Toddler Rules

The toddler rules of possession have been published on many social media sites in various forms (see above, left column).   They have me thinking: why do toddlers do what they do, and how can parents use that reasoning to help parent?

I firmly believe that young kids don't misbehave on purpose in most instances. They are exploring limitations, learning new things, and learning to work with others.  They don't have the coordination to avoid all spills and falls. They lack the understanding of natural consequences.  Rules of life haven't all been explained to them yet... and even if they have been explained, they are hard to understand!

If you've ever read any of the Junie B. Jones books, you will see that although the adults in her life are frustrated with her actions, Junie B. has a very innocent and well-intentioned reason behind every wrongdoing.  Parents just don't see it that way.  So how do we find the reasons behind the actions?  Kids can't express the "why" of their actions. They are often confused when they get in trouble, then act out even more in anger or frustration.

Toddlers are experiencing a rapid growth, both physically and emotionally. They learn new skills, become better coordinated, and are able to experience many new things.  They say "No!" often and can be very independent. This independence causes rifts between them and their parents, much like the growing independence of teenagers.  Teens and toddlers are very similar. Learning to break away from parents is natural at both of these life stages, and it is difficult for many at both times.

Some important points: 

• New environment or toys encourage exploration, so give clear directions and set limits.
• Tantrums can be from frustration. Try to figure out your child's intent and use that to help modify the tantrum. Sometimes a time out helps all involved calm down!
• Tired, sick, and hungry trigger us all to be more irritable, impatient, and confused. Avoid these at all costs!
• Change to routine throws toddlers off. Try to keep the same routine daily, and if it will vary, give kids a head's up in advance.
• Kids crave atttention. Even negative attention (such as yelling at them) is attention. They will do what they need to get your attention, so try to fill them will praise and attention when being good and avoid attention when they are misbehaving (without allowing safety to suffer). Time Out is the perfect time to avoid talking to kids and physical contact with them.  
• Fill them with confidence and praise when they're being good! It's sometimes hard to remember, but praise quiet voices, independent play, saying kind words, or other "good" behaviors.  You can praise with words, a hug, and more.

Even many adults have yet to learn about anger management, patience, sharing, and manners, so we must expect that toddlers and young kids have not mastered those skills.  You don't want your child to be one of those adults who never masters those skills, so model good behaviors and encourage/reward them in your kids!

Injuries from pacifiers, bottles and sippy cups?

Just last month I saw an article about a child who was nearly scalped by his sippy cup during a car accident. The article was about the dangers of projectile objects in the car.  (For the full article, see the link.)

Now an article is released in Pediatrics on the numbers of injuries associated with bottles, pacifiers, and sippy cups during the past nearly 20 years.  The authors studied ER visits after children under 3 years of age were injured by one of these items designed for infants through preschoolers.  They did not include children who went to their own doctor or whose injuries were more minor and did not require medical attention, but the numbers were much higher than expected.  Nearly 200 young children a month visit an ER for injuries due to one of these items.  Lacerations were the most common injuries, especially to the mouth.  Injuries occurred mostly from falling, not product malfunctions.  They were most common in the 1-2 year age group, when kids are starting to walk around (and run!)

Take home message: use these items wisely.

Pacifiers are a great soothing tool to help infants and young children fall to sleep.  Limit them to sleep.  When kids are up playing, they don't need them.   This has been my advice for years due to the fact that keeping the paci in the bed also decreases risk of infections and aides in getting rid of it at an earlier age.  Now I have another reason!

Bottles are an essential source of nutrition for most infants.  Feeding time is also a comfort time.  Infants should be held for all feedings initially, then older infants can be seated if they are not still held. They do not need to walk around with a bottle in their mouth ever!  Eating on the go is unhealthy for us all.  We should sit at the table and eat.  (This might also decrease choking, as kids running around with food in their mouth are more likely to choke than those seated at a table.)  Toddlers should learn this habit young as well.  Once they are a year of age they should transition away from a bottle. 

Sippy cups also do not need to be carried around throughout the day. I often see kids with drinks other than water being carried around much of the day.  They simply don't need to do this: it is bad for their teeth and it increases overall calorie intake, contributing to obesity. Toddlers and older children can be offered drinks with meals, while seated at the table.  If thirsty between meals, have them sit and relax with their drink.  That is a good habit for us all, but our on-the-go society easily helps us forget the basics. 

Our kids teach us many things about life.  Maybe we can learn from them with these simple rules.  We can all sit to enjoy our meals and snacks and stop eating on the run!  We'll be healthier in many ways!

March for Babies: Team Mighty Maxwell

Thunderstorms didn't keep us from walking in Sunday's March for Babies!

Why did we walk?  Every year thousands of babies are born too soon.  Dr. Ratliff and her husband's son, Max, is one of those babies.  He was born April 9, 2011, and at just over a year of age is still in the NICU.  He has grown from 1 pound 3 ounces to over 16 pounds, but his lungs are still immature and he requires a ventilator to breathe.

We want to support Max and the more than half a million babies who are born too early every year.

March of Dimes has their March for Babies every year to celebrate and remember the babies who are born too early, are sick, or die in the newborn period.  Teams raise money to support research to help babies grow into healthy children.  Teams then join the celebration at the walk.  Radio Disney was on hand to entertain kids before the walk, along with bounce houses, face painting, and more fun!

Several friends and family members joined team "Mighty Maxwell."  We met under the Family team tent and tried to wait out some of the rain.

 At this point people were in good spirits waiting for the 10am start time.

 The sun was mostly out until just before walk time...

The occasional light rain lead to a severe downpour with lightening and thunder.  During a break from the downpour we decided to start the walk in a "lighter" rain.  Yes, we got wet from head to toe!

After the walk some of us had fun listening to the band celebrate under a protective covering.  There were even characters from Star Wars walking around for photo ops!

What a fun way to celebrate all these babies, support parents, and fund researchers!

The money raised to help premature and sick newborns live to be healthy children is worth the wet feet!

For more information on the March of Dimes research, click here. For information on March for Babies, click here.

The Big Kid Bed

Parents often try to keep the crib as long as possible to avoid the problem of their toddler/preschooler leaving the bed again and again at bedtime, but eventually they all need to take the plunge and get a big kid bed.

It always blows me away that daycares get 1 year olds to sleep on cots. They stay there... how???  I suspect they are following what the older kids in the class are doing and they are never left alone. That makes it easier on many levels.  Parents don't have that luxury at home when transitioning to the big kid bed.

Parents can get the child excited about leaving the security of the crib by talking about the bed before it is used.  Have kids help pick out sheets or a pillow for the bed.  Remind them during the day how big they are when they ___ (fill in the blank with "use a spoon," "pick up a toy," etc). Warning:  This can backfire if they really are afraid of the bed and they do want to not be big, so they stop all the "big kid" behaviors.

If kids are afraid of their new bed, lay together to read books at nap and bed time.  If you still have the crib available, ask if they want to sleep in the bed or the crib. Simply having the choice might empower them to want to stay in the bed.  Feel free to leave a light or night light on in the hall (or even in the room if they prefer).  Eventually they won't need it, but it can really help if they want it!  Go through a routine of checking the closet (then closing the closet door), checking under the bed, and picking a favorite toy to be there while your child sleeps. It is amazing how much the power of suggestion that a stuffed toy will stay with them works!  Let them know you will check on them soon... and do, but wait a little longer each night until they are asleep when you check.

For kids who are prone to falling out of bed, decide what works best for that child.  Some parents put the mattress on the floor, so if they roll off it is no big deal.  Many parents use bed rails that keep kids in the bed.  Unfortunately if they roll hard enough, they can get trapped between the mattress and bed rail.  I know this from experience! My son would do that and it would FREAK him out. He usually went to sleep without much fuss, but after he would get stuck in the rails he was too scared to sleep. We finally just put the bed against one wall and moved everything away from the other side of the bed except a nice layer of pillows and blankets.  When he fell out of bed (yes, most nights...) he landed on the pillow pile and kept sleeping.  Problem solved!

Pick a reasonable bed time.  Account for all the time it will take to do all the stall tactics when picking the bedtime.  If sleep time needs to be by 7:30, and you know they will resist brushing teeth, need to potty a 2nd time, get a drink, check the closet and under the bed, and read 3 books... get started in plenty of time to do all of that and still have them tucked in for the last time before 7:30.  Ironically as kids get more tired, they get more wired, so DO NOT allow this process to run too late! They will hit a 2nd wind and be up far too long.  We all know what kind of day tomorrow will be if they are up too late tonight... and it isn't pretty!  Then they are over tired for the routine the next night, which can lead to an earlier 2nd wind and more troubles!

One trick I've learned that works well for older toddlers and preschoolers is the card trick. They start each night with 3 cards. Every time they leave their bed for another hug, a drink, to potty, etc, they surrender a card to you. Once all 3 cards are gone, they can't leave the bed any more.   If they have cards left over in the morning, they get a sticker for each card.  They can earn up to 3 stickers (or make it special to get an extra sticker if they have all 3 cards!)  When they reach a set number of stickers they earn a prize.  Go over the rules of the cards and stickers during the day several times so they know the rules before you start the system.  At bedtime minimize the talking and just let them figure it out when you ask for cards or refuse to let them have a 4th resistance tactic.  You can use cards from a regular deck, or you can make it even more fun by having your child make his own cards.  I also suggest making a simple sticker reward chart, keeping in mind how difficult you think it will be to earn stickers and set a realistic goal for all the needed stickers to be earned within a week. If they don't earn the prize fast enough at the beginning they might lose interest (but it needs to be enough time that they earn it). You can make it more difficult over time, as their bedtime routine gets better.  Remember that each day is new, so they start with 3 cards and you can talk up how much you know they can keep them all!  Praise all the good choices, and if they struggle with it try to find positives to praise... "You kept your cards a little longer last night. I can tell you're working on keeping them all night!" For ideas of reward charts and cards, check out this fantastic free site!

If kids end up in your bed in the middle of the night and you don't want them there, you must firmly but without much discussion bring them back to their room. Too much snuggling, talking, or other interactions will only reinforce them coming to you again.  And again.  Night after night they get to spend more time with you-- that's what they see every time you give them attention when you need to limit the interaction.  Attempt to get them to walk themselves, but if they refuse, carry them with outstretched arms facing away from you to decrease body contact.

If you don't mind them in your bed, be sure you are ready for a long term commitment to a family bed because once the habit's started it will be harder to break until the child wants to sleep independently.  I learned this the hard way.  Sleep deprivation makes parents do things they never thought they would... in the beginning you just want to get sleep. After awhile I realized I was kicked and punched often throughout the night by my lovely little angel who was not a great bedfellow.  She affected my quality of sleep for quite awhile. I still love her greatly...

If all else fails, talk to your child's doctor about sleep problems. Some sleep problems are due to real medical conditions and these should be evaluated.  If sleep problems continue, loss of sleep can affect growth, learning, behavior, and more... don't let it get to that point!

Why Screen Free?

Every April and September there is a nationwide Screen-free Week to unplug from the screens and plug back in to our families.  Why do I support this wholeheartedly? Because I see the benefit from getting away from it all every once in awhile.  We live in a media-rich society, so I know that it is impossible to completely turn everything off... most of us couldn't do our jobs without a computer.  But I challenge you to substitute recreational screen time with other activites for just one week and see what happens. 

Some facts and statistics:

• Screen Time = television, video games, computer time, handheld games, social media, movies -- anything with a screen.
• The typical school aged child has 7.5 hours of screen time daily. That's more time than ANY other activity except sleep!
• The typical preschool child watches over 4.5 hours of screen time daily.
• Screen time is linked to aggression, ADHD, and obesity among other things.
• The American Academy of Pediatrics (AAP) recommends NO screen time under 2 years of age and no more than 10 hours per week for older children.
• The AAP recommends no televisions, computers, or other electronic media in children's bedrooms.
• An average preschool child sees nearly 25,000 commercials.
• Screen time inhibits sleep.   
• More from the links below!

Since my family has been doing this I find an interesting pattern: 

• my kids initially grumble (ok, it is a stronger disagreement, but...) 
• they quickly find other things to keep busy
• they play better together with less fighting
• they argue less with me when asked to do something
• we overall enjoy one another more
• at the end of the week they choose to do things without the tv or computers
• they slowly start to watch / do more on the screens
• they are once again addicted to the screen and I have to pull them away.

What can you do besides watch tv or play on the computer or game system?

• Go for a walk.
• Ride a bike.
• Play ball.
• Have a picnic.
• Play a board game.
• Read a book.
• Make up a play.  Be creative!
• Dance.
• Cook dinner together as a family.
• Talk to a friend or family member. Talk, not text!
• Go to the park or zoo.
• Check out the new aquarium.

It is an overall good experience. Read my post-Screen-Free Week Reflections from the last screen-free week here.

I will try not to be on line during the Screen Free Week, April 30-May 6th. (Hard work, I know... scanning the internet is my biggest pastime/hobby ~ AKA timewaster.)  

Join me off line and plug in to your families!  Have a fun week and I'll see you back on Facebook and Twitter May 7th!  

For more information:

Fact Sheets from Commercial Free Childhood

Common Sense Media 

Dr. Christakis on Media and Children

Car Seat Confusion and Booster Boo Boos

Happy in her rear-facing seat!

Many parents are confused by car seat rules, regulations, and recommendations.  For many it is a rite of passage with the first birthday to turn kids around forward facing.  Then they move to a booster before kindergarten and they lose the booster on their 8th birthday.

What is magic about any age that allows a child to sit in the next level of seating?  Kids vary greatly in their size at these ages, yet age seems to determine seating for many kids.  We don't pick clothing based on age. Shoes are not worn based on age. Why don't we fit kids into cars as carefully as we fit them into clothing?

There is so much misinformation out there, it's no wonder people are confused!  And it's not only confusion, but parents make choices based on so many other factors.  For some it is convenience for themselves ~ it's easier to let a child self buckle in a booster.  Sometimes the numbers of kids combined with the size of the car simply don't allow rear facing for the tots.  Many parents simply want to give up the fight with kids as they fight to grow up into the next step.  So many temptations for parents to move onto the next level before kids are ready.  I understand, really! It was a fight to get my kids into car seats (forward and backwards) as infants and toddlers.  They would arch their back and I felt like I would break them as I pushed on their middle to force them back while I pulled on arms and buckles to force them in.  I can't tell you how many times my daughter at 10 years/5th grade complained that she was "the only one still in a booster!"  She just recently (finally) can fit into some seats without a booster, but the seat needs to be narrow.  Thank you, growth spurt!

Because there is often mention in the car seat instruction manual that kids can turn around at 1 year and 20 pounds, many parents think kids must turn around at that age/size. This is not true per car seat safety testing (unless the seat is older and has lower size restrictions- and then it should be replaced).  It is not required by law in any state or safe by safety standards to turn around at this age/size.  The head size of toddlers is still very large compared to their body. The force on the spinal cord is much greater for a toddler in a forward facing crash due to the larger head and lower muscle strength compared to older children and adults.

The two biggest concerns I hear from parents about rear facing seats:

1. The kids hate being rear facing.
2. The legs are too long.

I find that many kids are perfectly happy rear facing. Others are not happy being strapped in period.  Either way, sometimes what kids like isn't what's best for them. I just want kids to be the safest they can be!

Parents worry that once the legs can reach past the seat that rear facing is not safe.  That sounds reasonable: the long legs would be squished or uncomfortable for kids.  While it is true that most kids will outgrow the rear-facing seat due to height before weight, it is okay to remain rear facing as long as  they fit the limits posted on the side of the car seat.  Read your manual.  If you can't find it, look online.  Studies have shown that kids are 5 times safer rear facing! Even if they kick the back of the seat.  In Sweden they keep kids rear facing until 4 years of age!

There are many sources of confusion with car seats and boosters.  The law does not equal the recommendations by safety experts and it differs from state to state.  The law is the minimum requirement for buckling kids in car seats. The law does not necessarily mean the safest way to buckle the kids up.  Car seats and boosters vary by age and size limitations, there is no standard.  Cars vary in the size and angles of their seats, making the car seat or booster fit differently in every model of car.

The law often does not support the best safety standards:

• Most states (29) do not require kids to wear helmets on bicycles, yet we know that they save lives. 
• Only 20 states require all motorcyclists to wear helmets.
• Only two states prohibit children under 1 year from riding on a bicycle/carrier.
• Three states have no booster seat laws.
• Only 5 states have seat belt requirements in school buses.
• Kansas law allows tots to turn forward facing at 1 year and 20 pounds and allows kids over 4 years to ride in booster seats.

My recommendations:

• Keep kids rear facing until they are at the maximum height and weight of their rear-facing car seat. If the car seat does not allow rear facing until at least 2 years and 30 pounds, buy another seat.  
• Kids can be forward facing in a 5 point harness from 2 years/30 pounds (or bigger if your seat allows rear facing longer) until they are at least 40 pounds and 4 years of age (many seats will harness larger children).  The harness is always safer, but when a child can sit still, not unbuckle self inappropriately, sit without leaning forward/to the side, and the shoulder and lap belts fit them appropriately, then they can sit in a booster with the seat belt.
• Kids can sit without a booster when they can pass the 5 Step Test.  For more on why they shouldn't graduate out of a booster too soon, check out this great page on The Car Seat Lady.
• Kids should never sit in the front seat until they are teenagers (or the size of a teen).  
• Never turn off the air bag to allow kids to sit up front. Think for a minute: why are airbags there in the first place? To save lives! People in the front seat are MUCH more likely to be injured/killed in a crash. If the child is too short and the airbag will hit them in the face instead of the chest, they need to be in back!  
• Never buy a used car seat or booster seat from someone you don't know well. You cannot guarantee it has not been in an accident and you should not use a seat after an accident.
• Do not use expired car seats.  They expire in 5-8 years due to breakdown of the materials of the seat, older technology, and unavailability of replacement parts. Check the labels on the seat for expiration date or use 6 years from date of manufacture.
• NEW addition based on a reader's Facebook comment: Do not use bulky clothing or padding under the seatbelt. Kids are much safer if they are buckled in snugly, then a blanket or cover can be placed over the belt if needed for warmth. Don't believe me? Buckle your child in with the coat and/or sweaters on, then take them out without changing the seatbelt tightness. Put them back in and buckle, again without changing the belt tightness. See how much extra belt there is? With the force of an accident they can move too much!

I wonder how long it will be before the safety recommendations are even stricter:  rear facing until 4 years like Sweden?

I always joke that the babies born today will drive backwards by joystick by the time they can drive!

Don't let your kids take the lead with decisions. Don't do what the neighbors do. Do what you know is safest for your children.  Their lives may depend on it!

For more information and state specific laws:

Helmet Use Laws

Child Passenger Safety Laws

How Boosters Work

The Importance of Rear-Facing video with crash test views forward vs backward

Traffic Woes

6:15 am: things look great!

Last week I started to see a trend toward both early and late arrivals.  Because appointments are scheduled on average every 15 minutes, showing up even 10 minutes early or late can cause significant backlogs in our flow (some were over 25 min late... and not people who are usually late -- we track those).  We need to see all patients who come to the office, and will work them in the best we can, but unfortunately when people arrive at times other than their scheduled appointments, there is no way to see everyone in a timely manner.

I apologize to all of my patient families who waited and will wait. Believe me, I HATE to run late. Rest assured that when it is your turn, I will spend the time needed with your family.  

While we moved south of the major construction, Highway 69 is still used by many to get to us and is experiencing significant delays at various times of the day. Side streets are having more traffic because people are avoiding the highways.  I appreciate everyone's help and patience during this construction time.

• Please check KDOT or Scout if you will be traveling on any of the area highways to approximate your travel time and adjust accordingly. 
• If you will be late, please call ahead. This allows us to rearrange the flow, such as by working in early arrivals (we usually have them wait in the waiting room so that we can see on time people first).
• If you are early (some are planning on more travel time than needed!) please let the receptionist know.  If the provider you are scheduled to see has an earlier time available, you can be worked in early. If another provider has a no show or late arrival and you are willing to see them, please let the receptionist know you are flexible.
• If you are late, you might be asked to wait until your provider has another opening or you might be asked to see another provider. Please let the receptionist and nurse know your preference.  I appreciate your flexibility.
• PLEASE: if you are coming between 8 and 8:30 (very busy traffic time) and 1:30 and 2... try especially hard to be on time! Those are the first appointments of the morning and afternoon. If we get started late, it is especially difficult to get back on track!
• Please let the nurse know if you need to leave soon.  She will try to estimate how long it will be for your scheduled provider and see if there is someone else who can see your child if needed. 
• Bring any forms you might need already completed. If it takes 10 minutes to fill out the forms in the waiting room, you will save 10 minutes!