How to make tummy time easier

tummy-timeI recommend that parents don’t worry about tummy time until babies are 4 weeks old. The reason for this is because it’s hard enough in the first month to feed, bathe and get babies to sleep without worrying about head contr

Once parents start tummy time, lots of questions come up. How long should it last? How many times a day should we do it? What should we do if our baby cries during tummy time?

No one has studied this scientifically, but I recommend doing tummy time 3 or 4 times a day for about 5 to 10 minutes per session. If your baby cries during tummy time, there are a few things that might help.

  • Pull the baby’s elbows in towards the body. This stabilizes the shoulder area and may make it easier for the baby to lift her head.
  • Lie on the floor with the baby so when she looks up, she sees your face.
  • Put the baby on her dad’s chest while he’s leaning back at a 30 to 45 degree angle. This will make it easier for the baby to lift her head. This can also work on a mom’s chest unless the baby smells the breast and looks down instead of up.
  • Babies may be more willing to do tummy time at certain points during the day. A good time to try it is shortly before a feeding when she’s alert, but not too hungry.

How should you talk to your daughter about puberty?

In my experience, 90% of girls are not excited when puberty starts. And it’s not just their impending period that’s on their mind. Most girls are happy with the body they have and see no reason for it to change. This uncertainty happens because the physical changes of puberty precede the psychological ones. When I discuss this with girls at their 10- or 11-year-old checkups, my goal is twofold. First, I want them to know that they are not alone in their feelings about puberty. Second, I want parents to know that girls may be reluctant to talk about puberty even though moms want to provide them with the benefit of their experience. However, I encourage moms to always keep their “radar on.” If a girl brings up pubertal issues, moms should drop what they’re doing and be open for a discussion.

I also share a story about what happened in my own home when my daughter, now 21, turned eleven. My wife and I bought Molly a copy of the American Girl book, The Care and Keeping Of You, which is a terrific book for girls entering this stage of their lives. Molly looked at the book and literally threw it across the room. We told her that was okay, but added that her mom would be available to discuss anything in the book if Molly wanted to. Over the next six months, we found her occasionally reading the book at night before bed.

My final comment on this subject at checkups is to remind girls that puberty takes years to finish, and I guarantee that they will be happy with their grownup bodies once the process is over.

What’s better, sippy cups or straw cups?

Sippy-cups-vs-straw-cupsNewborns have a sucking reflex that enables them to nurse or bottle feed. This reflex involves opening their mouths and moving their tongues in and out to “milk” the nipple. When babies start solid foods around 6 months of age, they usually push food out of their mouths because that’s what their tongues are used to doing. It takes a week or more for babies to learn how to use their tongues effectively with spoon-feeding, but they continue with the milking action when taking breast milk or formula.

Sippy cups have been around for as long as I can remember. Straw cups are relatively new on the scene. When babies drink from sippy cups, some of them continue to push out their tongues, which could lead to lisps and other speech problems later on. However, with straw cups, they are more likely to keep their tongues in their mouths, which is theoretically better for speech development.

So which type of cup is better for infants and young children? Here’s what Maia Magder, a speech pathologist at NIH, has to say about the matter: “There is no hard evidence that sippy cups cause speech delays, but it’s important to provide infants with opportunities to move their mouths in more advanced patterns to foster feeding and speech advancement.”

Regular “open” cups are the best for speech development, but babies are pretty messy, so many parents aren’t ready for this step until the toddler years. Here is Maia’s take on getting rid of spouts and straws: “Offering an open cup as early as 8 or 9 months helps with jaw stabilization, which is another important factor in speech development. As for the messiness, like other aspects of parenting, think of it as balancing the new with the old. It’s always important to read a baby’s signs and signals when using cups so that your baby doesn’t choke.”

Should you compare your kids?

should you compare your kidsParents frequently hear that they should never compare children to each other. As a pediatrician, I can unequivocally state that this is one of the dumbest things I’ve ever heard. Not only do we compare our children to each other, but we also compare them to other people’s children. Why? Because it’s instinctive for humans to compare things. We compare which apples to pick at the grocery store. We compare which shampoo to buy. We compare which clothes to wear to work.

So where does this “wisdom” come from? I think it’s derived from the difference between comparing and judging. Things can be different without one being superior to the other. When it comes to children, there is never one thing you are comparing. People are more complicated than apples or shampoo so most parents find they appreciate each child for different things. The flip side of this is also true. Namely, each child can make us crazy in different ways.

When this topic comes up in my office, I start by telling parents what I just said. I then expand on the topic by reminding them that what you never want to do is to compare your kids unconsciously and not be aware of it. It’s also a bit perilous to censure one child by invoking the more desired attributes of his sibling.

I have two teenagers who are very different. I horse around with and go to movies with my son, but have intellectual conversations with my daughter. I am proud of both of them, but in different ways. Sometimes I wish my daughter and I could do things like I do with my son and visa versa. That is comparing them, but neither one is a better child than the other. The flip side is that they each annoy me in different ways as well.

Comparing your kids to your friend’s kids is a bit trickier because you don’t have all the facts regarding someone else’s children. You may still find that you like certain aspects of your friend’s children more than your own. Just remember that most kids behave better with people other than their parents.

It’s also very important to remember that children have big ears. They love to eavesdrop on their parents because it’s exciting to hear what grownups have to say when they are alone. If my son heard me saying something comparing him to his sister, I am setting myself up for trouble. I can think it, and I can discuss it with my wife. But this should only be done when all children are accounted for.

Don’t force kids to say they’re sorry

Dont-force-kids-to-say-theyre-sorry-Altercations between young children are common. If parents are around to witness the squabble, they usually ask the aggressor to say he’s sorry. This is a reasonable thing to do because adults are supposed to teach children how to behave in social circumstances. However, most parents have been in the situation where one child does not want to say he’s sorry to the other. What should you do then, especially if your child was the one who wouldn’t say he was sorry?

Not only are you likely to be embarrassed if this happens, but you may also feel a strong sense to force your child to apologize. Encouraging kids to say they’re sorry is logical. Forcing them is not. In some cases, a parent will threaten to take away TV, dessert or other privileges if the child refuses to say he’s sorry.

Although I appreciate the motivation to encourage your child to apologize, if it’s not sincere, it’s not clear that anything will be gained by forcing the issue. My recommendation, in this situation, is to model the appropriate behavior for your child instead of turning it into a showdown. Make eye contact with the victim and say something like this: “I’m so sorry, Henry. We don’t allow hitting in our house, and I don’t know why Ryan did that to you.” You might also consider ignoring your child for a moment and hugging the child who was hurt.

Children learn by experiencing the consequences of their actions. In the above example, you ignored your son and gave positive attention to the child who was wronged. This is only half of the intervention. For the next five or ten minutes, you would watch your son like a hawk so you could give him positive attention for appropriate behavior. Psychologists call this process, “catching them being good.”

Tips for How to Swaddle a Baby

How to Swaddle Baby

Swaddling is a time-honored method to help babies calm down. It helps fussy babies relax during wakeful periods and makes it easier for most newborns to sleep.

Infants respond to swaddling for two reasons:

  1. Newborns have a number in innate reflexes, including the Moro (or startle) Reflex. If a newborn is jostled or surprised by a noise or physical movement, he will typically extend his arms outward and then rapidly flex them in front of his body. A Moro response can be triggered by an infant’s own movements or by actions coming from his surroundings. Either way, the reflex may cause the infant to wake up or start to cry. Swaddling inhibits the Moro Reflex.
  2. Before birth, infants are in the confined space of the uterus. While it is important to be able to move their arms and legs after birth, research has shown that newborns calm down if they are held with their arms against their bodies. This can be accomplished by a reassuring hug or by swaddling them in a blanket.

Like all aspects of parenting, it is important to strike a balance with your baby. It is important for your baby to experience different types of physical interactions. This includes hugs, kisses, skin-to-skin contact, gentle rocking, and massage, etc. So while swaddling can be a real “life saver” when a baby is fussy it is best used when the child is sleeping or for brief periods (around 20 to 30 minutes) while awake.

Two aspects of swaddling are important for you to consider:

  1. The best way to swaddle babies is by keeping their arms at their sides. The reason for this is because most babies will “break out” of the swaddle if their arms are positioned in front of their chest. There are a number of commercial blankets to make this easier to do.
  2. The goal of swaddling a baby is to restrain his arms. The swaddle should not restrict the baby’s legs because it is important for him to be able to flex his knees and hips at all times. The reason this is important is because infants can develop a hip problem (developmental dysplasia of the hip) if their hips are restrained in an extended (straight) position.

Most doctors recommend that parents stop swaddling babies by about four months. At this age, the newborn reflexes that can interfere with a baby’s sleep have disappeared and many babies are starting to roll (and trying to break out of a swaddle). This is also the time when a baby will more actively interact with his surroundings. He will grab objects and explore them with his mouth. He may use a pacifier or suck his thumb for self-soothing purposes.

Teaching children to swallow pills

Learning to swallow pills is difficult for many children. One technique I find helpful is to “hide” the pill in another food before attempting to swallow it. Bread is an excellent choice because it’s sticky and easily encases the pill. Before you suggest the technique to your child, remind her that she swallows large chunks of food all the time. The reason this trick works is because the bread “fakes out” her throat so it doesn’t know a pill is coming. This is how it works.

  • Have your child chew a small piece of bread.
  • Once the bread is gooey, ask him to push the pill into the center of the bread.
  • Next, ask him to move the bread/pill mixture to the back of his mouth and swallow it with a sip of water.
  • Have your child practice with small pieces of candy like tic-tacs. Once this has been mastered, she can graduate to M&Ms and capsule-shaped candy like Mike and Ike.
  • Once your child has done this a few times, swallowing a pill is usually easy.

I use a variation of this technique for children who take time-release capsules, but can’t learn to swallow the pill. Time-release capsules can be opened and their contents can be mixed into pudding or applesauce. To ensure that children don’t chew the beads, I have them practice with candy sprinkles. Once they have done this a few times, they can accomplish the same thing without crushing the granules of their medication.

Young children don’t know what the expression “sore throat” means

Next to colds, throat infections are the most common reason children see the doctor. It is important to realize, however, that young children do not know what it means when someone asks them if they have a sore throat. Therefore, if you are inquiring about this symptom, ask your child if it hurts when he swallows. You would be surprised how many children will say yes to this question even if they just told you they do not have a “sore throat.”

A practical suggestion for pet funerals

When a pet dies, parents often want to give the animal a funeral so their children can “memorialize” the pet as a member of the family. In many parts of the country, it is illegal to bury a pet because the body may attract scavengers such as rats. In these jurisdictions, the family’s veterinarian commonly disposes of the body. 

Because I live in an area that prohibits animal burials, I encourage families to still have a memorial service; only in this case they bury a memento instead of the pet. Children can pick a favorite toy, a picture, or even write a poem or heartwarming anecdote about the animal. This approach follows community rules, but lets children have some closure regarding their pet’s death. 

Easing the transition to nursery school

Many children have difficulty separating from their parents when they begin nursery school. My wife came up with a terrific idea to help our son adjust to school. First, she asked the director for a class list two months before school began. Then she called all of the parents on the list and invited them and their child to a Sunday morning play session at the school playground. She told parents that she would be there with our son every week, but that other people could come whenever they wanted to. By the time school began, our son had met everyone in his class and knew half of the children pretty well. His transition in September was much easier than his mom or I would ever have predicted.

A variation on time-out

Time Out is one of the most effective behavior techniques you can use with children. Although most doctors recommend Time Out for aggressive behaviors such as hitting or biting, parents sometimes overuse Time Out by choosing this punishment for just about any infraction their children commit. There are a number of behaviors that children exhibit during the day that are bothersome, but do not reach the level where a person could get hurt or something might be broken. In this instance, it is helpful to use a lesser punishment, which I call Time Off. Time Off is an action that grows out of what psychologists call “I” messages, i.e., “I don’t like it when you…” The types of actions that Time Off helps control include annoying behaviors such as teasing or being disrespectful. 

The difference between Time Out and Time Off is the following: In Time Out, the child has to sit in a specific location for one minute per year of age. If the child talks or gets up, the “clock” is reset and Time Out starts over. In Time Off the child has to go somewhere else in the house and must stop the behavior that led to the punishment. There is no set time, but the child cannot come back until he is ready to act normally. As a further incentive to get children to comply with the punishment, children who do not follow the rules of Time Off will subsequently have a full-fledged Time Out. 

Beware Of Older Siblings When You Start Solid Foods With Your Baby

Older brothers and sisters learn quickly that babies only drink breast milk or formula. Once you start feeding your baby jarred foods at six months of age, an older sibling may think it is okay to share his food with the baby. Therefore, make sure to tell your older child that even though the baby is now eating from a spoon, he is still too little to eat “big-boy” food. If your older child is interested in feeding the baby, you can supervise spoon-feeding once the baby has demonstrated that he is a competent eater. Make sure that you stay alert for sharing even though you have warned your older child to keep his “macaroni and cheese” to himself. 

Reuse Pull-Ups And Be Environmentally Conscious

Lots of kids continue to wet the bed at night even though they are successfully using the potty during the day. (Even at six years of age, 12% of kids wet the bed.) Most parents use Pull-Ups during this period of nighttime wetness to make the morning routine easier for everyone. However, most kids become dry gradually and many of them will still be in Pull-Ups even though they are dry three or four nights per week. If your child is dry at night, you do not need the Pull-Up away the next morning. In most cases, a child can reuse a dry Pull-Up five or six times before it gets so tattered or baggy that it needs to be thrown away.

What To Do If Your Child Misses A Birthday Party Because He Is Sick

Sooner or later most children will miss a friend’s birthday party because they get sick or come down with a contagious illness. It can be very difficult to explain to a young child why she cannot go to someone’s party. Instead of worrying about making other kids sick, your child will focus on what she is missing (this self-centered behavior is completely normal in young children). One way to handle this situation is to call the birthday girl’s parents and ask them to save a little piece of the party for your child. They can keep a few decorations, a goody bag, and two pieces of cake and ice cream. Then, when your child has recovered, she can go to her friend’s house with her present and they can have a mini-party together.

Does Your Toddler Have A Problem With Stuttering?

As children learn to speak, pauses and repetitions of syllables or words are normal. Parents typically notice episodes of stuttering interspersed with periods of normal speech. The stuttering that is seen in this age group is developmental in nature due to the acquisition of new language. In essence, the child can think of words faster than he can say them. Developmental stuttering occurs in children from 18 months to four years of age. It usually resolves in three to six months. It is different from true stuttering, which is seen in older children and adults.

  • Toddlers who stutter demonstrate some or all of the following symptoms:
  • Repetition of the first sound of a word such as “d-d-d-dog,” “ca-ca-ca-cat,” or “I-I-I-want.”
  • Repetition of a phrase within a sentence such as “I want-I want-I want to go.”
  • Open their mouth to speak and make a throaty sound, but fail to say anything.
  • Express frustration at not being able to get the words out.

If you notice any of these symptoms, consider discussing them with your child’s doctor. The approach that is usually recommended includes the following:

  • Speak slowly and clearly to your child at all times.
  • Do not interrupt or correct your child and do not finish sentences for him.
  • Remain calm while your child is speaking as though you had all the time in the world for him to finish.
  • Do not say anything about the stuttering. If your child expresses frustration about the problem, calmly reassure him that everyone has trouble getting their words out from time to time.

A Primer on Tantrums

Tantrums are a normal part of child development. Although they typically begin at age two, it is not uncommon for children to start having tantrums as early at 18 months. The standard advice for dealing with tantrums is to ignore the child until the behavior stops. This teaches the child that tantrums are not an effective way to solve problems. Ignoring tantrums also gives the child the opportunity to learn self-control.

Although tantrums appear to come “out of the blue,” most are triggered by predictable interactions between the child and her environment. The following acronym may help parents head off tantrums before they begin: FACT.

Frustration: Toddlers become frustrated numerous times during the day. The most common triggers are not getting their way, having difficulty completing a task, or not being able to communicate due to immature language skills.

Appetite (hunger): Young children are often unaware of their body’s hunger cues and may have a “meltdown” simply because they need a snack.

Choice: Young children may have difficulty transitioning from one activity to the next and are frequently held captive to other people’s schedules, i.e., they are asked to get dressed, eat meals, or leave the house with little say in the matter. Parents can prevent problems by giving children a couple of warnings before transitions occur and by offering choices whenever possible. For example, if your child does not want to get dressed, you may be able to avoid a struggle by saying, “Do you want to wear your green socks or your red socks?”

Tired: Tantrums are often triggered because a child needs a nap, did not get enough sleep the night before, or because he is tired due to an illness. If you see this behavior, comfort your child or encourage him to take a nap.

I frequently recommend the book “1-2-3 Magic” by Thomas Phelan. It is an excellent resource on discipline for children 2 to 12 years of age.

Why do toddlers eat less than babies?

One of the most common concerns I hear during the second and third years of life is that children become picky eaters. There are a number of reasons why this occurs:

• Children gain less weight in the second and third year and therefore need fewer calories to sustain growth. For example, the average baby gains 15 lbs in the first year of life, but only 10 lbs between one and three years.

• Because jarred foods are watered down, they contain fewer calories per volume than table foods. Therefore, your toddler doesn’t need to eat as much table food to get the same calories she did from jarred food.

• Toddlers love the newfound independence that comes from being able to walk and play. Therefore, they are often more interested in playing than eating.

• Toddlers begin to express their own personal likes and dislikes and will reject food that’s not appealing to them.

• Milk contains a lot of calories. Sometimes toddlers will not eat much because they are getting too much milk. In general, we recommend that toddlers drink between 16 and 24 ounces of milk per day.

• Fruit juices fill children up and contain little nutritional value even if they are 100% juice. Children don’t need juice, but if you use it, be sure to dilute it with lots of water.