When a Semi-Automatic Response Won’t Do

Today’s headlines are full of news about the most recent school shooting. As a parent, this is terrifying. As a pediatrician, it’s both incredibly sad and frustrating. I’ve dedicated my life to keeping kids healthy. It’s always hard when children die: when entire communities grieve the loss of that child’s spark and potential. Sometimes it’s disease that is responsible – but much more often it is preventable accidents.

Schools should be safe places. Yet, there’ve been 74 school shootings since the horrors at Sandy Hook. As a nation, we’re averaging over a shooting per school week. During the evacuation of Reynolds High School in Troutdale, Ore., authorities found another student with a gun in the school. This gun wasn’t related to the shooting. But, one has to ask: why in the world are students bringing guns to school? And how do they get them?

In a country with our enormous resources we should all be shocked that homicide remains the second leading cause of death for all children aged 1-19, according to the American Academy of Pediatrics. Black teens are in an even more precarious place – with homicide being the leading cause of death for black kids aged 15-24.

I have no interest in politics when it comes to the safety of children, only common sense and responsibility. I have no desire to hunt, nor do I care to take away everyone’s reasonable weapons. But no one needs a massive magazine. I wish I could live in a world where the only magazine my kids had to learn about had pictures of Beyonce and Justin Bieber.  But I don’t and I have to be a realist in addition to a dreamer.

So, I have a dream.

In my dream, children are safe in their schools. Kids aren’t exposed to guns there.  There are mental health resources available to those who need them – and they are easily utilized. Every child has a pediatrician, and scheduled check-ups so that mental health issues can be detected early and treated and so that we pediatricians can help level the playing field for parental education. All kids have the same opportunities – for education, for extracurricular activities, and, yes – for food and shelter.

And I understand reality – so in our home we sometimes ask our kids (girl, 9 and boy, 6) about guns. We recently asked them again: “what would you do if you found a gun?” Our son doesn’t understand the difference fully (nor is he expected to) between play guns and serious weaponry so I worry that he would play with it… But he’d give it to his teacher (I think he has a crush on her). So that’s guns 1, parents 0 because he needs to leave it on the ground so he doesn’t blow away his class by accident… Our daughter would not touch it and would tell a grown up. She learned from our panic attack at last request when she would have thrown it away…so as highly educated and passionate individuals we’re only batting .500.

Please keep your reasonable guns locked and empty. Please talk to your kids. Please teach responsibility. And please help to create a world where we can still raise dreamers.

7 Ways to Help Your Child Learn to Read for Read Across America Day

Image via: Flickr (CC)

It’s Read Across America day, and Dr. Deb Lonzer is chiming to promote cuddling up to read a good book with your children every day.

According to the American Academy of Pediatrics (AAP), “a family routine of daily reading with young children contributes significantly to their later literacy skills and success in school. In addition, reading books with children is an interactive activity that promotes their social and emotional development”.

According to Dr. Lonzer, one of the most important ways to promote your child’s literacy is to have books in the house, whether this means many trips to the library, developing your own collection of children’s books, or perhaps both.

7 ways to help your child learn to read:

1. Run your finger under the words as you read to show your child that the print carries the story.
2. Use funny voices and animal noises. Do not be afraid to ham it up! This will help your child get excited about the story.
3. Stop to look at the pictures; ask your child to name things she sees in the pictures. Talk about how the pictures relate to the story.
4. Invite your child to join in whenever there is a repeated phrase in the text.
5. Show your child how events in the book are similar to events in your child’s life.
6. If your child asks a question, stop and answer it. The book may help your child express her thoughts and solve her own problems.
7. Keep reading to your child even after she learns to read. A child can listen and understand more difficult stories than she can read on her own. (Thanks healthychildren.org!)

Looking for a good book for your toddler or preschooler? Have you checked out Dr. Lonzer’s book, The Flushville Four? Your kids will love the characters; the illustrations will win you over; and your kid just might start to show an interest in using that potty!

3 ways #2 can derail your potty training efforts

Usually your child’s first potty training successes will be urination. It can take some time for a child to be mature and focused enough to sit on her potty chair to poop. In today’s blog, Dr. Deb Lonzer discusses a number of ways that #2 can derail your toilet training process.

What’s the big deal about #2?

Image courtesy of Abby Batchelder (Flickr CC)

1. Some tots feel that the poop is a part of them and worry about what happens to it when you flush it. You can reduce this anxiety by showing them that everyone poops – the family pet, birds, you – and that we all move on. Allowing them to control the flush valve can also make it more fun and help them to feel in more control. If your child poops in her pants, take her to the bathroom with you and let her flush the poop.
2. When was the last time your toddler sat still for 2 minutes? Sitting on the potty takes time – and most kids don’t have the concentration necessary to do it. Dr. Lonzer recommends reading to your child (have you purchased your own copy of The Flushville Four yet?). You can also allow your child to sit on the potty while watching a short DVD.
3. Withholding poop is common during potty training. As children attempt to “hold it,” and they sometimes develop a fear of letting it go.

Has it been days since your child’s last poop? Here are some ways to help reduce constipation.

• Increase the amount of fiber she eats. Make sure you’re serving enough fruits and vegetables, and whole grains bread and cereal.
• Increase her water intake.
• Increase her activity levels.
• Try to reduce the stress you may be placing on your child around potty training.
• Limit foods that can be constipating, like rice, dairy, peanut butter, and cooked carrots.

If these things don’t help, or if you are worried about your child’s health, Dr. Lonzer recommends calling your friendly pediatrician.

Should we make kids apologize?

Apologies are important right?

We’ve all been there. You’re at the grocery store with your three year-old who is feeling VERY excited and independent as she pushes her mini-cart at top speed through the produce section. You’re getting whiplash, trying to keep an eye on her and select bananas. Inevitably, your beloved devil crashes into someone. You want to keep walking, pretending she’s not yours. But instead, you do one of two things: 1) you apologize to the injured party for your daughter; or 2) you make your daughter apologize.

What’s wrong with that? You want you daughter to grow up to be polite and empathic. So you force her to make apologies.

But, if your daughter is NOT sorry, you are actually teaching her that words matter more than emotions. You are teaching her that lying (saying she’s sorry) is OK if the end (mom lets me keep pushing the cart) justifies the means (having to speak to a stranger who got in my way). This is a difficult situation, because apologizing for your kids comes with it’s own disadvantages. Toddlers learn best by imitating their parents and through positive reinforcement. So, the next time you accidentally bump into someone in the store, apologize. Every time you do something for which you are sincerely sorry, apologize. Let your child see that this is how you handle situations in which you hurt someone, even if it is embarrassing. And, if you catch your daughter apologizing with sincerity, talk about how proud you are of her as you walk away from the poor unsuspecting shopper she just bruised.

For school-aged kids, positive reinforcement works better than negative reinforcement. You should talk to them about what is important, about your family values, when it’s not embarrassing (i.e., NOT when they bump into someone at the store, but when you have their attention at the family dinner table). Then, positively reinforce their polite and empathic behavior anytime they do it spontaneously. This teaches them that apologizing was an appropriate response, and that apologizing can sometime lower the significance of the transgression.

So, what about encouraging your kids to say please and thank you? These manners can be mandated because they are more about social acceptability and don’t imply potentially false emotion. Again, though, unless you want to sound like a broken record for the next 16 years, teaching social behaviors by modeling – with some reinforcement – is the way to go!

Potty training setbacks

Potty training setbacks happen to the best parents. In fact, I’ve never counseled a parent who did not witness a period of stubborn tantrums during the potty training process. Like most processes or transitions, progress is rarely a smooth ride. Sometimes the potty train goes in reverse a little and then goes forward again; sometimes it even jumps the tracks a bit.

• Fears are a common part of the process.  Parents have the most trouble understanding the fear of flushing.  Your child may be convinced that part of her is flushing away.  She may be afraid of the noise.  If she has any fears, flush while she’s in the room with you, watching.  Let her see the water swirl.  Drop some food coloring in and let her see the colors swirl.  Also remember her fear of failure and her fear of disappointing you – let her know you’re proud of her efforts and don’t show negative emotions.
• Kids will sometimes use the potty erratically, having enormous success and then tremendous failure.  This should be expected.  If she doesn’t seem to be able to progress over a few months, talk with your pediatrician.
• Withholding poop is common during potty training.  Eating lots of fiber, fruits and vegetables and drinking lots of water with some juice will help to make poop soft and easy to pass.
• Some kids also withhold pee.  This is usually less of a problem except that it can cause accidents and wet underpants.
• What if, after all your hard work, your child refuses to use the potty?  Screaming and tearing our hair out is not your only option, and it won’t help.  Walk out of the room and collect yourself. It’s important to keep your cool or your child may become fearful and there shouldn’t be fear associated with going potty.  Be sure to think about something besides your child’s pee and poo after she goes to bed at night.
• Kids have tantrums and refuse to do things because they want attention and they want to be in control.  Deal with his tantrums the same way you would in any other circumstance; but this may mean that he is not mature enough to move forward.
• If your child doesn’t seem to be moving along, help her make baby steps – let her keep her diaper on but teach her to pee or poop in the bathroom.  Then she can pee or poop on the potty – but still keep her diaper on.  Next, she can sit on the potty without a diaper but she doesn’t have to do anything but sit and play or you can read to her.  Finally she can try to pee or poop while she sits on the potty.  Take as long as your child needs at each step and let her sit on the potty as long as she needs to try to pee or poop.
• If things are going very slowly or are on and off, maybe you need to break the training process into smaller steps.  If kids withhold or refuse to use the potty, it’s probably normal – and is pretty common during the process.  Changing your rewards and your expectations may get things back on track.

Potty training success: Reinforcing potty wins

What do you do when you have potty training success?

You’ve been placing your tot on the potty chair every two hours religiously. Or, you’ve been rushing him to the potty every time he starts to get that glazed look in his eyes. Finally – and it will happen – you hear a few dribbles. You are so proud and relieved you practically jump out of your skin. How do you convey your feelings in a way that will reinforce this potty success? Do you dole out M&Ms? Stickers? Hugs? Do you take your kid to Target and let her pick a toy? Before you go overboard with a pony or a trip to Disney, let’s talk about rewards that you can use consistently throughout the potty training process. (And, yes, that’s right. You’re not done training just as soon as you hear the first tinkle.)

As your child starts to get it exactly on the mark some times, challenge her with phrases like, “good job – soon you’ll do it every time.”   A smile from you is a big reward and she will remember what made you happy and try to do it over and over.  Some other examples of appropriate rewards include: stickers, quality time with mommy, story-time with daddy, etc.

To help the process continue to move forward, associate big girl efforts and achievements with big girl rewards.  Think along the line of: “Big girls get to play with dolls and big girls use the potty so, if you use the potty you can play with your favorite dolls”.   Or “some of your friends are wearing big boy pants – if you use the potty you can pick out some great big boy pants too”.

Avoid the trap of providing a reward for every effort – kids are very good at working the system, and before you know it they’re not willing to do anything unless they get a prize.

Not another accident! When there are accidents – and there will be – don’t get upset and create guilt or fear in your child.  Grit your teeth if you have to, but tell her she’ll “do better next time.” This gives her a goal to work toward and she’ll continue to look for achievements.  Keep a neutral expression on your face – you don’t want to smile and reinforce the behavior so she continues to do exactly the same thing time after time, and you don’t want to scowl and have her think she was bad so she’s afraid to try again…you’re Switzerland…be neutral.

Sledding: Keep your kids safe on the slopes

I’m not sure what winter has been like in your neck of the woods, but in Cleveland, it’s been so bitterly cold that we’ve been hibernating in our house for weeks. The natives are getting restless here. We’re ready to layer up, and wander outside to feel the fresh air on our faces. With Groundhog Day this weekend, we could be facing another six weeks of winter, and many more mornings at the sledding hill.

Just how safe is sledding? It’s important to remember that there are risks for just about every game our children play. In the United States, there are approximately 20,000 sledding-related emergency department visits per year. Of those visits, about 25% are to treat cuts and bruises, 25% are for fractures, and 33% of them are head injuries. The head injuries are the most concerning, with 70 percent of these children being admitted to the Intensive Care Unit. Almost half of these injuries are sustained by children aged 10-14. Boys account for sixty percent of injuries. Half of ER visits are the result of collisions, mostly with trees or other sleds, sometimes with motor vehicles.

There are safer ways to sled.

• Make sure your kids ride steerable sleds.
• They should only go down hills feet first.
• Avoid areas with trees, crowds, streams, streets, fences, and drop-offs.
• Watch for signs of frostbite and hypothermia.
• Younger children should wear one additional layer of clothing than you would yourself.
• Make sure the slopes aren’t more than 30 degrees.
  Don’t forget the sunscreen, even on cloudy days.
• The American Association of Pediatrics recommends wearing helmets while sledding.

In December I was interviewed by The Weather Channel. Here’s the behind-the-scenes video my PR rep took: 

Introducing the potty to your toddler

The time has finally come. Maybe your child cues you before he wets his diaper, or hides behind a couch to poop. Maybe your toddler begs for “big girl” pants every time you visit the store. Maybe you are just sick and tired of changing diapers and lugging around a 30-pound diaper bag. Whatever your reasons, here are a few things to keep in mind as you introduce your child to potty concepts:

• Take her with you to pick out her new potty equipment – and then talk up her big girl potty and how much fun it will be to use it.
• Use easy consistent terms like pee, poop and potty.
• Use appropriate terms for body parts  – this is uncomfortable for many people, so everyone is a little different – using the term privates or pee pee or butt are fine for most people; others use more anatomically correct terms – find your comfort zone and run with it.
• Dress your child in simple clothes that she can take off herself or with little help; avoid one-piece outfits like overalls.
• Flush the toilet regularly within earshot of your child so she is not frightened by the noise.
• Set a routine for sitting on the potty.  A good time to do it is after the child wakes with a dry diaper – there’s got to be some wee-wee in there and just sitting on the potty may help her pee.  Meals help to make us feel like we need to poop – particularly breakfast and dinner – so have her sit on the potty for 5-10 minutes after meals.
• Let her sit on the potty during normal daily activities like playing – or watching a short DVD or reading a book (I highly recommend The Flushville Four).  This helps to reinforce how safe and normal the potty is.
• An open door policy for the family bathroom is great, but be careful if there are older siblings at home – they may not be comfortable with the door open so respect their privacy also.
• If your family has pets, let your child see your pet doing “its business” to reinforce that everyone pees and poops.
• After your child poops in a diaper, bring her with you as you carry it into the bathroom, and let her watch you empty the diaper into the potty because that’s where it belongs – and have some enthusiasm as you do it – kids are generally very excited that they make poop!

As your child has more success, give her more autonomy – within boundaries that you set up.

Think of three stages to get to your final goal:

1. When you see the signs that she needs to use the potty say,  “I think you need to potty – you should go to the bathroom”.  Go in and help her undress and use the potty.
2. After she’s done that a few times, then when you see the signs say, “Time to go in the bathroom and get undressed so you can use the potty”.  Go in after she undresses and help her use the potty.
3. After she’s good with that, when you see the signs say,  “Go in the bathroom, get undressed and sit on the potty and I’ll be right in”.   Help her wipe when she’s done and then help her get dressed again.

Potty training: What supplies do we need?

Now it gets really interesting…well, as interesting as the potty can get…

Companies spend a lot of time and money marketing various gadgets sure to potty train your child. You can buy princess thrones, animal shaped chairs, portable seats you can carry with you at all times, and even a mini-urinal for training boys.

What do you need to have at home? 

Image courtesy of: Jenny Cu

A toddler seat on a toilet can work well and feel safe, but it can be harder to get up on so make sure you have a step for it.  Many kids do better with their own potty chair but they are a little less portable. Whichever you decide to use, let your child help pick out the potty or the step to climb up. Help her decorate it in her own way so it feels like hers.  Remember that the potty chair is not a toy so it’s best to not let her play with it – but it should be fun and she should feel like it’s hers.

You may find that your child can use both a toddler seat and a potty chair so you can have one at home and take one with you.  But, at least at the beginning, most kids do best when things are consistent – so, whenever you can, use the same equipment at home and at daycare. You can have a toddler seat in every bathroom at home if it’s feasible – and if you use a potty chair you can move it into any room you want.  Any time you’re going on a trip for 2hrs or more, take your potty with you – it helps things feel safe when the need comes and you’re not at home.

Should my son sit or stand?

If you’re planning to train your boy to pee standing up it’s a good idea to use a potty chair to make it easier. Boys don’t need to stand in the beginning and it’s actually a little tougher on the poor guy to do it that way – plus he may think that if standing is good enough for peeing it’s good enough for pooping, if you know what I mean… So think about letting him learn sitting – then he pees and poops exactly the same way.  He can stand as he gets more experience and imitates the older boys or men in the family.  As he starts standing for peeing, give him a little challenge and put a target – like some cheerios – in the bowl for him to aim at so your bathroom stays more sanitary.  Girls may also want to try standing to pee – if you can handle it, put down a drop cloth and let her try – she’ll see pretty quickly why it’s a bad idea for her.

What about toiletries?

There is no compete agreement on training pants – it’s certainly reasonable for nighttime or when you will be away from a potty for any period of time, but some experts think it may slow the overall potty training process because kids can feel like it’s ok to just go in their pants while they’re up and active.

Toilet paper can be as cool for kids as it is for cats and dogs – so teach them from the start that a little can go a long way!

And having wipes is a good idea, but there is no substitute for washing hands after using the potty!

Potty Training: In 4 phases

Image courtesy of: Jay Ryness

If you think about how kids’ brains work, the best time to potty train is between 18 months and 3 years – and most people start around 2 years old.  Regardless of what you may hear, the body is not able to control bowel or bladder function under 12 months of age.

Boys may train slightly later than girls, but there isn’t a good reason for that.

If kids are interested and enthusiastic and they want to use the potty all the time, let them!  Otherwise, asking them to use it more than three times a day is not recommended until they’re closer to 2 1/2 years old.

Some superstars can complete potty training in just a week or two, but you should plan about 3-6 months for your child to be able to both pee and poop on the potty.

It takes about a year to be dry at night – but it can take much longer, particularly in boys…don’t panic when you hear this, but some kids still wet the bed into the teen years…not all, but some…

What makes KIDS want to potty train?

So, we’re talking about a big process here – why don’t we just make it easy and stay in diapers all our lives?  Well, I can think of some obvious reasons that I’m happy to be out of diapers…but why do kids want to potty train?

• They generally want to get out of diapers – diapers are bulky and less fun than big girl pants.
• They want privacy and autonomy – the most talented 2 year old can’t change his own diaper, but he can use a potty well.
• And, of course, regardless of how they feel when they hit the teenage years, all kids at this age want to be just like a parent or older sibling.

So help them to capitalize on their desire to go more places and have more fun – all the while being able to have more control over themselves and the privacy of using the bathroom.

And why do parents want potty-trained kids?

Your friends can finally give their potty advice to someone else!

And:

• Diapers are not cheap.
• It’s easier to take care of kids in underwear.
• Kids in underwear are less likely to spread some minor illnesses to everyone else in the family.
• And, if you use them, some preschools don’t allow diapered children.

So, how do you know exactly when to start potty training?  You can just set a date and run with it, like the day after her second birthday…or you can watch for her to give you signs that it’s time to start – maybe earlier, maybe later than her second birthday.

Here are some of those signs to watch for:

• Imitation – she wants to do what others do at home, including vacuuming and mowing the lawn – if only it could last…
• Learning to put things away – like toys.
• Excitement when you to notice what she’s doing well – keep giving her simple tasks to build her internal pride and self-confidence.
• Independence – like playing on her own, brushing her teeth, feeding herself.
• Curiosity about what happens in the bathroom and about wearing underwear.  And even about her private parts… quick diversion: this may pain you to hear, but remember that it is not harmful or bad for children to touch and be curious about their ‘privates’.  Kids should be allowed to experiment with their own bodies as long as it’s in the privacy of a bathroom or bedroom; and, obviously, teach them from the start that they should never touch others or allow others to touch them.

4 Phases of Potty Training

We’re so close to starting the process of potty training now.  But kids are not necessarily able to do it all immediately – there are actually four phases of potty ability.  For some kids these all occur almost at the same time, for others they are spread over weeks or months, and for some the order of the phases is different.  But in general, these are the phases of preparation for potty training that you’ll see.

Phase 1 is when he lets you know after he peed or pooped.  Depending on age, this can be verbal: “wet”, “diaper dirty” or non-verbal, like squirming in a dirty diaper or pulling off a wet diaper.

This signals go-time for the actual training process.  Get the potty chair out if you haven’t already – that allows him to see it as a part of every day life.  Make nonjudgmental comments that set the stage for him.  Here’s an example: Remove his wet or soiled diaper.  Praise him for how nice he looks and smells without a messy diaper.

Phase 2 is when he gives you signals that he is about to go.  Watch for squatting, going behind the couch or turning red in the face.

When you see these things, give him a chance to use the potty.  For example,  “It looks like my big boy has to use the potty – let’s go sit on the potty!”  Be excited when you lead him to the potty – use excited body language, smile, use your voice to let him know you’re excited.  Afterwards, give him a hug or a sticker even if he doesn’t exactly poop or pee – start right from the beginning to help him see that this is a positive process and it’s all good as long as he’s trying.

Phase 3 is when he wakes up dry after a short nap – bladder control is right around the corner.

Phase 4 is regular spacing of bowel movements at similar times each day.