Baby 411 & Toddler 411 Blog

When is too big or too old for a stroller?

It was meant to be a joke, but TooBigForStroller.com is causing quite a stir in the mommy social media world. Like the recent Suri Cruise-too-old-for-binky-debate, some parents are taking this as a personal affront to their parenting skills.

Reality check moment: there are MUCH bigger parenting offenses that have potential lifelong consequences on a child than carting a kindergartner around in a stroller. So, put this in perspective!

That said, I agree that some parents use strollers for children who are clearly capable of walking a decent distance. Yes, it is convenient. Yes, it adds an element of pedestrian safety when going across a crowded city street. And yes, a parent could probably get an extra hour or two in at Disney World with a tired kid if the child doesn't have to walk from one attraction to the next. (Adults aren't immune to this behavior either— Disney rents scooters for non-handicapped people who simply aren't in the mood to take a walk in the park!)

But, there are both short and long term health benefits to walking and that is why my worried doctor radar goes off here.

Walking is a form of exercise, people. And that's something many American kids don't get enough of. We've all heard the stats about our obesity epidemic. As a pediatrician, I am deeply concerned about our sedentary culture.  In our media-rich world, kids (and adults) spend several hours a day sitting in front of a screen. That's several hours too many.

Why would an able-bodied child prefer to walk when he gets a free ride from the chauffeur driven limosine? When the convenience of a stroller trumps physical activity for your child, that's when it becomes a poor parenting choice.

So when is a child "too big" or "too old" for a stroller?

1. Too big? Typical strollers on the market have a maximum weight capacity of 40 lbs. Most kids will reach that by 4-5 years of age at the latest. But if you have to squeeze your child into the seat or his feet touch the ground, he's definitely too big!

2. Too old? Ask yourself the following questions. If you answer YES to all 3, it's time to ditch the stroller.

• Can my child walk easily and confidently?
• Does my child follow directions/hold hands while walking without making a break for it?
• Is my child old enough to unstrap the restraints in a stroller and potentially create a safety risk? (Same rules apply for putting a child in a shopping cart.)

If your child gets tired at Disney (or any other family vacation destination), that means it is time to take a break. And, if your child isn't old enough to walk around Disney World, you are probably wasting your money going there in the first place!

 

Suri Cruise & Binky Addiction: When is it time to move on?

Newborns have very few skills to soothe themselves—sucking being one of them. So, it's commonplace to find an infant using a pacifier or sucking his thumb or fingers. But by 4—6 months of age, babies have other strategies to calm themselves down. And by the time babies reach their first birthdays, they are definitely ready to lose the binky and move on.

But, we've all seen kids who are much older than that clinging to their beloved binky. Case in point: Suri Cruise, who turns 5 next month. Other than this accessory clashing with her Dolce&Gabbana handbag, is there any harm in continuing to use the binky?

Yes. And that's why I am bothering to write this blog. It's not because I really care what celebrity families do. It's because MANY other parents continue to give their kids a pacifier long after they really need it and it can have some adverse health effects. Here are a few:

1. Pacifier use is a known risk factor for ear infections. Ear infections are not fun.

2. Prolonged pacifier use in preschool years and once the permanent teeth come in (around age 5) can lead to an altered bite position of the teeth or a cross bite. Can you say expensive orthodontist bills?

3. Older kids who use pacifiers also put other things in their mouths to explore them, instead of using their hands. That means more risk of germs entering the mouth and leading to infections. Also not fun.

4. Pacifier use at bedtime is a sleep crutch. Kids think they need to be sucking to fall asleep, thus they need to suck when they awaken at the end of every sleep cyle (about every 90 minutes). If the pacifier falls out, they wake up and start looking for it (or scream for a parent to come put it back in). There is a real health value in a good uninterrupted night's sleep for both child and parents. Most parents are too exhausted to get out of this vicious cycle to realize that!

I think parents allow the binky to remain in their child's life long after infancy because life just seems easier with it around. It calms and quiets the child, or it helps the child fall asleep. But the truth is, kids are much more resilient than parents give them credit for. Out of sight is out of mind. If the binky disappears, the child quickly moves on and adapts. Really! And, it only gets harder to take away as your child gets older.

Sometimes Mom and Dads need to grow up with their child!

Did you watch the Dr Oz Autism show? Comments from Dr Ari Brown

I am thankful to the Dr Oz Show for the opportunity to participate in their autism show. I hoped the show would help educate the public and move the conversation forward, which is why I agreed to be a part of it.

As a pediatrician who talks with families everyday in my office, I know parents want to know more about both vaccine safety and about autism. I’m also a mom. Like you, I need accurate information to protect my kids as best as I can.

I am concerned that viewers took away a very inaccurate view of vaccines. The most vocal audience members represent a small minority. Most parents of children with autism agree with the scientific evidence and do not believe that vaccines cause autism.

And, an overwhelming number of healthcare providers worldwide do not believe vaccines and autism are linked. What viewers witnessed on the show was far from the norm.

Also, most parents in this country support vaccinations. In fact, 99.4% of American children under 3 years of age are vaccinated. 

            I base vaccination decisions for my patients and my own children on science, not anecdotes or conspiracy theories. I’m passionate about vaccinations because I watched a child die from chickenpox—a vaccine-preventable illness. I refuse to let another child become a statistic because of hearsay. I’m compassionate towards families whose children have autism, because I have personally walked that road with several patients.

These are the messages that resonate with me, as a parent and a doctor. I hope they will resonate with you.

 

1. Multiple studies conducted by academic institutions worldwide—which are not funded by pharmaceutical companies—have shown that vaccines do not play a role in autism. Here are the studies. Vaccine safety concerns have not been ignored. In fact, they have been addressed appropriately.
2. Delaying or selectively choosing some vaccinations has absolutely no benefit and only risk. It does not prevent autism, but leaves the youngest children vulnerable to serious infections. The diseases that vaccines protect against can cause disabling health problems or death—and they are often the most severe in younger children. They are not minor illnesses. Here are the diseases preventable by vaccination.
3. The vaccination schedule recommended by the American Academy of Pediatrics and the Centers for Disease Control has been studied extensively by the most respected group of experts in their field. The time frame provides the safest, most effective way to give certain vaccines together.
4. Dr Bob Sears, a panelist on the show who supports a delayed vaccination schedule, has said, “My schedule doesn’t have any research behind it. No one has ever studied a big group of kids using my schedule to determine if it’s safe or if it has any benefits.” (“The Truth about Vaccines and Autism.” iVillage, September 2009). Since that statement, a 2010 study showed that children whose shots were delayed were just as likely to develop autism as those who were vaccinated on time. As one father on the show said so eloquently, the point of delaying shots seems to be just to make parents feel like they are doing something, when in reality, the decision puts their child at risk.
5. While it was not addressed on the show, the combination measles-mumps-rubella (MMR) vaccine and its association to autism have been debunked. The scare began with a report in a British medical journal in 1998 that was recently retracted. Over the past decade, researchers dutifully tried to duplicate the findings of that report and no one ever could. The question was asked, and it was answered.
6. It’s true—today’s children get more shots than we did as kids. Modern medicine now provides protection against twice as many deadly, disabling diseases. That’s a good thing! For instance, there is now protection against three different forms of bacterial meningitis. Infectious diseases are everywhere. No one can predict when a child will be exposed. And, even in the era of modern medicine—when someone becomes infected with a vaccine-preventable disease, it is usually too late or there is nothing to treat the infection. Prevention is key.
7. Parents, healthcare providers, and researchers all seek answers for autism spectrum disorders. We will be most successful by working together with the same goal–to discover the true causes of autism.

My advice to parents is to examine the scientific evidence for themselves. Your child’s health is too important to base decisions on inaccurate information. Seek reliable sources for medical information. Go to the AAP website and talk to your child’s doctor. As pediatricians, many of whom are parents too, we vaccinate our own children to protect them. We wouldn’t do anything differently for your child.

For more information on autism see this link. 

"Hot saucing" is for Tex Mex food, not discipline

Dr Phil, The View, Today Show...everyone seems to be talking about the Hot Sauce Mom. Frankly, I am disgusted by this parent who has resorted to bullying her child into submission. So, it's time for me to pull out my Discipline 411 lecture and share it on this blog post.

Every once in a while, a parent asks at the two-year well check when their child is old enough to be disciplined. My response: “Umm, about a year ago!”

When your darling 9-month old looks back at you with a smirk on his face before he uproots the daffodils in your garden, he definitely knows he is doing something wrong. And, it means he is ready to be disciplined.

The word, discipline, literally means “to teach”. Your job as a parent is to teach your child which behaviors are appropriate and which aren’t. Discipline does not necessarily mean “to punish”.

There are many ways to teach a child that a behavior is inappropriate. Here are a few ground rules:

1. Your child understands “no”. He may pretend that he doesn’t—but that is because he wants to make sure that you really meant it! But, saying “no” 50 times a day can lose its effectiveness. You need to have several strategies besides this one.
2. Many of your child’s inappropriate behaviors are just a ploy to get your attention. Good attention (your praise) and bad attention (your lecturing) is attention either way. So, ignoring the bad behavior and taking a moment to notice and praise your child being good is an extremely effective discipline strategy.
3. Do the time if you do the crime. I am a big believer in using natural consequences to teach personal responsibility. You want your child to realize that his behavior can lead to an undesirable result. Example: If you throw your food, you get excused from the kitchen table/high chair. (In the real world, if you throw your food, you get thrown out of the restaurant, right?) Next time, if your child is hungry, he will remember to eat and not act like John Belushi.
4. Some behaviors deserve a “time out”. No, you can’t expect your child to sit in a “naughty chair” or the penalty box—especially if he is under 2-3 years old. A time out simply means time away from you, or time you are not giving him attention. So, a younger child can sit on a parent’s lap facing outwards. Or, the parent can walk away and leave the child where he is (as long as he is in a safe place like his room or the living room). A good rule of thumb: one minute of time out for each year of age.

 So, when do you just say, “no”, when do you simply ignore the behavior, and when is it time for a time out? That’s what you have to decide. I suggest reserving “time outs” for behaviors that can potentially injure the child or someone else.

For those of you who say, “I’ve tried time out and it doesn’t work”…remember, you are planting the seeds of discipline. Do not expect a tree to grow overnight! If you are consistent and follow through, you will see the fruits of your labor a few years down the road—that is, your child will behave well even when you aren’t watching his every move.

There is no place for pulling out the black belt, or hot sauce, to get your child to behave. To the Hot Sauce Mom, I say, GROW UP and be a parent! You deserve more than a misdemeanor.

Closely spaced pregnancies: a risk for autism?

A study published today in the journal, Pediatrics, examines the interval between pregnancies and the odds of a child having autism. Researchers looked at the birth records of 660,000 second-born children born in California and the timing of their conception after the oldest sibling was born.

The results? Compared to children who were conceived at least three years after their sibling was born:

• Babies conceived less than 12 months after the birth of the first-born child were THREE times more likely to be diagnosed with autism spectrum disorder (ASD).
• Babies conceived from 12 to 23 months after the birth of the first-born child had almost two times the risk of ASD.
• And, even babies conceived 23-35 months after the first-born child had a slightly greater risk of ASD.

Unfortunately, the researchers have no idea why the odds are greater when the spacing between pregnancies is shorter. Perhaps it’s because a woman’s nutritional stores have not had enough time to be replenished. Or maybe women who have put off parenthood until later in life have more closely spaced babies—and parental age itself is a risk factor for having a child with an ASD. This study isn’t going to give us those answers.

Bottom line: We are learning more and more about autism every day. Thus study alone should not necessarily influence your decision on how long to wait between pregnancies. However, the current recommendation from the Centers for Disease Control is to wait at least 18-23 months between pregnancies for a mother and baby’s optimal health.

Does your child have NDD? That wasn't a typo

NDD stands for Nature Deficit Disorder and it's on the rise in American kids who are glued to screens of all kinds. Remember the good old days when our parents told us to "go play outside" and we didn't see them until dinner was on the table? What happened? Are we so afraid of stranger danger that we keep our kids locked up in our homes? Or, are there so many fun things to do with screens these days that sunshine and exploration of the nearest creek or woods can't compete?

Author and keynote speaker for the American Academy of Pediatrics national meeting, Richard Louv, expressed his concerns of our children's lifestyles yesterday in San Francisco to a packed crowd of pediatricians.

Louv encourages families to look at the real statistics about childhood abductions. The numbers have actually been going DOWN for the past 20 years. And, he says, "the vast majority of abductions are not by strangers, but by somebody the family knows." While media outlets send chills down every parent's spine when they report on these heart-breaking cases, the cases are actually pretty rare.

His advice to pediatricians: "Recommend to parents that kids go outside." Pretty simple stuff, yet incredibly important. I couldn't agree more.

Here's my advice: Maybe parents should go outside, too. And on that note, I am turning off my computer and going for a walk!

 

 

Q of the day: Bedwetting, how much longer?!

Q. My 6 year old son has been toilet trained since he was 3, but he still wears pull-ups at night. We've tried to limit how much he drinks at night and all kinds of bribes, but nothing has worked. I'm considering taking the pull-up away to see if this will motivate him. Any suggestions?

A. This is a common misconception about toilet training. Daytime and Nighttime skills are completely independent of each other. A child may toilet train during the day and then it may be years before he is dry at night. Each milestone requires a certain level of both brain and body maturity. It's actually normal not to be dry at night until age 7.

To be dry at night, a child must have the bladder capacity to hold his pee all night long (and some kids really do have a teeny bladder). And, he must be able to wake up when the urge to pee occurs during sleep.

Most kids who still pee at night are deep sleepers who just don't have the nervous system maturity to be awakened by the feeling of needing to pee. So, if you leave your son in bed without a diaper, he will just awaken in a pool of pee. He won't be motivated by wanting to be dry or by any bribe you can offer (you have already tried that)--because it's not about lack of desire. It's about brain and body immaturity and a small bladder that can't hold it all night.

If he is 7, still wetting the bed, and really wants to be dry at night, then I recommend a bedwetting alarm (sold online for about $50--and sometimes reimbursed by health insurance) to do "behavioral training". A child can train his brain to awaken at the first sense of wetness. And after a few weeks, he'll awaken to the urge to pee. Yes, it really works for an older child who is committed to solving the problem.

For now, no caffeine and no liquids after dinner. The less he drinks, the less pee he will make at night. And, don't worry about it or punish him.

P.S. Bedwetting runs in families. But no one ever talks about it at Thanksgiving dinner.

Toilet Training tips

Reader question of the day:

Q. My 2 1/2 year old seemed like he was ready to potty train so he has been wearing underwear for the past four weeks. He was interested at first and we used a sticker chart for his successes. He's only told me once that he needs to pee and refuses to poop on the potty. Now he doesn't seem to care about getting stickers. What should we do?

You are currently being toilet trained, but unfortunately, your child isn't!  

Look at wearing underpants as a privilege for toddlers who are ready. Toilet training takes only one day--but it has to be the right day! Unfortunately, if you've been working at this for four weeks, you didn't pick the right day. For now, continuing your current regimen will only lead to frustration on your part and a sense of failure for him.

What to do? I suggest putting him back in diapers until he is developmentally ready to toilet train. Wearing diapers is not "going backwards," rather it is taking the pressure off both parent and child until it is really the right time. You will know if your child is "ready" if he is unhappy about being wet or dirty and if he is clued into the urge to go. (Toddlers will go and disappear behind the couch, into the closet, etc and poop privately. Clearly, they know what's about to come.) At that point, put him in training cotton underwear (called training pants) sold at baby specialty stores for a weekend. (I don't recommend Pull Ups or other toddler training diapers. There is very little motivation to stay dry in them.)

It doesn't sound like your son is ready, and that's okay. You can always try again in a few weeks if he shows more signs of being ready. But don't worry if he isn't--try again another time. You may have a few false alarms until the time is really right. By the way, sticker charts, candy, and other forms of bribery don't work very well. The only TRUE motivation to be potty trained is the desire to be clean--that is what will make your child stop what he is doing and take the time to go to the bathroom. 

Good luck! And don't worry...it will happen!

Binkies and breastfeeding can mix

This week actually brought health news other than H1N1 virus.

A study in this month's Archives of Pediatric and Adolescent Medicine sought to debunk a myth that's been circulating for quite some time: Pacifiers don't make a baby or mom choose to stop breastfeeding. Once again, correlation does not necessarily mean causation. Although babies who use a pacifier may breastfeed for a shorter time in their lives than those who do not use a pacifier, the pacifier itself is not the reason. Parents who choose to use a pacifier may also choose to nurse for a shorter period of time—for a variety of reasons that should be explored and addressed to improve breastfeeding rates.

After reading this study, I personally feel better and less conflicted in the advice I give to parents. I am a strong breastfeeding advocate. But, I also know that newborns have very few strategies to console themselves other than sucking. That's why the pacifier works. However, I do think breastfeeding should be well established before offering up that binkie. Babies can suckle a little differently with a pacifier vs the breast (especially if you use a brand other than Soothie), and it can cause some real discomfort to mom if that happens.

For the first couple of weeks, try letting your newborn suck on your finger to settle down. Then, you can offer a pacifier later on. If you do go the paci route, just know when to stop using it!! Your toddler has no good reason to have a pacifier—really, folks.

Pacifiers and Breastfeeding: A Systematic Review. Nina R. O’Connor, MD; Kawai O. Tanabe, MPH; Mir S. Siadaty, MD, MS; Fern R. Hauck, MD, MS Arch Pediatr Adolesc Med. 2009;163(4):378-382.

New Autism Screening recommendations

The American Academy of Pediatrics now recommends that ALL children be specifically and systematically screened for autism at their 18 month and 2 year old well checks. A questionnaire should be given to parents at both visits and reviewed by the doctor. While there is no one perfect screening test, the one being recommended by the AAP is called the "M CHAT". It is available in the public domain and we will post it on our website for you to download shortly.

The goal is to identify children at risk at an earlier age so that therapy can begin as soon as possible. Kids who have early intensive therapy clearly do better.