Toddler

All Articles in the Category ‘Toddler’

How Do Doctors Screen For Autism?

Pediatricians, nurse practioners, and family doctors start screening your baby or toddler for signs of developmental or communication challenges like autism from the very first visit. As a pediatrician, how your baby responds to you (and to me) during the various visits during infancy and toddlerhood guide me in their screening. In the office I get to observe how a baby giggles, how they look to their parents for reassurance, how they try to regain their mom’s attention during our conversation, how they point or wave, how they respond to their name, and even how and why they cry when I’m around. Those observations in combination with family history, health exams, and parental perspectives remain extremely valuable for me in helping identify children at risk for autism.

However, more formalized screening is recommended at both the 18 month and 24 month well child check. In most offices, clinicians use the M-CHAT, a 23-point questionare parents fill out. Often, I have to help parents answer one question in particular, (“Does your child make unusual finger movements by their face”) but other than that, most families find it easy to fill out. Using this standardized screening, pediatricians can pick up children at risk for autism and will be prompted to start conversations about language delay, concerns about behavior, or possible next steps for a toddler at risk with additional genetic, neurologic, or developmental testing.

It’s important to note that screening isn’t diagnosing. If your child has a positive screen for autism, it doesn’t mean they will be diagnosed on the spectrum. And further, if your child screens normally but you continue to worry about autism, don’t be shy. Read full post »

Reassuring Infant And Toddler Communication: When Not To Worry About Autism

Many parents worry about their child’s development at one point in time. With each of my boys, I had worries about their communication and thought their language delays or behaviors signaled something serious. That might just be the “worrier” in me, but it might just be the “mom” in me, too. Competitive parenting makes us all a little nuts…

Here’s a few signs that your child is developing great communication skills on time. However, if at any time you worry that your child isn’t expressing joy, communicating thoughts, or reflecting an understanding of your language, visual cues, and behavior talk with your child’s doctor. If you don’t feel heard or continue to worry, schedule another visit. If you still worry, contact another doctor for a second opinion. Instincts serve us very well when it comes to parenthood. Further, find some peace of mind if your child is doing many of the behaviors listed below!

Reassuring Developmental Milestones For Infants & Children

  • Responds to her name between 9-12 months of age.
  • Smiles by 2 months, laughs and giggle around 4-5 months, expresses great joy to your humor around 6 months.
  • Plays and thinks peek-a-boo is funny around 9 months of age.
  • Makes eye contact with people during infancy.
  • Tries to say words you say between 12 and 18 months of age.
  • Your toddler uses 5 words by 18 months of age.
  • Copies your gestures like pointing, clapping, or waving.
  • Imitates you — ie pretends to stir a bowl of pancake mix when you give them a spoon and bowl or pretends to talk on the phone with a play cell phone.
  • Shakes head “no.”
  • Waves “bye-bye” by 15 months of age.
  • Points to show you something interesting or points to get your attention by 18 months of age.

Flying With Toddlers: Tips For Distraction, Tips For Tantrums

Flying with toddlers is far more difficult than flying with an infant in my opinion. It’s the need to get up, run the aisles, move around, have another snack, read a different book, take an abbreviated nap, go pee, and that minute-attention span that makes it not only exhausting but nerve-racking for most of us. Although the challenge is real, success comes with having a good plan, allowing extra time, and packing the right snacks, toys, and books to keep your toddler occupied. That 3,000 mile flight at 30,000 feet can be a ton of fun! The above tip came from a friend years ago. Prepare for the worst and expect the best when flying with toddlers–hopefully this blue tape idea sticks. (ha)

Now dealing with tantrums while up in the air is another challenge in and of itself. Many of us heard about the toddler kicked off an airplane, and have also heard about the opinion for commercial airline children-free flights. Although I wholeheartedly disagree that we should segregate flights by age, I do think these stories in the news media elevate our anxiety for flying with our children. Don’t let it. You’re always the best one to support and help your child on the ground or up in the air. Don’t let the public shake that truth. My tips for dealing with tantrums at 35,000 feet aren’t very different from those on the ground: provide consistency, provide distraction, and provide comfort. But more, set yourself up for success by clearing the tension with passengers sitting next to you ahead of time. Acknowledge the challenge. I’ve found it not only decreases my own anxiety, it allows for a much better reception when things don’t go as planned.  Click to read full post for my additional 1-minute video explanation and a few ideas. What are yours? Read full post »

Cocoon A Newborn, Only An Email Away

This week, Washington State declared that whooping cough (pertussis) has reached epidemic levels. Since the beginning of the year, we’ve had more than 600 documented cases in the state, a dramatic increase since last year. The increase puts our new babies at risk.

In clinic I’ve been urging new parents to cocoon their babies. That is, provide a family of protection by having every single child & adult immunized against whooping cough, influenza, and other vaccine preventable illnesses. By surrounding a baby with only immunized people, you cocoon them against serious infections.

Whooping cough is a highly infectious respiratory illness spread by sneezing and coughing that can be deadly to young infants. Getting a Tdap shot is the best way to avoid getting whooping cough. Amidst an epidemic, we worry most about newborns because they are most vulnerable to complications and lack vaccine-protection. If every child and adult that surrounds a newborn gets a Tdap shot, the likelihood of the baby getting whooping cough approaches zero.

Most newborns get whooping cough from their family or adults around them. That’s where an email comes to play.

You’re going to have to be fairly Mama-Papa-Bear about this. You’ll have to show some strength to create a very safe home, even when it feels somewhat over-the-top. As I said to a number of families in clinic today, “It only seems entirely over-the-top-nuts until we lose another newborn to pertussis.” Being smart now will save lives.

Make a new rule: no visits with a newborn until all visitors have had the Tdap shot. Even Grandparents.

Write an email to family and friends to explain.

A sample email for you to use/copy/share –written today by a friend of mine–mother to that darling baby girl born last week: Read full post »

All Grandparents Need A Tdap

Some of my best friends are about to have a baby, the due date only a few weeks away. I’m teary thinking about it as my excitement for her arrival exceeds the speed limit. They asked my opinion this week for getting their extended family immunized in light of the recent Whooping Cough (pertussis) outbreak in our area. I advised them that all teens and adults (including grandparents) need a Tdap shot before they are with the baby. Even pregnant women are getting immunized after 20 weeks gestation to protect their newborns at and after birth.

Ideally, everyone should have the Tdap shot at least 2 weeks before the baby arrives.

My friends advised their parents. But both grandmas were turned away–one here in the US and one abroad. Each were told by a physician that they didn’t need the Tdap shot because they were over 65 years of age.

That physician was wrong. Whooping Cough (pertussis) knows no age. And immunization recommendations for pertussis protection have changed this past year because of rising rates of infection and infant deaths.

The best way to protect a newborn baby from getting Whooping Cough is to cocoon them with family and friends who are immunized against it.

Here is an overview on protecting your family from Whooping Cough.  <——Share this link with friends having new babies.

All grandparents, all adults, and all teens need a Tdap shot before holding a newborn baby.

Ask questions, please. And one more thing, can you suggest girl names? My friend is beside herself that they don’t have one picked out…I’ll buy you coffee if you suggest the name she chooses (hint: use a real email)

Toddler Sleep: Early Morning Awakenings

Every week in clinic families ask me about strategies to help with children who awake before the sun is up. We all thrive with improved, uninterupted, prolonged periods of sleep at night. Particularly on those Saturdays where an extra hour or two of sleep can be life-sustaining for exhausted parents to toddlers and preschoolers. Because of our boys’ early schedules, late last year Santa conveniently dropped off an incredible tool: a toddler teaching clock. The clock has helped our 3 year old know when 7 o’clock rolls around. And we’ve made a deal with boys for 2012: no leaving their bedroom until 7 appears on the screen. And so far, it’s working–we’re batting about .900. Learning to play quietly on their own in the early morning has been a great benefit, too.

Toddlers and preschoolers between 1 and 3 years of age need about 11 to 13 hours of total sleep within 24 hours (night time and nap combined). Sometimes no matter what time bedtime starts, early morning awakenings continue to happen. As many parents learn, moving bedtime later doesn’t always shift the time a child awakens in the morning. But with time, shifts in schedules sometimes improve that Saturday morning sleep…

Dr. Craig Canapari, a pediatric pulmonologist and sleep expert in Boston helps explain some reasons for these uber-early wake-ups and what we can do about it:

Why does my toddler get up so early in the morning?

Read full post »

Toddler Sleep: 4 Reasons Toddlers Wake Up At Night

There is a lot of writing online about how to get your baby to sleep through the night during infancy but not as much expertise to help those of us with toddlers and preschoolers who wake a number of times. Between age 2 and 3 when O was released from crib jail and moved to a big bed, he’d come to find me a couple of times a night. I’d often awake (and startle) to find him standing next to my bed! I tried many things to improve his opportunity for a full night’s sleep yet for those kids who never quite figure out that sleeping through the night starts around 7 or 8pm and ends with the sun coming up around 7am, we want to help. Recent data shows that 1 in 5 infants who have trouble sleeping may continue to have challenges during the toddler years. Clearly challenges with sleep that span multiple years affect many of us.

I turned to a pediatric sleep expert for help. Dr. Craig Canapari is a doctor I met on Twitter (of all places) who answered questions surrounding sleep challenges for toddlers. Dr Canapari is a father to 2, a pediatric pulmonologist & sleep expert, and is thinking of starting a blog! He told me that when he was a kid he, “definitely did have problems falling asleep sometimes,” so not only is he an expert, he’s experienced! Check out his responses here and leave comments and questions — I’ll get him back on the blog to respond as needed.

Why does my toddler wake up at night?

Every parents has experienced the dreaded 2 AM call. You hear your little one stirring on the monitor. Either you wait, fingers crossed, to see if they go back to sleep and they don’t, or you run in there as fast as you can to stuff the pacifier in their mouth before they really wake up. Most babies are capable of sustained sleep (6-8 hours in a row) at night by age six months. If you are nursing your child, it may take them a bit longer to achieve this. I think that it is reasonable that every child should sleep through the night most nights by 9-12 months of age. Now, every child wakes up sometimes at night. I view the awakenings as a problem if they are more than a few minutes in duration, occurring multiple times at night, or resulting in significant daytime irritability for either the child or the parents.

If your child is having problematic nocturnal awakenings, there are a few possible causes: Read full post »

Reading A Growth Chart: Mama Doc 101

Parents, pediatricians, and nurses have been using growth charts since the late 1970’s to track growth in their infants and children. The charts were revised back in the year 2000 as the data for the first charts (from a small study in Ohio) that didn’t accurately reflect the cultural and ethnic diversity of our communities.

The hallmark of a well child check is the review of a child’s growth. Growth can be a reflection of a child’s overall health, nutrition, and/or tolerance of possible underlying medical conditions. So understanding what your doctor or nurse practitioner says about your child’s growth should be a priority.

Watch the video to learn more about interpreting growth charts.

If your doc doesn’t have a computer in the room, ask to see the chart (on paper) or on a computer in their office. It will not only inform you, I suspect it will delight you to see what your child has done since the last time they have been seen.

The human body really is a fine-tuned machine and growth is simply astounding if you really stop to think of it.

If you have a challenge understanding how your child is growing or how the growth chart is presented, demand clarification. It’s okay if you don’t understand the presentation of facts on these grids; have confidence to speak up and ask for the doctor or nurse practitioner to explain it.

Revisions to the growth charts in 2000

Understanding growth charts

Half & Half

I had a great trip to the grocery store today with the boys. Life has been so hectic these past few weeks, we haven’t had weekend time for a leisurely trip to the aisles of fruit and fondue. Today, we had the luxury of time, a list, and a proper plan. They weren’t hungry (and neither was I) so our stomachs didn’t drive the cart and the boys were uniquely engaged. We perused the produce area. We made peanut butter in the machine that crushes raw peanuts. We talked about some of the beginnings of the food we bought (the avocado came from Mexico, the mini-oranges from California). But I thought most about how pleased I am when I end up at checkout with more fresh food in the cart than food stuffed into packages. Today I think I came close.

And that’s the lesson. One thing I say over and over again in clinic is, “If at all possible, for every single meal you offer your child at home, make sure 1/2 the plate is covered in fresh fruit and veggies.”

So if that’s the goal, the cart should always look the very same way.

Pacifiers: A Love Affair Worth Having?

Pacifiers, a love affair worth having? It’s up to you, of course. Pacifiers are hotly debated among some parents, some pediatricians, some lactation consultants, and some dentists. I say some, as I believe not all clinicians have strong impressions/judgments. That’s because pacifiers don’t cause excessive harm. Yet most parents agree on one thing: they all have an opinion about what to do with one. Some hate them, others adore them. Just like babies. Silicon pacifiers can be all the rage, or none of it…

At our house, we had a love affair with a pacifier. Twice. Without even trying. And it all happened by accident.

Although the American Academy of Pediatrics and National Institute of Child Health and Human Development recommend using a pacifier at night to decrease the risk of SIDS, if your infant doesn’t like one, you certainly DON’T need to force it upon your content baby. Don’t over-think or over-value the pacifier, either.

With F (our first born), I waited, held off, and withheld the pacifier hoping to improve my changes of successful breastfeeding. We had a few sleepless weeks (with the fussing and crying normal for a newborn) until a couple weeks of age when we realize it really was the “plug” he was looking for. F’s crankiness improved, and we had another tool to help support him when holding, rocking, feeding, changing diapers, or swaddling didn’t soothe him entirely. The pacifier was just something he loved.

With O (our second), I didn’t get the choice. While in the NICU, the nurses used the pacifier to “quiet” him down. I asked that they didn’t, but when I returned to feed him, there it was again, in his mouth. And he was in love. So we continued to use it and I didn’t take it from him. As I’ve written before, I loved to see him enjoy and indulge with that pacifier. I mean, he really craved and adored the time he got with it (mostly during sleep or in the car). Weaning him from it was harder on me, it turns out. And I faltered a couple of weeks after the wean during a moment of weakness…

We used pacifiers in our homes until both the boys were just under 2 years of age. And like I said, it really was a love a affair.

The reason is simple, babies soothe by sucking and pacifiers are a perfect tool. My advice on pacifiers: follow your instincts. You’ll be able to find studies both that support use and studies that dissuade use to back up either decision. So don’t over-think this. And stop beating yourself up for using one if you are…

Mama Doc’s Cliff Notes On Pacifiers:

  1. These are things you already know: Wash the pacifier regularly (dishwasher safe are easiest) in warm soapy water, get rid of old pacifiers that show cracking or damage, and use a one-piece silicone design if possible. Don’t dip the pacifier in anything (ie sugar water, honey, etc) ever. And never tie the pacifier around your baby/toddler’s neck.
  2. As your child grows, the pacifier should, too. Don’t let toddlers have infant sized pacifiers due to choking risk. Smaller pacifiers may rest more on their front teeth as well and cause more malocclusion or “bucking” of teeth. Get the correct size pacifier if your older toddler or preschooler still uses one.
  3. When your child approaches 6 months of age, consider weaning. If neither of you are interested in breaking up with pacifier, try again at 2 years of age. By 3 years, get it out of the house or the love affair will cause a most terrible break-up.

Additional Safety Tips on Using Pacifiers:

Mayo Clinic’s Do’s & Don’ts on Pacifiers

Review article about dental problems caused by pacifiers after age 3.

Satisfying your baby’s needs: Pacifiers