Category Archives: Toddler

Baby, Infant, Toddler, Uncategorized

Scheduling Babies

So many parents with new babies are told, “get your baby on a schedule. Things will be a lot easier and you will get more rest.”

The problem with this advice is that it comes too early and without enough information. When babies are born, they schedule us and we do not schedule them. We need to follow their lead. For three months they should be spoiled. After three months children can learn some scheduling. But the first thing to work on is night sleep. After three to four months, children can learn to sleep for longer stretches. So parents can let up on their responsiveness to their children at night and see if they can learn to fall back to sleep again without cues from us.

After night sleep is accomplished, children develop into nappers over time. Napping is usuallly haphazard until closer to 9 months of age. By that time children start developing a natural schedule of two naps a day. By 15 to 18 months those two naps become one longer nap and then you have your child scheduled! But you didn’t do it. Children evolve into that schedule over time. Don’t let anyone tell you to push your child into a schedule before they are developmentally ready.

Behavior, Community, Pre-Teen, Teen, Toddler

Tips for Managing Screen Time

Maybe I am harping on this a little too much. But I do not think so. I believe that screens are detrimental to the healthy development of human brains. It seems that the American Academy of Pediatrics agress with me. But too my surprise, it seems that a lot of parents agree too. In a recent article in the NY Times, Bruce Feiler surveyed parents about what they do about their kids screen time. He found that the majority of parents have rules governing their kids screens. Here sre some of the things he learned in his survey of parents and some of my suggestions added in.

 

  1. Parents need to be examples and put their phones down. More and more we are all becoming addicted to our screens.
  2. Delay getting a first phone until kids really need it. You may need your child to get a phone by the time they are in middle school for communication needs. But it does not have to be a smart phone. It can be a dumb phone to call and text only.
  3. When your child gets a phone or tablet, set up strict rules for them. No internet during the school week, and only 1 hour a day of screen time! Set up a contract and monitor use from the start. Yes, you will be a mean parent but you will be in the majority with other parents.
  4. Homework needs to be safeguarded. Yes, more homework is online. But other communication and apps need to be limited to decrease distraction. Have kids do homework in common areas. Check in on them. Your presence turns off cheating on rules. And no social media during homework time.
  5. No phone use 1 hour before bedtime. Screen use has been shown to hinder normal sleep patterns. Also communication through texting interrupts sleep. Check phones into a common charge area at night so phones are charged for daytime when you need to communicate.
  6. Make rules for teens that they must answer your calls or texts within three tries. The excuse about not having reception is no excuse. You need to be able to reach them.
  7. Meal times should be screen free times. Eat together and talk.
  8. Limit social media accounts. Younger kids do not need facebook, snapchat and other accounts. Each account drains time from your child. Use a common ipad for their accounts so you can monitor what is going on.
  9. Punish kids with device removal. Check in regularly. Adjust house rules as you need to. Read some random texts. Read them aloud to embarass them. These are ways to have some control of what they do in this open arena we call the internet.
  10. Family time is very important. Interaction is the only antidote to screen time. Have game nights. Cook together.  Get outdoors together. Have parent-child date nights. Any fun you can have without the screens is good fun and interactive fun.
  11. Don’t give up the fight. Screens are a privilege for kids to have not a right for them to have. You have control and pay for the screens. Turn off your router if you must.         Good luck!
Age Group, Pre-Teen, Teen, Toddler

Screen Time is Mean Time

Years ago a number of pediatricians and I spoke about kids getting heavier. After years of observing this trend, research showed that indeed there was an “obesity epidemic”as  if we needed research to prove that. Also years ago, I met with a number of child psychiatrists at a meeting and we discussed our respective literature to see if we had seen anything written about electronic media driving kids toward ADHD, anxiety, and depression. At the time we had not seen any such research even though we all felt that to be true. Now we have the research and the support and new guidelines.

 

Missed during the end of this raucous election cycle is the recent recommendations from the American Academy of Pediatrics for screen time for kids of all ages. The recommendations are more strict than before based on some scary information. There is little doubt that parents are not even close regarding the use of screens in rearing their children. And I find it an uphill battle whenever I talk about it. But there are important things to recognize before you lay your child in front of your phone or ipad.

 

First it is very important to think about our children’s brains and how they develop. Interaction with live three dimensional people is critical at any age even teenagers. Babies learn to smile in response to faces. Speech is taught by speaking and reading to children. Teenagers learn to read emotion in faces by the end of high school only through seeing actual faces! Children learn right, wrong, sorrow, joy, disappointment and resilience through personal experiences. Nobody can deny any of these statements. Yet we work against these important developmental stages through the overuse of screens – and yes they are being overused by everyone including parents!

 

Starting with early childhood, parents with good intentions use electronics to try to teach their children. Many products have come out to support this parental desire. One problem exists with these products and TV shows. Under age two, there is no evidence that supports the notion that electronic games or TV shows help children under two develop. In fact, it is clear that young kids can operate an ipad, or sing along with a show theme, or even learn a word. However, it is not clear if this improves a child’s ability to interact. Even new words learned from a device may not be learned enough to use that word in their world. Ability to use an ipad is not a sign of improved intelligence at 20 months of age! This is why the AAP recommends no screens for children under 2.

 

Over age two, children may derive some benefit from educational TV, and educational computer programs. But that benefit is only realized if parents are involved with those shows and programs in order to reinforce the learning through ( you guessed it ) interaction. When parents reinforce the learning from a program by explaining what the child saw, and using what they learned, children actually learn the material. Without the follow through with interaction, children learn less of the material. Kids who learn through electronics and interaction together receive a benefit that can be recognized in kindergarten and first grade. Aside from that narrow perspective, TV shows and computer games have no benefit and can have detrimental effects. One of the key effects is teaching distractability and disturbing their ability to follow instructions. Both of those things are problems for school.  So the recommendation from the AAP is very limited ( 1 hour a day ) use of screen time for kids 2 to 5 years old and that screen time should be of educational content, and be supervised and reinforced by parents in order to be beneficial.

 

Now to the real fly in the soup. Parents that I know believe that school age and teenager screen use has gotten out of control. The American Academy of Pediatrics would agree. Being realistic, even schools are putting homework onto ipads and computer systems. So some screen time may be necessary. Some screen time is important to young adults in order to stay connected with friends. But there are extremes of use that are not good. We see more obesity that is tied to screen use. Our kids are sleeping less and are more tired. Social isolation is increasing with screen use. We even have a new psychiatric diagnosis called Internet Gaming Disorder where children and teens are addicted to gaming! And that is not all, we have more ADHD, anxiety, and depression that can be associated with screen overuse. I am convinced that fewer boys are going to college because of their screen use. The ratio of boys to girls in college has been steadily increasing in favor of girls for years and the boys that are going to college have lower scores than boys did in the past. We have not even talked about the antisocial behavior that is taught in games and online. Could our boys be taught attitudes about women in the games they play or sites they visit online? You bet! And should I even mention sexting? Or sex predators? If you want more information about how boys are affected by screen time among other issues check out the documentary “The Mask You Live In” on Netflix.

 

 

Screens are a new necessity in our lives. Parents can hardly put them down so how can we expect kids to? But we all need to put the screens down more. Every home should have some basic rules in place. Limit the time for non academic screen use. Turn off televisions when not in use. Avoid using media to calm your child. Monitor the content of your child’s TV and screen viewing. Keep TVs and other screens out of bedrooms. No screens  during meals one hour before bed. Develop your own Family Media Plan by checking out www.healthy children.org/MediaUsePlan . Children at all ages need to have their faces seeing other faces and interacting in order to develop and learn normally. This is so important and we are seeing the effects!  Screen time is mean time because it is bad for the development of our children. So please try and improve on your media use plans today. Thank you!

Toddler, Uncategorized

Three “NO-NO Battlegrounds for Parents

From the time that I became a pediatrician, thirty some odd years ago, I have been counseling parents to stay a way from three battles. We all know we “have to pick our battles”.  Early on in my career I saw an article that explained the three areas that I am talking about as “no-no’s” to battle with your kids.

As we engage with kids we often try to take control in areas where we do not have control. The result is a battle we cannot win.  I intend on doing a podcast on this issue too. Perhaps I can elaborate more there. So what are the three areas to NOT battle with your kids over?

  1. How much they eat! They have ultimate control of how much they put in their mouth and how much they swallow. You cannot make a child eat. REPEAT…you cannot make a child eat. Nor should you worry about how much they eat. You can control what choices they have for food. And you should take control of that!
  2. You should not battle over sleep. You cannot make your child sleep. But you do have control of bedtime, where they are to go to sleep, and the total hours of bedtime.
  3. You cannot make a child poop in the potty. They have control over where they put their poop. You have control of incentives and discouragements. In other words you have control over your responses after they go to the bathroom. You can act disappointed and cold if they are not pleasing you about their choice of going in their pants. And you can be pleased about when they succeed in the potty.                                                                                                                So there are the three no battle areas. Good luck! Actually this takes a lot of stress away when you realize what you have control over and what you do not. More details of approaches are in other articles on this website and in podcasts to come.   Check them out….thanks
Behavior, Homepage, Nutrition, Parenting Tips, Toddler, Uncategorized

Food Rules

Every family should have some rules around food and eating. From the time I was trained as a pediatrician until today, I have been taught that food should not be a battleground. As parents, we think we need to get kids to eat. But we DO NOT. They will eat what they need to grow on from the balance of food we present. Here are some rules every house should apply.

Do not pressure kids to eat.

Do not worry about how much your child eats at any age!

Make them eat from your choices , not theirs.

Their choice should be to eat or not eat.

Do not play around to “get them to eat”.

Do not pay attention to their behavior around food.

These rules should make your house more peaceful around meals and dinnertime. To learn more join our discussion of these rules on Thursday October 30th at 11:30 at our parent coffee. Good luck.

Dr. Orr

Family, Parenting Tips, Pre-Teen, Toddler

What’s With Those Boots?

Almost every week I see a child in my office with a  pair of funky boots on. The boots are usually rubber with  easy to pull handles. The toes are decorated with a face  of an animal – perhaps a duck, frog or ladybug. The day  might be bright and sunny, but the child comes clomping  into the room with their rubber boots proudly on their  feet. I often ask them “What’s with those boots?” To  which the mother sheepishly responds, “She wants to wear  them everyday and I just don’t want to battle her.” The  fact of the matter is that all parents have to choose their  battles and there are some battles just not worth fighting.

So how should parents choose their battles? We all  know, as parents, we have to confront our children over a  number of issues. Too many parents feel like they are  battling their children all day. How do we know when to  put our foot down and when to let them wear their boots?  The answer is somewhat personal. It depends to some degree  what is truly important to the parent. But as a young  pediatrician, I was taught that there were some guidelines  about battling with children. As I became a parent, I  found that these guidelines were helpful. Here are those  guidelines and some others I have added.

1. You cannot control whether your child eats or not.  You can control what food is put on the table. A  child can be given a choice before the meal such  as “Do you want PB & J or Tuna fish for lunch?”  Once a choice is made stick with it. The child  can eat or not eat!

2. You cannot control your child’s choice of friends.   You can control how much time those friends spend  at your house. Children often choose friends  that are unlike themselves. You may consider  them a “bad influence”. But you cannot impose  control over your child’s choice. You will be  very frustrated if you try to choose your child’s  friends. You should only control what you can –  perhaps the time available outside of school for  your child to be with that friend.

3. You cannot make your child go to sleep. But you can establish and control a bedtime. Many  children are made to be in bed but stay awake for  a time before drifting off to sleep. Your job as  a parent is to enforce the time for your child to  be in bed. Your child can choose between being  awake and going to sleep.

4. All parents need to win the battles over safety.  Kids cannot run out into the street, must wear  seatbelts and ride bikes with helmets on. Safety  is the area where parents have a right to battle  their kids.

5. Hygiene is another worthwhile battle. Baths need  to be taken, hands washed, teeth brushed and noses  left alone – at least in public.

6. Choice of clothing is a famous morning battle.  Clothes should be put out the night before. But  as with the choice of foods, once the clothes are  put out, don’t open the choices up for debate  again. The child can choose between the two sets  put out the night before and only those two sets.  To force a choice, move to the next phase of the  morning – breakfast or even leaving the house.  Many children need to finalize their choice for  clothes in the car!

7. Parents often feel pressured into battles because of time. We know that deadlines exist but kids  don’t care. So when we want to get our kids  ready, we often pressure them to dress, eat,  and get their things ready. Of course as they  resist our pressure, we get more upset. The key  is not to pressure the kids because of our time  consciousness. Just be clear on what they need to  do, give five minute warnings for each step they  need to make, and set a “drop dead time” when –  ready or not – half dressed or partially fed – you  are out the door! The next days you will see more  cooperation during your 5 minute warning periods.

The major issue with the battles we have with our children  is that parents may sense a loss of control. If you are  feeling controlled by your child over an issue, then you  need to decide what your child has control of and what you  need to control. You control the choice of foods; your  child controls how much they eat. You control the choice  of clothes; your child chooses between the two sets in the  morning. You set the bedtime; your child decides to sleep  or not. By allowing your child some sense of control then  you can be better choosing your battles. And then it might  be okay if your child chooses her boots everyday too!

Behavior, Family, Parenting Tips, Pre-Teen, Psychology, Teen, Toddler

What Our Reactions Teach Our Children

You are spending a beautiful day at a park with your kids. While fixing a zipper on your older child’s jacket,  your toddler falls on a walkway. Apparently unhurt by the  fall, you see your two year old on the ground peering  around for you. Another mother helps him to his feet and  he smiles up at the friendly woman. Then he catches your  eye and bursts into tears as if hurt. Is he hurt? Has he  learned to cry with falls? Is he expressing emotion to  test your reaction?

This is a small example of how our reactions can teach  our children behaviors. Parenting is an interactive  process. Both parent and child may develop behaviors in  response to the others reaction. When a child first falls,  we may react with worry and concern about injury. We may  run to the child’s aid most often to discover minor  scrapes. Nonetheless the child cries – perhaps not with  injury but responding to our reaction of fear for injury.  Thus a pattern of behavior for both parent and child begins  mostly due to our reaction.

This is not about falls. Certainly some falls can be  hurtful and need sympathy but a grand majority are not.  The point is that children can subconsciously manipulate  our behavior patterns just as we can subconsciously  manipulate their behavior patterns. This can happen in  many areas. Food battles often occur as children wait for  their choice of food to arrive while watching a parent  worry over their refusal to eat. Bed times can be delayed  as children use fears to make us come for multiple curtain  calls. Sometimes kids know how to put on a face or an  emotion that pulls on our heartstrings and gets them the  reaction they want from us. Some kids learn to get  attention from parents by behaving badly. They establish a  pattern early and learn to get parent’s reactions to bad  behavior.

So what are parent’s to do? How do we measure our  reactions? How do we analyze what we are doing that is  resulting in behavior patterns we don’t like in our kids  and in ourselves? These questions are what make parenting  one of the most introspective experiences in our lifetimes.

Think for a moment about some areas of parenting where  you react strongly. Ask yourself a few questions. Do you  have some unrealistic fears that make you react to your  children? Are you afraid they will starve? Do you worry  about them getting hurt? Do you think our kids can’t  manage without you? What is so important in situations  that make you react strongly? What assumptions are you  making? Do these assumptions make sense? Or are they  false assumptions drawn from your history or heritage?

Do you take everything your child does as a reflection  of you as a parent? Do you respond to your children in an  effort to control them? What children do is a reflection  of them not you. And as much as you try to control them  they will have to assume control of themselves for  themselves.

Answer these questions for yourself. Recognize why  you have strong reactions to some of your children’s  behaviors. If we can understand our reactions and where  they come from, we can start to temper our emotions in  different situations. You will see your children  responding less in behavior and tempering themselves as a  result. As we control ourselves, many times our kids will  become better in behavior. It seems so basic but is very  difficult to see and understand when you are in the midst  of battles. It just seems to happen that the more self  aware parents are, the more self aware their children will  become.

Behavior, Family, Parenting Tips, Pre-Teen, Psychology, Toddler

What Is a “Time-Out” Anyway

You’re in a supermarket and your kids get into  trouble. You warn them, “If you don’t stop you’re going  to get a “time-out” when we get home.” They don’t get  better so when you get home you enforce a “time-out”. You  direct them to respective chairs where they sit. They  say they are hungry. You tell them, “You’ll have to wait  until “time-out” is over.” You ask them what they want  for lunch. After you finish making their lunch you say  their “time-out” is over and they may come to eat. Was the  “time-out” effective? Did they learn anything? Did they  feel anything? What is a “time-out” and how do you give  one to your child?

A “time-out” is a period of isolation you purposely  give to your child where they do not get any attention from  you and they don’t control you. It doesn’t matter where  they are, or whether they have a “time-out” place. The  action is louder then words. The key points are personal  isolation and lack of control. Nobody is willing to  continue behavior that yields isolation and control of  nothing.

Let’s think about this a moment. What should a child  get for a positive behavior? If a child helps at the store  or cleans their room he or she receives praise and a  positive response from their parent. They receive  attention and control their parent’s response for that  moment. So what should children receive for a negative  behavior? Certainly not the same attention from the parent  and controlling their parent’s response! We should  consistently give negative behaviors a rapid response but  that response should involve little attention and a  controlled reaction from you. This is the reason “time-outs” are introduced as a tool for parents.

So when your child misbehaves, give them a quick  correction. Then isolate them with coldness. Don’t  respond to them at all. If you can’t ignore them where  they are (if they are screaming, crying or tantruming) then  put them someplace else or go somewhere else where you can  ignore them. During this entire time stay firm but in  control. Don’t let them control your response. You  control it. Through being isolated while you are in  control your children get just punishment for negative  behavior. Over time they will have no motivation for  continuing that behavior.

In the scenario I started with, the parent warned  about a “time-out” while in the store. But negative  behaviors need more immediate consequences. Then when  arriving at home, the “time-out” was really a peaceful  interactive time together while waiting for lunch. When  being punished kids need quick, stern correction followed  by a feeling of isolation from their parent while the  parent stays in control. A “time-out” is then properly  done. A “time-out” is not a thing to be warned about and  given to a child later. It is an action done rapidly  without warning after negative behaviors. As parents we  have a right to respond to behaviors that we do not want to  see. If ”time-outs” are done right, kids learn over time  that positive behaviors get a better response and naturally  gravitate towards them.

Baby, Behavior, Cultural Influences, Parenting Tips, Pre-Teen, Toddler

What Is A Good Playdate?

Ah, remember those days when we, as kids, ran out and played in the neighborhood with other kids. I remember  running inside to tell my mother I was hungry so I could  gobble down a sandwich just to get back outside for our  game. Dirty sneakers, muddy pants, smudged faces, and  sweaty heads were the norm after school and on weekends.  Bats, balls, gloves, ice skates and sleds are in every  picture from my childhood. Play was arranged by stepping  out the front door. Arranging a playdate? My mother rarely  had to face this parenting challenge. Today, parents need  to decide about playdates regularly.

I recognize that some neighborhoods may still have the  community environment that allows spontaneous play, but  most families today face the problem of separation between  friends which then require parents to arrange playdates.  What is a good playdate? How can we arrange a playdate so  that we are comfortable about safety, diet, and  constructive play?

Playdates are very important for children. From the  time children are three years old and recognize that there  are people their age on this planet, they want to interact  with playmates. Children develop their brain power through  interaction with people. So playdates are a necessity in  this increasingly isolating society of ours. A good  playdate is one where children play actively with each  other sometimes causing conflict and solving it together.  Battles over legos, homemade forts, or who plays what role  leads to problem solving skills, compromise, creativity,  and use of the imagination. We know that creativity is all  but erased in computer games. Imagination is stifled by TV  and movies. Kids can get enough of those without wasting  time with a friend with screens in front of them.

Good playdates take more than the type of play.  Supervision is necessary even for the closest of friends.  Someone needs to be there to be sure conflicts don’t get  out of hand or to help support the friends’ activities. An  adult can also be sure that kids don’t snack  inappropriately between play. Good snacks are increasingly  important and can be easily accepted when provided with a  little creativity.

Obviously, good playdates take some work. Parents  need to talk to one another – not just about scheduling the  playdate. Good playdates really depend on communication  between parents. Meet the parents of playmates. Stop in  at drop-off and observe a little of the play environment.  Parents need to make sure the other parents know your  expectations. Be explicit about your expectations over TV  and computer time. Ask about outdoor time during playdates  if the weather permits. If you are the host parent, be  available for some supervision. Be true to the other parent  and enforce agreed upon rules for the playdate. Many  parents want to hear that parents have the similar opinions  about play. It is wonderful to find good playmates and  families that carry out similar values in playdates. This  is important even as your children enter middle and high  school.

If a playdate doesn’t work out to your liking take  control of the playdate. You can require that your child  and that friend play together at your house. If you don’t  approve of play between your child and their friend, veto  the playdates or minimize their time together. You do not  have to debate your decisions with your child. You have a  right to agree or disagree with playdates!

A discussion of playdates cannot ignore the ever growing sleepover nightmare. More and more I am hearing  about sleepovers that include very late nights, children  awake later than parents, unsupervised TV and internet use,  and the post-sleepover “hangover” where parents deal with  over tired children on a day reserved for homework or  family time. It is amazing that parents are pushed to give  into these sleepovers without restriction. Parents have a  right to put restrictions on sleepovers – especially in  later years. Even teens can have a lights out time. Time  restrictions on computer and internet use are important.  There are good reasons to limit their use after certain  hours.

If sleepovers and their aftermath get out of hand  (moodiness, decrease in school work) a parent needs to  say ‘no’ to them. Your child will not suffer because  “everyone else is going to be there”. Your child can be  picked up at 11 and sleep at home. They won’t miss much  and they’ll sleep better.

Parents need to be aware of what happens in playdates  and sleepovers and exert some influence over them. Bad  playdates and sleepovers are not helpful to your child or  to your family’s functions. Keeping your child’s  interactions with friends as healthy as possible is a  worthwhile concern for all parents. Parents need to feel  empowered to exert their influence even into teen years.  Your child will be better off for it.

Baby, Behavior, Family, Parenting Tips, Toddler

Toilet Training Made Easy

At times I feel like I can hear all the phrases used in different households by different people. I can hear mothers saying “Do you need to use the potty now? Do you  want to try?” When changing diapers at the changing table children hear, “When are you  going to use the potty? Mommy doesn’t want to change these diapers forever, you  know?” Another phrase that echoes around is, “Oh won’t it be great when you are using  the potty?” Grandparents get into the fray with the admonishing phrase, “You don’t have  her out of diapers yet? I had all of you out of diapers before you were walking.” Oh  friends and neighbors aren’t innocent. “You should put her in pull-ups” or “Just buy  him Sponge Bob underpants” or “Put him on the toilet every hour”, or “Have you tried M  & M’s as a reward?” It is as if it takes a village to toilet train a child!!!

Yet it is wonderful when a child is finally toilet trained. It marks an end to a  stage. Parents deal with less mess. No more buying diapers. And the most appreciated  factor is that the never ending unsolicited suggestions from relatives and strangers will  stop. Getting there will be great. But getting your child “toilet trained” requires little  “training” from you.

The amazing thing about this process is that most children train themselves when  they are ready. After all, they do have ultimate control over this issue, don’t they? They  decide. They have control. The biggest battle of “toilet training” is fighting all the  pressure to “train your child”.

Think of it from the child’s point of view. When all the young child is hearing is  “potty, potty, potty….,” they recognize only that a fuss is being made over them. When a  fuss is made over them for doing nothing, there is no motivation for a child to change  from doing nothing. They are smart enough to realize that if they change and go in the  potty, then they risk all the fuss about them over the potty will end. From the child’s  point of view isn’t it better to continue having people make a fuss over you for not going  in the toilet?

There is an easier way to toilet train. First, despite what you are told, most  children do not go on the toilet before two and a half at the early end. Most children  toilet train themselves at three years old. By the time your child enters that age, he has  probably seen people go to the bathroom and perhaps has tried copying the action  himself. But as your child approaches three, it is time to stop talking and reminding  about the toilet. You should pay no attention to toilet issues. It should appear to them  that it doesn’t matter to you where he goes to the bathroom. In fact, it shouldn’t matter to  you since they have control of this issue, right? Make diaper changes boring – even  emotionally cold. Don’t let diaper changes lead to play, reading, or other fun. Make it  all business. Make sure grandparents and others don’t pester your child about the toilet either. Tell them he will train when he is ready. Your child may try to go to the  bathroom in other places like a corner of a room. A quick correction and coldness will  suffice for any “accident”. Don’t over-react to it. Only respond with praise to your  child’s toileting actions to valid attempts at the toilet. This way the only attention your  child is getting over this issue is with positive attempts at the toilet. Eventually he or she  will move towards this positive experience. Be patient. After all your child will not go  to college in diapers.