Toddler

All Articles in the Category ‘Toddler’

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)

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It’s Hot Out But The Water Is Still Cold

igram lifejacket jumpThere have been 4 teen drownings around here just in the last week. I’m left with a pit in my stomach that as the sun shines and our region heats up we lose children to preventable injuries at rapid-fire pace. This happens every year; drowning is the 2nd leading cause of injury-related death in childhood (and the #1 cause of injury death in toddlers between age 1 to 4). In general there are two groups of people who drown the most: toddlers and teens. The spaces and places (and circumstances) for typical drownings for those groups are different but the foundation is the same: water, especially cold water, is always lovely on a hot day but always poses unacknowledged dangers.

This really isn’t meant to be a finger-waggy post. This is meant to inform us all with refreshers to the opportunity we all have when living near water with children in our midst. Forward these reminders to anyone you can think of who may benefit. We may never know if we prevent a death but it sure is worth the effort to keep trying…

Drowning Statistics & Risks:

  • Drowning is second leading cause of injury-related death in children in our country following motor-vehicle crashes. In general, the risks come from improper attention to the risks of water, improper supervision, and surprise (i.e. the current moves faster than expected, the water is colder, the child toddles into the pool while no one sees in a matter of seconds).
  • Toddlers AND teens are the most likely groups of people to drown; risks are higher for boys than for girls. Toddlers drown because of improper supervision, teens tend to drown because of improper awareness of risks. In fact it’s also where you are that matters. Data has found, for example, that you’re at a 6-fold increase risk for drowning when visiting a friend’s home with a pool.
  • Cold water, alcohol & drug use (for teens or supervising adults), and distractions increase risk for a drowning or near-drowning event.

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Summer Reading From Day One

boys readingThe boys and I read two extra books last night — we almost skipped it altogether as it was late and we were beat from a long day and yada, yada, yada…you know the drill. But reviewing this data changed me, yet again. I knew some of the value of reading to young children before I had kids because of my experiences being a teacher and my training in pediatrics but the refreshers provided this week only compound my interest in screaming the value of reading from the rooftops.

It’s NEVER too early to start reading to your baby. Reading aloud before bed is always the right thing to do.

This week The Clinton Foundation with Too Small To Fail, The American Academy of Pediatrics, Reach Out And Read, and Scholastic got serious about ensuring our country takes reading seriously right out of the gate. For the first time ever the groups have come together to proclaim that parents should start reading to children “as early as you can” after birth. The new policy and partnership emphasizes the need for early reading to all infants and children while also emphasizing the necessity that all pediatricians promote this healthy habit at birth and through all preschool doctor visits. Profound health disparities currently exist for US children and book time. I suspect the numbers will surprise you.

It’s a no-brainer to most parents I talk with that reading books enhances development, literacy, and school readiness. What may surprise you is that reading has also been found to enhance the relationship between a child and parent. Reading books (or even the newspaper) to your infant from day one can have profound effects on how they live, how they talk, and how they learn — the impact extends well into adulthood. From the very beginning, though, some children are missing out. Children from low-income families hear fewer words in early childhood and know fewer words by 3 years of age creating the “word gap” early in their lives. The more words a child hears during early, critical times for language development, the more they’ll know. And although reading books can be a great resource to introduce an expansive, enriched vocabulary, less than 1/2 of children are read aloud to in this country every day.

All families face issues of limited time, limited parental understanding of the key role of reading aloud, and competition for the child’s interest and attention from other sources of entertainment ~  The American Academy of Pediatrics Council on Communications And Media ( 2011)

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Living In A Museum: Safe Medication Storage

OTC Safety Info Where Do Kids Find MedsJune is a lot of things to me this year: the month I turned 40 (yipeee!), the earnest start of summer, the beginnings of an awesome USA performance in the 2014 World Cup and also National Home Safety Month. Of course it may be easy to make time to celebrate turning 40 or to watch the taped game where USA beats Ghana (go team!) but there really is one thing we should move into position numero uno. Can you make your house more museum-like, at least when it comes to medication safety this summer? Here’s why it should be placed at the top of the list.

A quick digression: no question I’d really like to live in a museum — unlike lots of others, it seems — I’m one of those people who hates a messy house although our house really does get highly disorganized (I find errant legos in every room/every day, our beds aren’t always made and may I ask where in the world do all the dirty socks come from?). I would prefer a museum-like home, beautiful stone on the floor, gorgeous lighting, thoughtful works of art on the wall and no distracting debris. A clean surface on which to place my purse when I walk in the door would be a good compromise! When I looked at the Up & Away tools that helps provide tips for parents on medication safety at home it reminded me that yes- museum living is definitely what I want (I mean, heck, look at that kitchen!!). HOWEVER, the realities of having 2 kids and limited time to keep organizational systems in check I’m going to have to settle for my not-always-perfectly cleaned floors, the walls of childhood art, the stacks and piles of mail and school forms, and the lighting I’ve got. But one thing I won’t sacrifice are the safety systems we’ve made to keep medications and toxins out of reach, even as our boys get older. Some data here reminded me I need to revisit our systems. Read full post »

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

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