Two Peds in a Pod®

Hail to the Tooth Fairy: young school age child development

The Tooth Fairy rocks!

For kids, the Tooth Fairy takes the worry out of the stage around five to seven years when they start to worry about their “body integrity.” Kids are concerned about keeping their bodies intact. This is the age of Band-Aids and boo boos, of skinned knees on the playground and falls from bikes without training wheels. When a child loses her tooth, a PIECE of her BODY falls off. Often the child experiences discomfort as the tooth gets very loose. Many become anxious and have difficulty eating when the tooth gets to the “hanging by a thread” state. Kids BLEED if they lose a tooth by biting into an apple or knocking into something. Yet adults convert this potentially anxiety-provoking event of losing a tooth into an exciting rite of passage. Without the Tooth Fairy, we’d have a batch of kids mortified by a normal physical change. Who ever invented the Tooth Fairy was a GENIUS!

Our patients have taught us interesting “facts” about the tooth fairy over the years:

Some tooth fairies leave the token under the pillow, others leave it at the bedside.
Some tooth fairies leave money, others a small toy, and some write messages.
Some tooth fairies are boys and some are girls.
Some look like Tinker Bell and others look like trolls.
Some tooth fairies don’t have change for a twenty dollar bill.
Tooth fairies can look like someone the child already knows, even a mom or dad!
Tooth fairies can sense a missing tooth even if the child loses the tooth on the playground or swallows it by mistake, so it’s okay if the tooth is not left under a pillow for the Tooth Fairy. She’ll still come.

Pediatrician dentists recommend children begin regular dental visits within six months of getting their first tooth. Most babies get their first tooth between four months and twelve months, so by eighteen months of age your child should have had her first dental visit. Don’t forget to start brushing as soon as that first tooth appears. With this being said, it isn’t just kids who need to look after their teeth. No matter what age you are, you should clean your teeth at least twice a day.

It’s okay to brush with water alone or use a baby tooth and gum cleaner. Add toothpaste by age two years, when kids can learn how to spit. Ask your dentist or pediatrician about fluoride supplementation if there isn’t any fluoride in your water supply. For more tooth tips see our guest blog post by Dr. Paria Hassouri and take advantage of this free tooth brushing chart which you can personalize with your child’s name. Take good care of those primary teeth, even though they are destined to be taken away by the Tooth Fairy.

Julie Kardos, MD with Naline Lai, MD

Dr. Kardos feels nostalgic. Her oldest child, who stopped eating for the two days before his first baby tooth fell out, just lost his last baby tooth last week. And yes, the Tooth Fairy did visit her twelve-year-old.

February 29, 2012 by twopedsinapod

Cinnamon Challenge = Potential Choking Calamity

Do not take the cinnamon challenge Beware. There’s another choking “game” out there. This time, kids try to swallow a teaspoon (or more) of cinnamon without water as quickly as possible without coughing or vomiting. The cinnamon usually forms a thick slurry in the back of the throat and causes gagging and coughing. Hence, the “cinnamon challenge.”

We first saw warning reports of the cinnamon challenge via recent emails circulated by principals in local school districts, but yesterday Dr. Lai heard about it directly from a kid and his mother in her office. Luckily, the teen and his friends who played it the other day were fine. However, everyone did cough after taking in the cinnamon and one kid in his group threw-up.

“Do you know why people cough?” I asked him.

“Why?” he said.

“It’s a sign your body is trying to protect your airway,” I said.

The trend is spurred on by kids trying to copy YouTube videos and Daniel Tosh on the television show Tosh.0

Current statistics for emergency room visits or deaths related to this particular “game” are hard to come by. But we do know in 2000, according to the Centers for Disesase Control, 160 children aged 14 years and under died from airway obstruction associated with inhaled or ingested foreign bodies. Food was associated with about 40% of those deaths. Especially for those who already have sensitive airways such as those with asthma, any substance which tickles the back of the throat can produce spasm in the lungs. Also, the substance itself can get into the lungs.

Tosh starts off the video above by saying, “The internet is full of challenges.” Well, we’re on the internet too, Tosh, and we challenge you to model the healthy behaviors – not the dangerous ones.

Naline Lai, MD and Julie Kardos, MD

February 23, 2012 by twopedsinapod

How to treat bloody noses- nothing to sneeze at

Our fantastic Two Peds in a Pod photographer Lexi Logan recently put in a request for a post on bloody noses. I cringed, thinking any photo would not be pretty. “No problem,” she replied,” I’m thinking just a tissue and a top-of-nose shot… pinch angle.”

I was aghast. “Looks like you fell for the number one myth associated with bloody noses,” I said.”That’s the wrong spot to pinch.”

“See,” she told me,”that’s why I need the post.”

So, how does one squelch the fountain of red which spews from a bloody nose? Apply pressure to the SIDE of the nostrils—not up near the bridge of the nose. More blood vessels lay near the bottom of the septum, the divider which separates the nostrils, than near the top. Pinch the nose firmly. Since kids never seem to apply enough pressure on their own, go ahead and pinch for them. You’ll find it easier to pinch both nostrils simultaneously even if the blood is dripping from only one side.

Now hold. Hold. Hold. Hold in the middle of the night until you nearly fall back to sleep. Hold until the pot of spaghetti boils over. Hold for at least ten minutes before peeking in order to allow the blood to clot. If the nose is still oozing, pinch for another ten minutes. Have your kid sit up straight or lean slightly forward. Otherwise, blood will drip down the back of her throat and cause nausea and vomiting.

Do not be surprised after an episode if the next couple of nights bring more bloody noses. At night during sleep kids tend to rub their noses. Any scab that formed from a recent nose bleed gets sloughed off.

To prevent reoccurrence, protect those fragile blood vessels by keeping the inside walls of the nose moist. Once or twice a day, spritz saline into the nose, then apply a thin layer of petroleum jelly. Try running a cool mist humidifier in your child’s bedroom.

Prevent nasal irritation by decreasing environmental irritations such as cigarette smoke or dust. Teach your child to dab at his nose or blow gently when he has a cold. Ironically, some steroid nasal sprays, which treat runny noses caused by allergies, can irritate nasal passages.

Your kid is having too many bloody noses when you start to carry around tissues or your child sleeps with a box of tissues next to his pillow “just in case.” Go to your child’s doctor if this occurs. Also, go if there are signs of a clotting problem such as easy bruising, bleeding gums, or heavy periods. Likewise, if bloody noses take more than twenty minutes to clot, or if the nose bleed requires an emergency room visit or packing in the nose, make an appointment. Other reasons for more evaluation include if your family has a history of clotting disorders, your child gets speckled flat rashes that look like broken blood vessels (petechiae) which do not blanch (lose color for a second when you press on it) or if a nosebleed is caused by trauma.

Your child’s doctor may recommend sealing vessels with cauterization or investigating for possible blood clotting problems. Depending on your child’s age, she may also recommend a short course of oxymetazoline (eg Afrin). Be sure to use oxymetaxzoline according to directions- overuse can cause rebound symptoms.

Ultimately, you may find that your kid’s bloody noses are just the result of the perfect storm: dry air and a kid who picks his nose. In the meantime save that thirty percent-off Kohl’s coupon. You might be buying a lot of pillow cases.

Naline Lai, MD and Julie Kardos, MD
©2012 Two Peds in a Pod®

February 21, 2012 by twopedsinapod

Infant CPR: Do you know what to do?

We asked Dr. Raymond Wu, the doctor behind the popular new infant iphone app babyCPR, to talk about how to perform CPR on babies under one years old. We even convinced him to time a discounted app price with the release of this post!

If you found your baby unconscious, would you know what to do? Could you pull it off correctly while in a panic? Every moment without Cardiopulmonary Resuscitation (CPR) increases your child’s possibility of brain damage and death. Learning CPR is just one of a number of safety precautions any parent should take.

Well-performed CPR can mean the difference between a good and bad outcome, which could be the difference between life or death. In this article, we’ll go over important aspects of CPR. After reading this article, you should have a good understanding of why CPR works and how to perform it effectively. CPR is different for when it comes to performing it on a baby. So you might have been trained in giving CPR to adults, but it won’t be the same for infants.

What is CPR?

CPR stands for Cardiopulmonary Resuscitation, or more simply, “heart-lung support.” The two main components include chest compressions and rescue breaths. When the heart stops beating, chest compressions are used to maintain some blood circulation. Since the body continues to use oxygen even when breathing has stopped, we help replenish oxygen by providing rescue breaths. The idea is to help pump oxygenated blood to the body’s organs — most importantly, the brain.

Infant CPR basics

The guidelines for infants (children less than 1 year old) are to provide 30 chest compressions and alternate with 2 rescue breaths.

For each chest compression, place the baby on a hard flat surface then place two fingers in the center of the child’s chest. Quickly press down 1.5 inches, or about 1/3 of the thickness of the baby’s chest. Then release until the chest recoils, which allows the heart to refill with blood for the next compression. Do this at a rate faster than 100 compressions per minute.

To deliver rescue breaths, first attempt to open the infant’s airway by tilting their head and lifting his or her chin. After opening the airway, put your mouth over the infant’s mouth and nose, and make a good seal. For each breath, blow gently for about 1 second. A good breath will make the baby’s chest rise. Avoid blowing too hard since that can damage the baby’s small lungs.

If someone is with you, send them for help right away while you perform CPR. If you are alone with the baby, perform 2 minutes CPR before calling for help, then immediately resume CPR as soon as possible.

Infant CPR is NOT like adult CPR

Babies are not just tiny little adults. They have special needs and therefore require special care. You may have heard about hands-only CPR for adults. This does NOT apply to infants. Since they are so small, they have limited oxygen reserves in their body. You need to provide rescue breaths regularly to replenish these reserves.

Why the compression rate is now faster than 100 per minute

The previous American Heart Association (AHA) guidelines asked people to do compressions at exactly 100 per minute, but the newest 2010 guidelines now simply ask to go faster than 100 compressions a minute. Researchers found that with the previous guidelines, most people were going too slow and had overly long breaks between sets. The new guidelines encourage people to focus on improving blood circulation in the baby.

Tip: Following the beat of songs in your head like “Staying Alive” or “Mary Had a Little Lamb” can help you maintain the correct timing while you do chest compressions.

Practice makes perfect

If you learn CPR correctly and then practice correctly, you won’t lose any precious time when your baby needs saving. Practicing allows you to quickly recognize what to do and cements the skills. That way, you can remember what to do even when in a panic. Your baby’s life may depend on this.

For more information

I covered some basic aspects of infant CPR here but there are more details that are important to know, including what to do when your baby is choking. Traditional CPR classes are available in many areas and usually take about 3-4 hours. The American Red Cross provides many of these courses and The American Heart Association has a class locator on it’s website.

Looking for other ways to learn? A new method of learning CPR is iphone app BabyCPR (available on itunes). This app allows you to practice on a simulated baby.

Raymond Wu, MD

Dr. Wu completed medical school and internal medicine training at Northwestern University. He founded Transcension HealthCare to pursue his passion and vision for improving healthcare through the effective use of technology. He specializes in medical simulation technology and is a leader in developing computer-based medical simulators. Recently, he had the pleasure of becoming an uncle, and looks forward to creating software for his niece as she grows older

February 13, 2012 by twopedsinapod

Podcast: The barky cough of croup

You wake up in the middle of the night to the sound of a seal barking inside your house. More specifically, from inside the crib or toddler bed. Unless you actually have a pet seal, that bark is the sound of your child with croup.

What is happening and what to do? Press play here to listen to our latest podcast:

Julie Kardos, MD and Naline Lai, MD

February 6, 2012 by twopedsinapod

Make every bite count: how to increase calories for underweight children

Although the United States is in the midst of an obesity epidemic, some children are underweight. Your child’s pediatrician charts your child’s height and weight in order to determine whether he is growing appropriately. Just as obesity has many causes, kids can be underweight for many reasons. Regardless of whether the cause of your child’s poor weight gain is medical or behavioral, the bottom line is that underweight kids use more calories than they take in.

Here are ways to increase calories. Remember, you cannot force children to eat if they are not hungry. For example, you can’t just demand that your child eat more noodles. Instead of trying to stuff more food into your child, increase the caloric umph behind a meal. Make every bite count:

Mix baby cereal with formula, not juice or water.
After weaning formula, give whole milk until two years, longer if child is still underweight.
Add Carnation Instant Breakfast or Ovaltine to milk.
Add Smart Balance, butter, or olive oil to cooked vegetables, pasta, rice, and hot cereal.
Dip fruit into whole milk yogurt
Dip vegetables into cheese sauce or ranch dressing
Offer avocado and banana over less caloric fruits such as grapes (which contain only one calorie per grape).
Cream cheese is full of calories and flavor: smear some on raw veggies, whole wheat crackers, or add some to a jelly sandwich
Peanut butter and other nut-butters are great ways to add calories as well as protein to crackers, sandwiches, and cereal.
If your child is old enough to eat nuts without choking (as least 3 years), a snack of nuts provides more calories and nutrition than goldfish crackers or graham crackers.
For your older child feed hardy “home style foods.” Give mac ‘n cheese instead of pasta with a splash of tomato sauce or serve meatloaf with gravy instead of chicken breast
Try granola mixed into yogurt or as a bar.
Give milkshakes in place of milk (no raw eggs!)
Choose a muffin over a piece of toast at breakfast.

Some causes of poor weight gain are medical. Have your child’s doctor exclude medical reasons of poor weight gain with a thorough history and physical exam before you assume poor weight gain is from low caloric intake. Sometimes, your child’s physician may need to check blood work or other studies to help figure out why he is not gaining weight appropriately.

Some common behavioral causes include drinking too much prior to eating, picky eating, or parents failing to offer enough calories. Sometimes tweens and teens develop a pathologic fear or anxiety about gaining weight and deliberately decrease their food consumption. These kids have eating disorders and need immediate medical attention.

A common scenario we often see is the underweight toddler whose parents describe as a “picky eater.” Meal times are stressful for the entire family. Mom has a stomach ache going into dinner knowing the battle that will ensue. Her child refuses everything on the table. Mom then offers bribes or other meal alternatives. Dad then gets into the fray by making a game out of eating, and when the child does not eat, in frustration he yells at the child. Grandma then appears with a big cookie because “well, he needs to eat SOMETHING.” All the adults end up arguing with each other about the best way to get their toddler to eat. If you recognize your family in this example, please see our post on how to help picky eaters for ways to break out of this cycle.

Just as obese children need to see their doctors to check for complications relating to their increased weight, underweight children require weight checks to make sure that they gain enough weight to prevent poor height growth and malnutrition.

Julie Kardos, MD and Naline Lai, MD
©2012 Two Peds in a Pod®

January 30, 2012 by twopedsinapod

About gender identity: when your boy says he is a girl or your girl says she is a boy

The news is filled with stories about boys wearing pink nail polish, a baby whose gender will be kept a secret by his/her parents, and Chaz Bono’s new book and identity as a man. What’s the deal with gender, and why have the media waves exploded in the past few years? Is gender variance becoming more common, or just more recognized? And what should you do if your son wants to wear pink or your daughter cuts her hair short?

First, some definitions.

–Gender is one’s internal sense of self as male, female, or neither, while sex is assigned at birth based on external appearance. As one astute child told me, “sex is what’s between your legs, while gender is what’s between your ears.”

–Gender expression is how one chooses to portray his or her sex or gender—for example a male child (sex assigned at birth) who feels he is a girl (gender) might still wear boys’ clothing and hairstyles to fit in with peers (gender expression). Or, a female child (sex) feels she is a girl (gender) but prefers to wear boys’ clothing (gender expression) and chooses a gender-neutral name. Her gender expression is masculine.

–Gender variant, gender diverse, and gender nonconforming refer to a child who expresses gender identity or expression that is different than what one expects based on sex. These terms refer to a wide range of children—from the little boy who likes to play with Polly Pocket dolls to the male child who insists he is a girl and wears dresses to school. Some gender variant children will be transgender, which refers to a child who persistently feels the sex assigned at birth is incorrect.

When gender variant children reach puberty, they may become aware of their sexual orientation, or who they are sexually attracted to. They may find that they are attracted to the “opposite gender” and have a straight (heterosexual) orientation, or they may be attracted to the same or any gender, and identify as gay, lesbian, or bisexual. Of course, these labels become especially confusing when discussing gender variant teenagers. For example, is a female-bodied teen who identifies as a man (transgender) and attracted to women heterosexual or homosexual? For this reason, many young people choose to identify as queer, an umbrella term with a positive connotation that conveys many ways of loving people with different bodies and gender expressions.

How common is gender variance?

International epidemiologic studies estimate the prevalence of transgender adults to be anywhere from 1 in 1,000 to 1 in 30,000. That’s a huge range. When you include children who are gender variant but not transgender, the numbers are much higher. For example, Gender Spectrum, an organization that I work with in California, conducts trainings at schools that have identified a gender variant child who is facing bullying or discrimination. To date, they have been invited to nearly every elementary and middle school in their geographic area. Most schools in this area have approximately 100-500 students, so my best estimate of gender variance in my geographic area is 1 in 500.

How do you know if a child is gender variant?

The child tells you. Many of the gender variant children I know recall telling their parents at an early age that they felt different. For example, some transgender boys (i.e. born in a female body, identify as male) I know corrected the adults who tried to call them girls as children, insisting they were boys. One parent recalls her transgender son telling adults “I am a boy now, but when I grow up I will be a mommy.”

Most kids exhibit some sort of gender exploration in their early childhood, and this is a normal part of development. However, a child who is shows gender variance generally makes claims that are early and persistent, and then develops distress when corrected by adults. The “test” becomes when a child is given the freedom to express his/her internal sense of gender. In gender variant children, this distress will be alleviated.

What do you do if this describes your child?

The emerging consensus among experts is to let your child guide you, and to aid your child in his or her gender exploration by working with local resources to create a supporting and accepting environment. In the past, some experts recommended a sort of reparative therapy, for instance removing all “girlish” toys from a boy-bodied child’s home and insisting that he wear only “masculine” clothing. While this may have worked for a short time, the child’s distress often emerged later on, often in puberty, with depression and suicide. In fact, a survey of transgender adults showed that one-third of them had attempted suicide in their life, some as young as age seven or eight. These are good reasons to pay attention to your young child. Research shows that children raised in supportive families have more positive outcomes.

Parents raising gender variant children worry about their safety and acceptance in their schools, neighborhoods, and extended families—and for good reason. Gender variant children are bullied and face discrimination, abuse, and violence at rates much higher than their peers. Often, parents do not agree with each other—as one parent may allow more gender exploration than the other. The child’s gender presentation may not be accepted in churches or within the family’s religious belief. It is imperative that families obtain professional help, especially when there is disagreement between parents on how to support the child. In addition, there are many parents groups and conferences where families can meet each other for mutual support.

If you are concerned about a child in your own life, there are wonderful organizations that can help you.

Resources:

Resources: Gender Spectrum www.genderspectrum.org

Family Acceptance Project http://familyproject.sfsu.edu/

Trans Youth Family Allies http://www.imatyfa.org/

My favorite blogs, articles, and videos about raising Gender Variant Children

Sarah Hoffman’s Parent Blog http://www.sarahhoffmanwriter.com/

A Boy’s Life from the Atlantic http://www.theatlantic.com/magazine/archive/2008/11/a-boy-apos-s-life/7059/

Two Families Grapple with Son’s Gender Identity from NPR http://www.npr.org/2008/05/07/90247842/two-families-grapple-with-sons-gender-preferences

Transgender Kids recent CNN segment http://www.cnn.com/2011/09/27/health/transgender-kids/index.html

Ilana Sherer, MD

Returning guest blogger Dr. Ilana Sherer is the Director of General Pediatrics of the Child and Adolescent Gender Center at UCSF. She is a recipient of the Chancellors Award for LGBT leadership at UCSF and also of the American Academy of Pediatrics Dyson Child Advocacy Award.

January 23, 2012 by twopedsinapod

The Hidden Homeless: Children and Families

As a call to service in honor of Martin Luther King Day, we bring you an eye opening child advocacy post from guest blogger Dr. Heidi Román, who works with underserved children and their families in California .

Early in my pediatric residency training I entered the exam room to see a one-year old patient. Her mom blurted out excitedly, “We finally have a place to live.” It turned out that they had been living in motels or with relatives for most of the child’s life. I paused for a moment as I realized that it had never really registered. She had been seen in our clinic for multiple visits, but no one had noticed the changing addresses. No one had asked the questions in a way that allowed her to tell us. They were homeless. This was my wake up call. Since then, I have met many families affected by homelessness. Many hard working families are pushed into poverty and homelessness by loss of a paycheck, foreclosure, or divorce. They are reluctant to talk about it. Children and families are the “hidden” homeless.

While the mainstream media consistently covers the recession, quoting jobs numbers and the like, there is a disturbing new set of data out that doesn’t seem to be getting much press. Last month the The National Center on Family Homelessness released their report on child homelessness entitled “America’s Youngest Outcasts 2010“, and the news is not good. During the time period of the recession (2007-2010) there was a 38% spike in the number of homeless children. Currently, there are 1.6 million homeless children in the United States. Children now make up almost 40% of the homeless population and families with children are the most rapidly growing segment of the homeless population.

That’s a lot of kids and families. And, as children are often not included in homeless statistics, the number is probably higher. Why don’t we hear about it more? Well, homeless families tend to be the invisible segment of the homeless population. They fly under the radar. They move from place to place. They “double up” with friends or relatives for a few months, and then stay in a shelter or motel for a while. They sleep in their car. Parents may not even report that they are homeless to teachers or health care providers for fear of losing their children. There are various reasons that families become homeless. Certainly worsening poverty, due to job loss or changes in welfare programs, is a major cause of housing loss for families. But, domestic violence or parental separation is also very often to blame.

Once families become homeless, it is very difficult to escape. Even if the parents are lucky enough to find a job, it will likely pay only minimum wage. Adequate housing is still out of reach for these families. This is true regardless of the state, city, or town the family lives in; and the gap between income and housing costs is even greater in areas with a high cost of living.

Experiencing homelessness profoundly affects a child’s physical, psychological, and educational health. Homeless children have higher incidence of trauma-related injuries, poorly controlled asthma, developmental delays, growth problems, and anemia, among other health problems. Homeless children are far less likely to have a medical home or adequate health insurance. They are far more likely to utilize the ER for care at a later stage of illness. Homeless adolescents have much higher risk of being victims of violence or sexual abuse and have higher rates of substance use, HIV, and teen pregnancy.

Homeless children, regardless of cognitive ability, do far worse in school. They are more likely to change schools during the year or miss more school days, greatly affecting their ability to do well academically and flourish socially. Even simple things, like being asked by a teacher to draw their room or describe their house, become awkward and painful.

What’s being done about this? Sadly, not much. Per the State Report Card on Child Homelessness, only seven states have extensive plans relating to services for homeless families. In the current economic and political climate, the number of homeless children and families continues to increase and the services provided to them are shrinking.

What can we do?

If you or someone you know is at risk of homelessness:
- Talk to someone you trust- a physician, teacher, church staff, or social worker. Learn about emergency assistance programs in your area.
- If you will be homeless in a few days or weeks, The National Coalition for the Homeless has a list of things to do. It includes making sure you have a current and available ID, packing a bag of essentials for each family member, and applying for public and transitional housing. Search the Coalition’s directory of homeless advocacy organizations and shelters.

If you are a person who cares about these kids and families:
- Learn about the “hidden homeless” and start talking to friends and colleagues. Work to change misperceptions about homelessness. Find out how your state is doing in terms of providing services to homeless families.
- Consider volunteering with or donating to an organization that fights to end homelessness. National organizations include The National Coalition for the Homeless, The National Law Center on Homelessness and Poverty, and The National Center on Family Homelessness. Find a local organization to work with here or via internet search.
- The National Coalition for the Homeless has a great list of other creative ways to get involved.
- Finally, contact your congressperson and tell them you support H.R. 32 The Homeless Children and Youth Act of 2011. This bi-partisan bill changes the definition of “homeless person” to include certain adolescents and youth that are currently excluded for technical reasons. Their inclusion would allow them to access much needed services. If I can’t convince you, perhaps these kids can. They testified about their experience being homeless at the H.R. 32 hearing on child and youth homelessness, held by the U.S. House of Representatives’ Financial Services Subcommittee on Insurance, Housing, and Community Opportunity last December.

Heidi Román, MD

Heidi Román MD, FAAP is a mother and pediatrician who practices in San Jose, California. She has special interest and experience working with under-served families from diverse racial and socio-economic backgrounds. Dr. Román is a passionate child health advocate who works towards improved health for all kids, both in and out of the clinic. She writes about everything from parenting to policy at mytwohats.wordpress.com.

January 16, 2012 by twopedsinapod

An overlooked source of mouth sores

When I was a kid I used to be afraid the suction tube used at the dentist’s office would suck up my tongue. I have never seen that happen, but I have noticed that when children undergo long dental procedures, the suction is often hooked at the corner of the mouth for an extended period of time. Between the saliva that accumulates under the hook and “digests” the lip and the wet irritation from a piece of plastic pressing against the edge of the mouth, the kids may emerge with a sore at the corner of their mouths. The catch: the sore usually does not appear for a couple of days, sending parents into my office concerned about cold sores or infection after they have forgotten about the dental visit.

Fortunately, the mucosal (moist) areas of the mouth heal rapidly because of a rich blood supply which brings nutrients to the area quickly. However, before it heals, the area on and around the lip where the suction sat looks ugly, white and heaped up the by the third or fourth day after the dental visit. Keep the area clean with soap and water and put on a barrier protection such as petroleum jelly based product (eg Vaseline, aquaphor) so that any drool will not further irritate the area. Apply barrier protection the next time your child visits the dentist.

Still better than having your tongue sucked up.

January 10, 2012 by twopedsinapod

Parents of one-year-olds: Rule your Roost!

When your baby turns one, you’ll realize he has a much stronger will. My oldest threw his first tantrum the day he turned one. At first, we puzzled: why was he suddenly lying face down on the kitchen floor? The indignant crying that followed clued us to his anger. “Oh, it’s a tantrum,” my husband and I laughed, relieved.

Parenting one-year-olds requires the recognition that your child innately desires to become independent of you. Eat, drink, sleep, pee, poop: eventually your child will learn to control these basics of life by himself. We want our children to feed themselves, go to sleep when they feel tired, and pee and poop on the potty. Of course, there’s more to life such as playing, forming relationships, succeeding in school, etc, but we all need the basics. The challenge comes in recognizing when to allow your child more independence and when to reinforce your authority.

Here’s the mantra: Parents provide unconditional love while they simultaneously make rules, enforce rules, and decide when rules need to be changed. Parents are the safety officers and provide food, clothing, and a safe place to sleep. Parents are teachers. Children are the sponges and the experimenters. Here are concrete examples of how to provide loving guidance:

Eating: The rules for parents are to provide healthy food choices, calm mealtimes, and to enforce sitting during meals. The child must sit to eat. Walking while eating poses a choking hazard. Children decide how much, if any, food they will eat. They choose if they eat only the chicken or only the peas and strawberries. They decide how much of their water or milk they drink. By age one, they should be feeding themselves part or ideally all of their meal. By 18 months they should be able to use a spoon or fork for part of their meal.

If, however, parents continue to completely spoon feed their children, cajole their children into eating “just one more bite,” insist that their child can’t have strawberries until they eat their chicken, or bribe their children by dangling a cookie as a reward for eating dinner, then the child gets the message that independence is undesirable. They will learn to ignore their internal sensations of hunger and fullness.

For perspective, remember that newborns eat frequently and enthusiastically because they gain an ounce per day on average, or one pound every 2-3 weeks. A typical one-year-old gains about 5 pounds during his entire second year, or one pound every 2-3 months. Normal, healthy toddlers do not always eat every meal of every day, nor do they finish all meals. Just provide the healthy food, sit back, and enjoy meal time with your toddler and the rest of the family.

A one-year-old child will throw food off of his high chair tray to see how you react. Do you laugh? Do you shout? Do you do a funny dance to try to get him to eat his food? Then he will continue to refuse to eat and throw the food instead. If you say blandly,” I see you are full. Here, let’s get you down so you can play,” then he will do one of two things:

1) He will go play. He was not hungry in the first place.

2) He will think twice about throwing food in the future because whenever he throws food, you put him down to play. He will learn to eat the food when he feels hungry instead of throwing it.

Sleep: The rule is that parents decide on reasonable bedtimes and naptimes. The toddler decides when he actually falls asleep. Singing to oneself or playing in the crib is fine. Even cries of protest are fine. Check to make sure he hasn’t pooped or knocked his binky out of the crib. After you change the poopy diaper/hand back the binky, LEAVE THE ROOM! Many parents tell me that “he just seems like he wants to play at 2:00am or he seems hungry.” Well, this assessment may be correct, but remember who is boss. Unless your family tradition is to play a game and have a snack every morning at 2:00am, then just say “No, time for sleep now,” and ignore his protests.

Pee/poop: The rule is that parents keep bowel movements soft by offering a healthy diet. The toddler who feels pain when he poops will do his best not to have a bowel movement. Going into potty training a year or two from now with a constipated child can lead to many battles.

Even if your child does not show interest in potty training for another year or two, talk up the advantages of putting pee and poop in the potty as early as age one. Remember, repetition is how kids learn.

Your one-year-old will test your resolve. He is now able to think to himself, “Is this STILL the rule?” or “What will happen if I do this?” That’s why he goes repeatedly to forbidden territory such as the TV or a standing lamp or plug outlet, stops when you say “No no!”, smiles, and proceeds to reach for the forbidden object.

When you feel exasperated by the number of times you need to redirect your toddler, remember that if toddlers learned everything the first time around, they wouldn’t need parenting. Permit your growing child to develop her emerging independence whenever safely possible. Encourage her to feed herself even if that is messier and slower. Allow her to fall asleep in her crib and resist rocking her to sleep. Everyone deserves to learn how to fall asleep independently. You don’t want to train a future insomniac adult.

And if you are baffled by your child’s running away from you one minute and clinging to you the next, just think how confused your child must feel: she’s driven towards independence on the one hand and on the other hand she knows she’s wholly dependent upon you for basic needs. Above all else, remember the goal of parenthood is to help your child grow into a confident, independent adult… who remembers to call his parents every day to say good night… ok, at least once a week to check in…. ok, keep in touch with those who got him there!

January 4, 2012 by twopedsinapod

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