Bed Wetting
Bed-wetting is normal and very common among preschoolers, affecting 40 percent of children at age three. It is much less frequent in school-age children, occurring in 20 percent of five-year-olds, 10 percent of six-year-olds, and 3 percent of twelve-year-olds. Thus, during the middle years of childhood, parents may want to seek the assistance of their pediatrician in an effort to reduce or eliminate bed-wetting, or enuresis.
For a child to remain dry at night, her brain must keep a full bladder from emptying. Or a signal from the bladder must be strong enough to awaken the child from sleep and send her to the toilet. It is a complex neurodevelopmental process for the bladder to send the signal, for the brain to receive it, and for the child to respond by awakening and using the toilet.
There are many theories about the causes of bed-wetting. Many parents fear that a disease is causing the difficulty. However, no more than 1 percent of cases actually are related to physical diseases such as kidney or bladder infections, diabetes, or congenital defects of the urinary sys-tem. In these instances the child also generally experiences changes in the frequency and volume of daytime urination, or discomfort associated with urination.
In the majority of cases of bed-wetting, however, the cause is simply delayed maturation of bladder control mecha¬nisms, often related to the child’s genetic background. These children are physically and psychologically normal…
Constipation
Bowel patterns vary in children just as they do in adults. Because of this, it is sometimes difficult to tell if your child is truly constipated. One child may go two or three days without a bowel movement and still not be constipated, while another might have relatively frequent bowel movements but have difficulty passing the stool. Or a child’s constipation may go unnoticed if he passes a small stool each day, while a buildup of stool develops in his colon. In general, it is best to watch for the following signals if you suspect constipation.
- In a newborn, firm stools less than once a day, though this can be normal in some exclusively breastfed infants
- In an older child, stools that are hard and compact, with three or four days between bowel movements
- At any age, stools that are large, hard and dry, and associated with painful bowel movements
- Episodes of abdominal pain relieved after having a large bowel movement
- Blood in or on the outside of the stools
- Soiling between bowel movements…
Dental Care
Healthy mouth and teeth are an important part of a child’s wellness. Adding a dental professional as a resource to your support system can provide ongoing peace of mind for your entire family…
Car Seats
One of the most important jobs you have as a parent is keeping your child safe when riding in a vehicle. Each year thousands of young children are killed or injured in car crashes. Proper use of car seats helps keep children safe. But with so many different car seats on the market, it’s no wonder many parents find this overwhelming.
The type of seat your child needs depends on several things, including your child’s age, size and the type of vehicle you have. Read on for more information from the American Academy of Pediatrics (AAP) about choosing the most appropriate car seat for your child.
Note: The “Types of car seats at a glance” chart is a quick guide on where to start your search. It’s important to continue reading more about the features and how to use your car seat. Additional safety tips are at the end of this article.
| Age Group | Type of Seat | General Guidelines |
|---|---|---|
| Infants / Toddlers | Rear-facing only seats and rear-facing convertible seats | All infants and toddlers should ride in a Rear-Facing Car Seat until they are 2 years of age or until they reach the highest weight or height allowed by their car seat’s manufacturer. |
| Toddlers / preschoolers | Convertible seats and forward-facing seats with harness | Any child 2 years or older who has outgrown the rear-facing weight or height limit for their car seat, should use a Forward-Facing Car Seat with a harness for as long as possible, up to the highest weight or height allowed their car seat’s manufacturer. This also applies to any child younger than 2 years who has outgrown the rear-facing weight or height limit of their seat. |
| School-aged children | Booster seats | All children whose weight or height is above the forward-facing limit for their car seat should use a Belt-Positioning Booster Seat until the vehicle seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age. |
| Older children | Seat belts | All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection… |
Feeding Your Infant
Breastmilk or formula should be your child’s sole nutritional source for about the first six months, and the major source of nutrition throughout the first twelve months. During this time, you and your pediatrician will need to pay attention to her pattern of feedings and make sure that she’s getting enough for growth…
Colds / URI
Your child probably will have more colds, or upper respiratory infections, than any other illness. In the first two years of life alone, most youngsters have eight to ten colds. And if your child is in child care, or if there are older school-age children in your house, she may have even more, since colds spread easily among children who are in close contact with one another. That’s the bad news, but there is some good news, too: Most colds go away by themselves and do not lead to anything worse.
How Colds Spread
Colds are caused by viruses, which are extremely small infectious organisms (much smaller than bacteria). A sneeze or a cough may directly transfer a virus from one person to another. The virus also may be spread indirectly, in the following manner.
- A child or adult infected with the virus will, in coughing, sneezing, or touching her nose, transfer some of the virus particles onto her hand.
- She then touches the hand of a healthy person.
- This healthy person touches her newly contaminated hand to her own nose, thus introducing the infectious agent to a place where it can multiply and grow—the nose or throat. Symptoms of a cold soon develop.
- The cycle then repeats itself, with the virus being transferred from this newly infected child or adult to the next susceptible one, and so on.
Signs and Symptoms of a Cold
Once the virus is present and multiplying, your child will develop the familiar symptoms and signs:
- Runny nose (first, a clear discharge; later, a thicker, often colored one)
- Sneezing
- Mild fever (101–102 degrees Fahrenheit [38.3–38.9 degrees Celsius]), particularly in the evening
- Decreased appetite
- Sore throat and, perhaps, difficulty swallowing
- Cough
- On-and-off irritability
- Slightly swollen glands
- Pus on the tonsils, especially in children three years and older, may indicate a strep infection.
If your child has a typical cold without complications, the symptoms should disappear gradually after seven to ten days…
Nutrition Recommendations
Young athletes often try special diets and supplements to improve their athletic performance. However, many of these products do not live up to their claims to increase strength, speed, and athletic skills. Athletes should focus instead on following the basics of proper hydration and nutrition. Both are crucial in supporting growth and athletic performance. The following is information from the American Academy of Pediatrics about proper nutrition and supplement use.
Fluids
Athletes can lose body fluids very rapidly, so they must make sure they are always well hydrated. Thirst is not a good gauge of fluid needs, and waiting until thirsty to drink can decrease athletic performance. The following are tips on how to maintain appropriate fluid intake:
- Start each workout well hydrated.
- Drink more fluids if urine is not pale or clear.
- Drink fluids during workouts, especially if workouts are longer than 45 to 60 minutes. Frequent small sips of fluid are best. Most teen athletes should drink about 8 ounces of fluid every 20 minutes during an intense workout.
- Switch from water to sports drinks after 1 hour of activity. (Note: Children will drink more if they are given fluids that have taste, color, and a small amount of sodium (like sports drinks).
- Coaches and parents should make sure fluids are always available and encourage appropriate fluid breaks.
- Athletes may want to weigh themselves before and after workouts to see if they are getting enough fluids. Each pound of weight lost during a workout should be replaced with 16 ounces of fluid…
Healthy Eating
The specific nutritional choices you and your youngster make are crucial. Good nutrition is essential to good health and the American Academy of Pediatrics encourages parents to think of their nutritional decisions as health decisions…
Crying / Colic
Crying serves several useful purposes for your baby. It gives her a way to call for help when she’s hungry or uncomfortable. It helps her shut out sights, sounds, and other sensations that are too intense to suit her. And it helps her release tension…
Newborn Care
It doesn’t take long to develop the confidence and calm of an experienced parent. Your baby will give you the most important information—how she likes to be treated, talked to, held, and comforted. This section address the most common questions and concerns that arise during the first months of life…
Immunization Safety
Today, most children in the United States lead much healthier lives and parents live with much less anxiety and worry over infections during childhood. Immunizations are one of the success stories of modern medicine…
Sun Safety
Follow these simple rules to protect your family from sunburns now and from skin cancer later in life.
- Keep babies younger than 6 months out of direct sunlight. Find shade under a tree, umbrella, or the stroller canopy.
- When possible, dress yourself and your kids in cool, comfortable clothing that covers the body, like lightweight cotton pants, long-sleeved shirts, and hats.
- Select clothes made with a tight weave – they protect better than clothes with a looser weave. If you’re not sure how tight a fabric’s weave is, hold it up to see how much light shines through. The less light, the better.
- Wear a hat or cap with a brim that faces forward to shield the face.
- Limit your sun exposure between 10:00 am and 4:00 pm, when UV rays are strongest.
- Wear sunglasses with at least 99% UV protection (look for child-sized sunglasses with UV protection for your child).
- Use sunscreen.
- Set a good example. You can be the best teacher by practicing sun protection yourself. Teach all members of your family how to protect their skin and eyes.
Sunscreen
Sunscreen can help protect the skin from sunburn and some skin cancers, but only if used correctly. Keep in mind that sunscreen should be used for sun protection, not as a reason to stay in the sun longer.
How to Pick Sunscreen
- Use a sunscreen that says “broad-spectrum” on the label – that means it will screen out both UVB and UVA rays.
- Use a sunscreen with an SPF (sun protection factor) of at least 15. The higher the SPF, the more UVB protection the sunscreen has.
- Look for the new UVA “star” rating system on the label.
· One star is low UVA protection.
· Two stars is medium protection.
· Three stars is high protection.
· Four stars is the highest UVA protection available in an over-the-counter sunscreen product. - For sensitive areas of the body, such as the nose, cheeks, tops of the ears, and the shoulders, choose a sunscreen or sunblock with zinc oxide or titanium dioxide. While these products usually stay visible on the skin even after you rub them in, some now come in fun colors that kids enjoy.
Sunscreen for Babies
- For babies younger than 6 months. Use sunscreen on small areas of the body, such as the face and the backs of the hands, if protective clothing and shade are not available.
- For babies older than 6 months. Apply to all areas of the body, but be careful around the eyes. If your baby rubs sunscreen into her eyes, wipe the eyes and hands clean with a damp cloth. If the sunscreen irritates her skin, try a different brand or try a sunscreen stick or sunscreen or sunblock with titanium dioxide or zinc oxide. If a rash develops, talk with your child’s doctor…
Potty Training
In order for a toddler to be successfully potty trained, she needs to be able to sense the urge to go, be able to understand what the feeling means, and then be able to verbalize that she needs your help to make it to the toilet and actually go. Waiting until your child is truly ready will make the experience much faster and more pleasant for everyone involved…
Thumb Sucking & Pacifiers
If your child sucks strongly on a pacifier or his thumb or fingers beyond 2 to 4 years of age, this behavior may affect the shape of his mouth or how his teeth are lining up. If your child stops sucking on a pacifier or his thumb or fingers before his permanent front teeth come in, there’s a good chance his bite will correct itself. However, if the bite does not correct itself and the upper adult teeth are sticking out, orthodontic treatment may be needed to realign the teeth and help prevent broken front teeth…
Temper Tantrums
It’s hard for young children to hold strong feelings inside. When they feel frustrated or angry, they often cry, scream, or stomp up and down. This is a temper tantrum. Temper tantrums are a normal part of your child’s development. They usually begin around age 12 to 18 months, get worse between 2 and 3 years, then taper off after that, once children are able to use words to communicate their wants and needs.
How to Pick Sunscreen
- Try to stay calm. If you shout or get angry, it can make things worse. If you can’t stay calm, leave the room. Wait a minute or two, or until her crying stops, before returning.
- Distract your child. Try a new game, book, or toy. Sometimes something as simple as changing locations can prevent a tantrum. For example, if you are indoors, try taking your child outside to distract her attention.
- Give your child a time-out. Take your child away from the problem and give her time alone to calm down. A good rule of thumb for a time-out is 1 minute of time-out for every year of your child’s age. For example, a 4-year-old would get a 4-minute time-out. After the time-out is over, talk with your child and make sure she understands why she got a time-out and how to deal with it next time. Don’t use time-out too much or it won’t work.
- Ignore minor displays of anger such as crying, screaming, or kicking. Try touching or holding your child to calm her. Or try standing nearby without talking until she calms down. If your child is having a tantrum in a public place, take her home or to the car.
- Some behaviors are not OK and should not be ignored, such as: · Hitting or kicking people · Throwing things that might hurt someone or break something · Screaming or yelling for a long time
If these things happen, take your child away from the problem. Say firmly, “No hitting” or “No throwing” to make sure your child knows these behaviors are not OK.
Never punish your child for temper tantrums. She may start to keep her anger or frustration inside, which can be unhealthy. Keep in mind that as your child grows, she will learn to deal with her strong emotions.
Do not give in to your child just to stop a tantrum. This teaches your child that temper tantrums get her what she wants. Also, don’t feel guilty about saying no to your child. Set the rules and stick with them. When parents change the rules, it is harder for children to understand which rules are firm and which ones are not. Discuss with those who care for your child which rules are really needed and how to be firm about them…
Handling Obesity
Various factors can influence the likelihood of a child’s becoming overweight. Obesity is usually defined as more than 20 percent above ideal weight for a particular height and age…
Diaper Rashes
If your baby gets diaper rash (and to prevent future diaper rashes) it’s important to keep the area as clean and dry as possible. Change wet or soiled diapers right away. This helps cut down how much moisture is on the skin.
- Gently clean the diaper area with water and a soft washcloth. Disposable diaper wipes may also be used. Avoid wipes that contain alcohol and fragrance. Use soap and water only if the stool does not come off easily. If the rash is severe, use a squirt bottle of water so you can clean and rinse without rubbing.
- Pat dry; do not rub. Allow the area to air-dry fully.
- Apply a thick layer of protective ointment or cream (such as one that contains zinc oxide or petroleum jelly). These ointments are usually thick and pasty and do not have to be completely removed at the next diaper change. Remember, heavy scrubbing or rubbing will only damage the skin more.
- Do not put the diaper on too tight, especially overnight. Keep the diaper loose so that the wet and soiled parts do not rub against the skin as much.
- Use creams with steroids only if your pediatrician recommends them. They are rarely needed and may be harmful.
- Check with your pediatrician if the rash: · Has blisters or pus-filled sores · Does not go away within 2 to 3 days · Gets worse
Causes of Diaper Rash
Over the years diaper rash has been blamed on many causes, such as teething, diet, and ammonia in the urine. However, we now believe it is caused by any of the following:
- Too much moisture
- Chafing or rubbing
- Yeast infection
- Bacterial infection
- Allergic reaction to diaper material
When skin stays wet for too long, it starts to break down. When wet skin is rubbed, it also damages more easily. Moisture from a soiled diaper can harm your baby’s skin and make it more prone to chafing. When this happens, a diaper rash may develop.
More than half of babies between 4 and 15 months of age develop diaper rash at least once in a 2-month period. Diaper rash occurs more often when:
- Babies get older — mostly between 8 to 10 months of age.
- Babies are not kept clean and dry.
- Babies have frequent stools, especially when the stools stay in their diapers overnight.
- Babies have diarrhea.
- Babies begin to eat solid foods.
- Babies are taking antibiotics, or in nursing babies whose mothers are taking antibiotics.
Call the Pediatrician If:
- The rash does not look like it’s going away or gets worse 2 to 3 days after treatment.
- The rash includes blisters or pus-filled sores.
- Your baby is taking an antibiotic and has a bright red rash with red spots at its edges. This might be a yeast infection.
- Your baby has a fever along with a rash…
Sleep
Babies do not have regular sleep cycles until about 6 months of age. While newborns sleep about 16 to 17 hours per day, they may only sleep 1 or 2 hours at a time. As babies get older, they need less sleep. However, different babies have different sleep needs. It is normal for a 6-month-old to wake up during the night but go back to sleep after a few minutes…
Teething
Teething usually starts during these months. The two front teeth (central incisors), either upper or lower, usually appear first, followed by the opposite front teeth. The first molars come in next, followed by the canines or eyeteeth.
There is great variability in the timing of teething. If your child doesn’t show any teeth until later than this age period, don’t worry. The timing may be determined by heredity, and it doesn’t mean that anything is wrong.
Teething occasionally may cause mild irritability, crying, a low-grade temperature (but not over 101 degrees Fahrenheit or 38.3 degrees Celsius), excessive drooling, and a desire to chew on something hard. More often, the gums around the new teeth will swell and be tender. To ease your baby’s discomfort, try gently rubbing or massaging the gums with one of your fingers. Teething rings are helpful, too, but they should be made of firm rubber. (The teethers that you freeze tend to get too hard and can cause more harm than good.) Pain relievers and medications that you rub on the gums are not necessary or useful since they wash out of the baby’s mouth within minutes. Some medication you rub on your child’s gums can even be harmful if too much is used and the child swallows an excessive amount. If your child seems particularly miserable or has a fever higher than 101 degrees Fahrenheit (38.3 degrees Celsius), it’s probably not because she’s teething, and you should consult your pediatrician.
How should you clean the new teeth? Simply brush them with a soft child’s toothbrush when you first start seeing her teeth. To prevent cavities, never let your baby fall asleep with a bottle, either at nap time or at night. By avoiding this situation, you’ll keep milk from pooling around the teeth and creating a breeding ground for decay…
Breastfeeding
Feeding your infant provides more than just good nutrition. It also gives you a chance to hold your newborn close, cuddle him, and make eye contact. These are relaxing and enjoyable moments for you both, and they bring you closer together emotionally…