Toddler

All Articles in the Category ‘Toddler’

Car Seats and Booster Seats And Your Precious Cargo While Carpooling

A friend pulled me aside last week urging me to write about car seat and seatbelt safety. His family had been involved in a rollover accident on the way home from school — literally, just turning in an intersection, as I understand it, they were plowed into by another car which caused their car to flip. No one was seriously injured, thank goodness, but the children were left dangling upside down, hanging by seat belts, until the medics arrived. Clearly they were shaken…and reminded how precious our time is on this planet — and how the most dangerous thing most of us do everyday is drive. All the children had seat belts on and all the children were in the back seat. Phew!

Thing is, just after this dad urged me to write this, I mean literally, just minutes later, we pulled away from a group of parents at pick-up and I watched an 11 year-old get into the front seat of her family’s car and drive away. My stomach dropped. Children under age 13 shouldn’t be in the front seat and goodness gracious, the irony of the timing just got me in the gut. Hard to message and write about something that I feel parents don’t want to know more about. Something about a laxity here for many people remains…seems this is advice many already feel they know (and don’t want to take).

3 reasons children shouldn’t sit it front seat until age 13 years: 1) It’s always safer to ride in the backseat (it’s also illegal to ride in front under age 13 years in WA state), 2) children under age 13 years are at increased risk for injury from airbags (designed for a 140 lb male), and 3) children’s bone development at the hips and breastbone is immature leading to increased risk of more serious injury in front seat

When it comes to infants and little children, maybe it’s different — I feel like parents are more interested in the data and reminders. Research out last week confirms what pediatricians have been recommending for years: rear-facing car seats to keep children safer in rear impact collisions. “We found that the rear-facing car seats protected the crash test dummy well when exposed to a typical rear impact,” said lead study author Julie Mansfield. If you’re hit from behind or the side or the front, we want children under 2 years of age rear-facing!

I talked to Dr. Beth Ebel, a Seattle Children’s pediatrician who also researches injury prevention and cares for children at Harborview Medical Center. Dr. Ebel is an expert on teen and child injuries and is especially knowledgeable about injuries related to vehicle crashes. Dr. Ebel came on my podcast to share how parents can help protect their children in their car and in the cars of others who drive their precious cargo around. Her points are emotional and inspiring to me.

5 Tips On Rear-Facing Until At Least 2 Years Old

  • The American Academy of Pediatrics recommends children travel in a rear-facing car seat until they are at least 2 years of age. If the seat allows for longer (based on size), there is NO rush to turn your precious cargo forward.
  • The worst crashes are when a car hits something from the front. Rear-facing seats protect the child’s head, spread out the force of a crash evenly across the seat, and significantly reduce the risk of injury.
  • Consider buying a larger car seat which accommodates your child through the toddler period, and THEN can be turned front-facing when your child is at least 2 years old and has reached the weight limit recommended by the car seat manufacturer. You’ll save money in the long run since you won’t need to buy a new car seat for years.
  • Use the easy “latch and tether” method to securely attach the car seat where possible. If you must attach the seat using a seat belt, make sure the seat belt is tight (i.e. the seat belt has no slack and won’t loosen).
  • Some parents worry they can’t see the child. There are mirrors for rear-facing seats if you must briefly check at a stop light. But keep in mind that you AND your child are safest when you concentrate on driving with your eyes on the road.

Booster Seats Until 4 Feet 9 Inches Tall

  • DO THIS NOW: put a mark on the wall at 4 foot nine inches from the ground. Tell your children to come and ask about getting out of a booster only when they are taller than the mark.
  • Children should stay in harness-type (“5-point”)seats until they outgrow the manufacturer’s recommendations. Most kids outgrow their harness seats between 4 and 6 years of age, and are then ready for a booster seat.
  • The booster seat is critically important because it helps the seat belt (and your child!) stay in position during a crash so that the car can do its job to protect the occupants. Seat belts are only designed for adults and don’t fit properly until a child is around 4 feet 9 inches tall – most kids will reach this height sometime between 9 and 11 years of age. I also like to remind kids that when in a booster they are up higher and can see better out the windows.
  • Some parents mistakenly put kids into the seat belt when they aren’t big enough. Dr. Ebel sees these older kids admitted to Harborview or Seattle Children’s with serious abdominal injuries, spinal fractures and head injuries because the seat belt doesn’t hold their torso in a crash.
  • Don’t negotiate on car safety. She and I both keep extra inexpensive booster seats and ask that every kid traveling in our car use one and provide it to others driving our children. (By the way, it is the law and the driver is liable).

Keep Your Children Safe In The Car

  • The biggest tragedy is when a child isn’t buckled in the right seat, or worse, isn’t buckled at all. Even a very low-speed crash can cause life-threatening injury, ejection from the vehicle, or worse.
  • Buckle up every trip. Every time. Even when you drive five blocks to grocery shop. Most crashes happen close to home. And children remember consistency – “we always buckle up in the car”.
  • Install a car seat in every vehicle in which your child regularly travels. Buy an inexpensive seat for grandma, dad, or your regular child care provider and leave it with them. Make it easy for them and explicitly spell out your expectation that your child must ALWAYS be in the right car seat.
  • Dr. Ebel’s trick for carpools: “Thanks so much for taking Elena; we really appreciate it. Do you have a booster seat for her or shall I leave one for you?”
  • Keep your child in the back seat until they are at least 13 years old. Make it a clear rule and don’t cave. It’s harder to transition them back to the back seats than it is to never allow them the “treat” of sitting shotgun.
  • There’s no reason to progress your child out of a booster seat before they are 4’9″. Every time you transition them you decrease their level of safety.

For a list of car seats and booster seats that meet Federal Motor Vehicle Safety Standard 213, view the American Academy of Pediatrics (AAP) Car Seat Product Listing. This list includes rear-facing car seats, convertible seats, 3-in-1 seats, combination seats, belt-positioning booster seats and travel vests.

Source: https://www.healthychildren.org/English/safety-prevention/on-the-go/pages/Car-Safety-Seats-Information-for-Families.aspx

Make the Most of Your Car Time

Remember that kids pay attention to what you do, not what you say. So set an example. Buckle up, put down your phone. Ask that kids also put down their electronics in the car. Driving time is a great chance to catch up in our busy lives; use it to listen, chat, sing or enjoy a shared sound track or radio station. Putting away your phone and redirecting attention to your child proclaims, “You are the most important person to me.”

Limit The Juice: None for Babies, Only Ounces For Kids

Not news that pediatricians recommend against juice. But the news this week is clearer: no juice for babies, only tiny bits for toddlers, and less than a cup a day for the rest of us. Fruit juice is widely thought of as a healthy and natural source of vitamins and hydration. And although I won’t vilify having juice in the diet of an older child, I can’t endorse it’s ever good for a child. Pediatric recommendations for juice got stricter this week. Juice is never really recommended in an a child’s diet past ounces to a cup a day but now it’s recommended as a NEVER during infancy.

Although whole fruit (i.e. an apple or an entire avocado or apricot) is one of the main focus foods in the Dietary Guidelines of Americans, fruit juice may feel a thoughtful substitute, but it’s not. In fact, even 100% fruit juice offers no real nutritional benefit and it’s never needed. The short list for why?

  • Juice is just a bunch of water and simple sugars (naturally occurring sugar is sugar) and lacks fiber or protein.
  • When you obtain calories from juice you take them in at a faster rate than is ideal. Juice is known to contribute to overweight and excess energy imbalance in children. We don’t need to drink these calories.
  • Whole fruit has the advantage of containing quality fiber that’s good for us.

Read full post »

Possible Allergy Protection From Thumb-Sucking And Nail-Biting

We do have to pick our battles at home. As a pediatrician I’ve never gotten too excited about advising parents to spend a lot of energy trying to rid your child of the thumb-sucking or nail biting habit. In general parents aren’t successful — peers are. Often it’s when friends or peers bring the habits up that children are motivated to stop. We can help support them by reminding them when hands are in their mouth or even having them place socks on their hands while watching television as that’s a common time for the behavior. Although many parents worry about their children sucking their thumbs and fingers, it’s a common habit, with some studies finding almost 25% of children do. Much time is spent thinking about ways to help our children quit, worrying whether germs on their hands will translate to illness and hoping it doesn’t affect their teeth. A new study today this week in Pediatrics highlights perhaps a positive effect of thumb sucking. It’s worth a mention.

Allergy Protection From Thumb-Sucking And Nail-Biting?

The study evaluated children between age 5 and 11 and their later diagnoses of hay fever, allergy skin prick testing and asthma. The premise of the study builds off the somewhat controversial concept of the hygiene hypothesis. The basic premise of the hypothesis is that germ exposure early in life can contribute to how our immune system responds as we grow and develop. We may build up tolerances and immunity that conform us into less allergic people if we have different bacteria and germs around. Basically, living in a sterile environment may not be “safer” as some believe lots of dirt, bacteria, and germs early and maybe not so many sensitivities later…

In the past theories for the hygiene hypothesis have supported a decrease risk of asthma (dirt and germs coming in from and on pets may decrease allergies or asthma later) and a small 2013 study a couple years back found those children who had parents who “cleaned” the pacifier with their own mouth may be less likely to develop allergies (theory was the bacteria transfer from mom/dad’s spit to baby changed their pattern of exposure to bacteria and possibly a tendency away from allergies and asthma later). So some researchers looked a the effects of children who have their hands in their mouths more to see if any protection comes of it — they evaluated data spanning from childhood to adulthood. Read full post »

Candy Or Medicine? Safe Medicine Storage

candy or medicine

Image c/o Strong Health

The role parents play in poison prevention is paramount. The above image shows just how easy it is to confuse medicine with candy. Especially if we message this improperly. When my boys were young I started calling liquid medicines “yum-yums” in an effort to get them to take acetaminophen or other medicine easily only to realize as I was doing it I was advertising the wrong thing…totally novice move as a mom and pediatrician. Clearly as parents we’re always a work in progress.

Safe medicine storage is one of those obvious things we feel we have under control. But numbers for accidental ingestion in the US prove we don’t. Young children are earnestly dependent on us doing this better.

Check out the above image — the packaging of medication earnestly isn’t any different to most of us than the packaging for candy. Imagine a 3 year-old trying to differentiate between the two in a moment of discovery. Pretty easy to imagine a 4 year-old stumbling upon a skittle and seriously impossible to imagine them over-riding their curiosity to explore/enjoy with their mouth. Chances are, that medication/skittle is going into their mouth.

Medication storage isn’t just for your typical over-the-counter (OTC) medications. With our households changing and many people coming though them, we have to think about prescription medications, liquid nicotine, marijuana and household products that all need to be up and out of reach. To that end, safe medicine storage is an important part of family and household safety. This week is National Poison Prevention Week so the perfect time to perfect our homes a little more. This includes any home your child plays in or stays in. Read full post »

7 Quick Tips For Healthy Mouths

oral health 1

Valentine’s Day this weekend….Even if you think it’s a card-store holiday chances are your children LOVE it. So power on Super Mama & Super Papa and learn something that makes it worth it. The American Dental Association declared February National Children’s Dental Health Month (I’m thinking because of the holiday and all those sugar hearts). This may have to do with candy…..but please read on even if you DON’T have a sweet tooth. Setting a good example and teaching children from an early age how to take care of their teeth is worth all of our time. It’s something I’m STILL working on as a parent. This matters because tooth decay is the most common chronic disease in kids age 6-11 and adolescents age 12-19. Additionally, at least 20% of children ages 5-11 have at least one untreated decayed tooth. Flossing and brushing 2 times a day changes the odds. Boom.

7 Tips For Healthy Teeth:

Read full post »

Window Falls: Innocence And Curiosity

Window falls are a gut-wrenching topic because they cause devastating and preventable injuries in children. This hits home for me; in just 9 years of pediatric practice I’ve had a handful of patients fall through open windows and screens. Every single fall has occurred because of innocence and curiosity — a child just wanting to see, or be involved in, something outside. So many of us don’t get our 2nd or 3rd story windows secured for children and we often just don’t expect a child to push through a screen… 

Each year in the United States 15 to 20 children under the age of 11 die, and nearly 15,000 are injured, because of falls from windows. A colleague, Dr. Lauren Wilson, is sharing her story, her perspectives while working in the hospital (Harborview Medical Center), and her ideas for preventing injuries as we close out this hot summer in our town deplete of air conditioners. We’ve included some tips on preventing falls in your home below. Don’t wait!


As a pediatrician, I was called four times last week to help care for young children with severe head injuries due to falls from windows.

Each time my pager goes off to mark a potentially devastating injury, I mourn. Not just for the family whose life is changed in that moment, but also for our city’s failure to make basic efforts to prevent these falls. I also know each time I am called that this will not be the last.

Despite reporting on these injuries, children continue to be injured at alarming rates. Since January 1 this year, Harborview Medical Center has treated 42 children with fall-related injuries in the hospital. Dozens of other fall-related injuries are cared for in primary care clinics and emergency departments. Read full post »

Hot Days: Why Children Are At Particular Risk

Hiking on a hot dayEven here in the cool Pacific Northwest the summer months can send temperatures soaring into the 80’s, 90’s and 100’s. Hot for any average adult, but potentially even more dangerous for young children. Our country is currently experiencing rolling heat waves. Thing is, children heat up faster than adults (five times faster) because they have fewer sweat glands, their body-to-surface ratio is different (their sweating would never do as much good) and this combination makes it more difficult for children to regulate internal temperatures. Couple this physiology with children’s inability to tell us they’re HOT (infants/toddlers) or the instincts of a child or teen athlete (who may not know limits or want to regulate activity) and it can sometimes lead to overheating.

Heat is different for children than adults. They are at particular risk for two reasons: their dependency and their judgment.

Frankly, I worry most about children being left or trapped in hot cars this time of year. Ten children have already died this year in the U.S. after being trapped in a car that can heat up like a cooking oven. Yesterday, with millions of Americans on heat advisories, NBC national news showed footage of bystanders this week breaking glass to save a child left in a hot car. Even though everyone seems to believe it won’t happen to them, about 3 dozen children die each year (primarily during the summer) after getting forgotten or trapped in a car that heats up. If you think you’re too smart for it to happen to you or your family read this — a piece I’ve called the most devastating article around. Read full post »

What To Do If Your Child Is Drowning: Infants & Toddlers

6-1 baby in waterWarm weather is here and summer is approaching and if mother nature is kind, we’ll have plenty of sun-filled days over the next few months to spend by the pool or at the beach. Unfortunately, this is also the time of year when drownings increase. Young children are especially high-risk because of their profound curiosity around water and lack of awareness of danger.

Drownings are preventable deaths but even the thought of them spooks most of us. Often, a drowning event looks, sounds, and appears unlike we’d expect. I’ve written before about the silent danger of drowning, but rather than reiterate the warnings of how to prevent drowning, this year I wanted to find out what you should do if you realize your child is actually drowning. Put a couple thoughts and tools in your hands to know WHAT to do if faced with an emergency.

I tapped Dr. Linda Quan, an emergency attending physician and drowning expert at Seattle Children’s for information on what to do if you come upon a infant/toddler, school-age child or teenager is drowning. Preparing for this can help boost awareness and response if ever you support or discover an infant or young toddler in need for rescue. Read full post »

The Inconvenience Of Prepackaged Baby Food

dv2159103Feeding a toddler is hard work because of all sorts of normal shifts that happen after the first birthday. But new data out this past month (see below) reminds us how pre-packaged baby food isn’t the best food source, despite package claims. Whole food, the food your family eats, and the fresh stuff is the way to go.

Infant hunger matches their rapid growth; we’re used to our babies ravenous and near consistent basis from day one yet as infancy progresses feedings space out and form meals. By a year of age most children go 4 hours or more between eating. Toddlerhood is a completely different story; growth slows after a year of age and toddlers start to test limits in profound ways. Food is no exception. It can be tempting to reach for whatever’s convenient that you know your kid will eat (fish crackers, anyone?) but in the long run making good nutritional choices for whole food regularly will exceed the nutritional detriments of pre-packaged “toddler” food.  In fact, a new policy statement released by the AAP this month is urging parents (and schools, daycares etc.) to take a “whole diet” approach to kids’ nutrition, namely focusing on a mix of foods from the five food groups and avoiding highly processed foods. Read more about the policy here from my friend Dr Claire McCarthy. These “fresh is best” ideas aren’t new to you I suspect but the data about food being marketed to us (and our children) is: Read full post »

Perhaps Not Intuitive? Car Seat Use From Day One

car seatNew data presented at the recent American Academy of Pediatrics meeting found 93% of parents to newborns incorrectly positioned and buckled their infants into their car seat on their first trip home. A little more proof that perfectly buckling a car seat isn’t an innate early-parenting skill! Even Prince George’s royal family didn’t get it right. I’m certain I didn’t do this perfectly either on our maiden voyage home (I remember using a zip-in blanket in the seat) nearly 8 years ago. As The Car Seat Lady reminds, “products that have a layer that goes under the baby’s body can make the baby unsafe. This is true even if the product is designed with slots for the harness straps to fit through.” Most of us clearly mess this up and although the first trip is just one trip, it may be emblematic of our everyday use.

Car seats and booster seats are important for child safety; our habits for their use begin the moment we leave the hospital or birthing center. Although those “bucket” infant car seats are safest (we’d all be safer in the car facing the rear, and in a bucket) we move away from them when our infants are around 9-12 months of age. But do remember, with every graduation to a new seat, you decrease protection. For example, when you move from a a rear-facing infant seat —> rear-facing carseat—>forward-facing carseat—>booster seat—>seat belt—>front seat at age 13,  each time you advance the child safety seat, you’re decreasing protection you provide. Don’t rush the transition! Keep your child rear-facing until at least age 2 years and in a booster until they are at least 4 foot 9 inches (57 inches) tall.

The No-Duh Importance Of Car Seats

  • Car crashes are the leading cause of death for children in the US. Creating safe habits from day one matters…don’t blow off importance of car seat safety as helicopter parenting. Using the child car seat well every time is an easy way to layer protection and channel your bursting baby love.
  • Infant car seats, rear-facing seats and boosters all hold equal import. Only two states require car or booster seats until age 8 (WA is not one of them) even though children should be in booster seats until they are both 4 foot 9 inches and between age 8 and 12 years.
  •  Car seats reduce risk of death by 71% for infants and 54% for toddlers if used properly: “Results of several studies have indicated that misused child safety seats may increase a child’s risk of serious injury in a crash.” (Page 9)

Read full post »