Category Archives: Toddler

Just Do It

Your usually compliant fifteen month old starts arching her back to avoid getting into her car seat. Tooth brushing is met with firmly sealed lips. Perhaps changing  into pajamas gets to be a struggle. Suddenly everything you do with your 15 to 18 month old child’s body becomes a  wrestling match. What is going on? How should parents face these challenging struggles?

I see many parents who spend time every day trying to  rationally talk their toddler into doing what the parents  want. They often give up with a frustrated shrug saying  “he just won’t cooperate”. It is quite natural for  children of this age to refuse to have things done to their  bodies. At a year and a half of age children become very  focused on “me”. They strive for control of things for  themselves. At the same time that they refuse to have  things done for them they often demand that “I do it”. Of  course they may not have the skills to do things well such  as brushing their teeth or buckling their car seat.  Nevertheless, they want to do it themselves. Interceding  with their process causes a fit. So what is the best way  to face this willfulness?

Children at this age do not respond to reasoning very  well. After all, they do not have a reasonable assessment  of their ability to accomplish certain tasks, do they?  Parents will waste time and energy trying to rationally  discuss the approach to the problem at hand. We do better  giving the child a fair chance at the task and them taking  over with “our turn”. Many children won’t react well to  even a shared task. Nevertheless, parents need not allow  the child to control the situation for too long. After a  couple of options and a certain amount of time my wife and  I would resolve the situation by saying “sorry, its time to  just do it”. We would know that we would face a struggle  but we would be ready for it. The first step in “doing it”  was being in position to avoid an escape. Often my son or  daughter would need to be held. Gentle consistent pressure  would overcome any back bending resistance to a car seat.  It takes practice to hold your child and brush teeth or  change a diaper. A colleague of mine was in the practice  of changing a diaper with her knees holding her child’s  torso so her face, body and arms faced her child’s legs. Her arms were free to clean the dirty diaper area. It  seems mean and we need to be careful about how much force  we use. But because many toddlers resist things that need  to be done, parents need to have a point to “just do it”.  It’s not only a slogan for Nike. It is a necessity in homes with toddlers around. Yes we can give toddlers  choices. We can give them a moment to decide to cooperate.

In Their Faces

A one month old looks passively around the exam room and finally meets my eyes. He stops and stares with wonder.  He found something he enjoys looking at – an oval face.

A two month old takes a shorter time to search the room and  find my face. He doesn’t just stare, he smiles and coos –  as if he has things in his head to say but doesn’t know how  to get the words out.

A four month old looks right at me and smiles and coos.  Sometimes he screeches out loud to get my attention. He  doesn’t want me to talk to his mother he wants my total  attention.

At six months of age, a baby looks at me with a frown at  first. He tries to judge my emotion. If I turn to him and  frown, I could make him cry. But I never do that. I know  what he is looking for. As I go over to the exam table I  smile widely. My little friend responds with a beaming  smile and a gurgle.

It gets harder at nine months because at that age they  don’t like any smiling faces, they prefer the faces they  know and love – mom and dads. But that’s okay with me  because as they cry in response to me in the office at  nine months of age, I take comfort in knowing they are  developing well.

I am so lucky to have a job where every week I get to  experience babies. I love to see the changes in their  responses to me as they develop.

Watching children develop is such a joy. I never tire of  seeing it happen. It is something we should all enjoy and  take interest in.

The development in children in the first five years is  absolutely fascinating. They start with responding to  faces with smiles and coos. They progress to knowing their  parent’s faces and preferring those faces to others. They  start learning words in order to interact better. They  fear strangers yet act like the world is theirs to explore  When not getting their way with the world, they start  having temper fits. But as language and understanding  improve the fits go away and sharing begins. Through  sharing and interaction more words and language come. And  when learning more about that language a fascinating world  of the alphabet, letters and labels becomes awakened.  Before we know it, our child is ready for kindergarten.

The first years of our children’s lives are precious  because of this amazing development that occurs. Ninety  percent of their brain development occurs in those first  five years. But they cannot develop alone. This is why  we need to pay attention to our children. They need us  because they can only develop in these vital years through  interaction with us. We need to remember to turn off the  distractions – the TV’s, the movies, the computers – and  stay in our babies’ faces. By being “in their faces” they  develop the skills they need to interact. And by being  in our children’s faces we get to witness it all unfold.  Parents shouldn’t forget this lesson just because our kids  get older. Almost at any age our children can learn from  us. In order to do that they need to interact with us.  This is what family time should be all about – interacting  and watching them grow before our eyes.

How Should We Handle a Crying Child?

Much attention has been given to handling a crying baby. But what about a crying child. I have heard people deal with crying children in inappropriate ways. I hear  phrases like “Stop your crying!” That phrase never helps. Other phrases are tossed around such as “If you don’t stop crying you’ll really get it!” Or finally I often hear, “Oh  just take it, you crybaby?”

When our children are babies we often have solutions  for crying. As children get older we become frustrated with our lack of control of our child’s cry. We can no  longer just feed, rock or console our child out of crying. Yet we want them to stop their crying. It is just human  nature to want crying to stop. But should our desire to  stop the crying govern our actions? Of course not. Everyone needs to realize the natural tendency to do, say  or give things to make crying stop. But we should refrain from doing those things. How should we respond to a crying  child?

First we must ask why the child is crying. Did they  miss out on getting something? Is there a disappointment they are facing? Were they physically hurt? Are they  angry? Emotionally hurt by a friend? We are the adults.  We can usually figure out why someone is crying. And if we  figure it out, we should explain that to the child so they  understand why they are crying.

Then we should put that reason for crying in  perspective. “Your hurt (pain) will go away. We all get  disappointed at times. Your friend hurt your feelings and  that is hard for anybody.” With this we can help with some  physical touch, pats on the back or hugs – whichever is  appropriate. By explaining the “Why” of the hurt and just  being there we have expressed understanding and empathy.  That is what a crying child needs.

The crying may not end after that but our job is not  to stop the crying. We need to squash that natural desire  to just get the crying over with! Many times we need to  let them cry. We should not excuse it. (Oh he’s just  tired). That dismisses any true emotion there is. We  should not reward it. (An ice cream will stop that crying.)

Good News About Vaccines

For the past several years I have found myself on the defensive over a very fundamental treatment I provide as a pediatrician. I have been giving children vaccines according to the American Academy of Pediatrics guidelines for 22 years. But in recent years there has been a backlash against the very vaccines we use to prevent known serious illnesses. As a response to this backlash I built a file of articles that supported the use and defended against supposed side effects of the vaccines. In recent days there has been great news about vaccines to add to my file. The news is they are safe and do not cause autism.

In the late nineties two events stoked the fires of skepticism about vaccines. First, in 1998, a well known British medical journal, the Lancet, published a report based on work of thirteen prominent physicians stating that the MMR vaccine was associated with autism. A storm of controversy over the use of the MMR vaccine followed. The second event in the late nineties that caused a furor was the removal of thimerosal from vaccines. Thimerosal, a preservative used in vaccines, contains mercury. It has never been shown to be a health hazard. However, because of the potential for buildup of mercury in the body, it was prudent to remove thimerosal from vaccines. This was done on a voluntary basis by the manufacturers. Just that move caused speculation that vaccine manufacturers were hiding something. Further speculation followed that thimerosal was associated with autism – with no medical evidence proving it.

Through the early part of this decade, scientists and lay people have battled on both sides of the argument. Advocates for parents of autistic children questioned the MMR and thimerosal link while doctors and researchers tried to study the association. Now, within the past two months two news reports help clarify the reality.

First, in April, ten of the original thirteen investigators who published the link between the MMR vaccine and autism retracted their conclusions. It was revealed that the study, which was funded by lawyers who focus on vaccine damage cases, was markedly flawed. The original study that served as a basis for legal cases involving the MMR vaccine around the globe was biased. The lead investigators in the study are currently under legal investigation for conflict of interest.

A second story about vaccines came out in May 04. The Institute of Medicine released a report by its thirteen member panel saying that there was “little credible evidence that thimerosal was associated with autism“. Autism is a complex and difficult problem for parents and children. I know many autistic children and their families. There is still no clear explanation for autism. I wish there was. But at least we can learn some lessons from these two reports.

These two reports are of great value to physicians who promote vaccines for kids. The first report about the authors of the Lancet article takes the wind out of the sails of the MMR – autism relationship. It had been viewed with skepticism and was never supported by other research. But now to have the original authors retract their opinions makes the original article meaningless. Coupled with research disproving the MMR autism association we can now put this speculation to rest.

The thimerosal argument was piggybacked onto the MMR argument for those who wanted to link vaccines to autism. But with “no credible evidence” for such a link we can now be doubly reassured that vaccines have no connection with autism.

The general public never sees the illnesses we seek to prevent with vaccines. The illnesses are awful and often deadly. It is one of the miracles of medicine that we have vaccines for our children. Due to vaccines far fewer children need respirators, spinal taps, intravenous medicines, hospitalizations, ER visits, and intensive care unit treatments. We see far fewer cases of meningitis than we saw even 10 years ago. And in our lifetime – we will see polio eliminated worldwide because of vaccines.

So when I give immunizations to children these days, because of the recent news, I give them with renewed confidence that they are the most valuable preventative care treatments I give to children. I feel so lucky to have them. Now, I just hope more people can be reassured about their safety.

From Toddler To Preshooler – The Not So Terrible Two’s

Mothers often marvel at their one year old children. In one very short year their children went from a dependent infant  to a free walking toddler. They tripled their weight, became  curious in the world around them, and want freedom to move  around it. It is just a wonder to behold. But parents often  dread what is to come – the famous terrible two’s & horrible  three’s.

As a pediatrician, however, I marvel at the next  transition. As a toddler grows towards two years old and  beyond, a personality develops. They start to show preferences  and interests. They don’t get distracted as easily away from  their desired object. They demonstrate a will and  determination. Eating a meal in full is no longer easily  accomplished. They decide about foods they like and don’t like.

This transition is equally remarkable as the first year  of life. But for parents, it can be hard to enjoy their child  at this age since we enter a challenging time of parenting. With  the fascinating growth of personality come the parenting battles  we all fear – tantrums, food battles, toilet training, and more.  These challenges are really appropriate steps in their  development, so we have to reframe how we look at these little  people in our lives. How can parents marvel in this development  while peacefully managing a different interaction with their  child? This is the challenge of meeting the “terrible twos and  the horrible threes”.

We can meet the challenges of the toddler years if we  understand them in respect to their development. All the new  challenges our children give us during this time are a direct  result of their new skills, new curiosities and new  determination. Food challenges are due to slower rate of growth  which causes smaller appetites. By looking at their  development, we can better understand their behavior. Then  perhaps we can be more measured and controlled in response to  their behavior. As we control our reactions to their behaviors,  we actually improve our interaction with our children thereby  making these “terrible” times much easier. Let’s look at some  examples.

Parents often witness a drop off in diet in children by 18  months of age. Sometimes it is difficult to have a child sit  for fives minutes to eat. And the amount of food consumed  versus going to the dogs (literally) may be a pittance. Many  parents end up falling back on old reliable foods (spaghetti,  Mac and cheese) just to get their kids to eat something. What  is happening in their development at this age? They are curious  and active. They don’t want to sit. Their growth rate is much  slower than the first year so they don’t need to eat as much to  grow. And they are showing preferences in what foods they like.

Taking this in perspective parents shouldn’t expect full  meals eaten. They will eat what they need to grow on – all  children do. Parents need to watch not to cater too much toward  their child’s likes and dislikes. Keep variety coming. They  will learn to pick from a varied diet and will grow on it. The  age old worry about how much a child eats at any one meal is  unnecessary.

Where do tantrums come from? Your poor young children!  They get some voice, some legs and mobility, they see all the  opportunity for exploration around them, and they think the  world is theirs. Unfortunately they don’t see what is safe  and unsafe. We need to say “no” and keep them safe. But when  their exploration and freedom are limited, they react. They  try a behavior. When you don’t allow them to bang the table  with silverware in a restaurant, they may try a temper fit;  they may cry;’ they may strike out and hit. All these are  trials. Attempts. They aren’t malicious or mean. They are  simply trying to change our minds. They want their freedom and  control back so they try a behavior on for size. Unfortunately,  there are times that we need to take control. We need to keep  situations safe. Recognize these behaviors as attempts to  influence our decisions. But don’t take the bait and don’t take  it personally. Most behaviors that aren’t given much attention  usually fade away. Behaviors that don’t gain much control of  the situation also fade away. Don’t let these behaviors control  you or the situation and don’t give them undue attention and  they will go away – over time. Be patient.

Many young children and preschoolers hate transitions. It  may be that you need to leave the playground. You may need to  drop them off at preschool. Or you may need to get them in bed.

Many young children develop bad habits. Nose picking, nail  biting, even handling their privates may all occur at  embarrassing times. Part of toddler-hood to preschool  development is body exploration and self care. They do have  control of their hands and control of many body parts. It is  their body. What we can do is teach them where caring for the  body is appropriate – in privacy. Teaching and allowing body  care in private keeps this battle small. Instead of saying  “don’t pick your nose” say “if you’re going to pick your nose do  it in the bathroom or your bedroom”.

This age group also transitions into the ultimate body  control function of childhood – training to use the toilet.  This can be a big control battle and as I said above they have  control of many of their body parts. This is particularly true  of their bowels. Many pediatricians feel that this issue should  never become a battle. It is really your child’s choice where  they go to the bathroom. It is their accomplishment to go in  the potty – not the parents. It really shouldn’t matter to the  parents where a child goes to the bathroom. We do have control  over how and where to clean them up. We can show what is normal  for adults in going to the bathroom. And we can encourage them  to go to the bathroom like us. But when they decide to be  “trained” is really up to the developing child. (Incidentally,  most girls aren’t “trained” until 2 1?2 and most boys at 3 or  older!)

There are many issues to face with children from 18 months  to three years of age. It is truly a fascinating transition.  By viewing our challenges in interacting with our children in  light of their development, it makes it easier to understand  what to do. There are many things we need to be in charge of.  And there are some things they have ultimate control over.  Often, as parents, we need to step back and think about where we  draw the line, where we take control and when we concede control  to them.

I have developed a list of guidelines (The twelve rules of  parenting young children) for dealing with toddlers to  preschoolers. Here they are.

Recognize that this is an age of wonder, exploration,  determination, and attainment of skills.

Praise the positive. Marvel in it. It is through our  praise that they appreciate their skills.

Don’t dwell on the negative – move through it.

Don’t sweat how much they eat – just keep a balanced diet  coming.

Ignore the fits – if they don’t work, they’ll stop using

They all toilet train so why sweat it!

Read, Read, Read – they love words and love to build  vocabulary.

Enjoy their interests.

You do need to say “no”.

When you do – expect some behavior.

Transitions are tough – help them move through them –at  some point “just do it”.

Enjoy their stories – they love telling them.

Dr. Brian G. Orr is a pediatrician and author of A  Pediatrician’s Journal. He also writes a parenting column for  papers North of Boston. Donna Raskin is a writer and a teacher in the North Shore of  Boston.

Brian Orr M.D. and Donna Raskin co-authored The Everything Guide  to Raising the One Year Old and The Everything Guide to Raising  the Two Year Old.

Fixing Bad Habits

Those thumb suckers, and nail biters and nose pickers, and knuckle crackers,  what are we to do with our kids and their bad habits. As parents we often feel  responsible for our children’s behaviors. Because of this feeling of responsibility we try  to take charge of our kids annoying habits. Unfortunately they have control of their  fingers and nails and knuckles. So the more we try to control these habits, the worse they  often become.

Parents need to recognize that we are not responsible for our children’s behaviors.

The problem with bad habits like nail biting is that these behaviors or actions are  directed towards themselves – not toward others. You cannot separate your children  from themselves or separate their nose, mouth, or fingers from them. Although  sometimes you may want to! Yet these habits are annoying to watch. Many parents can’t help but yelling “Stop biting your nails! Don’t you see what you are doing to your fingers? Your nails are dirty. Keep them out of your mouth.” Yet the temptation for  them is always there as is our temptation to correct them.

Some parents try the toxic route – Tabasco on the thumb for thumb suckers for  example. And some parents try the hiding method such as using gloves or wraps over the  hands as if by hiding the extremity the child will forget they have nails to bite or fingers  to suck. But somehow kids work around these “fixes” so they don’t work.

What parents can do is equate these habits to other body care issues that demand  privacy. Nail care, nose care and thumb sucking all can be done in privacy. In fact, we can make this a family policy. All nail biting, thumb sucking, knuckle cracking, and nose picking need to be done in privacy! Making these privacy or bathroom issues, changes the battle over whether they can do their bad habit to where they can do it. That is  something we can enforce. Over correcting and giving undue attention to these habits  often increases them. Demanding privacy for them at least diminishes what you see of  these bad habits over time. And when it comes to habits, out of sight – out of mind is a win – win policy for home peace.