While toilet training is an important milestone in the early childhood years, it can also be a confusing time, filled with plenty of questions. For example, you may wonder, when is the right time to toilet train my child? How do I know if he or she is ready? How long will it take? What are the best methods to use? 

The first and most important thing to realize about toilet training is that no two children are exactly alike, and only you should decide what’s best for your child and your family. To make that decision a little easier, here are some basic guidelines and answers to frequently asked questions:

Is your child ready?

In general, most children are physiologically ready for toilet training in terms of digestive system and bladder maturity around 18 months of age, but may not be mentally or emotionally ready until well after their second birthday. According to the American Academy of Pediatrics, some early signs of readiness for toilet training include:

• Your child stays dry for at least two hours at a time or wakes up dry after naps.
• You can tell when your child is about to urinate or have a bowel movement because of his/her facial expressions, squatting or posture, or your child is verbally able to tell you.
• Your child can follow simple instructions, including walking to the bathroom and helping undress.
• Your child asks to use the potty or asks to wear “big-kid” underwear.
• Your child seems uncomfortable with a soiled or wet diaper and asks to be changed.

Your child seems ready, so what’s next?

As most parents realize, simply obtaining a potty chair is not enough, but it is an important first step. Make this a special event for your child.

• Take him/her with you to buy a potty. Explain to him/her what a potty chair is used for and let him/her help choose which one to buy.
• Once you have brought the chair home and set it up, write your child’s name on it. Let your child play with it and make it his/her own.
• When he/she has become familiar with the potty, keep in mind that it will take frequent reinforcement and reminders to help your child understand what it is actually used for.
• Remind your child that the potty is where he or she goes to the bathroom. Encourage him/her to sit on the potty while fully clothed.
• If you see straining or squatting, or other signs your child might be having a bowel movement, persuade him/her to do so while sitting on the potty in a diaper. Then you can remove the diaper and let the child “help” you move the stool into the potty. This will help reinforce the association between the potty and elimination.
• Switch from diapers to underwear. Allow your child to participate in this step by having him/her pick out the underwear at the store.
• Make sure that your child is wearing clothing that’s easy to take off when he/she does need to use the potty. Avoid dressing your child in overalls and complicated buttons, zippers, belts or tights.
• Praise your child every time he/she is successful in using the potty. A small reward, such as a sticker, can be a useful tool. If your child has an accident, do not use negative reinforcement or punishment.

A few words about accidents

Accidents are a normal and expected part of potty training, so it’s always a good idea to be prepared. For the first few months after potty training is complete, bring along diapers, wipes and a change of clothing to any outings with your child. If your child has an accident, help him/her understand what to do differently next time, and remember that the best way to respond is with support and encouragement. Quickly help your child change into dry clothing, and let him/her know that whenever he/she needs to go, it’s okay to tell an adult right away.

To learn more

As always, please don’t hesitate to ask your health care provider about potty training.  We’re always happy to help. Here are some additional books/resources that might also be of benefit to you and your child:

For children

• Once Upon a Potty by Alona Frankel, Harper Collins, 1999
• Everyone Poops by Gomi Taro, Kane Miller Book Publishers, 1993
• Flush the Potty by Ken Wison-Max and Liza Baker, Cartwheel Books, 2000

 For parents

• Guide to Toilet Training by Mark L. Wolraich with Sherrill Tippins, Bantam Publishing with the American Academy of Pediatrics, 2003

American Academy of Pediatrics Web site: www.aap.org

Playing sports can be a big part of a child’s life.  Sports help kids stay active and fit and can boost self-esteem.  While all sports have a risk of injury, proper preparation can help to limit that risk.  Some ways to reduce injuries include:

• Wear gear that is appropriate for the sport and that fits properly.  This includes pads like soccer shin guards and football shoulder pads, chest and leg protection for catchers, helmets for football and batting, mouthpieces and face guards and protective cups and eyewear.
• Strengthen muscles – conditioning exercises before games and during practice strengthens muscles used in play.
• Increase flexibility – stretching exercises before and after games and practice can increase flexibility.
• Use the proper technique – learning basic skills and techniques should be more important than winning and should be reinforced during the playing season.
• Take breaks – rest periods during practices and games allow the body to recuperate and can reduce the risk of injury.
• Play safe – rules against actions that can cause injury such as headfirst sliding in baseball and softball, spearing in football, and body checking in ice hockey should be strictly enforced.
• Listen to your body – stop if there is any pain. 
• Avoid heat injury – drink plenty of liquids before, during, and after exercise; wear light clothing; decrease or stop activities if the heat or humidity is high.

Sports related injury can be caused by trauma or by overuse.  An overuse injury, like a stress fracture or tendonitis, usually occurs from repetitive motions without enough rest to allow for healing.  They can occur from overdoing a single motion, such as “pitcher’s elbow” tendonitis caused by too many pitches without enough rest and from too many activities using the same joint, such as a shoulder injury in someone who plays volleyball, softball and swims.  The most common sign of an overuse injury is pain – after a practice or game, during the activity (whether or not the athlete can still play) or constant or chronic pain, even when not playing.  Treatment of overuse injuries generally requires rest and some physical therapy as well as adjustments in training techniques and limited repetitions of the overused motion.  Overuse injuries can be prevented by stopping at the first sign of pain and by avoiding over training.  The best way to prevent over training is to monitor the amount of time spent doing an activity.  Limit sports to one per season and limit training to no more than five days per week.  Encourage varying training exercises from day to day, such as formal skills training one day and general conditioning the next.

Injuries can involve soft tissue and or bones.  Soft tissue injuries can be strains, sprains, or contusions.  A strain is when a muscle or tendon is stretched or torn.  A sprain involves a ligament and occurs when a joint is forced beyond its normal motion.  A contusion is a bruise within a muscle.  Bleeding inside the muscle can lead to swelling, pain, spasm, and restricted movement.  An injured bone can be bruised or broken.

Any joint can be sprained; ankle and finger sprains are common.  Signs that a joint may be sprained include pain, swelling around the joint and being unable to move the joint.  A broken bone can have the same symptoms, and an x-ray is often ordered to look at the bones.  Rest, ice on the injured site and elevation of the injured area to help prevent swelling can be started right after any injury.  After an x-ray is done to look at the injured area, a more targeted treatment can be started.  A fractured bone or a complete tearing of a ligament may require a referral to a specialist for casting and further treatment.  If the x-ray does not show a fracture, a sprain needs protection and immobilization.  An uninjured finger can be used to splint the injured finger by “buddy taping” them together.  An injured ankle can be wrapped with an elastic bandage or splinted.  After a week or two, once the joint is no longer painful or tender, stretching and resistance exercises can be done to loosen the joint, strengthen the surrounding muscles, and restore function.

Sports learned in childhood can become life-long activities.  Proper training and preparation can limit injuries and maximize fun.

Sources: www.healthychildren.org

Tooth decay, also known as early childhood caries, is the most common chronic children’s disease in the country and the number one dental problem among preschoolers. The Centers for Disease Control and Prevention (CDC) has stated that dental caries is five times more common than asthma and seven times more common than hay fever in children. The good news is that tooth decay is a disease that is mostly preventable. Good tooth care can keep cavities from happening in your child

Tooth decay starts to develop when a child’s teeth and gums are exposed to any liquids or foods for long periods of time. Cavities are holes in teeth that are formed when certain bad bacteria in your mouth use the sugar in food to make acid. This acid eats away at the enamel covering of the teeth and causes holes.  The more sugar on your child’s teeth, the more bad bacteria, the more acid, the more cavities.

Your child might be at risk for cavities if he or she eats a lot of sugary foods (such as raisins, cookies and candy) and drinks a lot of sweet liquids (such as fruit juice and punch, soda and sweetened drinks).  Your baby or young child is especially at risk for cavities if they go to bed with a bottle or if they carry a bottle or sippy-cup of juice or milk around during the day.  Your child also might be at risk if he or she was born early or very small, has special health care needs, has white or brown spots on their teeth, has a primary caregiver who has a history of many cavities or “soft teeth”, or do not go to the dentist very often.

An ounce of prevention is worth a lifetime of smiles.

Fluoride is an important part of your child’s dental health.  Fluoride is a naturally occurring mineral that is often added to the tap water. Fluoride helps make teeth strong by hardening the tooth enamel and preventing tooth decay. If you live in an area where the tap water doesn’t contain fluoride, or your family uses well water, or you drink un-fluoridated bottled water, your health care provider may prescribe daily fluoride supplements.  Only give as much as the directions say to use, because too much fluoride can cause spots on your child’s teeth.

Prevent Tooth Decay:

Feed your child healthy food. Healthy eating habits lead to healthy teeth.  Choose drinks and foods that do not have a lot of sugar in them. Sweets (candy or cookies), starchy foods (crackers) and sticky foods (fruit roll-ups, fruit-snacks or raisins) stay in the mouth longer, so they can easily cause tooth decay. If your child wants a snack between meals, give your child fresh fruits and vegetables instead of candy and cookies.  Be careful with dried fruits, such as raisins, since they easily stick to the grooves of the teeth and can cause cavities if not thoroughly brushed off the teeth.

Baby-bottle tooth decay:

Babies who go to bed with a bottle of milk, formula or juice are more likely to get tooth decay. Teeth can decay quickly because the sugar in formula, milk or juice stays in contact with the teeth for a long time during the night.  Because dental caries is a complex disease, the current preferred term for baby-bottle tooth decay is Early Childhood Caries.

Tips to avoid Early Childhood Caries:

Never put your child to bed with a bottle or food. Not only does this expose your child’s teeth to sugars, it can also put your child at risk for ear infections and choking.  If you do put your child to bed with a bottle, only fill their bottle with plain water, not milk or juice.  Again, this is not recommended.

Stop nursing when your child is asleep or has stopped sucking on the bottle.

Do not to let your child to use a bottle of milk or juice as a pacifier.

Start to teach your child to drink from a sippy-cup at about 6 months of age. Plan to stop using a bottle by 12 to 14 months at the latest.

A teeth owner’s guide

Check and Clean Your Baby’s Teeth:

Healthy teeth should be all one color. If you see spots or stains on the teeth, take your baby to your dentist.  Baby teeth are important.  As soon as a baby’s first teeth appear—usually by age six months or so—the child is susceptible to decay. It’s important to care for your child’s baby teeth because they act as “placeholders” for adult teeth. If baby teeth are lost too early, the teeth that are left may move and not leave any room for the adult teeth to come in. Children with dental caries in their baby teeth are at much greater risk for cavities in their adult teeth.  Tooth decay in baby teeth can be painful and cause health problems like infections, which can at times be life threatening. It can also lead to teasing and speech development problems. 

Establish good oral health habits early:

Start children with good dental habits before the first tooth appears.  After feedings, gently brush your baby’s gums using water on a baby toothbrush that has soft bristles. Or wipe them with a clean washcloth.

Brush ‘em if you got ’em:

Clean your child’s teeth as soon as they come in, using a clean, soft cloth or by gently brushing the gums and teeth with water and a soft infant toothbrush. Clean the teeth at least twice a day. It’s best to clean them right after breakfast and before bedtime. Once your baby has 8 teeth, you can start using a child-sized toothbrush for daily cleanings.  At about age 2, most of your child’s teeth will be in. Once your child can spit and not swallow the toothpaste, begin using fluoride toothpaste. Use a pea-sized amount of toothpaste and push it into the bristles of the toothbrush with your finger before brushing your child’s teeth.  This will limit the amount she can accidentally swallow. As your child gets older let her use her own toothbrush. It is best if you put the toothpaste on the toothbrush until your child is about age 6. Until children are 7 or 8 years old, you will need to help them brush. Try brushing their teeth first and then letting them finish. Be sure that you spread the toothpaste into the bristles of the brush and use only a pea-sized amount of toothpaste.  Flossing is also a good habit to get your child into.

Cavities are unfortunately common in children.  Learn good habits that you can do prevent problems in your child.  Don’t use a bottle to put your child to bed.

It’s okay to let your child drink water, but set limits on when your child can have other kinds of drinks.  Look at your child’s teeth for discoloration so you can find cavities early.  Find a dentist when your child turns one. This gives the dentist a chance to look for early tooth problems and to talk to you about how to care for your baby’s teeth. It also helps your child feel okay in the dentist’s office. 

Be a good role model – eat healthy foods – including snacks, don’t drink sugary drinks, brush at least twice a day, floss, and go to the dentist twice a year. 

Sources

American Academy of Pediatrics; First Steps to a Healthy Smile (Copyright © 2008)
American Academy of Pediatrics; HealthyChildren.org; Healthy Children Magazine, Winter 2007
American Dental Association: www.ada.org/public/topics/decay_childhood.asp
American Family Physician; Taking Care of Your Child’s Teeth, www.familydoctor.org
National Maternal and Child Oral Health Resource Center; Facts on Early
Childhood Caries (ECC) (2nd ed.)© 2004 by the Center,Georgetown University. www.mchoralhealth.org

“Mommy, I don’t feel well.  I think I’m going to throw up.”

Most children will go through at least one episode of vomiting and diarrhea.  Health professionals call these illnesses gastroenteritis, or “gastro”.  The most common causes of gastro are viruses.  Although it is often called “the flu”, influenza doesn’t cause just vomiting and diarrhea and the flu vaccine will not prevent it. 

Rotaviruses are the most common cause of severe diarrhea in children under 2 years old.  Fortunately, there is a very effective vaccine that protects children from getting extremely sick if they do get the virus.  Most children receive three doses of the vaccine by their 6-month check-up.  While it doesn’t prevent infection entirely, it lessens the amount of diarrhea and the length of the illness.  Before the vaccine was available, many infants and toddlers needed to be admitted to the hospital because of dehydration.  The vaccine has made these admissions much less common.  Rotavirus is most common from November to March.

Another family of viruses, the Astroviruses, infects mostly infants and children younger than 4 years old.  These illnesses occur most often in the winter.

Caliciviruses are a third family of viruses that cause gastro in both children and adults.  Among these is the Norwalk-like virus or norovirus.  These viruses cause problems year-round.  They are often spread from person to person.

Most cases of viral gastro are not serious, but your child may feel very sick.  In addition to vomiting and diarrhea, your child may have a fever, abdominal pain, headache, muscle aches and just generally feel tired and irritable.  Depending on the cause, these symptoms start 1 to 4 days after catching the virus and can last up to 14 days.

The diagnosis is usually made by the symptoms of the illness and by examining the child.  Most viral gastro will improve without treatment; antibiotics don’t help and may even make the diarrhea worse. 

The most important thing to do is keep your child hydrated and as comfortable as possible while the immune system takes care of the virus.  Encourage your child to rest. 

If your child is vomiting, allow her stomach to rest by not giving anything to eat or drink for two to three hours after the last episode of vomiting.  Then offer 1 ounce of an oral rehydration solution like Pedialyte every half hour for 2 hours.  If there is no further vomiting, increase to 2 ounces every half hour for another hour.  After that, small amounts of clear liquids like Popsicles and Jell-O can be offered.  After 12 to 24 hours, small amounts of solid foods may be given.  If at any time vomiting reoccurs, go back to resting the stomach and try again in two to three hours.

If your child has diarrhea but is not vomiting, encourage her to drink lots of fluids, including some oral rehydration solution like Pedialyte.  Your child can continue to eat her regular diet, but be careful of juices that can increase the diarrhea.  Using a barrier cream like Desitin if your child is in diapers can prevent diaper rash.

The most serious complication of gastro is dehydration.  Signs of dehydration include: increased thirst, less urine, dry mouth, fewer tears, less playful, sunken soft spot in an infant and sunken eyes.  Call your pediatrician if you suspect your child is dehydrated, continues to vomit for over 24 hours, has severe abdominal pain, refuses to eat or drink, has a fever over 102 degrees F, is excessively sleepy, if you see blood in the stool or vomit or if you have other concerns.

Sources:  www.aap.org, www.healthychildren.org