low thyroid hormone levels cause symptoms such as constipation, fatigue, abnormal weight gain, brittle hair, and dry skin. Hypothyroidism can be diagnosed with a simple blood test and is part of the newborn screen blood test.
  • Lactose Intolerance: In the case of lactose intolerance, milk does NOT do a body good. Although lactose intolerance isn’t a milk allergy, per se, it can still upset kids’ stomachs. Lactose intolerance is most commonly associated with diarrhea, but it can swing to the other extreme and cause constipation.

Tips for Managing Constipation in Toddlers

  • Call the Doctor So They Can Rule Out Any Worrisome Causes of Constipation.
  • Increase the Fiber in Your Child’s Diet.
    • High-fiber foods include fruits, veggies, beans, whole grains, and certain cereals (such as Bran Flakes that have been softened with milk).
    • Some doctors even recommend adding high-fiber juices, such as prune juice or apple juice, to the whole milk or offering them straight up. This is one of the few times doctors give juice the thumbs-up. Limit your child’s juice intake to a max of 4 ounces per day, though.
    • Get Wise about the fiber requirements for children and additional examples of high-fiber foods.
  • Decrease Your Child’s Milk Intake (Especially If It Exceeds 24 Ounces Per Day) and Increase Their Water Consumption.
  • Try a Stool Softener Like Miralax (If the Doctor Approves). Miralax is a pretty benign medication. It’s a tasteless powder that can be bought over the counter at a drugstore and then mixed with a beverage (like water or milk). Avoid mixing it with juice because:

    1. The Miralax-juice mixture produces a lot of gas in children,

    AND

    2. Juice isn’t great for kids anyway.

    Miralax needs be given daily for several months to make the stools consistently soft. Ask the doctor what dose they recommend for your child.

    Insider Info: Parents often abandon the Miralax too soon (i.e. once their child has their first normal poop), but it’s wise to continue it for a bit longer to make sure the stools stay regular. 
  • Try a Suppository (If the Doctor Says It’s Ok). If the stool softener isn’t working, the doctor may add a glycerin suppository to your child’s regimen. Glycerin suppositories go up the bum and are often used in conjunction with Miralax.
  • Hit the Reset Button (in Severe Cases of Constipation). Severe constipation is often marked by chronic abdominal pain and, weirdly, diarrhea. Diarrhea caused by constipation is called “overflow diarrhea” – i.e. diarrhea that uncontrollably flows around a big, hard stool that’s stuck in the bum.

    Children who develop severe constipation often need a “clean-out” either at home or in the hospital. A clean-out is when the child takes heavy-duty stool softeners and gets a big-time enema to reset their system and flush out the poop that’s been sitting there. It can take a week to do this at home or a few days to do it in the hospital. The hospital setting is reserved for particularly tough cases of constipation.

    After the clean-out, it’s important to keep your child’s stool soft, so they don’t flip back into the old cycle of being afraid to poop and getting constipated again.  

The Bottom Line

Constipation is a common complaint in the pediatric world. Fortunately, it’s often a transient problem that’s solved by increasing the fiber in a child’s diet, having them drink more water, and limiting their milk consumption to 16-24 ounces per day. Moderate-to-severe cases of constipation may require a trip to the doctor, a laxative, and in some instances, a full-on bowel clean-out with an enema. Call the doctor if you’re worried about your child’s constipation.

Celebrities Are Just Like Us!

“I wish that being famous helped prevent
me from being constipated.”

~Marvin Gaye

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 13 (Week 1) of Parenting Your Toddler! 

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

Get Wise About It All Below…

Toddlers (like everybody else) can develop some bad habits. Two common habits at this age include pacifier addiction and thumb-sucking. The solution to both of these problems involves time, patience, and a little effort.

Get Wise About How to Manage These Two Issues in the Hot Topics Below…

Weaning Off the Pacifier

The pacifier may have served your little one when they were an infant, but now that your child is a toddler, you may be ready for them to kick the pacifier habit to the curb.

So How Do You Get Rid of the Pacifier?

There are 2 Schools of Thought On This One. They Are:

1. Break the habit slowly.

2. Go cold turkey.

Your Approach Will Depend on Personal Preference AND Your Child’s Temperament.

  • For the gradual wean, you can start by limiting the pacifier use to bedtime and then dropping a night each week until your child has given the pacifier up completely.
  • If the slow wean approach makes your toddler even more obsessed with the pacifier, going cold turkey might be a better solution for them.

Other Creative Tips Heard Around Town:

  • Poke a Tiny Hole in the Tip of the Pacifier: When you do this, the pacifier will no longer provide suction and therefore won’t stay in your child’s mouth as easily. Your child may not be a fan of this approach, but they may also decide that the damn thing doesn’t work anymore and it’s time to give it up.

    A Word of Caution:     Don’t cut the tip off the pacifier (which can create a choking hazard). Use a pin to make a hole in the pacifier, instead.
  • Give the Pacifier a Dramatic Sendoff: Gather all of the pacifiers together and tell your child that the binky “fairy” or “superhero” (insert your own word here) is going to take the pacifiers away and give them to new babies. Then make them disappear overnight (i.e. throw them in the trash). This can work if your child is in a giving mood and grasps the concept (which is hit or miss at this age).
  • Sew the Pacifier Into a Teddy Bear: This tip is from Parents magazine. Go to a Build-A-Bear Workshop in your area (this is a store where kids can build their own teddy bear) and have the pacifier sewn inside the bear. Hopefully your child won’t rip the bear to shreds to get the pacifier out (just kidding!).

When Should My Child Give Up the Pacifier?

Experts Vary In Their Answer to This Question: 

  • The American Academy of Pediatrics (the AAP) recommends that kids give up the pacifier between 6 months to 1 year of age.

    Why? As you may remember, the AAP is on board with pacifiers early on, because they have been proven to be protective against SIDS (Sudden Infant Death Syndrome). The SIDS risk declines after 6 months of age, however, and disappears by 1 year. As your child gets older and the protective effect of the pacifier is no longer needed, the AAP becomes more focused on avoiding the cons of the pacifier (namely the dental issues and the increased risk of middle ear infections).
  • The American Dental Association (ADA) has a slightly different take than the AAP and suggests giving up the pacifier by 2 years of age.
  • The American Academy of Pediatric Dentistry (AAPD) encourages kids to ditch the pacifier by age 3.

The Bottom Line: The age at which children should give up the pacifier isn’t set in stone, so don’t stress too much about it. Pick a time when you feel ready-ish to help your kiddo wean off the pacifier, then go for it.

Breaking the Thumb-Sucking Habit

Some babies like to skip the middleman (the pacifier) and suck on their thumb or finger(s) instead. The beauty of the thumb is that it’s always with your child and acts as an instant self-soothing tool.

The problem with the thumb is the same: it’s always with your child, making the thumb-sucking habit a bit harder to break. You can’t just throw the thumb away or pretend the “binky fairy” came and got it.

The Good News? 

You have time. Encourage your child to leave the thumb-sucking habit in the dust by age 4. 

Why? Because after 4 years of age, there’s a higher risk of dental issues. 

Here are Some Tips to Help You Phase Out Your Child’s Thumb-Sucking Habit:

  • The first step is to set boundaries around the thumb-sucking. For example, you can tell your child they can suck their thumb only while inside the house (vs. outside).
  • Avoid the nasty-tasting sprays and constricting thumb splints — they don’t help much. Instead, offer a different self-soothing tool (such as a blankie or a teddy bear) when your child goes to suck their thumb.
  • Give rewards (like a sticker each day) for not thumb-sucking.
  • If all else fails, the dentist may be able to hook your child up with a temporary device that attaches to their teeth and prevents thumb-sucking.

The Bottom Line

If your kiddo is still hooked on the pacifier, work on breaking the habit before 3 years of age, but know that it doesn’t have to happen all at once. If thumb-sucking is your child’s chosen vice, take steps to limit the behavior and to fully extinguish it by age 4.

“I always wondered why babies spend
so much time sucking their thumbs.
Then I tasted baby food.”

~Robert Orben

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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