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My sister-in-law was startled when brown spots began to appear on her preschooler’s teeth. A trip to the dentist revealed that my nephew had eleven cavities, the result of constantly drinking juice as an infant and toddler. Unfortunately, time in the operating room was required to fill all the rotten spots. Today our guest blogger, Dr. Paria Hassouri, answers frequently asked questions on infant dental care. Starting care as an infant can prevent your child from ending up like my nephew with a mouthful of cavities. Dr. Hassouri is a board certified pediatrician who completed her training at the Cleveland Clinic Foundation.  She has been in practice for seven years and is with Cedars Sinai Medical Group in Beverly Hills, California. She is currently writing abook about the experience of pediatrician moms across the United States. – Dr. Lai

When do I need to start brushing my baby’s teeth?

You should start brushing your baby’s teeth as soon as they come out.  You can either use a clean moist washcloth or a soft baby toothbrush to do this. Before this point, many pediatricians advocate wiping your infant’s gums with a washcloth a couple times a day.

While plain water is enough to clean the teeth and gums, you can also use a small amount of fluoride-free toothpaste. Flossing should begin anytime there is tight contact between the teeth, particularly when the molars come in.

When will my baby get his/her first tooth?

While most babies will get their first tooth between 6 to 10 months, your baby may not get his/her first tooth until 15 to 18 months.

What is “baby bottle tooth decay” and how do I prevent it?

Baby bottle tooth decay is caused by frequent and long exposure of an infant’s teeth to liquids that contain sugar.  The sugar penetrates the gums and affects the teeth even while they are below the surface. Sugar-containing drinks  include milk and formula (even breastmilk), fruit juice, and other sweetened drinks.  Putting a baby to bed for naps or at night with a bottle increases the risk.  And again, remember that your baby does not need any juice.

When does my baby need to first see a dentist?

While the American Academy of Pediatric Dentistry recommends dental visits starting at age one, you can ask your pediatrician when he/she thinks that your baby should first see the dentist.  If you are already following a good dental care regimen which includes brushing your baby’s teeth regularly and not letting your baby fall asleep with a bottle, your pediatrician may say that you can wait longer for the first dental visit.

What to I do if my baby dislikes or refuses to let me brush his/her teeth?

Even if your child resists brushing, it is still very important to brush the teeth twice a day. You can try brushing in front of a mirror or taking turns with your child.  You can also try having your child hold a larger, thicker handled toothbrush while you use a thinner handled toothbrush to brush the teeth. In this way, the thicker toothbrush acts as a “door stop” that your child can bite on to keep his mouth open while you follow through with the thinner toothbrush.  Finally, you can try blowing bubbles or singing a special song while you are brushing your child’s teeth.  That way your child associates this special activity with tooth brushing; but keep in mind that this only works if you reserve the blowing bubbles or other special song for tooth brushing.

What should we do if we don’t have fluoride in our water ?

If your water does not contain fluoride, ask your pediatrician or dentist about fluoride supplements starting at six months old.

Paria Hassouri, MD

© 2010 Two Peds in a Pod

 

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Remember Elmer Fudd from the Bug Bunny cartoons? He was the hunter who would say “Where’s the wascally wabbit?” instead of “Where’s the rascally rabbit?” Think how frustrated Elmer was as a kid when his parents and teachers didn’t understand him.   

Unclear speech or lack of speech development can be a sign of hearing loss or an inability to communicate (autism, retardation or developmental delay).  Amy King, MA, CCC-SLP with over 12 years as a speech therapist outlines important speech and language milestones to watch for: 
 

Receptive Language Milestones- what your child understands (children should be doing these things by the time they reach the year marker)

By the time they are

1 year:  shakes head to respond to simple questions such as “Want milk?” and identifies some body parts

2 years:  Follows 1 step directions- “Go get the ball.”

3 years:  Follows 2 step directions- “Go get the ball and give it to daddy.” 

4 years:  Understands if/then- “If you pick up your toys, then you can help Mommy make a cake.”

5 years:  Follows 3 step directions- “After you wash your hands, get the napkins and put them on the table.” 

Expressive Language Milestones- what your child is able to say

1 year: 1 word

2 years: 2 word sentences- two words with one meaning such as “thank you” does not count. Expect phrases such as “mommy up” for “mommy, pick me up.”

3 years: 3 to 5 words—Dr. Kardos tells parents think Cookie Monster from Sesame Street: “me want cookie”

4 years: 4 to 7 word sentences with consistent correct use of parts of speech (nouns, verbs, adjectives, pronouns, prepositions, etc.): “I want to go to the park.” 

Speech Milestones- phonetics (sounds should be produced accurately and consistently in words and phrases)

By the time they are:   

3 Years:  sounds of the letters:  m, b, p, h, w, n, f,

 4 Years:  t, k, g, ng, s, r, sh

5 Years:  z, l, v, y, th, wh, ch

6 Years:  j, st, br, cl, r (by now if not before) 

Speech Intelligibility -how well strangers understand your child

         2 Years:     at least 25%-50% of what your two year old is saying

         2 ½ Years:  at least 60%-75% of what your two and a half year old is saying

         3 Years:      at least 75%-90% of what your three year old is saying

         4 Years:      at least 95% of what your four year old is saying 

Fluency- stuttering

         Stuttering is normal in the preschool years.  Be sure to give the child time to say what she is trying to say. Dr. Lai likes to think of a preschool stutterer as a child whose mind is thinking faster than he can move his mouth. If stuttering lasts more than 6 months and is accompanied by facial contortions, grimaces, or repetitive body movements, speak to a medical professional. 
 

Red flags that always need further workup:

o  Does not coo by 4 months of age

o  Does not babble by 9 months of age

o  Child does not respond to his/her name by 9 months of age

o  Child does not look at you, others or objects upon request by 9 months of age

o  Does not gesture (point, wave, grasp, etc.) by 12 months of age

o  Child does not respond to your simple verbal requests (e.g., “Look!”, “Wave bye-bye”, “Come here”, “Give a kiss,” etc.) by 12 months of age

o  Does not say single words by 16 months of age

o  Does not say two-word phrases on his or her own (rather than just repeating what someone says to him or her) by 24 months of age

o  Loss of any language or social skill at any age

 
 Amy King, MA, CCC-SLP

©2010 Two Peds In a Pod

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Here is how to tell if your child is VERY ill with fever vs not very ill:

 

Any temperature in an infant younger than 8 week old that is 100.4 (rectal temp) degrees or higher is a fever that needs immediate attention by a health care provider, even if the infant appears relatively well.

 

Any fever that is accompanied by moderate or severe pain, change in mental state (thinking), dehydration (not drinking enough, not urinating because of not drinking enough),  increased work of breathing/shortness of breath, or new rash is a fever that NEEDS TO BE EVALUATED by your child’s health care provider. In addition, a fever that lasts more than three to five days in a row, even if your child appears well, should prompt you to call your child’s health care provider, who most likely will want to examine your child. Recurring fevers should also be evaluated.

 

Should you treat fever? Given the information from above and from Part 1 of this fever blog post, you can see that fever is an important part of fighting germs. Therefore, we do NOT advocate treating fever UNLESS the side effects of the fever are causing harm. Reduce fever if it prevents your child from drinking or sleeping, or if body aches or headaches from fever are causing discomfort. If your child is drinking well, resting comfortably or playing, or sleeping soundly, then he is handling his fever just fine and does not need a fever reducing agent just for the sake of lowering the fever.

 

A note about febrile seizures (seizures with fever): Some unlucky children are prone to seizures with sudden temperature fluctuations. These are called febrile seizures. This tendency often runs in families and usually occurs between the ages of 6 months to 6 years.  Febrile seizures last fewer than two minutes. They usually occur with the first temperature spike of an illness (before parents even realize a fever is present) and while scary to witness, do not cause brain damage. No study has shown that giving preventative fever reducer medicine decreases the risk of having a febrile seizure. As with any first time seizure, your child should be examined by a health care provider, even if you think your child had a simple febrile seizure.

 

Please see our “How sick is sick?” blog post for further information about how to tell when to call your child’s health care provider.

 

Julie Kardos, MD and Naline Lai, MD
©2010 Two Peds in a Pod                                                                                                                                                 

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So now that your children have been back in school, there has been plenty of opportunity for germs to circulate. In addition to washing hands, your child’s body has many ways to fight germs. I receive many worried questions about fever, so here is what every parent needs to know:


Fever is a sign of illness. Your body makes a fever in effort to heat up and kill germs without harming your body.


Here is what fever is NOT:


·         Fever is NOT an illness.


·         Fever does NOT cause brain damage.


·         Fever does NOT cause your blood to boil.


·         Unlike in the movies and popular media, fever is NOT a cause for hysteria or ice baths.


·         Fever over 100 degrees F is NOT a sign of teething.


Here is what fever IS:


·         Fever is a body temperature that is equal to or higher than 100.4 degrees F rectally in a newborn until the age of 8 weeks old.


·         Fever is a body temperature of 101 degrees F or higher in anyone older than 8 weeks old.


·         Fever is a very effective defense against disease.


 To understand fever, you need to understand how the immune system works.


Your body encounters a virus or bacteria (germ) that it perceives to be harmful. Your brain sends messages to your body to HEAT UP and kill the germs. Your body will never let the fever get high enough to harm itself or to cause brain damage. Only if your child is experiencing Heat Stroke (locked in a hot car in July, for example) can your child get hot enough to cause death. This is because the heat source is EXTERNAL (a hot car) and not generated by your child’s body.


When your body has succeeded in fighting the germ, the fever goes away.  If you “treat” the fever with a fever reducing agent (Tylenol, Motrin, etc) the fever goes away temporarily but WILL COME BACK if your body still needs to kill off more germs.


Symptoms of fever include: feeling very cold, feeling very hot, muscle aches, headache, and/or shaking/shivering.


Fever may be a sign of any illness. Your child may develop fever with cold viruses, the flu, stomach viruses, pneumonia, sinusitis, meningitis, appendicitis, measles, and countless other illnesses. The trick is knowing how to tell if your child is VERY ill or just having a simple illness with fever.


Our Fever: Part 2 post reveals how to tell.

Julie Kardos, MD and Naline Lai, MD
©2010 Two Peds in a Pod

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Ode to the Binkie

Bed time when toddlers start to shout,

It is you, dear binkie, who knocks them out.

Those thumb suckers look so snide,

But haven’t been without you on a long car ride.

None in the diaper bag, none in the crib?

Take one from our infant sib.

If you touch the ground, I’ll give you a quick blow,

Back into the mouth you’ll just go.

But now my child can run and jump with both feet off the ground,

Two to three word sentences she can sound.

If old enough to politely ask for you,

Then old enough to make permanent teeth go askew.

Oh dear binkie, you once had your place,

Now let’s take the cork from the face.

Once you were our beloved binkie,

But right now… you are just stinky.

 

Whether you love or hate the pacifier, at some point, to avoid the possibility of dental and speech articulation impairment, your child needs to wean. Besides, it’s nice to see your child’s entire face. The easiest time to wean is usually around two to three years old. At that point, your child’s dependence on sucking for self-comfort begins to lessen and he begins to want to dissociate himself from being a “baby.”

Now that it’s the New Year, here are some ways to say bye-bye to the binkie, if this is on your child’s (or your) resolution list.

  • Throw the pacifier across the room and entice your child to say with you, “Yucky, binkies are for babies.”
  • Restrict pacifiers to specific places such as your home, crib, or bed
  • Take a  “Binkie finding hunt” with your child and gather all the binkies into a basket. Have the binkie fairy come overnight, take the basket, and leave a present in the morning. Alternatively, one set of parents told me that they told their child that they were gathering binkies for babies who didn’t have any.
  • If giving your child a pacifier is part of your bedtime routine, start to introduce something else such as a special blanket or stuffed animal.
  • Sometimes as parents, we are the ones who have to be weaned. When your child is upset, do not automatically pop a binkie into your child’s mouth. Seek other ways to help your child calm himself
  • Vow to yourself not to buy new pacifiers at the grocery store. Gradually the pacifiers left in the house will disappear or the mold on them will prompt you to throw them away.
  • Cut a small hole in the tip of the nipple- the binkie will not “be the same.” Tell your child that the binkie is broken and throw it away.
  • Vacations disrupt schedules. Therefor, sometimes in an unfamiliar bed, children wean habits. Conveniently forget the binkie while going on vacation and do not introduce it on return home.
  • By age three, most kids appreciate the value of a good bribe. Offer them a reward for going a whole week (or at least 3 days) without the binkie. One night doesn’t count because often the second night is more difficult for the child than the first when he is giving up the binkie. Once you have gone a week, the child will have no desire to go back. Just make sure you have disposed of every last binkie in your home so they will not have reminders of the “good old days.”

Naline Lai, MD with Julie Kardos, MD

Poem by Dr. Lai

©2010 Two Peds in a Pod®

Special note: all of Dr. Lai’s and Dr. Kardos’s children are former binkie users. You could call us “binkie specialists.” Leave a comment about how your child weaned.


 

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Mothers and fathers of twins know that parenting twins is not “twice the work” of singletons. Parenting twins is “EXPONENTIALLY the work” of parenting singletons. Think “singleton, squared.” I know. Not only do I care for twins (and triplets!) in the office, but also I have a set at home.

Discipline is tough. Twins squabble just like other siblings. The difficulty lies in that twins are at the exact same developmental stage as each other. In contrast, when you have a two-year-old and a four-year-old child, for example, you expect the two-year-old to not understand sharing or turn taking and you expect the four-year-old to understand both. Then, you can patiently explain to a four-year-old, “Well, if your younger sister has the doll, and you want it, you can make her very interested in another toy. Then, trade her the toy for the doll.”

When you have two-year-olds fighting over the same toy, you have few options. You can force turn taking, which always involves crying (for the one who is waiting for her turn). You can put the toy in time out which causes both twins to cry. Or you can put both twins in time out which, to help you visualize, can be like putting two angry Houdini octopi into a net together.

Turn taking can be taught using the “count to ten” method. Take this scenario: both twins “need” the same red car at the exact same time. You know that the only reason twin B wants the car is because twin A has the car (this is the same logic as for any sibling: “I covet what you have because you have it.”) You give the car to twin A and stay with twin B, hold his hand, and say, “When we get to ten, your brother will give the car to you.” Then you slowly count out loud to ten. If twin A does not give up the car, then gently take the car from him and say, “Now your brother gets the car until we get to ten.” Stay with twin A while twin B plays with the car and you count out loud to ten. Keep switching off until one brother says “I don’t want it” or simply gives the car away by the time you get to 3 or 4 in your count.

Using the “count to ten” method teaches several lessons: 1) how to count to ten, 2) how to wait your turn, and 3) that fairness matters in your home.  You also convey to your child that you will not abandon a crying, frustrated two-year-old. The textbooks say that two-year-olds are young to learn to share.  However, twins must learn how to share. And you know what? This method works.

When my twins started preschool at two-and-one-half years old, I warned their teacher that if she saw either of my twins standing next to a classmate and counting to ten slowly, loudly, and deliberately, that my child would expect that child to hand over whatever toy she had when my child got to ten! I had to prep my twins that home rules may differ from classroom rules.

What about time out? Time out doesn’t work as well with toddler twins. If one twin is in time out, the other twin will sabotage the time out by making a raucous.  One time, I put one of my twins in time out for biting the other one.  Because the biter was crying, the victim startled me when he also started crying and yelling “Let him out of Time Out, Mommy!”  One way around this is to put the toy that precipitated the squabble in time out instead of the child (one minute per year of the twin’s age). 

Even at the end of the day, discipline for twins differs. For twins who share a bedroom, every night is a slumber party. When my twins became old enough to talk to each other before falling asleep, I moved their bedtime earlier to allow them extra time to talk.  I found their conversations too cute to interrupt and didn’t have the heart to enforce sleep time. Plus I like to think that it made up for any bickering (ok, fighting and tears) that occurred during that day and allowed for extra bonding time. Like so many other aspects of parenting, sometimes you just have to go with the flow.

Julie Kardos, MD with Naline Lai, MD
© 2009 Two Peds in a Pod
With special thanks to my psychology-major lawyer-friend Karen for passing on the “count to ten” stroke of genius method of teaching “twin sharing.”

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The American Academy of Pediatrics has increased the recommended daily requirement for Vitamin D in children and adolescents to 400 IU (international units), based on studies of decreasing bone density in kids. This is equivalent to 32 ounces of milk per day. This is TOO MUCH milk for anyone other than an older formula-fed baby who has not yet started solids foods. All breastfed babies, babies on formula AND solid foods, and all other children and teens should be given a vitamin D supplement such as Tri-Vi-Sol or a chewable children’s vitamin. Read the labels: look for “Vitamin D—400 IU.” The goal is to prevent rickets (a bone disease that results in brittle bones) and to make sure growing bones reach their maximum potential for strength. Vitamin D is also important for other body systems such as the immune system.

Interestingly, 15 to 30 minutes of direct sunlight per week is all kids need to absorb enough vitamin D through skin. However, concern for increased risk of skin cancer from cumulative sun exposure means that kids are absorbing less vitamin D from sunlight because we parents are so good at applying sunscreen. Also, especially in winter months, children spend more time playing inside than playing outside.

Calcium requirements vary somewhat by age but generally can be met with 16 to 24 ounces (2-3 cups) of milk, or less if kids consume other calcium containing foods such as cheese, yogurt, broccoli, sweet potatoes, fortified cereals, or a supplement. The milligram (mg) requirements are around 500mg for toddlers, 800mg for children and 1200-1500mg for kids 11-18 years. To give you an idea of how to visualize this amount, one cup of milk contains 300mg of calcium. When you read food labels that report calcium as a percent of daily requirement, know that the “standard” for food labels is set as 1000mg. So if a yogurt container reports “25% of daily calcium requirement” you assume that the yogurt contains 250mg of calcium (25% of 1000mg).

So continue to have your kids Drink Milk! But remember to give them a Vitamin D supplement as well.

For more interesting tidbits about milk, please refer to our blog post: “Got Milk? Dispelling Myths About Milk

Julie Kardos, MD
©2009 Two Peds in a Pod

 

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Acetaminophen, brand name Tylenol, has been in the news recently, and parents are asking me if it is safe.


This medication, used as a pain reliever and as a fever reducer, is safe to give to babies older than two months, but you must be very careful about the dose that you give. Medicine doses are based on the weight, not the age, of a child. So when checking the label on the bottle that tells how much acetaminophen to give, look at the weight recommendations if there is a discrepancy between your child’s weight and age. If you are not sure, then ask your child’s health care provider. I cannot stress proper dosing enough because of how dangerous an overdose can be.


 Here are some facts you need to know in order to avoid over-dosing your child with Tylenol:


1)      Always measure the medicine in the dropper or cup provided by the manufacturer of that particular medicine bottle.


 


2)      Be aware that Tylenol infant drops are more concentrated than the children’s suspension liquid. This means that if you were to pour out equal amounts of infant drops and children’s suspension, the amount of drug is actually HIGHER in the measurement of infant drops than in the same measurement of children’s suspension. For example, one full infant dropper of Infant Tylenol Drops, measured to the 0.8ml line of the dropper, is 80mg of Tylenol. The same 0.8ml of Children’s Tylenol Suspension Liquid is only 25mg.


Another way to look at this medicine math: if you intended to give 80mg = 2.5ml = 1/2 teaspoon of Children’s Tylenol Suspension Liquid   but you actually gave your child 2.5ml = ½ teaspoon of Infant Tylenol instead of Children’s Tylenol, you would be giving them over 240 mg of Tylenol, which is THREE TIMES the amount that you wanted to give. Again, use the dropper provided to give Infant Tylenol drops and use the cup provided when dosing the Children’s Tylenol Suspension Liquid.


 


3)      Note that other medications have acetaminophen (Tylenol) in them. I advise my patients’ parents to avoid combination cold and flu medicines for two reasons. First, there is little evidence that shows that they actually provide symptom relief. Second, from a safety perspective, parents can accidentally overdose their child with acetaminophen because many contain acetaminophen in them. For example, as of this writing, the following medications all contain acetaminophen as stated in the ingredient list:


Benadryl  Allergy and Cold Tablets, Sudafed PE nighttime Cold Maximum Strength Tablets, Theraflu Nighttime Severe Cold and Cough Powder, Tylenol Plus Children’s Cold and Allergy Suspension, Tylenol Sore throat Nighttime liquid, Tylenol Chest Congestion Liquid, and Nyquil.


4)      Be aware that “APAP” in the ingredient list means acetaminophen.


Tylenol overdoses can be fatal by causing liver failure. If your child has a chronic liver disease, it is likely that she should avoid Tylenol altogether.


Because of the risk of overdose, I also avoid advising my patients to “alternate Tylenol (acetaminophen) with Motrin (ibuprofen).” I discourage this practice because I am afraid of parents forgetting which medicine they gave last and possibly over-dosing by mistake. Tylenol is meant to be dosed every 4 to 6 hours unless otherwise specified on the label or by your child’s health care provider. 


If you ever have questions about possible overdose, call the national US Poison Control Center at 1-800-222-1222.


Julie Kardos, MD
©2009 Two Peds in a Pod

Addendum 10/11/2011: The manufacturers of Tylenol (acetaminophen) responded to the hazard of parents and caregivers accidentally giving the wrong dose of infant drops ( see point #2 above) and stopped making the “concentrated infant drops.” Instead, they now manufacture the “infant drops” and “children’s liquid” using the same concentration as each other. Continue to use the measuring dropper or cup provided with the medication for proper measuring.

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A thrilling moment in the office is when a mom of a patient shares with me that she is pregnant again. I say, “Wonderful!” What better gift to give your firstborn than a sibling! And I love being a part of good news! As an older sister myself, as a mother of three children, and as a pediatrician, I know the net result of adding another child to the family is positively fabulous.


Although the news is good, sometimes parents are anxious about how to prepare their firstborns for the birth of their younger sibling. Here is what I usually suggest:

For most kids under the age of three to four years, time literally has no meaning.  At best, everything in the past occurred yesterday, and everything in the future will occur tomorrow. So in general, there is no magic moment to announce a forthcoming new baby. A few weeks ahead of time, simply start talking about “when a baby comes to live with us.”  Don’t expect your child to really believe you until you walk into the house with the baby. And don’t be surprised if your firstborn asks, “When is it leaving?” Kids this age do not understand the idea of “forever” or “permanent.”

Parents often feel guilty about bringing a second baby into the home. They worry they will not have as much time for their firstborn.  Well, here’s one secret. Newborns aren’t all that demanding. Unlike with your first born, you will never  have the time or urge to stare endlessly at your second born while she sleeps.  But, the second time around you will realize that feeding, changing, and washing a newborn take up relatively little time. Your firstborn will likely continue to be the center of attention. She is, after all, much more interesting now that she can pretend and play simple games. Believe me when I tell you that you CAN play Candyland and breastfeed an infant at the same time. You CAN burp an infant while reading aloud to a toddler. You CAN change a diaper WHILE pretending you and your toddler are wild jungle animals. You CAN make a bottle while telling a terrifically exciting story to your toddler.

A word about visitors and gifts: the best part of a gift, to a toddler, is opening it, NOT what’s in it. So don’t worry about trying to make sure your older child gets a gift for every gift the new baby gets.  Just allow your toddler to open all the baby’s gifts (if she wants to) because “babies don’t know how to open presents, but big kids do!” Also, newborns don’t care who holds them so visitors are a perfect chance to hand off the baby and get on the floor and play with your toddler. To a toddler, parents are the most important and interesting people in the world.  Even if ten people walk in to visit the baby, your toddler will not be jealous if YOU are the one playing with her.

By three years old, kids understand taking turns. In addition to the above tips, if your eldest asks why you need to hold/feed/care for the baby “so much,” just explain that it’s the baby’s turn. Then reinforce how glad you are that your eldest is able to talk, feed herself, play with toys, and maybe use the potty.  Remind her that her ability to be independent make her more similar to Mommy and Daddy than to a baby.

Finally, realize whether your firstborn embraces her younger sibling with open arms or pretends that the new baby does not exist, you will have plenty of love to go around . Your  heart is big enough for everyone.  Dr. Lai tucks each of her three children in at night with the words, “I love you more than anyone in the universe.”

Truth be told, no one will make your younger child laugh as loud and long as her older sibling. Also, older babies are much more interesting than newborns. Even “luke warm” older siblings will warm up as time progresses and the baby becomes more interactive.

In the meantime, tell lots of “when you were a baby” stories to your older child. Toddlers are egocentric (they all think the world revolves around them) and they will LOVE being the main character in your stories. Bring out baby pictures and videos of your firstborn to share. Be sure to point out how far she has come and all the great things she can do now as a big kid.

I end with a personal story:

When I was pregnant with twins, many of our friends commented to us about our firstborn son, “Boy, you are really going to rock his world.”

HIS world, I would think to myself. How about OUR world?

In order to prepare him for his transition from “only child”to “big brother” we emphasized to our son (who was three at the time) that most older brothers get only ONE baby. Our son would be getting TWO babies! He was excited about having two instead of one. For years afterwards, whenever he heard about a pregnant aunt, friend, or neighbor, his first question was always, “Oh, how many babies is she having?”

Out of the mouths of babes….

Julie Kardos, MD
©2009 Two Peds in a Pod

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The moment is here, your web cam is on and you beam your toddler’s first steps to hundreds of relatives.  But what comes after this highly anticipated moment?  Your toddler’s walking gait looks more like Frankenstein’s than that of an Olympic athlete.  Deborah Stack, who holds Masters and Doctoral Degrees in Physical Therapy from Thomas Jefferson University, joins us today to tell us what to expect next from your little Frankenstein.

Naline Lai, MD and Julie Kardos, MD

_____________________________________________________________

I remember looking at my 16-month-old son and telling him, “You need to learn to walk before your new brother or sister is born.” I did not relish the idea of simultaneously carrying two children.   But even after my second was born, I still did a lot of carrying.  We all focus on our children’s first steps, but mature walking does not occur immediately.  

Toddlerhood officially begins when a child takes his first steps, around 12-15 months, and ends with a mature walking pattern around age three years.  But what happens in between?  Look for your child to begin taking steps with his feet closer together. His hands progress from being held out to the side near the shoulders to a relaxed position lowered at his sides as he moves.  Children will also begin to be able to walk on a wider variety of surfaces such carpet, grass, sand and inclines.  They will learn to walk sideways and backwards as well as maneuver around and over toys in their path.  Initially your child will probably walk on his toes or with his whole foot hitting the ground at the same time and his feet as wide apart as his shoulders or even more.  By age three, most children will walk with their feet just a few inches apart and a “heel-toe” gait, meaning their heel will hit first and then they will shift their weight forward to the big toe before lifting it for the next step.  Skills such as running and jumping occur at varying times during toddlerhood.  

Taking a walk is a great way to help your child develop his gait. But don’t restrict him to staying on the path!  Try walking on grass, playground surfaces, sand boxes, and snow.  Once your child can walk on level surfaces, try walking up and down hills and then across them.  Decrease your support as he gains confidence.  At the playground, climbing is a great way for toddlers to strengthen their muscles, as well as to develop balance and spatial awareness.

This holiday season, save the shipping boxes.  Stepping in and out of low boxes is a great way to practice balance and will provide hours of fun during the upcoming holiday festivities.

These tips will help you enjoy your child’s “next steps” as much as his first ones.

Deborah Stack, PT, DPT, PCS

www.buckscountypeds.com
© 2009 Two Peds in a Pod

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