Toddler

All Articles in the Category ‘Toddler’

Constipation, No Fun For Anyone

Constipation is really no fun for anyone. No fun for baby or child, no fun for the parent who cleans the clogged toilet, no fun for the sister or brother who waits while someone works on solving the problem in the room next door. In general, constipation is a frustrating, sometimes embarrassing, and often chronic problem for young children. Here are a few ideas to get rid of the no-fun part and ways to protect your children, support them positively, and avoid dangers that can rarely come from over-the-counter (OTC) medications.

Before you reach for OTC medications, consider what is normal and what is not normal when it comes to poop. I usually break this down for children (and parents) in visual terms. I talk about things you find outside.

In general, poop in the toilet can look like a pond, a snakea log, or a pebble. When it comes to poop, we’re always looking for snakes. It seems to me that framed this way, school age children can do a better job knowing if they’re constipated or not. We’re looking for  Snakes in the Lake, people! Frame it this way with your child and perhaps they will be more likely to get a glimpse of what they produce in the toilet?

In my experience, parents worry a lot about hard infant or toddler poop in the diaper but constipation sneaks up on many families to school-aged children. After children are toilet trained and wiping themselves (around age 4 or 5) many parents no longer gaze in the toilet bowl. Long gone are the days of staring at every diaper as parents lose track of the daily poops, how often they poop, and how a child feels when pooping. But first, some definitions: Read full post »

New Recommendations Parents Should Know

New 2014 recommendations are out for improving our prevention efforts for children. Parents can help ensure children get what they deserve at check ups. The updates to recommendations for wellness check-up are written to guide physicians but parents are a key voice in ensuring it all happens!

Updated 2014 Recommendations For Check-Ups

Some relevant changes to prevention/screening for children:

  • Infants: All infants need a pulse oximetry screen at or after 1 day of life to screen for heart defects. The test is non-invasive (just requires a technician, nurse, or doctor put an oxygen probe on their arms and legs). More information on the test here. Ideal time for testing is between 24 and 48 hours of life. If your baby is born at home or outside the hospital, go in to see pediatrician for the screen on day 1 or 2! Toddlers should be screened for iron deficiency risk at 15 and 30 months of age.
  • Children: All children should be screened for depression every single year starting at age 11 years. Don’t ever shy away from discussions about mood with your pediatrician. In addition, all children are recommended to have cholesterol screening at age 9-11. I reviewed ways to prevent heart disease and cholesterol screening policy statement here.
  • Teens: All teens need an annual check-up (a complete check-up will provide some time alone with doctor and nurse; mom or dad will be asked to leave for at least part of the visit). All teens need HIV screening test at age 16-18 (or sooner) and girls get their first pap smear at age 21.

5 Things Parents Need To Know About Check-Ups

  1. Read full post »

New Obesity Data And Tips To Avoid It

New data published in JAMA today finds that there has been no significant change in rates of overweight/obesity overall for children between age 2 to 19 years of age since 2003. This is unfortunate news in the big fight against overweight and obesity. Conclusions from the study, “Obesity prevalence remains high and thus it is important to continue surveillance.” Obesity rates remain high at with 17% of children and more than 1/3 of adults.

The good news is that there was improvement in one small group, toddlers age 2 to 5. Numbers from National Health and Nutrition Examination Survey(NHANES) show reductions in overweight and obesity for the preschoolers by as much as 43% during the last decade. Really hoping this is a canary in a coal mine situation — perhaps they’re chirping a clue. Learning the “why” behind the reduction in obesity for preschoolers feels like a huge opportunity. However for the mass of people researched in total (over 9,000 from birth to age > 60 years) the data confirms we’re not done tipping the scales.

The research article evaluated rates of overweight and obesity between 2003-04 NHANES data and 2011-12 data on children and adults. The CDC is highlighting the success in the toddlers, stating:

While the precise reasons for the decline in obesity among 2 to 5 year olds are not clear, many child care centers have started to improve their nutrition and physical activity standards over the past few years.  In addition, CDC data show decreases in consumption of sugar-sweetened beverages among youth in recent years. Another possible factor might be the improvement in breastfeeding rates in the United States, which is beneficial to staving off obesity in breastfed children.

It’s wonderful to see signs of improvement in the small population of children included in the NHANES data but this research article doesn’t investigate how the improvements were made and/if they are stable. More research will have to unfold. We’re all desperate — parents, pediatricians, public health experts — for solutions that work in not only curbing, but reversing the rates of overweight and obesity. This data can potentially focus the light on where we need to look to study cause and effect to determine possible success stories and strategies. Five quick tips for parents now: Read full post »

Kids In Hot Cars

car seatUnthinkable really, leaving a child in a car and forgetting about them. But it happens more than a dozen times every single year here in the US. On average, over 30 children die from the consequences of heat stroke after being left or trapped in a hot car.

Children are particularly vulnerable to heat stroke because their bodies heat up 5 times faster than adults. The reason for their quicker warming stems from a child’s inferior ability to cool themselves (sweat) and their high surface-area-to-mass ratios.

A car heats up rapidly on a hot day. For example, if it’s 80 degrees outside your car can heat up to 123 degrees in an hour. Heatstroke can happen when it’s only 60-70 degrees outside and we all know from experience that in just 10 minutes, your car can rise 20 degrees in temperature.

Most people instantly feel that they could never forget their sleeping children in their car on the way to work. Read this incredible 2009 award-winning Washington Post article if you’re in doubt. Gene Weingarten chronicles the experience of a man on trial for murder after forgetting his child in the car. He weaves in details about the science of distraction. It’s a haunting and terribly difficult article to read but it’s wholly instructive: this could happen to any of us.

We have to create reminders and habits that prevent the possible mistakes of leaving an infant or child in a hot car (see below).

Parents may leave children in a car that can overheat by accident after forgetting to drop them at school in the morning. Mr Weingarten writes: Read full post »

Swimming Across The Pool

Splash

Our 4 year-old swam across the pool this past weekend for the first time. After years of swimming lessons this was a reason to celebrate: big throw! I hate to admit it but I’ve really disliked doing swimming lessons. Both boys often brought more tantrum and tears than tangible joy to the pool deck. After a day at work I would often leave evening swim lessons embarrassed, exhausted, or somewhat disappointed. They felt like #fails. So when we got across the pool this past weekend, we were all delighted. Finally the big win.

Swimming across the pool doesn’t mean I’m off the hook, of course.

I will say, however, that eating those veggies has paid off. Now that we’re finally swimming I’m thrilled we did lessons early. There is a lot more both our boys still need to learn about water safety and skills they’ll both need to be strong swimmers. For example it’s much harder for them to swim in the lake than the pool secondary to the waves and distractions. They still don’t understand risks of the water. So we have years of swimming lessons ahead but I’m feeling optimistic with the epic win last Sunday.

New data published in the last few years encourages swimming lessons earlier, as early as age 1 to 4 years. Data finds early swimming lessons reduce drowning risk in those children most at risk–toddlers (especially boys). Although swim lessons are never a replacement for close supervision, there may be some protection against drowning when children get started early. The American Academy of Pediatrics (AAP) says this about early swim lessons: Read full post »

Arsenic In Apple Juice

apple juice?Juice is never necessary is a child’s diet. Unpopular as this is to say, juice is always an extra, add-on, treat-type part of what children should eat. High in sugar and low in nutrition, excess juice in a child’s diet is linked to poor nutrition, obesity, and dental cavities.  Although 100% juice comes from fruit, after it’s smooshed and pushed through machines to produce clear juice it’s separated from much of the health benefits (fiber) from whole fruit.

Late last week the FDA provided an updated “action plan” and recommendation for monitoring inorganic arsenic levels in apple juice. Back in 2011, the controversy about arsenic in apple juice began when Dr Oz presented data on his afternoon television show that was quickly rebutted by Dr Richard Besser on Good Morning America. Dr Oz reported high levels of total arsenic (organic and inorganic) in apple juice but there were concerns of unnecessary scares. Up until this point, the FDA wasn’t mandating arsenic levels in apple juice. After a cascading series of events (much criticism and then more reports and analytics) it is now more widely accepted that up to 10% of apple juice may have higher levels of inorganic arsenic than we tolerate in drinking water. Inorganic arsenic consumption can damage organs in our body and in high quantities it’s linked to an elevated cancer risk. Organic arsenic isn’t harmful to our body (it passes right through) and is found naturally in many foods we eat like shellfish or seafood.

Consequently, the FDA has decided to decrease the level of inorganic arsenic they tolerate in commercial apple juice to that of levels acceptable in drinking water (10 parts per billion). Inorganic arsenic in our diet typically comes from food contaminated with and/or grown in soil with high levels of inorganic arsenic (animals fed food with arsenic or food grown in contaminated fields with heavy industrial products). In the past couple of years arsenic has enjoyed quite a bit of media spotlight, especially in light of evolving 2012 information about elevated arsenic levels in rice (cereal, noodles, white or brown organically grown or not). Because of this, most pediatricians now recommend offering infants rice cereal only once weekly. As with all concerns about the food we eat, moderation is key…5 tips: Read full post »

Value Of Well Baby Check-Ups



Some new data published in the American Journal of Managed Care finds increased value in preventative well baby and toddler check-ups. Not because it keeps pediatricians busy, but really because it potentially can save suffering and hospitalizations for young children that would otherwise hopefully not occur.

A study published this month evaluated over 20,000 babies and toddlers in the Group Health network. They reviewed medical charts to study both rates of hospitalizations and rates that families showed up for their well baby check-ups. They specifically evaluated rates of hospitalizations for what they call, “ambulatory-care sensitive hospitalizations,” in which access to routine care could potentially avoid an illness developing that would require a child to be admitted to the hospital for treatment. Here’s more and how you can find low cost medical or dental clinics for yourself or your child and get help applying for health insurance:

Read full post »

Preschoolers Can Learn Good Things From TV

tv watching when 4Television programming for children is abundant. Screens are a luxurious fixture in most of our lives and I’m not here to tell you to turn them off. Well, at least not today. In fact, that tactic, the one where we pediatricians urge families to turn off the TV, really isn’t working. Children tend to increase their TV viewing time as they age and preschool-aged children in the United States spend over 4 hours per day watching television at home and in day care. My good friend, Dr Claire McCarthy, offers up her opinion in this week’s Pediatrics.

Television viewing is only on an upswing over the past 5 years as more and more devices interdigitate into our children’s lives. I’m a perfect example. When my first son was born 6 years ago we had one television in our home and one computer. Today, we have a smartphone, an iPad, a computer, and a television. The screen choices continue to grow, the television shows continue to become more alluring, and the opportunities for viewing with new convenience is abundant. It’s true: some of the stuff out there designed to delight our children is awesome.

But not all of it.

So as our children continue to tug on our sleeves and hang on our pant legs asking for the iPhone just after they beg for TV time before dinner, we need to think clearly about an action plan. We need to make a thoughtful “media diet.” We need to think ahead of time what time we’ll offer up the devices and what content we want them to see. We should care–it really changes how they think and what they do. When we use a media diet, I suggest we’ll improve both our own satisfaction as parents and our children’s lives. Dr Dimitri Christakis, a pediatric researcher here at Seattle Children’s suggests:

We often focus on how much kids watch and don’t focus enough on what they watch

New research out today by Dr Christakis finds that our time and energy working to improve what our children watch, not just how much they watch, can have a positive impact on their behavior. Even for children as young as 3 years of age. Read full post »

You Need A Carbon Monoxide Alarm

There’s a new law today in Washington State requiring carbon monoxide (CO) alarms in apartments, condos, and single-family residences. You should have a CO detector on every level of your home (more tips below). I know you’ve heard that CO poisoning is not only dangerous but also potentially fatal. We also often hear horrific stories of accidental deaths from carbon monoxide after natural disasters. A recent study found disaster related deaths are particularly common (your power’s wiped out so you bring in a generator or grill for heating or cooking and get exposed to CO). Using a generator indoors is the most common cause of CO poisoning, followed by use of a grill. Unfortunately, over 400 people die in the US each year from CO poisoning—all of which could be avoided with proper education and detection in the home. The odd thing is that we often get to see CO toxicity play out on our favorite television shows (think Mad Men)~ the ever-again scene where someone clogs up the exhaust pipe of a car with a banana or handkerchief and dies (or attempts to) due to the toxic fumes.

One generator running inside a home, garage, or basement creates the equivalent carbon monoxide of 6 idling cars. Precisely why a generator needs to be 20 feet from inside spaces and away from open windows/doors. Carbon monoxide is found in combustion fumes–it can be produced by cars and trucks, small gasoline engines, stoves, lanterns, burning charcoal and wood, gas ranges, and heating systems. You likely know all this. But…

The thing to know: carbon monoxide in and of itself is more dangerous to babies and young children. Infants in utero, newborns, and young children process carbon monoxide differently, have more severe reactions, and may see effects faster than adults. If you and your young child were in a room that was filling with carbon monoxide, it’s your baby or child that would suffer the consequences first. They may not know how to tell you about their complaints and if they were sleeping you may not even know. Hence all of us needing a CO detector.

carbon monoxide teaching fr CDC

The Science of Carbon Monoxide Poisoning:

The red blood cells in our blood circulate oxygen to all of our muscles and organs for survival. When carbon monoxide (CO) is in the air it can function as a disguised villain. When carbon monoxide is inhaled into the lungs via contaminated air, the red blood cell picks up the CO instead of just oxygen. Each carbon monoxide molecule that attaches to a red blood cell displaces a spot for oxygen. Therefore the circulating red blood cells go around the body without oxygen causing improper circulation. Organ failure and death can result after higher and higher level of our cells are bound to CO instead of oxygen.

The graphic is from the Centers For Disease Control (CDC)’s comprehensive review on CO poisoning.

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Safe Holidays For Your Children

This is a wonderful time of year. It’s also a really stressful one for many of us. Some quick reminders about ways to stay safe while bringing holiday decor into your home, traveling, while arguing with your brother about gifts, and when potentially having more alcohol around than is typical…

  • FIRE: Be careful of lit candles and check the safety of lights you place on trees or around the outside of your home. Christmas trees are like kindling for house fires. Check out National Fire Protection Agency’s info or watch this video of a tree catching fire.
  • DECOR: Holiday decorations often bring hazards for young children. This include candle holders, Christmas tree ornaments, plants, decorative garlands, and hot liquids. I’ve cared for many children with scald burns from soups and hot liquids. With decorations, anything longer than 12 inches can pose a strangulation risk. Make sure your trees and larger decorations are mounted in a way that your child (of any age) can’t pull them down upon themselves.
  • ALCOHOL: With holiday and New Year’s parties fast approaching, it’s good to have a plan for alcohol–if you’re serving it or drinking it. Many sober alcoholics relapse this time of year and many small drinkers consume alcohol more excessively. We have to be careful with our guests and ourselves — for our children. Clean up after parties, too–don’t want toddlers finding the punch!

This kind of advice feels heavy-handed and self-evident. It’s not as if we wouldn’t have thought of most of this. Read full post »