Frequently Asked Questions

Since my last entry on this subject, baby sign language has become even more popular. These kids’ show no delay in their verbal language skills. Like I said earlier, it is great for an older child to know sign language so you can silently communicate if needed (like in church). And, yes, I finally saw the movie “Meet the Fockers” – Great movie!

Unless their doctor determines otherwise, exclusively breastfed term infants do not need extra vitamins. Human milk contains all of the essential vitamins. As long as your infant is getting enough milk, he or she is getting enough vitamins. Commercial formulas also contain all the essential vitamins, providing your infant consumes the entire can of formula each day. If your infant averages thirty-two ounces of formula (one liter) a day, extra vitamins are unnecessary unless he needs extra nutrition – for prematurity, for example. If and when your infant drinks less than this amount of formula each day, supplemental vitamins are advised depending on the consistent intake of solid foods. Regarding vitamin D: unless you live above the artic circle, you will get enough sunlight for your body to make the needed amounts of vitamin D.

The sole: As a general guide, the earlier the stage of walking, the thinner and more flexible the sole should be. Before buying a shoe, bend it in your hand to test its flexibility. Then watch your baby walk. The shoe should bend at the ball of the foot as your baby takes each step. Whether to get rubber soles or leather soles is a mater of which is most flexible. The rubber soles on some sneakers are thicker and stiffer than leather soles. Also, rubber soles tend to be more rounded, whereas the flatter leather soles tend to provide more stability. Remember: avoid stiff soles for young feet.

Construction: Stick with natural materials - leather or canvas - that breathe, letting air get to baby's perspiring feet. Avoid synthetics like vinyl, which don't breathe.

Fit: This is the most important part of selecting a shoe. A qualified shoe fitter will measure both feet while baby is standing, looking for flexibility at the ball of the foot while baby walks, and checks for toe room and heel slippage. Don't forget to let baby take a "test-walk".

I get this question often in my office. There is really only one thing you need to be aware of while taking an infant on a flight. Babies can't "pop" their ears to relieve the air pressure like adults can. This can cause significant ear pain and can turn a happy baby into a very fussy one for the entire flight. You can help balance the air pressure in baby's ears by breastfeeding during the entire ascent, and also during the entire descent. The descent is more important as the changes in ear pressure can be more painful at this time. Alternatively, you can let your baby suck on a bottle or a pacifier, however, the increased jaw motion during breastfeeding is better to keep the ear pressure equalized. Bring a bottle of Tylenol to give baby if crying gets excessive.

Medically, babies can fly at any age, even at day one. Airlines may have their own policies on how old a baby needs to be to fly.

Many people recommend giving benadryl to infants during a flight to ease the pressure in the ears. Benadryl does not equalize ear pressure. Its main effect is sedation. So while it seems to help with the ears, in reality it is just putting baby to sleep.

You should have older children chew gum during the ascent and descent to keep the ears clear.

It is also important to keep in mind that the safest place for an infant during take off and landing is in a car seat securely strapped in. While this does require you to purchase a ticket for the baby, it is simply safer. Once the plane is in the air, you can take baby out to nurse. On desent, secure baby in the seat a few minutes before the plane touches down.

What?! Santa’s not real? But, I just talked to him today, at the mall!

Yes, you have a point… we are lying to our children. But I personally don’t think it does any harm. While I have talked to many young adults that resent their parents for many things, being tricked about Santa has not been one of them. In my experience with my own kids, as well as many of my friends, the whole Santa thing has gone like this: between age two and seven-ish, it is a fun game, with letters to Santa, half-eaten cookie on a plate Christmas morning, etc. Then the child finally gets in on the secret, probably thanks to one of his friends. At this point, letters to Santa (and the tooth-fairy for that matter) are addressed to “Dad”, and the older child has fun playing Santa games on the younger siblings.

I think most of us have a lot of great “Santa memories”. I vividly remember trying to explain to my 5 year-old why she saw Santa Claus walking down the street! I do get a little bit sad when I think about my little girl growing up and losing that Christmas magic. It seems like a metaphor for life… it isn’t always going to be a bowl of cherries. I guess I wish we could all keep believing in Santa. For now, I need to help my younger one mail a letter to the North Pole, and also teach him the real meaning behind Christmas.

Regardless of what other people think, you will probably be breastfeeding your daughter for quite some time. It is still nutritious. Nothing magical happens to your milk at 1 year. Is your child malnourished? If your child does not appear malnourished to all these people around you, then it is none of their business what you are feeding her. You shouldn’t have to do all this “explaining”. I have many friends with younger kids, and I have no idea of what their kids eat – I guess I never really see them eat. Do you have to explain all the time because your 1 year-old is nursing in public all the time? If this is case, then maybe it would be wise to start setting limits with your daughter, such as “we only do nummies at home”. This worked well for our kids at this age. Let’s face it, it’s no fun to get all those disapproving stares at the mall.

Regarding scientific data, I have a feeling this won’t help you convince anyone of anything, but you could just tell them that the American Academy of Pediatrics new recommendation is this: “It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired”. A “google” search will get you the full recommendations if you want to read them for yourself.

Usually, most families have the opposite problem… the baby doesn’t want anything to do with daddy. Although I can’t see your particular family dynamic, my gut is telling me that this is a phase that will pass. At least baby is getting some quality time with both parents. Here are some suggestions to get through this:

1. Spend more intimate family time together - let your baby see dad and mom being close and affectionate. Give your baby the message that "The whole family loves each other".
2. Family walks - go for frequent family outings. The distracting surroundings may help baby forget to favor one parent over the other.
3. Hitting and biting are a “no-no” and should be gently corrected.

Be assured that over the next few months, baby will warm up to the idea that both parents are loveable.

Here is how the eye is supposed to work: tears are produced in a gland at the outer/upper corner of the eye – the lacrimal gland. The moisture flows over the eye, keeping it from drying out – this is aided by blinking. Any excess fluid then drains out of the inner corner and down the nasolacrimal duct (also call the tear duct) into the nose. When somebody cries, there can be an overflow of tears out of the eye and down the cheek. Many infants are born with plugged tear ducts, and have tears running down their cheeks even without crying (click here for more info on this). I have seen plenty of kids crying, but without tears rolling down the cheeks. This is probably because their tear ducts work very well (I do see the tear in their eyes, just not running down the cheek). It is unusual for a child to not produce any tears at all. Next time he cries, look for the eyes to become extra moist – if you don’t see this, then you probably should see an eye doctor to measure the level of tear production.

The smoke residue on clothes will probably not penetrate into the lungs like actual second hand smoke can. But, as you have experienced, the smoke odor from the residue on clothes can also hit you like a ton of bricks and will irritate the nasal passages and eyes. This irritation can make a person more susceptible to infections. It will be important for your husband to use a “smoking jacket” that he can take off after smoking.

You may find it at Baby's R Us, or you can call Crown Crafts Infant Products at 1-800-854-8760.

You can also order Dr. Sears Original baby sling from Dr. Sears online store or call us at 949-489-0020.

Many of my younger siblings were born at home, under the care of a midwife. The other siblings were present and it seemed to be a positive experience. My sister, Hayden, was 3 or 4 when she was able to watch her sister, Erin, be born. It was a special family time, and a completely positive experience. If things get crazy in the delivery room, you should have someone that can take the kids to another room and be with them.

I have vivid memories of my brother (Dr Bob) and I tearing around the slopes at a very young age. I think he was 3-4 and I was 5-6. We both had a lot of fun and I don't think it was too young. Those were the days of leather ski boots and wool gloves (with frozen fingers inside!) An injury at age three is not any different than at age 5 if that's what you are worryied about. Luckily, equipment is much safer and warmer now. A helmet is an absolute necessity at this age (actually at any age if you think about it).

How your sister is raising her infant may seem foreign to you, but she is just doing what comes naturally. This is how this will "play out":

For the first year or two, a child is primarily bonded to his mother. We see this pattern in many animal species, too. I wouldn't be concerned because this plays out very positively. Kids raised this way grow to be very bonded with their parents and out of this grows great confidence as they reach school age. As a result, they are ready to take on the rest of society. Mom and her infant develop a bond that is so strong, it is an instinct for both of them to be together. They learn to read each others subtle cues -- they "tune-in" to each other. Most infants tend to "need" their mommies quite frequently, so it is difficult for mom to be more than a few minutes away. My wife wasn't ready to be away from her baby for the first year and I respected that. Then, later, when our child was a toddler and had some other baby friends, we were able to get away for a quick dinner. Later that year my wife felt more comfortable leaving longer so that we could go out for a movie. When our child was four-years-old, we were able to take a few days away.

Dad's involvement certainly is less during the first 6-9 months, but he should try to spend time holding and rocking the baby. Mom should try to help by letting him hold baby when baby is well rested, and in a good mood. Setting dad up for success like this will help them to develop a good bond. Dad's bond usually is much stronger once the baby is a toddler. Yes, I did feel a little "left-out" when my kids were very young, but as they reached 1-2-years-old, I was able to get more involved. We had fun going for ice cream or to the park.

Now, about leaving the infant with the grandparents. Most of their child-raising experience came at a time when moms were encouraged to separate from their babies at a very early age. Many moms relate this story to me: While visiting the grandparents, or at a family get together, grandma was holding my two-month-old baby (nothing wrong with this). After a while, my baby got fussy for some reason. Mom's instinct kicks in telling her to respond to her baby's cries, but Grandma says, "He doesn't need to eat yet", or "Oh, don't worry, crying is healthy for him". It's amazing that some people still think that babies need to cry to help their lungs develop. It is very difficult for a mom to see her baby fussing on grandma's lap. This is a very hard time for mom, because she doesn't want to appear rude by insisting she get the baby back, yet it torments her to see her baby unhappy. Nobody else in the room understands this struggle because they don't have the same hormonal connection as the mother. Then grandma starts asking to keep the baby for an entire weekend! Mom could never allow the baby to stay with someone that doesn't understand his needs. The time for weekends at grandmas will come - in a few years. Believe me, by this time, mom and dad will really need a weekend alone! When it is time to leave the kids for a while, it is important that they stay with somebody that they are very familiar with. We left our four-year-old with friends that had kids the same age. Our daughter knew this family very well and felt comfortable with them. My wife and I also felt comfortable with the other mom's sensitivity to our child. I have talked with many moms (my mother included) that left their infants (me, when I was two-months-old) for a few days at a very early age. When they returned, they felt very disconnected to their baby and had a very hard time re-establishing their bond.

There will be times when your sister's child appears "too bonded" to his mother. I have seen many kids in my practice that I thought were too dependent on mom. Moms insist that they know their kids better than anyone, so I didn't interfere. It always seems that about a year later (usually when the kids turn 3-5) there is a sudden blossoming, a "weaning" of sorts, and the child says, "All my needs have been met; I must be a pretty special person; I have the confidence I need to take on the world." I am always amazed at how these "needy", "clingy" toddlers grow into very well-adjusted kids.

I hope this gives you some understanding of how well your sister is parenting. For more information on Attachment Parenting visit our Attachment Parenting Index.

My kids loved to play in their “exer-saucer”. This is basically a round table with a kid-sized hole in the center with a swivel seat. The child can sit and play with a variety of activities around the table, turning himself at will. Parents often ask if these are safe for the child’s hips or back – don’t worry, these toys are fine.

This is a very common issue with infant girls. I hope you found the information about this on our website; click here if you didn't. This is called labial adhesions, and you don't need to worry about this unless the opening is entirely closed. These adhesions are thought to happen because of a NORMAL lack of circulating estrogen in a young baby. These adhesions almost always open up with time, but sometimes the Doctor will prescribe an estrogen cream to be applied for about two weeks to help the process. There is a potential side effect of the cream: faint pubic hair growth - which doesn't happen very often. If this does happen, you simply stop the cream.

“Roseola” is a common illness in children ages 3 months to 4 years and is characterized by fever lasting between 3-7 days, followed by a rash that appears soon after the fever is gone. Roseola is caused by several different virus families including the enteroviruses, adenoviruses, parainfluenza virus. The most common virus that causes roseola is called HHV-6. So, yes, it is possible to get a “roseola-like” illness more than once.

I get the sense that what you are really asking is, "is my 4 year-old ready to attend and understand a funeral", "Will he get scared from seeing an open casket". The answer to these questions is, "depends on your child". Most kids this age will not understand why everyone is so sad, or why there is a person lying in the coffin. If your child is old enough to understand death, then maybe he will understand a little. He will probably not remember the funeral when he is older.

I think there's a more important question to be asking, "Will your 4 year-old allow you to fully devote yourself to the mourning process at the funeral". A funeral is an important time for those whose lives were touched by the deceased. It is a time to reflect on your loved one's life and to encourage and bond with those left behind.

Having recently attended my wife's grandfather's funeral, I am very glad we left our then 3 year-old home with a sitter. The main reason for this is that he would have whined and fidgeted through the whole long half day of service, burial, and luncheon. Add to this the stress of a 4 year-old pulling on your leg the whole time complaining, "I'm firsty", "my shoes hort", "I want to jump on those rocks". My wife and I would have been chasing him around the entire cemetery all day (just like at home!). He would have ruined our day of saying good bye. We were able to concentrate on our relationships with our loved ones, cry with them, reminisce with them.

Our son is now a typical 4 year-old and he is not yet ready to act appropriately at this type of function. He gets to come to baseball games, movies, but not funerals. I don't think he "missed out", he was too young to understand. My 8 year old daughter does not remember very significant events of her life that happened 4 years ago. She did come to the funeral and it was a wonderful experience for her.

Many parents now want to split up the MMR vaccine into separate components and give them separated each by a year. However, a doctor can’t order just single doses of each shot through the regular channels. They have to get 10 doses of each, and if there are only one or two patients in the office that want them separated, the doctor eats the cost of the unused shots. So most doctors, understandably, won’t do that.

Here are some ways that patients have found they can get the shots separately:

1. Go to a vaccine clinic at a large university hospital. I know one near where I practice that offers them separately.
2. Go to a travel clinic where people usually go to get unusual travel vaccines prior to international travel. Some of these carry the separate M, M, and R.
3. Ask your doctor to write you a prescription for each shot and try to get it filled through a pharmacy. You would bring the shot back to your doctor’s office (making sure you keep it a refrigerator temperature – 36 to 46 degrees F or 2 to 8 degrees Celsius) for the nurse to administer.
4. Ask for a prescription, but get it filled through an online medical supply company or online pharmacy. They can ship it directly to your doctor’s office (shipping isn’t cheap though). One such company that I know of is American Medicine, Inc. in Baton Rouge, Louisiana. You can find them on Google.
5. Check out our Vaccine-Friendly Doctor’s list to see if there’s anyone within driving distance for you. They typically would need you to become a patient and get checkups there in order to provide you with vaccines.
6. If you can’t find the separate shots anywhere, ask your doctor to start a list of like-minded patients and just skip the full MMR for now. Chances are over the next year or two the list will grow to include 10 patients. Delaying your baby’s protection for a year wouldn’t be too risky since the diseases are very rare.

Cost – I know it costs my office about between 35 and 50 dollars for each vaccine, so you can expect to pay at least this much plus whatever markup your provider deems appropriate.

is a very common situation for families who practice attachment parenting and nighttime parenting with their kids (like I do). Infants who are used to being nursed or snuggled to sleep are naturally going to want to continue to do so even after they are weaned from breastfeeding. This is often true until age 5 or 6 or even older. On the other hand, infants who are "trained" to fall asleep, and stay asleep, on their own often do not require a parent's presence to go to sleep when they are three years old. It all goes back to how you decided to do things early on. I am not saying that either situation is right or wrong; I am just stating what is typical child behavior.

I have faced this exact same situation with my own kids. My wife and I chose to "parent" our kids to sleep from early on. This required one of us to lie down and snuggle with them while they fell asleep. This was my wife's duty while they were still breastfeeding. When they were weaned, it became my job. I just snuggled in their bed with them while they fell asleep until they were about 5 years old. Then I began to sit on the floor next to their bed. I used a flashlight to read a book. It usually took about 30 to 45 minutes for my kids to fall asleep. Now that my kids are 5 and 8, I usually only stay in their room until the 5-year-old falls asleep (thankfully only 10 minutes or so), then I kiss my 8-year-old goodnight and leave. I come and check on him every 5 minutes or so until he falls asleep (which is usually right away).

I know this situation takes a time commitment on my part, and I am ok with that. I realize my kids are growing up fast, and soon they won't need me in their room anymore to fall asleep. I probably could have weaned my kids of this need sooner, but I just decided not to.

Now, not everyone is ok with this time commitment. Many people can't spend this half hour or so in their kids room every night. I know I had plenty of nights where I got frustrated with how long it was taking them to fall asleep. Sometimes I would fall asleep myself, then wake up groggy and grouchy.

So after having said all that, here is how you CAN try to wean your kids of this need and help them feel comfortable falling asleep on their own:

1. Every child is different, so there is no one set age at which kids should be expected to fall asleep on their own. Use your own judgment for your kids.

    

2. Start by no longer lying down in bed with your child. Sit or lay NEXT to the bed.

    

3. A flashlight and good book can help you pass the time.

    

4. Try reading bedtime stories with your child already tucked in and the lights down low. This will settle her down.

    

5. Choose a time limit. Stay for perhaps five minutes or so, then kiss your child and reassure them you will be right back to check on her.

    

6. Check on your child every so often by just stepping into the doorway. If your child looks up at you, quietly say, "daddy (or mommy) will be right back to check on you again." If your child doesn't look up, say nothing.

    

7. You must sit down with your child during the daytime to discuss the new rules and routine. Do not just surprise her with it one night at bedtime.

    

8. Discuss the new plan well ahead of time. Each night, remind her that soon mommy won't be lying down with her at night, but mommy will check on her as she falls asleep. This way she can prepare for the change.

    

9. Create a sticker chart reward system for each night she does well.

    

10. If your child does not accept the new situation, and you are having a huge battle that you do not feel comfortable with, then go back to lying down with her for short a time. Try again in a couple months.

     

11. Remember, there is no one age that this will be right for every child. Some may be ready at age 2, some at age 8.

This is a situation that frustrates almost every parent at some time. Realize first of all that this is very normal. It is not that you are doing anything wrong, or that something is unusual with your baby. It is very normal for babies to do this.

1. Wait for the "limp limb" sign - make sure baby is completely asleep. Baby will become very limp and heavy. Try lifting her arm and letting it drop. If it is limp, then baby is in a deep sleep. This usually takes at least 5 minutes or more after baby first appears to be asleep.
2. Keep the breast (or bottle) in baby's mouth while you lay her down - keep baby snuggled warm and tight in your arms while you gently lay her down. Stay in that position for several minutes under baby settles down again.
3. Slowly back off - first, slowly unlatch the breast (or bottle) from baby's mouth, then one arm, then the other, then your chest. Do this over several minutes.
4. Wedge in a replacement - have a warm pillow that you have been using during feeding ready to wedge up next to baby as you are moving away. Baby may think that this is still you next to her.WARNING - it is not safe to LEAVE a pillow wedged up next to baby while sleeping. Move the pillow away after several minutes once you know baby is asleep.
5. Lie down to nurse - you can also lie down with baby in a bed to breast (or bottle) feed baby to sleep. Follow the above procedures as you detach yourself from baby once she is truly asleep.
6. When baby wakes up screaming 15 minutes later, repeat the above over and over again until baby is three years old - a little humor there. But seriously, sometimes none of the above will work, and some babies will wake up after 15 minutes. This phase of nighttime parenting will pass in time as baby grows older. Browse through our sleep section for more information.

This is a dilemma faced by many parents who share a family bed with their nursing toddler. I discuss this problem with parents in my office almost on a daily basis. There are several different answers to this question, depending on both the parents' temperament and the baby's personality. Here is how I approach this situation with the different types of parent and child dynamics.

Situation One - The High Need Baby. If you don't know what a High Need Baby is, then you probably don't have one. If you are not sure, click here to find out if your baby fits this personality type.

This is the most challenging situation for parents to handle, and there is no easy solution. The first step is to understand why your high need child's sleep patterns are different. Basically, high need babies are not SUPPOSED to sleep through the night. Their whole system is wired differently than a non-high-need child. Yes, they will eventually sleep through the night, but often not at this age, and sometimes not until age 3 or 4. Click on Five Reasons Why High Need Babies Sleep Differently for more information.

A WORD OF ENCOURAGEMENT - all babies eventually grow up, wean, and sleep through the night in their own bed. Ask any parent whose children are older and they will tell you "they grow up so fast". "I wish I could snuggle with them in my arms again". "It was so nice to snuggle in bed and nurse them and hold them close". First time parents won't believe this, but there actually will come a day when you will miss this time in your baby's life. If you consider that you will be spending the next 50 or more years with your child in your life, then this next 6 to 12 months of night waking and nursing is really a short time. Hang in there. You will get through it.

Situation Two - the non-high-need baby. For babies who do not fit the above high-need personality type, this sleep situation is somewhat easier to fix as baby won't be quite as resistant to some of the above approaches. Please read the entire section above, since many of the principles and approaches will be useful to you.

Always be sure to consider that your child may be waking up more at night because of a medical problem. Click on Hidden Medical Causes of Nightwaking for further discussion.

Yes, it is very scary to watch your toddler walk off the edge of a high adult bed. The only way to prevent this is to lower your bed. Bed rails or pillows will not do the trick. I am constantly telling parents to get rid of the bed frame for the first year or so and just sleep on the mattress. You should also start teaching your baby to slide off the bed feet first, on his belly – just like he goes down the stairs. It usually doesn’t take long for him to figure this out if you show him a few times.

When is the right time? Whenever you are ready. I would imagine that Dad would love to return to his spot in his bed. It would be great to try both kids together in a bed of their own; they might go for this if done together. Our children were used to sleeping in our bed at this age, but they eventually learned. Sometimes it took incentives, we started by making a "star-chart". For every night she fell asleep by herself she would get a star, and after three stars she would get a prize. Some nights she would say, "I don't think I want a star for tonight", and that was okay - she was always welcome in our bed. Soon, she was easily falling asleep by herself, but most mornings I would awaken to find her snuggling between my wife and I. Again, this was not a problem for us (I love snuggling my kids). So, the next step was to make a star chart for staying in her bed ALL NIGHT. She earned a really nice prize for that accomplishment.

Parents usually need their children to go to sleep earlier than the children need to. Sleep is not a state you can force a child into. It is better to create an environment that allows sleep to overtake the child.

• Be sure your child is tired. You may have to omit or shorten the afternoon nap or take it earlier.
• Replace before-bed activities that rev-up a child (e.g., scary or stimulating TV, wrestling, sugary snacks) with wind-down interactions (for example, a warm bath, stories, quiet games, or a nutritious snack).
• Reasonably consistent bedtimes are healthful for children of all ages, and a sanity saver for tired parents. The child over three can understand the concept of bedtime. Children under five usually can't understand actual time, but can relate time to events: "When the video is over," "After you've had your bath and a snack." Try setting the stove timer to announce bedtime. If you don't take charge of your children's bedtimes, they will often drag it out until midnight.
• Bedtime routines are essential in getting children to sleep at an established hour. It should be fairly simple, for example, a snack, brush teeth and put on pajamas, a story, a prayer, and lights out. Do this every night and sleep will inevitably follow. This requires a commitment from you, but it's well worth it to know that in twenty or thirty minutes, start to finish, your child will be asleep.
• Remember, children want to have fun. If it's more fun to stay up, they'll fight sleep. They don't want to miss anything. Try making bedtime special and fun -- in a quiet way.
• Reserve favorite stories just for bedtime with the condition that you will tell the story only if your child is in bed at the appointed time. Alternate homemade stories with those in books. The most sleep-inducing stories are those that involve counting or repetition and lull the child to sleep.
• Take your child's favorite story characters and spin a long tale: Batman and Robin went fishing, and they caught one blue fish, two red fish and three green fish. Of course, don't just count -- embellish each "catch" with the sequence of getting in the boat, getting out the bait or lures, baiting the hook, casting the line, etc. Batman and Robin will be lucky if they catch more than a half- dozen fish before the child is asleep.
• A bedtime ritual conditions children to form a mental picture that sleep is soon to follow. The ritual helps them relax and get used to the idea. Before you begin the story, tell the child that he has to lie still for you to start the story. (Be sure the child is tired already.) Special bedtime rituals come with strings attached. "No backs rubbed after 9:00 o'clock." Use whatever enticement your child likes. Nighttime obedience has its rewards.

Martha notes:

"We realized that one way to deal with our little night owl, Lauren, is to respect her state of unreadiness for sleep. While we try for consistent nighttime routines, sometimes Lauren just isn't tired at her usual bedtime. She's ready enough to get into bed for stories, but after four or five, I can sense that sleep is the farthest thing from her mind. She'd be happy to lie there for an hour and listen to stories, then have the light out, hear lullabies, and flop around. (I fall asleep first on those nights.) If I don't wish to spend my time that way, we get out of bed and I give her the message that she's welcome to play quietly if she stays out of trouble."

babies and parents need naps. Ten-month-old babies need at least a one-hour nap in the morning and a one-to-two-hour snooze in the afternoon. Between one and two years, some babies drop the morning nap but still require one in the afternoon.

You can't force your baby to sleep, but you can create conditions that allow sleep to overtake him. Try:

Napping with him. You probably look forward to your baby's naptime so you can "finally get something done." Resist this temptation. Naps are as important for you as they are for your infant.

Establishing a routine. To get him on a predictable nap schedule, set aside time in the morning and in the afternoon and nap with him. This will get your baby used to a consistent pattern.

Setting the scene. A few minutes before naptime cuddle your baby in a dark, quiet room. Play soft music and nestle together in a rocking chair, or lie down on a bed. This will set him up to expect sleep to follow. Once he's in a deep sleep you can do one of three things; ease him into his crib, continue napping with him or slip away.

Our three-year-old refuses to nap. I know he's tired, and by late afternoon he's a bear. How can I get him to nap?

Many children need an afternoon nap (or parents need them to nap) up to age four. Naps have restorative value, allowing the person to unwind, rest, and recharge to go on with the day.

• Announce "special quiet time." Set the time of day that he needs a nap, and lie down with your child, closing your eyes for effect. Mothers often need a rest as much as the child and find this midday rest therapeutic.
• Don't succumb to the temptation common to a busy parent, "Now I can get something done." Gradually your child may fall into a predictable nap time without your presence.
• To entice resistant nappers, allow them to nap anywhere in the house. When, where, and how is up to the child. Make a "nap nook," a special place in a corner, on a mat, under the piano, or in a little tent made up of blankets. Try a large cardboard box with an opening like a cat door that the child crawls into when he is tired. This capitalizes on children's natural desire to create their own little retreats in all the nooks throughout the yard and house.
• Our "very busy" two-year-old cannot relax enough to nap if we just lie with her. So we started a routine of going for a stroller ride, and this lulls her off for an hour-long snooze.
• Another predictable way of getting her to sleep is to wait until carpool time and let her fall asleep in the car. If you are going to let your child nap in the car, be sure you can check on him and hear him when he wakes up. And never leave the windows up. If the weather is too warm, carry the carseat into the house.
• Condition your child to nap. Set a consistent nap time. While you can't force the resistant napper to sleep, you can create an environment that allows sleep to overtake him: lunch, a story, a dark room, and quiet music. Don't expect these conditions to result in sleep every time, or you will set yourself up to feel angry when those little eyes won't close. He may be weary but not sleepy – he can be irritable without having "bed" shoved at him and perceived as a punishment.
• If your child is not ready to nap, he may need another hour to play before he truly needs and can accept sleep. Or your child may simply need a brief "down" time of quiet play while resting in his room.
• By three, some children are ready to forfeit the afternoon nap and go for an earlier bedtime. This transition will take a while -- several months of napping every other day, then napping once or twice a week.
• Early afternoon naps and early bedtimes are not realistic when one or both parents arrive home late from work. Encouraging the child to nap early in the afternoon "so he'll be tired and go to bed early and we can finally have some time to ourselves" deprives parents of prime time with a cheerful baby. It is no fun to be with a tired child. We have found that later naps work better for us. When I come home from work, a rested and playful child greets me. With later bedtimes you give up some child-free time together; but once you have a child, your nightlife won't be the same for a long time.

's been proven that placing an infant to sleep on her back lowers the child's risk of SIDS (Sudden Infant Death Syndrome). In countries where there have been "Back to Sleep" campaigns advising parents to place their infants on their backs at bedtime, SIDS rates have fallen 30 to 50 percent.

Yet, remember that this is only a statistical correlation. It does not mean that if your baby sleeps on her tummy she's going to die of SIDS. Current SIDS rates are around one in a thousand babies; meaning that there's a 99.9 percent chance your child will remain a healthy little girl regardless of her sleep position. And while the cause of SIDS is still unknown, there is strong evidence that it is the result of an at-risk baby having an immature breathing- regulating system that fails to restart the breathing process when the baby is in a deep sleep. In fact, many SIDS researchers believe that a baby will naturally assume the sleep position that allows them to breathe more comfortably during the night. If your baby habitually flips over onto her tummy after you put her down to sleep on her back this may be the right sleeping position for her. If you want to be completely safe, however, you might want to try staying with your baby until she falls asleep; then turn her onto her back when she's in a deep sleep.

What is the worry about mercury and fish? Recently the FDA revealed that shark, swordfish, king mackerel, tilefish, and tuna fish contain higher levels of mercury and other harmful metals than do other fish. This is because these fish tend to live a long time before they are caught, thus allowing more pollutants to get into their tissues. These pollutants may be harmful to a developing fetus.

What fish is safe to eat? Salmon has the highest level of DHA (the most important healthy fat) and other omega-3's, and is one of the least contaminated fish. Tuna (not canned tuna) also has lots of DHA, but may also be more polluted. You CAN eat tuna and the other fish mentioned above, but you should only do so once or twice a month so you don't overload your system. Do not make any of the contaminated fish a routine part of your diet.

I recommend all pregnant and breastfeeding moms eat fish and eggs several times a week to make sure their developing babies get enough DHA and other omega-3's. Alternatively, you can take DHA and omega-3 oil capsules available at vitamin stores.

Click here to read more about why DHA is so healthy for infants and children.

You’re right, we have not yet written a book about what to expect with the second child comes along, but I imagine that we could call it, “Its The End Of The World As We Know It”. Just kidding, but really, the arrival of child #2 will mean some big changes. Instead of getting through your daily routine holding a baby in one arm, now BOTH of your arms will be full. Coordinating nap times can take some skill (hint: sleep when they sleep!) You will start to hear comments like, “Wow, you have your hands full!”, so start thinking of some witty responses. And, yes, your toddler’s behavior will likely regress. Potty training (if it has started yet) can go backwards, he might want to start nursing again, and tantrums can start to be a problem. Hopefully, during these 21 months, you have developed a strong bond with your child, and by now, you know him very, very well. This solid foundation will make it easier to react to his behavior as he realizes that he isn’t the only child anymore. It will be important to discuss that a new baby is one the way, so that he understands that he is not being replaced. A great way to do this is our book, “Baby On The Way” – click here for more info. I also found it helpful to give the older sibling some responsibility in caring for the new baby, such as going to get a fresh diaper during the changing procedure. Most toddlers love to “help” mom and this is a great way to keep them involved with the new baby.. Also, be sure to read our pages on sibling rivalry for some more insight into your concerns.

Many women experience some degree of “the baby blues” – mildly depressed mood, crying spells, mood swings. When it lasts for more than two weeks and symptoms are severe, we call it “post-partum depression” (click here here for a complete discussion). Like you mentioned, exercise is important, but you need professional help – now! If the baby blues, or depression, get to the point that you are having thoughts like this, then a short course of an anti-depressant is probably a good idea.

Yes and yes. Juice Plus is basically fruits and vegetables, with a few other natural ingredients. So it is both safe and beneficial to take during pregnancy and breastfeeding. You should also continue to take your prenatal vitamins during pregnancy and breastfeeding to ensure you are getting 100% of each and every vitamin (since JP is a natural mix of fruits and veggies, the manufacturer cannot precisely quantify the amounts of specific vitamins in the product).

Yes, it is generally considered safe to apply vapor rub or vapor patches to an infant’s chest to help with a cold. However, there is the rare possibility that the strong vapors could irritate the airway and make the symptoms worse. So, feel free to use this remedy, and the other cold and cough remedies recommended here.

Many pediatricians use medications that are not approved for kids – this is called “off-label use”. For example, a certain cream that is only approved for 6 year-old, but I feel comfortable using it in a 4 year old. This is quite common. Most of the time, there is no problem, and after further testing and experience, the medication then becomes approved for younger children. Other times, questions about safety arise and pediatricians need to stop using the med. I seldom use Miralax as part of treating constipation, I would not be comfortable using it off label. Doesn’t mean it’s not safe, just means that I haven’t used it enough to be comfortable. If your doctor is comfortable, and you trust him/her – then go with that.

I do often use Flax seed oil as part of my constipation “arsenal” and highly recommend it. This is something that is good for you anyway. Click here to read more about constipation.

The “non-sedating” class of anti-histamines has been in use for many years, and there is plenty of safety data on these. In addition, since these became “over-the-counter”, millions more have started using them. I think there is enough experience with these medications that I am not worried about long term use in kids. Since you have tried just about everything, go with what has worked. Children with allergies, like yours, have an increased risk of developing asthma, and there was a study a few years back that showed using one of these anti-histamines long-term, could reduce this risk significantly in these children.

2 more suggestions:

1. Your child developed these food allergies (egg whites, dairy, peanuts) before he should have started eating these foods. So, it is likely that he developed these allergies because he was getting them through your breast milk. With your NEXT child, I would highly recommend that you keep these out of your diet, especially peanuts.
2. I have many patients like your son whose chronic allergy symptoms have improved dramatically after taking the fruit and vegetable supplement called Juice Plus. One of the benefits of eating a variety of fruits and veggies is a healthy, regulated immune system. Allergies, like your son’s, are the result of an “out of balance” immune system. Click here for more JP information.

    

Yes, this drug recall actually happened in 2003, but this e-mail warning is still floating around. PHENYLPROPANOLAMINE (PPA) a decongestant, has been taken out of all cold remedies. The problems that caused the recall were related to diet pills that contained this ingredient, NOT cold remedies. If any of your cold remedies laying around the house have PPA, they are probably expired anyway.

DHA is probably the most important fat for infant brain growth and nerve and eye development. Breast milk does have DHA. There is no DHA in formula, although formula companies have known about its importance for many years. Formula all over the world has DHA in it, and the U.S. will be one of the last countries to add it to formula hopefully sometime in 2002.

So what should you do in the meantime? You can buy DHA oil capsules at most vitamin and health stores. I suggest the brand Neuromins. If you can't find this brand, be sure to find one made from sea algae. Other brands are made from fish oil, and these can be contaminated by heavy metals such as mercury.

Simply buy a bottle of 100mg DHA capsules, poke a hole in one with a knife (carefully!), and squirt the oil into one bottle of formula once each day. This will provide the much-needed DHA for your baby's nutrition.

The oil doesn't mix very well with the formula. So when your baby is over 6 months of age and you start foods, you may find it easier to add the oil once a day to some food.

How long should you add DHA to your baby's diet?

What about the ARA fat?

Click here for a complete discussion about the benefits of DHA.

This is when all those nutritional lessons we’ve been giving over the past few years hopefully start to pay off. In case you’ve missed our lectures or have not read our Family Nutrition Book, this is when it helps to know how to read a label. The packaged carrots that I have seen at the grocery store are usually in the same section as the ready to eat salads. These items usually have fairly short expiration dates, meaning that they are somewhat fresh. Next, look at the ingredient list: hopefully just carrots, maybe water. Anything more would tell you to turn around and buy some fresh carrots and peel them yourself. The bagged carrots I have seen are just carrots, nothing more. They’re even pre-washed and ready to eat (but I wash them anyway!)

Soy contains substances called isoflavones (specifically genistein and daidzein) that are similar to the hormone called estrogen. These “phyto-estrogens” (meaning “plant-based estrogens”) are much weaker than the actual hormone – in fact, they have only about 0.1% the activity. Soy has been used for years as an alternative therapy for menopausal hot flashes – so there does seem to be a mild hormonal effect in people that already have an estrogen imbalance. But in babies taking soy, I rarely ever see any signs of hormonal imbalance. For older children and adults, I believe the health benefits (decreased risk of certain cancers, heart disease, etc.) of soy far outweigh the potential risks. I use soy myself and for my kids. Populations that eat a lot of soy seem to be healthier than Americans. The only time I don’t like to use soy is in young babies as their only source of protein, unless they have a documented milk allergy. Many babies are on soy formulas that probably don’t need to be. There are several reasons for this, click here for full discussion of soy formula.

Water for infants? Older kids?

At this age, water is not necessary, but also not harmful. In other words: yes, it’s fine to give him sips. Starting solids doesn’t mean you have to start water, although it can help treat the constipation that might result from the solids. A common mistake that parents make is to give extra water on a hot day in lieu of breastmilk. This can lead to electrolyte imbalances in a young baby.

When the baby is older and starting to use a sippy cup, I prefer parents fill the cup with water, and not juice. Toddlers and older kids need to drink several cups of water each day – not several cups of juice. Kids get too much sugar as it is. A little juice is a nice treat, but I think it is important that when kids are thirsty, they ask for water – a healthy habit that will last a lifetime.

The answer is that if you give an infant under a year cow’s milk, the infant can develop microscopic gastrointestinal bleeding (you don’t see it in the diaper), and this can lead to anemia and other problems. Yogurt does not cause this same reaction. Now: WHY does this happen? It seems to be the milk proteins that are responsible for this mild allergic reaction. In yogurt or infant formulas, the milk proteins are “de-natured” by heat in such a way that this allergic reaction does not happen.

I would avoid the jello, just because of the sugar factor. Of the foods on our list for this age (California avocados, mashed potatoes, peaches, barley cereal, carrots, squash, teething biscuits, pear and apple juice) avocado would be ideal, you could easily chop it into little bite-sized pieces to make a finger food. In another month, she can move to the next section of the list (lamb, veal, tofu, poultry, noodles, bagel, beans, rice cakes, peas, egg yolk, yams, cheese, oatmeal and yogurt) and there are a lot of finger foods available.

The American Academy of Pediatrics recommends that raw honey not be given to infants under one year of age because of the rare possibility of being infected with the bacteria that causes botulism (Clostridium botulinum). Once a toddler reaches one year old, their digestive system is mature enough to kill any botulism germs.

• constipation
• flat facial expression
• poor feeding (weak sucking)
• weak cry
• decreased movement
• trouble swallowing with excessive drooling
• muscle weakness
• breathing problems

Infant botulism is a rare illness, affecting only about 100 infants per year in the United States. Most babies will recover fully with proper medical care.

After a year of age, I recommend adding fish to your toddler’s diet. There is a lot of different fish to choose from, but you may not know which ones are safe. Two easy ones to remember are: Wild pacific salmon (not farmed) and canned light tuna (not albacore).

Although some children at this age will be good eaters, the general rule is that most toddlers are very picky eaters. They will typically eat three or four bites and then want nothing more to do with the food. Parents often worry about their children's nutrition during this picky time. "How can my child grow on nothing but milk and crackers?" "Will he become deficient in certain vitamins?" "My baby absolutely refuses to eat any vegetable!" One reassuring aspect of all this is that yours is not the only child who refuses to eat. The vast majority of other toddlers go through this stage. You went through this stage when you were a toddler as well, and look how you turned out. (This may or may not be reassuring to you!) This simple fact of life is that toddlers are supposed to be picky eaters. In a world where they have little control in their life, it is one of the first areas that they can exert some control over. It isn't that they aren't hungry. It is simply that they realize they can turn their head, push the spoon away, clamp their mouth closed, and thus be in charge of the situation. This stage is a precursor to temper tantrums - the next phase of fighting for control. The bottom line is that baby will outgrow this stage. You can either stress about it and try every little trick in the book to coax your toddler into eating more, or you can just sit back and let him mature out of this stage in the next few months. Either way, he will come out just fine.

Strategies For Feeding The Picky Eater

Here are two strategies you can try to get a few extra calories and vitamins into your child:

• Grazing - do not expect your toddler to sit down and eat a full meal three times a day. Instead, keep out a plate of finger foods (healthy ones) on his table. Let him graze on and off throughout the day.

   

• Reverse psychology - at mealtime, have everyone sit down at the table and begin eating. Sit baby in the highchair, but don't give him any food. Pretend he is not even there. He will watch everyone else eat, and realize he's being left out. He may then ask for your food or reach for your plate. Do not have a plate of food ready for him, because if you then set a whole plate of food down in front of him, he may reject it. When he asks, give him a bite of food off of your plate (this can either be your own food or something you've prepared for him). Don't offer him a second bite until he indicates he wants more. Continue giving him bites while he is interested. Don't pay him too much attention. Act like he is interrupting you to get bites of food. The second you sense he is becoming a bit resistant, stop feeding him and go back to the ignoring phase. He may again start to feel left out and ask for more. Before baby realizes it, he has eaten twenty bites of food!

   

And what does baby perceive during this time? That he is in control. Some parents are afraid to let their babies control them. Well, in this situation, baby isn't trying to control you. He is learning to be in control of himself, and this builds better self-esteem and independence. This method works best when there is more than one person with you at the table. If you and baby are alone, then read a book or magazine. We are not suggesting you get in the habit of ignoring your child or reading during mealtimes when you could be interacting with him. But for this picky stage it is ok.

Feeding Strategies That Don't Work - What NOT To Do

Here are some feeding issues that some parents have tried, but may not be appropriate for toddlers at this age:

• Insist that baby finish his meal - making baby sit in the high chair until his food is finished is unrealistic at this age. An 18-month-old is unable to understand "you can't get down until you finish your dinner."

   

• Insist that baby not make a mess - this too is unrealistic. Toddlers are supposed to make a mess while eating. That is how they learn. You can draw the line on making a mess where you feel it is appropriate, such as when baby begins throwing his food, it's time to get down.

   

• Make baby eat what you have prepared - one of the most useful concepts parents learn is flexibility. Offer baby a variety of foods. Don't expect her to eat liver and onions! Baby may not feel like spaghetti that night. Offer her an alternative. Be careful not to give in too much, such as crackers and bread for dinner every night.

   

• Don't push it - when baby does not want any more, let him be done. Trying to coax a few more bites into him may turn into a battle, and may turn him off to eating. This makes him even more picky at mealtimes.

   

Remember, you can either spend the next two years worrying about your picky eater and trying every trick in the book, or you can just sit back, relax, and let your toddler go at his own pace. Either way, he will come out just fine.

This is a situation that many single women (and men too) are now having to face - going back to work and leaving your child with another caregiver. This situation also occurs in homes where both parents are working outside the home. For the purpose of this particular discussion, I am not going to present the pros and cons of returning to work versus staying home with the baby. I am going to assume the parents must return to work for financial reasons.

So the main question is, how does a mom prepare herself and her high-need baby for the day when she has to return to work (I won't discuss dad's here)? Here are five main ideas to help make this transition easier for everyone. These also apply to non-high need babies:

• Well, the number one most important note is to get your baby used to the caregiver early! Fortunately for this particular mom, she has another 5 months or so. Many parents only have six weeks of maternity leave. Start getting your infant used to the other caregiver early, weeks or months before you go back to work. Have the caregiver watch your infant for a few hours twice a week. Try to get the caregiver to spend a lot of time holding, talking to, feeding, and singing to the baby. This repetitive contact will allow your baby to develop a relationship with the person.

   

• The younger you start this process, the easier it is. Most newborns don't really care who is feeding and holding them, just so long as someone is (with some exceptions of course). It is therefore fairly easy to get your newborn accustomed to another caregiver. This is not true for many infants older than three months of age. By this age, they often do care who is holding them, and it better be someone they are used to! This becomes even truer by 6 months of age when stranger anxiety sets in.

   

• Try some introductory sessions together - this is more practical for an in-home daycare situation with only one caregiver. Stay with the baby and caregiver for a number of introductory sessions. Let your baby see you having fun and being close and friendly with the caregiver. This may not be practical for a daycare center. They may not allow you to accompany your infant to a daycare center and stay. If they do, than concentrate on one or two of the caregivers who plan to be there long-term.

   

• Try not to start daycare during the late fall and winter - young infants are really susceptible to catching colds during this time. While older children can tolerate colds and coughs with little problem, young infants can get a lot sicker from common colds. There is one particular cold virus in the winter called RSV that is very contagious and can cause breathing difficulty and wheezing for several weeks. If at all possible, delay going back to work until the late winter and spring.

   

• Try to choose a smaller in-home daycare if affordable - research has shown that infants get sick less often in this type of daycare than they do at larger daycare centers. The more kids and caregivers, the more germs will be passed around. It will also be much easier for your high-need baby to accept a single caregiver in a smaller setting.

   

• Try going "cold turkey" - some infants, especially non-high need ones, don't require the above preparations. They may be happy being watched by anybody. They may fuss a little, and go through a few days of being clingy. But some will get used to the new situation quickly.

   

• A note on high-need babies - I have given you some strategies to try to help get a high-need baby ready for daycare. Now for the bad news - this plan may not work on high-need babies. You may go through all of this preparation and when it finally comes time for you to go back to work, your baby won't accept it. He may cry and scream no matter what you or the caregiver do. Some will only cry for several days, then get used to it. Others, however, will cry and scream for 8 hours a day, 5 days a week as long as they are in daycare. I have seen this happen to a couple of mom's who really did need to work. Their babies spent months crying every day. They never did get used to it. If your baby doesn't accept the situation, you need to decide what to do. If using an in-home daycare, you may need to offer the caregiver more money to care for your child (no one knows better than you how much extra work a high-need baby is).

   

First, I would definitely discuss this with her mother as she might have some suggestions from dealing with this at home. At this age, I would probably NOT tell her to stop as this only calls attention to the issue. During this “terrible two” age, she might start using this as a control issue, and continue it just because she is being told not to. I would just try some very exciting distraction. Get her up from the table and play of game of chase, bounce, throw, etc; just use anything not sitting down. And remember, like I say in the other section; don’t make a big deal about this.

Does your toddler seem to want to break every rule you try to impose upon him? Does he go around the playgroup hitting and pushing? Does he try to break just about every safety rule in the book? Well, of course he does! This is what he is supposed to do at this age! (If your toddler doesn't do these things, then consider yourself blessed!) Although such behavior is frustrating for parents, consider what a toddler's mindset is. The whole world belongs to him. Everyone around him exists for his benefit. If someone is in his way, move over!

There is nothing wrong with a toddler feeling this way. It is a survival instinct, a way for young children to ensure they grow older. Young animals fight for food and territory, why shouldn't young humans? While this behavior is expected for a young toddler, it certainly becomes less acceptable as he grows older. This is where the principle of setting limits comes into play. This is a principle of discipline that is important for parents to understand at this age. Setting limits refers to teaching your toddler what rules or boundaries you want him to respect. Such rules may include "do not run into the street alone" or "do not hit". Understand that at this age baby is probably not yet ready to obey such rules, simply because his brain is not yet capable of understanding that there are consequences to breaking rules. Our grown-up minds can understand the three-step process of consequences: 1. Do not hit others, 2. If I hit others I will be punished, 3. Therefore I will not hit others. Makes perfect sense, right? Well, to our minds it does, but a young toddler is not capable of thinking this through to the third step. He can probably understand that you have told him "no hitting", and that if he hits he will be punished, but his little mind simply is not capable of concluding, "therefore, I will stop hitting others because I do not want to be punished". So if your child will not yet obey such rules or boundaries, why even bother? The answer is that you don't want a three-year-old who won't respect rules. By practicing this exhaustingly repetitive cycle of enforcing and punishing rules, you help your child to eventually learn the third step in this thought process. He may learn it in a few months, or it may take a year. But by enforcing these rules over and over again, you allow his little mind to practice this thought process until he is mature enough to respect and obey the rules. This leads us into one very important principle of discipline.

Choose your battles wisely
At this age, toddlers are incapable of following every rule about safety, social behavior, and family life. If you try to enforce every rule on an 18-month-old that you would on a three-year-old, then your whole day will be spent punishing your child. Your child won't learn to follow rules; he will only learn that life is full of fights and punishments. We suggest that you choose which rules that you feel are the most important, and decide which rules or boundaries are minor ones that are not yet worth fighting over. For example, perhaps it is important for a toddler to learn not to let go of your hand and run into the street, or not to bang on the sliding glass door with a hard object. These are pretty important rules. However, if your toddler likes to bang on the wall with his plastic toy hammer, or wants to let go of your hand to run around in your safe driveway, these are things that might be slightly annoying to you or border on being unsafe, but are probably not worth fighting over. By giving your child the freedom to explore, try new things, make some noise, and get a little messy, you are simply allowing him to be a toddler. Let the little things go. Concentrate on the big things. You will be able to spend more time playing with your toddler than disciplining him.

Time Outs
This has become a popular form of discipline, and is a good alternative to spanking. Time out simply means removing your child from the location where the unwanted behavior occurred and making him stay somewhere else for a short time. One minute of time out per each year of age is appropriate. Places to put your child include the couch, the stairs, his bedroom, or a chair. The main point is to place him away from the situation. Most toddlers at this age won't stay where you have placed them for the time out. Holding them on your lap for time out is a good alternative. This may not seem like a punishment, but if you pull her away from where she was playing and place her on your lap, she will probably protest. When you place your child in a time out, simply say "do not hit, that is an owie" or whatever the offense was.

Will giving an 18-month-old a time out change or decrease the unwanted behavior? Probably not! So why do it, you ask? For the reasons discussed above under "Setting Limits". Eventually, your child will mature intellectually enough to start obeying the rules. Giving time outs at this age will help her get there.

Temper tantrums

One important thing to understand about tantrums is that they are normal behavior, and should therefore not be punished. Toddlers are supposed to have tantrums. Your goal at this age should not be to stop your child's tantrums, but rather to guide your child through them and to minimize the situations that might elicit a tantrum.

This is where the principle of choosing your battles wisely comes in handy. For example, you and your toddler are shopping and she reaches from her seat in the shopping cart and grabs a box of crackers off the shelf. She is quite proud of this feat, and begins to shake and play with the box. Your first instinct may be to take the box away and put it back. After all, you don't buy those particular crackers and you feel your child must learn to keep her hands to herself in the grocery store. Well, as you can imagine, if you take it away, your child is likely to throw a tantrum (your child may not be at the tantrum stage yet). Think for a moment; would you rather have a screaming toddler for the rest of your trip through the store, or would it really kill you to just let her hold the box of crackers, then discreetly set them aside at the checkout line. By letting her hold the box, you aren't giving into her or letting her have her way, because she won't even know it is an issue if you don't intervene. You will be faced with this kind of choice many times each day. By pausing for moment and thinking "is this really something important enough for me to intervene and possibly elicit a tantrum, or is this a small issue not worth fighting over?", you allow your toddler some independence to be herself, and avoid many nerve-wracking temper tantrums.

How should you respond when your 18-month old has a tantrum? The answer to this question will change as baby grows older. During the first few months of the tantrum stage, we suggest you console baby and try to help her through it with reassurance or by distracting her onto a different task. You may also choose simply to let her be, and allow her to roll around on the floor kicking and screaming until she is done. You can also alternate between these two choices, consoling her for a bit, then letting her down to deal with it on her own when she needs to. The older your child gets, your responses may change.

This is something that many families face. Even the most involved dad can experience this rejection. It is nothing that dad did or did not do.

1. Spend more intimate family time together - let your baby see dad and mom being close and affectionate. Moms, give your babies that message that "I love this man, he is safe and fun!"

    

2. Let baby hear your voice - moms, as you step out of the room for a minute, talk to your baby in a reassuring voice until you come back. Baby will learn that you are still near, and baby is safe, while you are in the next room.

    

3. Family walks - go for frequent family outings. Have dad carry baby around most of the time. Baby may be too distracted by the surroundings to realize he is in the "wrong" parents arms.

    

I would treat this just like any other toddler problems like biting, hitting, and tantrums. It helps to get into the mind of your child, and try to look at things from their perspective. Try to understand why she is spitting – does she think it’s funny? Does she see daddy spitting? Does she get a lot of extra attention from you every time she spits? With some situations like this it is often easier to fix by NOT making a huge deal about it. You might have success by insisting she cleans up the spit mess that she makes. You can click here for a long discussion on bothersome toddler behaviors.

It is typical for a child’s imagination to become very vivid at this age. This is why I think it is important to look at your child’s environment and try to see it through her eyes. Try to be sure she isn't seeing any frightening images on T.V. or in books. Also, talk about the characters that she is watching, i.e. “That big bird is yellow and funny!”, “That Mr. Cookie (our name for cookie monster) sure eats a lot of cookies, I bet he gets a tummy ache”. When these vivid images are first presented to your kids, they may not know how to interpret them – scary or funny. When parents and kids are laughing together at the funny Elmo bouncing around the screen, then it helps the child not to be afraid. Of course, this can be more difficult when there are older children in the house because of the things they like to watch.

Dry scalp

• In infants with cradle cap, the scalp can have yellow scales and crusts, and might be greasy or dry. Often, the eyebrows are also affected.
• Sometimes, it will cause the skin around the ears to get red, scaly, and maybe look a little greasy.
• Cradle cap usually does not itch, and usually does not bother the baby.
• The cause is unknown, and without treatment, cradle cap will usually resolve by the child's 1st birthday.

Treatment:

Since cradle cap usually doesn't bother the baby, try the oil treatment first. If it persists or worsens, then add the dandruff shampoo treatment.

• Use baby oil or olive oil to soften the thick crusts. Rub it in with your fingers, let the oil soak in for 15-30 minutes, then gently remove the crusts with a soft toothbrush. Wash the oil out immediately. This is very important, leaving the oil in too long can cause her whole face to break out in a rash.
• Antidandruff shampoo. Use an over-the-counter brand, such as Neutrogena T-gel. Be careful to keep it out of her eyes. After lathering it into her hair massage the scalp with a washcloth. Use it once or twice a week for about two weeks.

When to see the doctor:

• The scalp or skin starts to look infected.
• The rash is spreading beyond the scalp.
• The cradle cap is not starting to clear up after a few weeks of treatment.

Cradle cap, or seborrheic dermatitis, occurs in most infants during the first few months of life. It is a crusty, oily build up that appears on the scalp, with an underlying redness and irritation. It can extend down onto the face, the neck, and the upper chest. It is analogous to adult dandruff. It is thought to be caused by a combination of oily skin, hormonal effects, and occasionally fungus growth. It can fluctuate in severity from day to day, sometimes appearing mild, and sometimes flaring up into angry, red, bumps and pimples.

Treating cradle cap - for the scalp and eyebrows, you can massage in olive oil or baby oil, then gently comb or brush out the flakes. This isn't a cure, however, and the crusts generally keep building back up again for the whole first year of life. You can get rid of cradle cap once and for all using dandruff shampoo (either a selenium or a tar based shampoo is fine) twice a week for several weeks. You can decrease the frequency as the condition improves. You may need to use it once a month or so to keep the "dandruff" away.

Treating seborrhea on the face and skin - you can use an over-the-counter extra-strength hydrocortisone cream once or twice a day for several days at a time to minimize the rash. This isn't a cure, however. It will just keep it in check until the condition naturally goes away.

Yes, you’re right, croup seems to be worse at night. It often catches parents by surprise as they awaken to their child’s dry, barky cough. Croup is probably worse at night because of the dry air from the heater. The symptoms are due to swelling of the vocal cords caused by a virus. Parents usually can get through the first night with moist air from the shower, or taking baby outside on a foggy night. The next day, symptoms will probably improve somewhat, but then worsen again the second and third night. If croup is severe enough, children might needs special medications to help reduce the swelling of the vocal cords. Click here for our croup information page so you can read the danger signs to watch for.

Here is some great information on cradle cap, which is similar to “dandruff” in older children:

• In infants with cradle cap, the scalp can have yellow scales and crusts, and might be greasy or dry. Often, the eyebrows are also affected.
• Sometimes, it will cause the skin around the ears to get red, scaly, and maybe look a little greasy.
• Cradle cap usually does not itch, and usually does not bother the baby.
• The cause is unknown, and without treatment, cradle cap will usually resolve by the child’s 1st birthday.

Treatment:

Since cradle cap usually doesn’t bother the baby, try the oil treatment first. If it persists or worsens, then add the dandruff shampoo treatment.

• Use baby oil or olive oil to soften the thick crusts. Rub it in with your finger, let the oil soak in for 15-30 minutes, then gently remove the crusts with a soft toothbrush. Wash the oil out immediately. This is very important, leaving the oil in too long can cause his whole face to break out in a rash.
• Antidandruff shampoo. Use an over-the-counter brand, such as Neutrogena T-gel. Be careful to keep it out of her eyes. After lathering it into her hair, then massage the scalp with a washcloth. Use it once or twice a week for about two weeks.

When to see the doctor:

• The scalp or skin starts to look infected.
• The rash is spreading beyond the scalp.
• The cradle cap is not starting to clear up after a few weeks of treatment.

As far as colds go, there are over a hundred different viruses that can cause a common cold. That is why some people seem to get colds over and over all winter long. In general, a cold is contagious from about 24 hours before onset of symptoms until about 5 days after onset. You can catch a cold by inhaling airborne droplets or, more commonly, by touching a surface that contains the mucous or saliva of someone with a cold. That is why hand washing is so important. For more information on the common cold virus and natural remedies click here.

This sure sounds like it was a normal lymph node when your doctor saw it. Now it has changed, so you should let your doctor check it again. Probably will still be nothing to worry about, but the only way to be sure is to get it checked out.

This sounds like a breast bud. Breast buds are actually the beginning stages of breast development. They are usually round, and located precisely behind the nipple (if it is off center, then other causes of lumps need to be considered). The actual term for early breast bud development is premature thelarche. This can be on one or both sides and can happen to girls anytime between birth and six years of age. While not considered normal, we also don’t consider this a disease. Most cases of early breast development are harmless, and do NOT progress to actual full size breast development. Your doctor should check for other signs of puberty: rapid growth, acne, pubic hair, and menstruation. If these signs are present, then a full hormonal workup should be done.

Why does this happen?
Breast development is stimulated by estrogen, but studies of young girls with simple premature thelarche show normal estrogen levels. Most physicians believe that some girls are just temporarily more sensitive to their NORMAL levels of estrogen.

Any treatment needed?
Usually no treatment is necessary. Since there is a very, very small chance that this is the actual beginning of puberty, it is important for parents and physician to monitor the breast buds for significant progression.

Thank you for your comments. Keep in mind that your doctor’s appointments are only about 10-15 minutes. I find it very difficult to do much teaching in this short amount of time. Your child is acting like he might have asthma. Many children’s hospitals have asthma classes, I try to make sure my asthma patients attend one of these classes.

Why do children wheeze? It could be something as simple as a respiratory virus, but if he is having multiple episodes then it is probably something more significant such as asthma. There aren’t very many tests that can be done on a child this age other than maybe a chest x-ray (which usually is not needed). Often, the best test is this: try a few different treatments and see what works the best. Knowing what treatment works best can then tell the doctor what the problem is. I know, this sounds a little backwards. Here are some of the “treatments” I try: Avoid certain foods like cow’s milk, dairy products, food dyes (e.g. yellow #5, Red #30), or foods that are high on our allergy list. If the child’s wheezing episodes stop after avoiding cow’s milk and dairy products, then the diagnosis is cow milk allergy or sensitivity. If we suspect an allergic culprit but can’t prove it, then allergy testing might be helpful, but it’s nice to confirm animal allergies before getting rid of the family pet! Often, we will use asthma medications intermittently to help with the symptoms while trying to figure out what the triggers are. Some children only wheeze every time they get a cold virus. After a few of these episodes, mom and I learn that he needs to start his asthma meds as soon as the cold symptoms start. To read more about asthma, click here.

Croup is a respiratory illness that is characterized by a “barky cough” that almost sounds like a sea lion along with difficulty breathing. The breathing is the scariest part, and when it’s severe, children act and sound like they can barely get a breath in.

Yes, you’re right; croup is caused by a virus which leads to swelling of the vocal cords and the raspy voice, cough and obstructed breathing. Moist air (steamy shower room, foggy night air, or several humidifiers in the room) and staying calm is usually enough for mild croup, but severe croup can need steroids or even a trip to the ER.

Some kids will be more prone to croup, especially if they were premature and needed to be incubated with a breathing tube. Other kids just have a narrow trachea for no good reason, but regardless, most kids will grow out of it by age 6 or so. Rarely, a child will have some other sort of abnormality of the trachea (usually born with it) that will cause recurrent croup. Doctors might suspect this if your child gets croupy with EVERY cold or is having many episodes of severe croup.

A person’s gut is constantly performing a balancing act between absorbing nutrients, water, and filtering out what we are eating (the good and the bad). It doesn’t take much to temporarily throw off the balance; too much dairy, not enough whole grains, or a virus. When the stools turn green (with or without diarrhea), it usually means that SOMETHING has interrupted the gut’s balance. In a younger, strictly breastfed baby, it is usually something that mom is eating. Most often, abnormal stools in a breastfed baby is due to mother eating/drinking cow milk products. If it is not that, then it could be any one of a number of things: soy, wheat, peanuts, Mexican food... My daughter was very sensitive to mom eating bananas, and eleven years later, she still doesn’t like them.

If baby’s stools turn green, then think about what you have recently eaten. Often the green color is temporary and they will go back to normal within a week. If not, then you might need to make some changes in what you are eating. If baby is having diarrhea that is profuse, watery, and green, then he probably has gastroenteritis (“stomach flu”). Click here for diarrhea discussion. Also read tracking down food allergies for clues on what might be upsetting his gut balance.

While on antibiotics, a person should take a “probiotic”. The antibiotic kills all the good bacteria in your gut, and you get diarrhea, cramps, bloating. Acidophilus (or other probiotics) will help replace the good bacteria. This is also a very effective treatment for diarrhea caused by the “stomach flu”. Acidophilus is present in yogurt, but most containers don’t tell you how much. I prefer to take acidophilus capsules. For the kids, you can get liquid, powder or chewable versions. Most good health food stores will carry this.

Many babies become constipated when foods are first added to their diet. The main reason for this is that the standard recommended starting foods are all constipating - rice cereal, bananas, squash, and applesauce. Why do health care professionals choose these starting foods when they know they will make most babies constipated? Good question. Even my own Baby Book lists these as starting foods.

The truth is, there is nothing special about these foods that makes them better to start out with. Babies don't actually even need rice cereal. So, if your baby becomes constipated after starting foods, here is what you can do.

1. Stop feeding him whatever foods you have started so far.
2. Introduce a food that you know won't constipated him. Some good suggestions include pureed peaches, prunes, or any green vegetable.
3. If your baby will not take these foods, or if these foods don't work well enough, try some diluted prune juice through a sippy cup.
4. Offer water more frequently.
5. Once baby's stools become more regular again, start adding some of those starter foods again, but in smaller amounts, and less often.
6. You will need to determine how much of these "loosening" foods your baby needs to keep him regular.

How do you tell if your baby is truly constipated? Simply stooling less often is not considered constipation. Here are some signs to watch for:

1. Straining to pass stools - your baby may strain just for a few minutes, or he may strain for hours or days.
2. Painful stools - if stooling seems to be hurting baby in any way, even if it does not appear unusually large.
3. Large, hard stools - this is a sign, but only if baby is straining or in pain. Large, hard stools that pass easily are not considered constipation.

What should you do to relieve the constipation until the loosening foods kick in? If baby is really uncomfortable, you can insert a thermometer about one inch into baby's anus. This will stimulate the anus to open and pass the stool. If this doesn't work, use half of a children's glycerin suppository available over the counter at the drug store.

Of course, the middle of the back seat is the safest place for a car seat, so anything you can do to put it there would be nice. Also, it can help to look out the front window from the center of the back. Dramamine is safe for 2 year-olds and up. Benadryl is similar (but not the same) and would be safe to try. Check out the Medicine Cabinet for the correct dose. Below are some more tips on dealing with motion sickness. If this becomes a persistent problem, an occupation therapist specializing in sensory integration might be able to help. An OT could test her vestibular system (this is where motion sickness comes from) and possibly show you some exercises to strengthen this system. To find an OT that could do this, visit American Occupational Therapy Association, Sensory Integration Special Interest Section: www.aota.org

What is motion sickness, anyway?

Motion sickness results from a conflict between the eye and ear: the inner ears detect that the car is moving, but the eyes-- focused within the car-- do not. The brain gets mixed signals, and nausea results. Usually your child will first complain that she feels queasy-- allowing some time to fix the situation before actual vomiting starts.

It is easier to prevent motion sickness than it is to stop it once it starts.

Tips to prevent motion sickness in the car:

1. Focus on the horizon
   • Encourage your child to focus on a distant point outside the car
   • Play car games like "I Spy" that get the child to look outside
   • Bring along books on cassettes or CD's; your child can listen while looking out the window
   • Limit activities such as reading or playing hand-held video games, where the eyes stay focused within the car
   • For toddlers in car-seats, position the seat so that the child can see outside
2. Avoid Rear Seats
   • Avoid the rear-most seat in a van - kids seem to feel the van's motion more in the rear seat
   • Facing backwards is to be avoided, too.
3. Fresh Air
   • A child on the verge of queasiness may feel better if the window is open
   • Also, no one should be smoking in a vehicle with kids inside!
   • Also avoid strong-smelling foods or snacks
4. Settle the stomach
   • A child fighting queasiness may feel better if he munches on a dry cracker
   • An empty stomach is not best for avoiding motion sickness
   • Avoid greasy and hard-to-digest food
5. Smoother Driving
   • The less braking and swaying the better
   • A suspension system in poor shape can make things worse
6. FREQUENT STOPS!
   • Plan enough time on your trip to stop and let your kids get out of the car
7. Watch for early signs of motion sickness
   • Make sure to listen, if your child says he's feeling sick or dizzy. Also, pay attention if she loses her appetite, or appears pale or sweaty.

Here are some additional tips:

• Peppermints candies. Keep a supply in the car
• Ginger snap cookies. Eat a couple before you start the trip and then periodically during the trip.
• Avoid reading in the car, particularly on winding bumpy roads. Be sure to keep eye focus mainly to front.
• Use Seabands, which are wristbands with a small round metal button that presses into the inside of each wrist. They are tight & work by acupressure. My wife swears by them!
• Place the child in the middle of the backseat so they can see out the front, rather than the sides, which can appear as a blur.
• Pick a spot as far away as you can see and just focus on that for a few minutes not the road whizzing by.
• Breath deep through your mouth, not your nose.
• Stick your hand out the window, just a little bit; the fresh air blowing on your hand can help.
• Keep an empty large Tupperware containers in the car with a cover, so that in case of an accident, you can re-cover the tub until you reach a place you can empty and rinse it out.
• Keep plenty of lollipops on hand
• A cool face cloth. The minute someone feels that urge come on, hand them a peppermint and have them place the cool face cloth on their forehead.
• An ice pack applied to the back of the neck -- ten minutes on, ten minutes off -- works wonders.
• Take Benadryl or Dramamine 1-1/2 hour prior to drive. Don't wait until you are already on the road or it will be too late.
• Keep a bottle of Fabreeze to get rid of accident odors
• Never travel without a big tub of wet wipes!
• Keep an extra change of clothing in the car.

Most large babies burn more energy than average babies. This is mainly because their metabolism is just a little higher. Why is this? Gestational diabetes is one cause. Also, simple genetic differences in people will cause a newborn to be a little larger, and whatever was causing this baby to be larger, will also cause the metabolism to be just a little higher. However, in the first few days of life, they are still getting the same amount of nutrition from mom as a smaller baby would, so they can be prone to low blood sugar.

A baby’s liver is responsible for helping the body utilize energy, so any immaturity of the liver could also cause a baby to have a low blood sugar. An immature liver will also cause a baby to be more jaundiced than normal – so this is probably why your baby had both a low blood sugar, and jaundice severe enough to require extended phototherapy. Bottom line: not much you could have done to predict this. It is considered a minor complication of being a large newborn, and most babies work through it easily with minimal help from the doctors.

Most toddlers will develop some degree of bow-legged ness regardless of which type of carrier is used. The Mei tai I am not familiar with (of course, the Mai Tai is a different story!). Babies typically are born bow-legged, and remain that way for over a year. Usually the legs start to straighten-out and are mostly straight by 18 months. After this, the legs start to get knocked-kneed and progress this way for the next few years. Finally, they become straight again by adolescence. There are some red flags to watch for: Asymmetry, short stature, or if the child is extremely knock-kneed.

It is true that drinking formula or juice while lying down can increase the risk of ear infections. This is because the liquid can enter the eustacian tube and introduce bacteria or viruses into the middle ear. The many germ-fighting ingredients in human milk keep harmful bacteria from bothering baby, so that stuffed-up noses and ears are less likely to become infected middle ears. Because breastfed babies are fed in a more upright position, they're less likely to experience milk backing up through the eustachian tube into their ears; if this does happen during a breastfeeding session, human milk is less irritating to the tissues of the middle ear than infant formula. Breastfed babies have fewer, or at least less severe, colds than formula-fed babies. Fewer colds means fewer ear infections. Breastfed babies have fewer respiratory allergies, another cause of fluid building up in the middle ear, which setts the stage for bacteria to grow.

Impetigo is a skin infection and usually looks red with a dried crusty honey colored discharge. It tends to spread. The usual treatment is an antibiotic cream such as BACTROBAN. For severe cases, I will also use an oral antibiotic.

I commend you for choosing to breastfeed and sticking with it. Your baby will be much healthier as a result. I am sorry that your doctor is so negative. When I don’t agree with a patient’s philosophy, I try to just be quiet – not antagonistic… YES, YOU CAN CONTINUE BREASTFEEDING.

What you really need to do is find a good certified Lactation Consultant to help you diagnose your rash. It is difficult to tell you what it is via e-mail, but it is very possible that it is a yeast problem. Here is some information about yeast on the breasts:

Candida (Yeast or Thrush) Infection on Nipples
Candida (also called yeast, monilla or thrush) is a fungus that thrives in warm, dark, moist environments, such as the mucus membranes of the mouth and vagina, the diaper area, skin folds, bra pads, and on persistently wet nipples.

Suspect candida as the cause of your sore nipples if:

• Your nipples are extremely sore, burning, itching, red, or blistery.
You experience shooting pains in your breasts during or just after feeding (especially during your milk ejection reflex).
• The usual remedies for sore nipples aren't working.
• Baby has oral thrush (white, cottage-cheese-like patches on the tongue and sides of the mouth) and/or a yeasty diaper rash.
• Your nipples suddenly become sore after a period of pain-free breastfeeding.
• You are taking, or have just finished taking, a course of antibiotics. Yeast infections are common following antibiotic treatment.

Here are some simple suggestions that may help prevent a yeast infection on your nipples, or cure a mild case of yeast infection:

• Yeast organisms hate sunlight, so give your bra and breasts a sun bath. Expose your nipples to sunlight for several minutes several times a day. After washing them, dry your bras in the sunlight.
• Air-dry your nipples after each feeding
• Avoid plastic-lined breast pads that irritate skin and trap leaked milk.
• Change nursing pads after each feeding.
• Wear 100 percent cotton bras and wash them daily in very hot water.
• Thoroughly wash pump parts that come in contact with your breasts in a bleach solution and boil them in water for five minutes daily.

Treating Candida: Infection of the Nipple
If the simple home remedies listed above don't bring relief, consult your healthcare provider about the following treatments:

• Apply an antifungal cream (mycostatin, clotrimazole, myconazole) to your nipples as suggested or prescribed by your doctor.
• If you have a candida infection in your nipples, baby should be treated for thrush even if you can't see any white patches in the mouth. Your healthcare provider will prescribe an oral antifungal suspension that should be painted on baby's tongue, roof, and sides of the mouth three or four times a day for a couple of weeks.
• If baby has a candida diaper rash, treat it with an over-the-counter antifungal cream.
• Eat lots of yogurt (the kind with live active cultures) and take oral acidophilus. This encourages good bacteria to live in your gut and discourages the growth of yeast.
• If your baby has thrush but your nipples are not yet sore, apply the prescribed medicine to baby's mouth just before feeding so that your nipples get the preventive benefit of the medication as well.
• If your healthcare provider advises you to wash the creams off your nipples prior to breastfeeding, do so gently with warm water.
• While nursing on a candida-infected nipple can be extremely painful, it is necessary to keep the affected breast empty to prevent mastitis, or even a candida infection deeper into the breast tissue. Pay particular attention to proper latch-on and easing your baby off your nipples at the end of the feeding, since infected nipples are more sensitive and prone to injury from improper sucking patterns.

This is a fine way to do things. How long the milk is frozen doesn’t really change how it should be thawed. Refrigerate over night or placing the bag in a pot of warm water is fine. After thawing, be sure to use it within 24 hours. Click here for more on how to store and thaw breastmilk.

A general guideline for a strictly bottle-fed baby is to give 2 to 2.5 ounces per pound of body weight per day. So, for a 10-pound baby, he would get 20 to 25 ounces per day. Divide this by 8-10 feedings per day, this gives about 2-3 ounces per feeding. When you are using a bottle as an occasional alternative to the breast, the amount of that particular feeding may vary. Don’t worry too much, just prepare a few ounces and if he doesn’t finish it, no problem. He is gaining plenty of weight.

Let’s say you’re at a friend’s party, have a couple of drinks and feel a little tipsy. At that point, there will be a small amount of alcohol in your breastmilk. Now, if the party goes late… things get a little out of hand… you’ve had quite a few more drinks, and wind-up prancing around your friend’s house wearing nothing but a bear-skin rug… there will be a lot of alcohol in your breastmilk!

What happens to the alcohol in the breastmilk? Do you need to pump and dump? The milk-alcohol level will be based on your blood-alcohol level. As your body metabolizes the excess alcohol and the blood alcohol slowly decreases, so will the milk level. You generally don’t have to pump and dump, unless you need to prevent engorgement. When the effects of the alcohol have worn off, then it is fine to nurse again.

One more thing: be prepared to pay top dollar to buy the negatives of any photos that were taken at the party!

• You might start with having the child use the diaper for bowel movements but he must empty the diaper into the toilet and then throw away the diaper (with supervision, of course).
• The next step might be the child stays in the bathroom to use the diaper, and continue to help with clean up.
• Then the child uses the diaper but must be seated to have a bowel movement. He can choose to sit on the toilet with the seat up or down, or maybe a chair. Eventually the steps lead to the child having bowel movements sitting on the open toilet with the diaper on.
• You then might be able to remove the diaper. If not, then you and your child can make a "magic diaper" that has a hole cut in the rear so that stool can fall into the potty. Children can usually quickly graduate out of the "magic diaper".

Okay, I had to re-research this a little bit: A humidity range between 40-60% is healthy for the body, mainly because bacteria have a hard time growing in this range. The EPA's recommendation of 30-50% is mainly for preventing mold growth in the house. Our local children's hospital keeps their air at 55%. The problem is that a higher humidity will promote mold growth. How a room is built and insulated is also a factor for promoting mold growth. If the walls are getting cold at night, then mold is more likely to grow.

You should aim for a higher humidity level, without any mold growth. This will vary depending on the season and the construction of the room. You can get an inexpensive humidity measuring device at your local hardware store. Remember that aiming a vaporizer at the baby's bed will raise the humidity level around the bed significantly, but the overall humidity of the room will not be as high. This is a nice way to give the baby the benefit of humidity while keeping the mold risk lower, just be sure the baby stays warm enough if you're using a cold mist.

This is very common in kids that use pacifiers or lick their lips a lot. We call it "lip-licker's dermatitis" (it's in the dermatology textbooks!). The cure is to stop licking your lips, or get rid of the pacifier, but that can be tough. I am a big fan of Aquaphor or Lansinoh ointment for this type of problem.

Many, many newborns get mild hiccups and we usually say, “It’s normal, don’t worry, it will go away soon”. On the other hand, if hiccups are very frequent, it is likely that something is in the breastmilk that doesn’t agree with her. Mom should avoid cow milk products first. If that doesn’t eliminate the hiccups, other likely culprits are:

•  
Caffeine – coffee, tea, soda
•  
Soy products
•  
Peanuts
•  
Shellfish
•  
Chocolate (sorry!)
•  
Citrus fruits
•  
Wheat
•  
Eggs

If the hiccups are still problematic after a few diet changes, then you should mention it to your doctor.

Instead of struggling with the baby toothpaste, I would get a cute toothbrush with one of her favorite cartoon characters on it. Let her “play” with this toothbrush (no toothpaste) while she watches you brushing your teeth. Sing a song while you brush, and maybe she’ll follow along. Until she is ready for fluoride (usually age 2 to 3), using a dry brush is fine. This will help foster a fun relationship with the toothbrush, which will be very important when she is older and has a mouth full of teeth. Most of the local pediatric dentists that I talk to have recommended using toothpaste with fluoride as soon as your child is able to spit it out – and then only use a small “pea-sized” amount.

Wow, you are certainly in a tough situation. I have many dads and daughters this age and older doing all of these behaviors that you are describing. I agree with you that these are just Daddy being Daddy. There is absolutely no problem with what you are doing as long as there is no history of inappropriate behavior toward your girls by anyone. Does that make sense? Sure, somebody else might have a different perspective on this depending on their background. If mom had ever been inappropriately treated, then she will be super-sensitive to how her girls are treated, and will certainly miss-interpret situations like this.

Father/daughter interactions can be appropriately close - much closer than she should be with any other adult male. My daughter (11 years old) will come up to me and jump on my back into the “piggy-back” position. Then I carry her around to her requested destination. While on a plane ride, she will put her head on my shoulder while she takes a nap. If these made her uncomfortable, she would not initiate these times of closeness. I would suggest you let your daughters ask for a shoulder ride or a knee to sit on, instead of you insisting on it.

When my wife and I return home from dinner and a movie, our kids are usually sleeping on the couch. After dismissing the sitter, my wife goes upstairs and readies the kids’ beds, while I carry them up and tuck them in. Absolutely nothing wrong with carrying my seventh grade daughter up the stairs and into her bed! Yes, she is heavy, and sometimes I wonder how far I could carry her if she was ever injured while we were hiking in the woods. Would your counselor have a problem with me carrying her for two miles with a broken leg?! She better not!

Your daughters will likely eventually seek life partners who remind them of you – and I say, “so far, so good”. Who you are, and how you behave will define, in your child’s mind, what an Ideal Man should and shouldn’t do. Lack of appropriate affection from father could make them more likely to seek inappropriate affection from other boys/men when they are older. I think your actions are perfectly appropriate and are helping you to build a strong bond with your daughters. Like me, I know you would never cross that line. Hugs, kisses on the cheek, and shoulder snuggles could and should last well into adulthood, and on their wedding day, you will probably share a dance with them, right? I doubt mom will have a problem with that.

You seem to be doing all you can do. So, now it is time to get him evaluated by a pediatric speech therapist. Most kids this age have a vocabulary of 50 words (some will have over 100) and while I have had many, many toddlers like this turn out to be just “late talkers”, it is important to rule out more serious developmental problems – a good speech therapist is a good place to start. She (or he) can help decide if there is anything to worry about. In the meantime, here are some things parents can do to help their children develop language skills:

• Read books and sing songs to your child on a daily basis, beginning in infancy.
• Introduce new vocabulary in a meaningful context, e.g., name specific foods at dinnertime.
• Speak directly to your child, and give him/her time to respond.
• Don’t use baby language.
• Avoid finishing sentences for the child.

The fact that doctor and dentist can’t tell you why the teeth are like this is probably a good thing: it means that there is no “bad reason” for it, and nothing needs to be done to fix it.

When both of a pair of teeth is affected (i.e. the two inside bottom teeth, or the two upper fang teeth) that usually means that something happened to these teeth earlier in their development. This is because teeth develop in pairs. What probably happened is this: At a certain point, these two teeth were in a stage of development that left them vulnerable to stress, like a pregnant mom getting the flu (none of the other teeth were in this particular stage at that time). Only the two vulnerable teeth are affected. We usually don’t worry about this, since the teeth are structurally fine, and they will be falling out in a few years anyway.

Uncircumcised infants do not need any special care for their penis. I call it "the un-care of the intact penis". You should completely leave it alone. You should NOT forcibly retract it, EVER. And you should not allow anyone else to do so either. This causes considerable trauma, both physically and emotionally. Forcible retraction can lead to soreness and infection of the foreskin.

Why all the controversy? Rarely, an intact foreskin will remain tight and unretractable into adulthood. This can interfere with urination. If this occurs, it can be corrected with a minor surgical procedure. Years ago, doctors thought that we should therefore forcibly retract the penis during infancy so that this rare problem won't occur. If it was not retractable by a few years of age, it should be forcibly retracted. Now we know that the trauma of doing so far outweighs any benefits.

The pain and trauma just isn't worth it. Virtually all foreskins will loosen up and retract just by the child normally exploring this body part.

When changing a baby girl’s diaper, parents often wonder if they need to spread the labia and wipe out anything that might have found its way in there. When our daughter was a baby, we would usually wipe “in there”. But, I see many babies during check-up that have lingering stool that was left in there – and these kids usually do NOT have any problems like bladder infections. So, I have usually thought that it probably does not matter if you deep wipe or not. Most diaper creams will not be harmful if they are placed inside the labia. However, if irritation is occurring, then it could be the cream. Another frequent cause of irritation is bubble baths or simply soaking in the soapy water. When a young girl is getting vaginal irritations – I usually recommend no soap or bubbles in the bath, and use the soap in the shower, or at the very end of bath time to minimize the time spent soaking in the soapy water.

1. Amaryllis
   • Mistletoe
   • Daffodil
2. Arrowhead vine
   • Asparagus fern
   • Pothos
3. Aloe
   • Dieffenbachia
   • Philodendron
4. Crown of Thorns
   • Azalea
   • Elephant Ear Caladium
5. Pot mum
   • Bird of Paradise
   • Emerald duke
6. Red princess
   • Boston ivy
   • English holly
7. Schefflera
   • Marble queen
   • Chrysanthemums
8. Caladium (angel’s wings)
   • Iris
   • Christmas rose
9. English Ivy
   • Spider plants
   • Sprengeri fern
10. Chrysanthemum
    • Lily of the valley
    • Jerusalem cherry
11. Creeping Charlie
    • Tulip
    • Creeping fig
12. Kaffir lily
    • Flamingo lily
    • Croton
13. Cyclamen
    • Angel’s trumpet
    • Poinsettia
14. Hydrangea
    • Devil’s backbone
    • Rhododendron

The medical term for this is Ankyloglossia. This is when the little flap of tissue under the tongue (the frenulum) is attached a little to far up the front of the tongue. This does not allow the tongue to stick out far enough. In mild cases, there is no problem. In more severe cases, the tight tongue makes it difficult to nurse, and might give the end of the tongue a "heart" shape. This problem is often recognized by a lactation consultant when helping a difficult nurser. When done early (in the first month of life or so), it is very easy to fix. Simply clipping the flap with a blunt-nose scissor will do the trick. No anesthesia needed when it is a thin flap of tissue, takes 5-10 minutes in the office and it won’t bleed. The hard part is finding a doctor who understands this problem and will perform the procedure. Most lactation consultants will know of a local doctor that is comfortable doing this.

After a few months, the frenulum thickens and will bleed if cut. By this time the procedure is more complicated and should be done by an ENT surgeon under general anesthesia unless they are much older and can hold still. Usually by this time, the feeding difficulty has been worked out (usually mom has given up on breastfeeding and is using the bottle) so the next concern is speech difficulties during the child’s preschool years. Trying to perform this procedure on a 5 year old is pretty much impossible without general anesthesia, so I don’t recommend it unless there is significant speech difficulty. If there are no speech problems, but just a funny looking tongue, I usually recommend waiting until the child can hold still for the procedure, usually age 10 or above.

So, bottom line: It is possible that the frenulum is still thin enough to be simply clipped. I would try to find a doctor right now who can give you an opinion, maybe a lactation consultant can help. If it is too late to be done without anesthesia, then it is not an urgent matter (unless there is feeding difficulty) and it would be wise to wait until the child is older and is at lower risk of problems from general anesthesia.

I still think that at this age, going to work with mom is better than day care. Watching mom work will probably provide some good stimulation; you will notice that he is very busy checking out what is going on around him. You will also be able to hold him occasionally if needed. Time spent actually reading is less important than just having time with mom – at this age. You will be able to sing in the car and do some fun playtime at home.

This is a great question. The key word here is BALANCE. Attachment Parenting is all about balance - finding the right balance between fostering a close relationship with your child and maintaining a close marriage relationship. These two sides do not necessarily have to be at conflict, especially if BOTH parents nurture an attachment with the child. When a mom and dad are fostering a close, attached relationship with their child, this naturally brings the parents closer together as well.

There are two main ideas to keep in mind here. For moms, realize that your husband really does need some alone time with you. Make some time to go out on a date once or twice a month. For dad's, understand that the mother/child bond may be more physically based and therefore your wife may naturally be more reluctant to leave your child alone to go out. Give her time and support. She will come around soon.

Again, the key word is balance. Too much focus in either direction will end up making either dad or child feel left out.

On another note, attachment parenting can really drive a wedge of resentment between a husband and wife if only the wife is fostering a close attachment and the husband/father is parenting more from a distance. Such a difference in parenting ideals can really put a strain on a marriage.

For toddlers that seem reluctant or downright hysterical when you try to leave them with a babysitter, here are a few tips. Don't try to do it cold turkey. Don't just hire some teenager one night and take off, leaving your child with a stranger. Build up to it. Have a close friend or relative come over several times. Let your child interact with him or her. Allow your child to see you both laughing and having fun with this person. Give your child the message that this person is "part of the family." Start this process early on, so that when you are finally ready to go out, your child will be ready as well. Try having just mom leave for an hour or so for a trip to the store, while dad and the friend stay home. See how comfortable your child is with this.

Most 13-month-old infants sleep 11 to 12 hours a day, including naps, so your daughter is only an hour short of the average. If she seems well-rested the next day, this may be enough sleep. But if she seems tired or irritable, or nods off to sleep frequently during the day, these are signs that she needs more sleep. Below is a chart of average sleeping times for children of different ages.

An 11 p.m. bedtime is unusually late for a 13-month-old. Modern lifestyles often push bedtimes later, especially among working couples who might not get home until six or seven in the evening and prefer that their baby take a late afternoon nap and be well-rested for quality time in the evening. Other parents prefer a later bedtime for their baby so they can get that extra hour of sleep in the morning. Still other parents want an earlier bedtime so they can get in some baby-free couple time in the evening.

Use the bedtime that works for you and your baby. If an 11 p.m. lights-out keeps your baby rested and suits your schedule, stay with it.

Hi Barbara, thanks for your question. This can be a tricky subject with many possible areas of confusion: how long can you keep milk stored in refrigerator? Freezer? Can you re-freeze? What type of containers are best? Below, you will find a link to the answers to all of these questions. Regarding your specific question: freshly pumped breast milk can remain at room temperature for 4-6 hours before it needs to be refrigerated. Research shows that bacteria does not grow well in fresh human milk, so you don’t need to worry if you can’t rush it to the refrigerator right after you pump. It does make sense, however, to get it refrigerated or frozen as soon as possible, and to keep it cool while transporting it.

Click here to read all about calcium and daily calcium requirements, as well as a list of calcium-rich foods.

Infants will slow down on breastfeeding (or bottle feeding) during the second half of the first year. This seems to be a normal pattern. They are no longer content to "waste" time breastfeeding when there is a world out there to explore.

Hepatitis B and C are mainly transmitted the same way that HIV would be transmitted (blood transfusions, contaminated needle sticks, etc.). The casual contact that would occur during a visit to the grandparents should pose no risk. This is different than another virus, Hepatitis A, which is much easier to transmit (not washing hands after using bathroom).

When a mother has a forceful let-down reflex, the baby may swallow a lot of air during feeding, and this can lead to some colicky symptoms: he may spit-up regularly, pass gas, choke or gag while nursing, have difficulty settling down to nurse, and he might arch away from the breast when the let-down reflex hits.

Another difficulty with over-active let-down is that baby gets mainly high sugar, low fat foremilk, without getting to the high fat hindmilk. All this extra milk sugar can make a baby gassy and fussy.

Here are some tips on handling this problem:

• Empty your breasts by pumping both sides for 5-7 minutes each morning.
• Feed your baby on only one breast for the next two to three feeds and then switch to the other side for the following two to three feeds. This gives baby more hindmilk.
• If the breast you aren't nursing from starts to feel engorged, place a cabbage leaf over it for an hour or two. This will slow the milk down a bit.
• You will eventually be able to pump less often in the mornings as you feel less full.
• When you've been able to decrease the pumping to only about one morning each week, you can probably stop pumping.
• Another trick is to make gravity work in your favor. Make baby nurse "uphill" by lying on your back and placing baby's head over your breast so he has to draw the milk up. This also may slow down the milk flow.

Crying is NOT needed for lung development. In fact, too much crying can be harmful to the brain. Research supporting this is presented in our soon to be released book about sleep.

I just read an article in a dermatology publication that pointed out that shaving hair does NOT cause it to grow in thicker.

It's the middle of the night and you are awakened by your child screaming from his bedroom. You rush in to see what's wrong and you find him sitting up in bed with a blank stare but very agitated. You try to wake him, asking him what is wrong but he doesn't respond, he just keeps screaming. You are scared and don't know what to do. After a few minutes, your child goes back to sleep and in the morning he doesn't remember the episode.

Characteristics of night terrors:

• Your child seems frightened, but cannot be awakened or consoled.
• Your child may sit up in bed, or walk around the room, screaming or talking senselessly.
• Your child doesn't acknowledge you, his eyes may be open but he seems to stare right through you.
• Objects or persons in the room might be mistaken for dangers.
• Episodes usually last between 10 and 30 minutes.
• Usually occur in children 1 to 8 years old.
• Your child cannot remember the episode in the morning.
• Usually happens within 2 hours of falling asleep.
• Night terrors are harmless and each episode will end on its own.

Why does a child get night terrors?
Night terrors are an inherited problem and occur in about 2% of children. It is as if the child is having a bad dream during deep sleep and cannot wake up. Night terrors are not caused by psychological stress, but they seem to be associated with being overtired.

Will my child outgrow this problem?
Yes, most children with night terrors will stop having them by age 12, usually sooner.

What should I do when my child is having a night terror?

1. Help child go back to sleep.
Do not try to awaken your child. Turn on the lights so that your child won't be confused by shadows. Remain calm, talk in a soothing tone, "you are okay, you are at home, you are in your own bed, you can go back to sleep". Again, speak calmly, and keep repeating these soothing comments. You can try holding his hand or snuggling him, but if he pulls away don't persist. Don't try to wake him with shaking or shouting, this will only agitate him more and prolong the attack.
2. Protect him from getting hurt.
Keep you child away from stairs, windows or sharp objects. Try to gently direct him back to bed.
3. Educate your caregivers.
Be sure to warn babysitters, family members, or others who might be caring for him at night. Explain to them what to do in case of an attack, so that they don't overreact.

Can night terrors be prevented?
The following exercise has been shown to stop night terrors in 90% of children. For several nights, keep track of the time between falling asleep and the onset of the night terror. Then, wake him up 15 minutes prior to the expected time of the episode, get him out of bed and fully awake for 5 minutes. Do this for seven consecutive nights. If the night terrors recur, repeat the seven nights of awakenings.

I wish my wife would let me keep the thermostat this low. I love to sleep in a very cold room, snuggled in thick covers. But, is this okay for young children? Newborns have little ability to regulate their own temperature, but as they get older, this becomes less of a problem. I don’t think 66 degrees F is too cold, this is only 2 degrees less than usual. Just be sure they are dressed warmly. Hands and feet are usually a good indicator, but if the body is bundled, and the extremities are not, then they will feel cold. If kids are wearing gloves and socks, and hands/feet are still cold, then they probably need more bundling.

I hear this almost every day in my office. Many infants sleep well for the first 5 months of life, and then teething sets in, and the night waking begins. This is so common, I have concluded that this is actually the norm, and 8-month-olds who DO sleep through the night are the minority.

Decades ago, every parent just took it for granted that babies wake up at night. It was expected, and therefore, accepted. Sometime in the 70's someone got it in their head that babies SHOULD sleep through the night. Since then, new parents are bombarded from all sides with the notion that their baby is supposed to sleep through the night. They hear if from friends, relatives, churches, and books. "Oh! Your baby isn't sleeping through the night?" "10 fool-proof ways to get your baby to sleep through the night." "My baby sleeps 12 hours straight without waking." Today, parents are led to believe that if their baby doesn't sleep through the night, something must be done about it.

The bottom line is that babies are not supposed to sleep through the night. Most will require some degree of parenting at night. This is simply the way it is, and as a parent, you signed up for this.

Now, having said that, there are many ways to encourage your baby to wake up less at night. Your goal, however, should be to decrease night waking, not to eliminate it altogether.

After making fun of lists and books that promise ways to get your baby to sleep, I must include my own tips on how to make nighttime easier for you and your baby. Here are 31 Ways To Help Your Baby Sleep Better.

Some parents who have chosen to sleep with their babies and breastfeed at night, and who are now dealing with this night waking issue, may begin to question their decision about this parenting style. To learn more about the benefits read 8 Infant Sleep Facts Every Parent Should Know.

A WORD OF ENCOURAGEMENT - all babies eventually grow up, wean, and sleep through the night in their own bed. Ask any parent whose children are older and they will tell you "they grow up so fast". "I wish I could snuggle with them in my arms again". "It was so nice to snuggle in bed and nurse them and hold them close". First time parents won't believe this, but there actually will come a day when you will miss this time in your baby's life. If you consider that you will be spending the next 50 or more years with your child in your life, then this next 6 to 12 months of night waking and nursing is really a short time. Hang in there. You will get through it.

TEETHING - be sure to keep in mind that this is almost always a contributing factor, if not the only factor, to night waking. Be sure you are adequately addressing this issue to minimize teething pain at night. Click here for a complete discussion on teething. Remember, although teeth don't usually come in until 6 months or later, teething PAIN can start as early as 3 or 4 months of age.

Always be sure to consider that your child may be waking up more at night because of a medical problem. To learn more read Hidden Medical Causes of Nightwaking.

Masturbation in the young child

Many young children touch their privates, and often it is simple curiosity: they are interested in "that thing" down there. They pull on it, push on it, wiggle it, and sometimes while exploring their diaper they find some poop! Wow, that came out of ME?! This is kind of fun! This type of touching is usually just a very curious toddler exploring his body, much like his finger explores his nose to see what treasures he can find.

Masturbation in a child is different; the child will usually appear dazed, flushed, and preoccupied while rubbing themselves with their hand or another object. Children might masturbate several times per day or only once a week.

Why do they do this? Mostly because it feels good. Some might do it because they are unhappy about something like getting their pacifier taken away. Children might also do this simply because they are constantly being told not to. Masturbation is NOT caused by simple irritation in the area - this just causes pain and/or itching.

Don't make a big deal about this: First of all, don't worry. About one third of young kids do this, and practically all teenagers do it. It is not abnormal unless they continue to do it in public beyond age 5-6.

It does NOT cause any physical harm, and does NOT mean you child will grow up to be sexually promiscuous. However, if adults overreact and make the child think it's evil or dirty then it can lead to emotional harm, such as guilt or sexual inhibitions.

What to do about it:

• Have realistic goals. You won't be able to completely stop your child from masturbating, so a realistic goal would be to just control where your child does this. Try to limit it to just the bathroom and the bedroom. You can say to your child, "it is okay to do this in your bedroom when you are tired." But don't completely ignore the issue; otherwise your child might think it is okay to do it anywhere.
• Do ignore it at naptime and bedtime. Just leave him alone during these times. Don't keep checking on him or asking where his hands are.
• Try distraction. At times other than naps and bedtime, try to distract this behavior with other activities or a toy. Getting his mind onto something else might help.
• Give an explanation: If the distraction doesn't help, then explain to your child, "I know that touching yourself feels good, but it is not polite to do it around other people, you can only do it in private." You need to insist that the child only does this his room or the bathroom.
• What about at preschool? The same principles should apply. The teacher should first try to distract the child with an activity. If that doesn't work, then try to get the child to "snap out of it" and grab his attention with a comment like, "Okay, Johnny, we need you to join us now!" Masturbation should only be tolerated at naptime.
• Spend more "snuggle time" with your child. You might be able to decrease this behavior if you give more hugs and cuddles throughout the day.

• Do not try to eliminate this completely. This will lead to more problems.
• Do not physically punish or yell at your child for masturbating.
• Do not use any physical restraints for their hands.
• Don't label masturbation as dirty, sinful, or bad.

In general, grinding the baby teeth is not a problem. It is often a sign of teething, very likely for a 12 month old. When he starts losing his baby teeth, the grinding should stop (if it even lasts that long). If he is grinding his adult teeth, then that is a different story, and a dentist should be consulted to look for damage. He might suggest that a tooth guard be worn while sleeping.

Watch your child sleep. If he has periods of sleep apnea – stretches of 10 to 15 seconds where he doesn't breath, followed by an intense catch-up breath – report this to your doctor. Sleep apnea and snoring at night may also be due to enlarged tonsils and/or adenoids. During the day, the tonsils do not compromise the airway. But at night the air passages relax and narrow, requiring more effort to force the air to move through them faster. This is what produces the snoring noise.

Have your child's nasal passages and throat examined by your pediatrician. If your doctor is unable to detect a structural problem, be sure your child's sleeping environment is free of allergens – including dust collectors and animal dander – which can cause nighttime stuffiness and result in noisy breathing. In addition to removing potential allergens, a bedroom air purifier (preferably the HEPA-type) can help, so can encouraging different sleep positions for your child. Sleeping on his side or stomach may relieve your child's snoring.

Sleep apnea interferes with a child's overall growth and well-being. Children alternate between light and deep sleep, and when their airway becomes obstructed, they often awaken startled from a lack of air. This causes an adrenaline rush and revs up the child's nervous system at night, interfering with sleep.

If your doctor thinks there is a structural cause for the snoring, you will probably be referred to an ear-nose-throat (ENT) specialist.

Incidentally, sleep apnea also can induce bedwetting. So, as an added perk, you'll probably notice more nighttime dryness once your child's adenoids come out.

A lot of babies don't like cribs. This is what we did to our bed to make it safe. First, we lowered it by removing the frame. Just have a box spring and mattress, this way it's low enough so that baby won't get hurt when she rolls off. This is also important over the next year or two when she is trying to climb in and out of bed; the lower bed the easier and safer it is.

Also, try a sidecar arrangement while she's sleeping. In this way, baby is within arm's reach for nursing and bonding, yet mother and baby are not so close that they keep each other awake. (You can buy a special baby bed called the "Arm's Reach® Co-Sleeper® Bassinet" that's designed to be used next to the parent's bed.)

You will also need to be sure your bedroom is baby-proofed. That way, when she wakes up and gets out of bed to come looking for you, she won't get hurt by anything in the room. You can use a monitor to listen for the sounds of her waking up.

Check out our Sleep section for more tips.

After one year of age it is okay to start eating fish - wild salmon being one of the best. No need to start a fish oil supplement before this - he gets all the healthy fat he needs from breastmilk. If mom doesn't eat fish regularly, then it would be good to take some sort of Omega-3 supplement, like flax seed oil, or DHA.

Group B Streptococcus is a bacterium that lives in the vaginal area of some women. While it normally does not cause any health problems for the woman, it can migrate up into the uterus during labor after the bag of waters has broken and infect both the newborn infant and the mother. It is for this reason that IV antibiotics are given during labor to women who are Strep positive. The antibiotics suppress or kill the bacteria so they do not infect the newborn or the mom. The longer a woman is in labor after the water breaks, the more chance the Strep has to get into the uterus and cause infection. It is generally felt that if more than 12 to 18 hours passes after the water breaks, this greatly increases the chance of infection. If, on the other hand, less than 12 hours passes, the chance of infection is minimal. In addition, if a mom has a fever over 101 during labor, this is a concerning sign that the Strep may have migrated into the uterus.

Some obstetricians and midwives choose to not test women for Strep. Instead, they will give IV antibiotics if a mom has fever during labor or if labor continues more than 12 to 18 hours after the water breaks.

The Strep bacteria often do not continuously live in the vaginal area. They usually come and go, so if a woman tests positive with one pregnancy, it is generally assumed that she will always be intermittently positive throughout her life. She is therefore treated as positive during subsequent pregnancies.

This Strep is not the same strep as the one that causes sore throats. They are completely unrelated.

Yes, according to the package insert for the TB test, there has never been a problem reported after giving an expectant mother a TB test.

I personally don't like to drink tap water myself, so I certainly would not give it to my baby on a regular basis. I do believe that hot water through a tap will contain more impurities from the pipes, . If mom really wants to save time, then she should buy ready-made formula. The current recommendations for mixing formula are this: use water that is "safe to drink" (that means bottled, filtered, or tap - from a safe source), and then BOIL THE WATER for at least a minute. This is important to kill any infectious organisms that might be lurking in the water. Then, it is important to LET THE WATER COOL before adding it to the formula mix. The American Dietetic Association recommends this because it is possible that adding hot water directly to the mix might affect the stability of the nutrients.

Children and adults need different amounts of iron at different times in their lives. Rapid growth increases iron needs. So does blood loss. Children ages 1-10 generally need about 10 mg. per day of iron. Since your child is only getting the occasional beef, other good sources of iron that he might like are lentils, prunes, tomato paste (oysters if he likes them). Click here for a complete discussion on iron and more food sources.

Yea! A math question! This is actually quite easy if you are used to doing “word problems” in math class (might need to ask your kids for help). First, look at the label and see how many grams a serving size is, we’ll call this number T for total. Then see how many grams of sugar are in each serving, we’ll call this number S. Then plug these numbers into this equation: S divided by T, and then multiply by 100. This will give you the percentage you are looking for. First, let’s do an easy example. Suppose the total serving is 100 grams, and the grams of sugar per serving is 5. You can probably do this one in your head: the answer is 5%. Let’s try a harder one: Organic spaghetti sauce (it was sitting on my counter…): the label reads serving size: ½ cup (125g). Sugars per serving: 8g. So, S=8, T=125. 8 divided by 125= 0.064 ---- multiply by 100= 6.4%. Squeezable grape jelly: T=20g, S=13g……. Wow! 65% sugar! Into the trash it goes. Click here to learn more about food package labels.

Omega-3 oils play an important role in keeping us healthy. They are good for just about every organ in our body: brain, skin, heart, gut, immune system. Cooking at high temperatures can damage oils. The more omega 3 fatty acids in the oil, the less suitable it is for cooking. The heat not only damages the fatty acids, it can also change them into harmful substances. Hydrogenated oils are often used for cooking. Because these oils have already been "damaged" by chemical processing, they are less likely to be further damaged by heat. The oils that are higher in saturated fats or monounsaturates are the most stable when heated. These include peanut oil and olive oil. The more fragile oils are best used at room temperature, like salad dressings. To preserve the nutritious properties and the flavor of unrefined oils, try the "wet-sauté," a technique that is practiced by gourmet chefs. Pour around one-fourth of a cup of water in the stir-fry pan and heat just below boiling. Then add the food and cook it a bit before adding the oil. Wet-sauté shortens the time oil is in contact with a hot pan. Stir frequently to further reduce the time the oil is in contact with the hot metal. Never heat oils to the smoking point, as this not only damages their fatty acid content, but also their taste; also the smoke alarm gets really annoying. Best cooking oils and fats are: butter, peanut oil, high oleic sunflower oil, high oleic safflower oil, sesame oil, and olive oil. For more information about healthy oils, click here.

Nope. Sourdough, French and white bread are all in the same category. Most people have known for years that white bread is not a healthy option. I still wonder why parents are giving it to their kids. Parents should only buy healthy whole grain bread. Shape young tastes early: When your infant is at the age that you want her to eat little bit-size pieces of bread, don't use white; use whole grain. Since your baby has never had bread, she won't know the difference. She will think that bread is supposed to have bits of grain, and seeds and have a richer flavor. Why is white bread so bad for us? The reason is the high glycemic index of this food. This is a measure of how quickly the food causes a spike in your body's blood sugar level. Table sugar and honey have a high glycemic index. The surprise is that white bread is almost as high! The heavier whole grain breads still have a lot of carbs in them, but the glycemic index is lower, meaning those carbs get released into the blood stream more gradually. Picking foods with a lower glycemic index is very important to reduce your risk of developing diabetes (about 30% of people will develop diabetes, so this is very important).

Certain deli meats are better than others. I personally stay away from the “sausage” style meats (bologna, pastrami, salami, etc). They have a lot of fat, and they are usually made with nitrites and or nitrates (both bad). I do like deli meat like chicken breast and turkey breast. I try to get organic versions of these, or at least check to be sure they are free of MSG or anything else I don’t want my kids eating.

Normally, I don’t worry about an 8-month-old that won’t eat solids yet. The eating usually improves over the next few months. However, I am worried that your daughter is following her brother’s footsteps and might end up having a legitimate nutritional problem. 24 pounds is very small for a 3-year-old. I have more questions than answers for you on this one. Is there some sort of chewing or swallowing reflex problem? A speech pathologist or occupational therapist could help evaluate for this. Could this be GER (Gastro-esophageal reflux)? Your doctor might be able to help you look for the other clues: spitting up, fussy, poor sleeper, foul breath, and hoarse voice. Your doctor can also see the big picture that includes overall health and development for any clues to a metabolic problem. Maybe there is some other sensory aversion to the textures of solid foods – again, an occupational therapist might be a good specialist to visit. Boosting nutrition in both kids also will need to be a focus. Continued breastfeeding for the young one will be important. For the older child: Avoid junk food, and find nutrient dense foods that he likes. If he likes to dip, then California avocado (guacamole), hummus, and full fat yogurt are great.

The best way to make food is to keep it fresh. For our kids, we used a little food grinder that we got at the Burlington Coat Factory baby section (why this store has a baby section, I don’t know…). It was about 10 dollars, and would easily grind fruits, veggies, and meats. At mealtime, we would pick something off our plates, grind it up, and give it to our little one. Or, we would make an extra serving for them without the spices.

Yes, you’re right. The recommendation is to avoid RAW honey under a year old. Cereals or graham crackers might be made with honey but should be okay for an infant under one year. HOWEVER: if you are talking about a sweet cereal similar to “Honey-Nut Cheerios”, I would suggest not giving that either. Any cereal with more than 6 grams of sugar per serving should not be on the shopping list.

Pedialyte is a good liquid to give children when they are dehydrated from an illness. It is formulated for better fluid absorption than other household beverages. Sick children seem to like the taste. I remember as a resident in training, I was in charge of teaching a group of medical students and one of them asked how Pedialyte tasted. I told him to try it (the unflavored version), and after a small gulp he was running for the nearest sink to spit it out!

The subject of your disagreement doesn’t matter; it could be nutrition, or discipline, etc. The point is that the grandparents should respect how you are raising your own children. If they have legitimate concerns for the children’s safety, then they should call the authorities… otherwise, it’s not their place to say what is right or wrong for your children.

Regarding proof of the ill effects of too much sugar and hydrogenated fats:

Oh, don’t get me started on this…

Pick up any Time, Newsweek, or Oprah magazine and you will see plenty of evidence of the ill effects of poor nutrition. Here are some of the highlights of what you will find:

• One in every three children born in 2000 will later develop diabetes.
• By age 12, 70% of all American children have the beginning stages of hardening of the arteries.
• One in three Americans will develop cancer.
• One out of every two children will develop heart disease

The problem is that she thinks that most adults walking around today are healthy and thriving. Nothing could be further from the truth! We all need to eat less sugar, more fruit and vegetables, and less hydrogenated fats. Keep up the good work!

Many parents of high-need babies come to me asking for help, just like this mom. They are tired from lack of sleep, worn out from holding baby all day long, and sometimes at their wits end. Some are ready to try the cry-it-out method just so they can finally get some sleep. I really do sympathize with these loving parents. Anyone who has raised a high-need baby understands the time and energy involved.

Unfortunately, there is no good solution to this situation. Asking a high-need baby to not want to be held all day or to sleep peacefully all night long is like asking a dog not to bark, the sun not to rise, or men to stop and ask directions. It really is possible. Every baby comes wired differently, with different levels of need. High-need babies simply must be held most of the time in order to feel emotionally secure and fulfilled. There is no good way around this. No amount of "letting them cry it out" is going to change this instinctive need they have. I suppose if you tried the cry-it-out method for long enough (for several months or so), she WOULD eventually get the message. But at what cost to her trust, sense of security, and self-esteem?

What parents in this situation should be asking is not "how can I change my baby", but rather "how can I meet my baby's needs and still retain my sanity on so little sleep?" The answer to this question can be found by browsing through our "high need" or "fussy baby" section on our site by searching these terms. You can also search "payoff" to read some encouraging words about how your investment will pay off in your child.

Hang in there. Your baby's level of need will change with time. There IS sleep at the end of the tunnel.

Breath-holding spells are common. They are not harmful, and kids will grow out of them eventually. They often start between 3 and 12 months of age. They can continue for several years.

The typical spell goes as follows - baby starts crying, continues exhaling as he cries, cannot stop the exhaling cry in order to take a breath, starts to turn blue on the lips and face, passes out, finally takes as deep breath and wakes up. He may be groggy for a minute or two afterwards.

This is a normal spell, and does not cause any harm.

You do not need to do anything to stop the spells, because there is nothing you CAN do. Simply hold your baby until the spell passes.

Complicated breath-holding spells occur when a spell lasts so long that it triggers a seizure. These can rarely occur, or may occur with every spell. You should talk with your doctor if your child is having seizures with the spells.

Don't take it personally. You are neither responsible for his tantrums nor for stopping them. The "goodness" of your baby is not a reflection on your parenting ability. Tantrums are common when a baby starts to strive for independence.

Identify the trigger. Tantrums are usually at the worse time for parents: when they are on the phone, at the supermarket, or busy in some other way. Think about it. The very circumstances that make a tantrum inconvenient for you are what set your toddler up for an outburst. Keep a tantrum diary, noting what incites your child. Is she bored, tired, sick, hungry, or overstimulated? Watch for pre-tantrum signs. If you notice a few moments before the flare-up that your baby is starting to whine or grumble, intervene before the little volcano erupts.

Stay cool. Temper tantrums in public places are embarrassing, often making it difficult to consider a child's feelings. Your first thought is more likely to be "what will people think of me as a parent?" If you feel trapped and embarrassed when your child is throwing a fit in a supermarket, don't lash out. She is already out of control and needs you to stay in control. Just calmly carry her (even if she's kicking and screaming) to a private place, like the bathroom or your car, where she can blow off steam, after which you can quietly settle her down.

Plan ahead. To expect a curious toddler to be the model of obedience in a supermarket when he is tired and hungry is an unrealistic expectation. Shop when you both are rested and fed, and let him be your helper from the safety of his belted shopping-cart seat. Morning is usually the best time for toddler behavior; in the afternoon he's more likely to be tired and hungry. For more tantrum information, try these two sections:

Temper Tantrum FAQ

Temper Tantrum Section

What is ITP?
ITP stands for idiopathic thrombocytopenic purpura. "Idiopathic" means that the cause is unknown. "Thrombocytopenic" means the blood doesn't have enough platelets. "Purpura" means a person has excessive bruising. You may also hear ITP called "immune thrombocytopenic purpura."

In people with ITP, all of the blood cells are normal except for the blood platelets. Platelets are the tiny cells that seal minor cuts and wounds and form blood clots. A person with too few platelets bruises easily and bleeds for a long time after being injured. The usual symptoms are bruises and tiny red dots on the skin. Nosebleeds and bleeding gums are also common. When the platelet count is very low, the person with ITP might have nosebleeds that are hard to stop, or might have bleeding in the intestines.

What causes ITP?
The cause of ITP is not known. People with ITP form antibodies that destroy their blood platelets. Normally, antibodies are a healthy response to bacteria or viruses. In people with ITP, however, the antibodies attack the body's own blood platelets.

How is ITP diagnosed?
Blood tests will confirm that the bruising is caused by ITP and not something more serious.

How is ITP treated in children?
Because most children recover with no treatment, many doctors recommend just watching them carefully and taking care of the bleeding symptoms. However, if the platelet count is extremely low, your child might need a short treatment with intravenous infusions (given in a vein) of gamma globulin or possibly a short course of steroids to increase the platelet count more quickly.

There are several good signs here: good weight gain, passing gas, and large, loose bowel movements. It doesn’t sound like a blockage to worry about. I often see babies go through a bit of a “poop transition” around this age. They seem to go from many stools a day, to only one or less. When I see a baby like yours in my office, and my exam doesn’t reveal any worry signs, then I try the following: if formula-fed, give the baby an extra 2 ounces of water per day (just add the water to one or two of her formula bottles). If breast-fed, I make sure mom goes off any cow milk products. Usually, these make the problem go away. If not, then time to go see the doctor.

The allergies may be the problem here. If she is having chronic post-nasal drip, that can cause bad breath. In addition to trigger avoidance, and medications, you might also help by performing “nose flushes” with nasal saline spray. Using this three times a day can help rinse out offending mucus. Be sure to read the allergy section on this website.

Also, being lactose intolerant will give you bad breath, if you eat or drink any cow milk products. So, be sure she is avoiding cow milk (and things made with cow milk) most of the time.

My brother, Dr Bob, is specializing in treating children with autism according to the DAN protocol. This addresses the many metabolic “quirks” that these children can have. He has had good success in improving these kid’s symptoms. While there are still many unknowns in regards to autism, there seems to be an autoimmune component. This is when the body’s own immune systems does not function properly and attacks the wrong cells in the body. When a person has an autoimmune problem, the thyroid gland can get attacked, causing an abnormal thyroid level. A child with suspected autism should get his thyroid hormone levels checked, in addition to many other metabolic studies. A doctor that is familiar with the DAN protocol can help with this. Here is a link to a DAN physician referral list: http://www.autismwebsite.com/ari-lists/danus.html

Usually, a baby’s natural oils should be enough to keep her scalp from getting too dried out. Reasons for dry scalp are:

• Shampooing too often: when my kids were this age, they got their hair washed only about once a week… whether they needed it or not (sorry, couldn’t resist). Many parents are washing their baby’s hair every day, and this often leads to dry scalp.
• Putting oil in the hair: baby’s sensitive skin can be easily irritated by oil that is left in the hair. This can start a vicious cycle: the scalp is dry, so parents start putting in moisturizing oil, which causes the scalp to get more irritated and dry, so they use more oil… and so on. Any treatment oils you use in the hair should be washed out.
• Click here for more info on cradle cap.

I would suggest not washing too often, and let baby’s natural oils do the trick.

Babies will sometimes skip a day like this. Often, near this age, many babies make a transition from several poops a day to just one per day or even one every few days. I wouldn’t worry about a baby that usually goes once a day, but then skips a day every once in a while – as long as the poops are their usual runny consistency.

The air in the house can get very dry when the heater is running. The air passages need to stay moist in order to stay healthy. I highly recommend using some sort of vaporizer or humidifier throughout the night. When we travel, we will run the hot shower in the hotel room for a few minutes to get a little steam in the air. Also, leaving some water in the bathtub can provide a little extra moisture in the air. In the morning, be sure to open windows and let the rooms air out for a while, otherwise mold can start growing on the walls (I learned this the hard way…).

Humidifier Vs vaporizer? Hot Vs cold? Doesn’t really matter. There are some very nice units on the market that can give both warm or cold mist, these are great. I have usually just used the cheap $15 units that give a warm steam and they have been fine. You need to be careful with these because the steam can burn.

NINE STEPS TO PREVENTING EAR INFECTIONS

If your child has had several ear infections already, or you simple wish to lower her risk of getting them in the first place, here are some ways to prevent or at least lessen the frequency and severity of ear infections:

1. Breastfeeding - there is no doubt whatsoever in the medical literature that prolonged breastfeeding lowers your child's chances of getting ear infections.

    

2. Daycare setting - continuous exposure to other children increases the risk that your child will catch more colds, and consequently more ear infections. Crowded daycare settings are a set up for germ-sharing. If possible, switch your child to a small, home daycare setting. This will lower the risk.

    

3. Control allergies - if you think allergies are contributing to your child's runny nose and, consequently, ear infections, click on allergies to find out more about how to minimize your child's allergies.

    

4. Feed baby upright - lying down while bottle feeding can cause the milk to irritate the Eustachian tube which can contribute to ear infections.

    

5. Keep the nose clear - when a runny nose and cold start, do your best to keep the nose clear by using steam, saline nose drops, and suctioning. See colds for more info on this.

    

6. CIGARETTE SMOKE - there is strong evidence that smoking irritates baby's nasal passage which leads to Eustachian tube dysfunction.

    

7. Echinacea - this is an herb which can safely and effectively boost the immune system. Click here for more information.

    

8. Chiropractic care - I firmly believe that chiropractic adjustments to the skull and neck can improve middle ear drainage and decrease ear infections.

    

9. Eat more raw fruits and vegetables - these can greatly boost your child's immune system and help fight off infections. If you have a picky eater, click here to read how Juice Plus can provide this nutrition for your child.

Nursing strikes are very common. They are sometimes triggered by a traumatic event, but can also occur for no apparent reason at all. It may seem like baby is trying to wean himself, but it is very unusual for a baby to wean on his own before age one. A clue that baby isn't trying to wean himself is that he will seem unhappy during the strike, may briefly take the breast, but then begin fussing and refuse again. You may not be able to identify the cause of the strike, but here are some possibilities:

• Sudden traumatic event - the most common of these is mom yelling when baby bites her while nursing, which is a common, and understandable, occurrence.
• Stress in the home
• Illness such as ear infection or sever nasal congestion
• Visitors in the home
• Big changes in the living environment

Here are a few things you can do to get through and encourage baby to begin nursing again:

• Try "sneaking" the breast in during the night, or nap time when baby starts to stir, but isn't fully awake yet.
• Spend a lot a skin-to-skin time with baby without specifically trying to offer the breast.
• Try to nurse baby in an unusual situation, such as walking around or other moving situation.
• Try a variety of positions.

You may need to pump your breasts to relieve engorgement during the strike. Baby may take this pumped milk from a cup or bottle.

Strikes usually last 2 to 4 days, and almost never result in permanent weaning.

I encounter this situation frequently in my office. Many parents have the misconception that all infants will be ready for foods between 4 and 6 months of age. The truth is that very few infants are developmentally ready at 4 months. In addition, it is now recommended to delay foods until 6 months in order to decrease the chance of allergies. I also have found that some infants are not developmentally ready for solids until 8 or 9 months. You can click here to read about what signs to watch for to determine when your infant is ready for foods. Breast milk is nutritionally complete for at least the first year of life. This means that infants can go for at least a year on breast milk alone, without eating any foods, and be nutritionally complete. Offering foods between 6 and 12 months of age is simply for social development and to get infants used to eating.

I encourage parents not to try to coax their 6 month old into accepting solids before he shows many of the signs of being ready. This can create a picky eater and negative feelings about eating.

It is generally felt that going on a major diet during breastfeeding can decrease the amount of much-needed fats in your breast milk. Babies' brains need a lot of good, healthy fats to grow and develop for the first two years of life.

Do not worry about carbohydrates and protein while you diet. Your milk will have plenty no matter what you eat.