Your Toddler

Preschool Lunch Isn’t Always Nutritious

Parents may be sacrificing nutrition by giving their children the food they like when packing their preschoolers lunch. That's one of the conclusions of a new study in the January 2009 issue of the Journal of the American Dietetic Association. The study found that 71 percent of packed lunches didn't have enough fruits and vegetables and that one in four preschoolers didn't get enough milk with lunch.

"What we found primarily was that parents weren't sending in as many fruits and vegetables and whole grains as they should, and the number of milk servings was low, too," said study author Sara J. Sweitzer, a registered dietician and a doctoral candidate at the University of Texas at Austin. The study was triggered by a recent change in Texas day-care regulations that allow day-care programs to stop providing meals and snacks. A subsequent survey found that about half of child-care centers in two Texas counties had chosen to do just that. But they survey also reported that directors of those centers said that children were being given chips, prepackaged lunches and "junk food" by their parents. Vegetables, fruits and whole grains were rarely included. To determine whether or not these results were true, Sweitzer and her colleagues interviewed the parents of 74 children from five day-care centers. All of the children were between three and five years old and most were white and from families headed by two adults. The children's lunches were observed for a three-day period so the researchers could accurately assess the nutritional content. 67 percent of the parents interviewed said they packed nutritious food, even though they thought their child probably wouldn't eat them. 63 percent said they packed foods they knew their child would eat. Milk was available at the child-care center, but the child had to request it. According to the study, only 29 percent of the packed lunches contained adequate fruits and vegetables and only 20 percent of the children had a milk serving at lunch. 11 percent didn't get enough whole grains. "Fruits and vegetables and whole grains need to be presented on a regular basis," said Sweitzer, adding, "With chronic disease issues such as type 2 diabetes on the rise, this becomes a very key time to educate this child about nutrition." The easiest thing to do, she suggested, is to pack up some of the previous night's dinner to be reheated in a microwave, which is usually available at child-care centers.

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Your Toddler

Magnets in Toys Pose Broad Dangers

Parents need to be better warned about potential health risks and symptoms of children swallowing toys with magnets.When giving your child toys this holiday season, parents need to be better warned about potential health risks and symptoms of children swallowing toys with magnets. That is the warning from a new study conducted by the Cincinnati Children's Hospital Medical Center. When ingested, multiple magnets can stick together across a bowel wall, leading to infection in the digestive tract, the need for surgery and even death. The study also found that parents often don't seek medical attention for a child who has swallowed a magnet as quickly as necessary.

The findings are based on the analysis of 121 magnet-swallowing cases in 21 counties and were published online in the journal Pediatric Radiology. "The majority of swallowed magnetic objects were components of toy sets, including many well-known brands," study author Dr. Alan Oestreich, a professor of radiology at Cincinnati Children's, said in a hospital news release. "Many of the children represented in the survey were 5 years of age or younger and dependent on their parents or guardians to ensure they do not have access to multiple small magnets." The authors urged parents to pay particular attention when buying toys for small children as written warnings are not mandatory on toys containing magnets. Symptoms of ingested magnets can be mild and flu-like, but nausea, vomiting, cramps or abdominal pain should be given medical attention.

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Your Toddler

Toddlers Lack of Sleep Tied to Behavior Problems

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Sleep is vital to survival and while we may appear to be doing nothing, our brains are very active. Sleep deprivation can make us grumpy and unable to make good decisions or concentrate. Not only do adults need sufficient amounts of sleep- so do children.

 A new study looks at the affects not enough sleep can have on toddlers and found that those little ones that slept less than 10 hours a night or woke up frequently were more inclined to have emotional and behavioral problems at age five.

Researchers were surprised that the “risks were so strong and consistent” said lead author Borge Sivertsen of Uni Research Health and the Norwegian Institute of Public Health in Bergen.

“While only an experimental study can determine causality, our study does suggest that there is an increased risk of developing such problems, also after accounting for a range of other possible factors,” Sivertsen told Reuters Health by email.

The results were from a long-term study of 32,662 pairs of mothers and children in Norway. The mothers filled out questionnaires when they were 17 weeks pregnant, when the child was 18 months old and again when the child was five years old.

Mothers rated 99 child behaviors on a scale from “not true” to “very true” and reported how long the child slept in a 24-hour period and how often he or she woke up during the night.

At 18 months, almost 60 percent of toddlers were sleeping for 13 to 14 hours per night and about two percent were sleeping for less than ten hours per night. About 3 percent of toddlers woke three or more times per night. Most kids woke a few times per week or less.

Toddlers who slept less than 13 hours per night often had emotional or behavioral problems at the same age, the authors write in JAMA Pediatrics.

They also had a higher risk of internalizing problems such as being emotionally mercurial, anxious and depressed.

While the study doesn’t prove causation, it does lend a lot of credibility to there being a link between too little sleep in toddlers and later emotional and social problems.

“Although it is difficult to tease out causality from observational studies, this longitudinal study does suggest that inadequate sleep in early childhood increases the risks for later emotional and behavioral problems,” said Michelle M. Garrison of Seattle Children’s Research Institute in Washington, who wrote an editorial about the research.

Not all of these children will necessarily develop mental health problems later in life. Other factors also play important roles like the child’s temperament and his or her parent’s emotional health.

If your child seems to have difficulty sleeping well or getting to sleep, talk with your pediatrician about tips to help your little one get the rest he or she needs. 

Source: Kathryn Doyle, http://www.reuters.com/article/2015/04/13/us-toddlers-sleep-behavior-idUSKBN0N41U920150413

 

Your Toddler

Liquid Nicotine Poisonings up 300 percent!

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Most people are familiar with e-cigarettes. New e-cigarette stores are popping up almost every day. City councils around the country are debating the pros and cons of setting age limits to buy them and banning them in places where smoking cigarettes is already forbidden.

There’s another e-cigarettes related story that’s is much more alarming that is beginning to surface - the potentially deadly liquids that are often bought and used to refill the e-cigarette vaporizer.

These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.

According to an article in The New York Times, e-liquids are being mixed on factory floors and in the back rooms of shops.

Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.

Many users, unaware of the toxicity of the ingredients, are casually leaving replacement bottles around the house where children are finding and ingesting them.

“It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

Nationwide, the number of poison cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals - triple the previous year’s number.

As two examples, of the 74 e-cigarette and nicotine poisoning cases called into Minnesota poison control in 2013, 29 involved children age 2 and under. In Oklahoma, all but two of the 25 cases in the first two months of this year, involved children age 4 and under. That age group is considered typical.

The e-liquids are much more dangerous than tobacco because liquid is absorbed quickly into the skin, even in diluted concentrations. Initially, many of the e-cigarette brands were disposable devices that looked like regular cigarettes. However, many of the newer e-cigarette vaporizers are larger and can be refilled with liquid that is generally nicotine, flavorings and solvents.

Unlike nicotine gums and patches, e-cigarettes and their ingredients are not regulated. The FDA has said it plans to regulate e-cigarettes but has not disclosed how it will approach the issue.

Chip Paul, chief executive officer of Palm Beach Vapors, a company that operates 13 e-cigarette franchises, estimates that there will be sales of one to two millions liters of liquid used to refill e-cigarettes.

If you look online, you can buy e-liquids anywhere from a liter to 55 gallon containers with 10 percent nicotine concentration.

Mr. Paul said he was worried that some manufacturers outside the United States — China is a major center of e-cigarette production — were not always delivering the concentrations and purity of nicotine they promise. Some retailers, Mr. Paul said, “are selling liquid and they don’t have a clue what is in it.”

The nicotine levels in e-liquids can vary. Most range between 1.8 percent and 2.4 percent, concentrations that can cause sickness, but rarely death, in children. But higher concentrations, like 10 percent or even 7.2 percent, are widely available on the Internet.

A lethal dose at such levels would take “less than a tablespoon,” according to Dr. Cantrell, from the poison control system in California. “Not just a kid. One tablespoon could kill an adult,” he said.

Many people believe that e-cigarettes are a new and valuable tool in the battle to quit smoking. The science isn’t there yet to say whether they actually help or just replace conventional cigarette addiction. But one thing is for sure, if you have e-cigarettes and in particular, e-liquid refill containers in the home, they should be kept out of a child’s eyesight and reach.

Source: Matt Richtel, http://www.nytimes.com/2014/03/24/business/selling-a-poison-by-the-barrel-liquid-nicotine-for-e-cigarettes.html?_r=1

Your Toddler

Parents Ignore New Car Seat Recomendations

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I have been surprised at the number of parents I have seen lately, who are either unaware or choose to ignore the changes in car seat recommendations for children under the age of two.I have been surprised at the number of parents I have seen, who are either unaware or choose to ignore the changes in car seat recommendations for children under the age of two.

I try to discuss car seat safety at each check-up appointment, and have always been especially mindful of doing this at the one-year check up. A new policy (April 2011) by colleagues at the American Academy of Pediatrics recommends what I have been discussing for a while now: children up to age two should remain in rear-facing safety seats. The new policy is supported by research that shows children younger than 2 are 75% less likely to die or be severely injured in a crash if they are rear-facing. So how did we get here? Original recommendations (established in 2009), I had followed with my own patients. I discussed turning the car seat to a forward facing position if the child had reached 12 months and 20 pounds. Then in April, an article was published (Inj Prev. 2007;13:398-402), which was the first U.S. data to substantiate the benefits of toddlers riding rear facing until they are two years of age. This study showed that children under the age of two are 75 percent less likely to die or experience a serious injury when they are riding in a rear-facing. That is a fairly compelling statistic to keep that car seat rear-facing for another year! Studies have shown that rear-facing seats are more likely to support the back, neck, head and pelvis because the force of a crash is distributed evenly over the entire body. Toddlers between the ages of 12 and 23 months who ride rear facing are more than five times safer than toddlers in that same age group who ride forward-facing in a car seat. There has also been concern that rear-facing toddlers whose feet reach the back of the seat are more likely to suffer injuries to the lower extremities in a car accident. But a commentary written by Dr. Marilyn Bull in Pediatrics (2008;121:619-620) dispelled the myth with documentation that lower extremity injuries were rare with rear-facing seats. So, it has now been over two years since this data was published and recommended, and parents continue to say, “I just turned the seat around any way” or “I didn’t know.” I did go look at car-seats the other day and I noted that the labeling on the boxes had all been changed to recommend rear facing until two years or until a toddler reaches the maximum height and weight recommendations for the model. I take this to mean that some “small” toddlers could even rear face longer as they do in some European countries. For safety sake, rather than convenience, keep that car seat in the rear facing position. I wonder if they will begin putting DVD players and cup holders facing toward these toddlers, as that seemed to be a concern of many parents. Maybe this will make it “okay” to listen to music or talk while in the car rather than watching TV, at least until a child is older!! If you need references on car seats go to http://www.nhtsa.dot.gov or http://www.seatcheck.org Send your question or comment to Dr. Sue!

Your Toddler

Anchor It!

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The U.S. Consumer Product Safety Commission (CPSC) has launched “Anchor It”, a national public education campaign, to help make people aware of the dangers that free-standing furniture and TVs present, particularly to children.

The annual number of children injured or killed from furniture and TV tip-overs is astounding.

According to CPSC data, unstable and unsecured TVs and large pieces of furniture kill a child every two weeks, on average, in tip-over incidents that are easily preventable.  CPSC also reported that 38,000 Americans go to emergency rooms each year with injuries related to tip-overs of top-heavy furniture or televisions placed on furniture, instead of a TV stand.  Two-thirds of those injuries involved children younger than 5.  Additionally, between 2000 and 2013, 84 percent of the 430 deaths reported to CPSC involved children younger than 10.

A January 2015 CPSC report found that a television tipping over from an average size dresser falls with thousands of pounds of force. 

The impact of a falling TV is like being caught between two NFL linemen colliding at full-speed—10 times. 

“Every 24 minutes in the U.S. a child goes to the emergency room because of a tip-over incident involving furniture or a TV,” said CPSC Commissioners Marietta Robinson and Joseph Mohorovic. “We must take action now. CPSC’s new ‘Anchor It!’ campaign is a call to action for parents and caregivers to ‘get on top of it, before they do.’ If we can prevent one more death, it will be worth it.”

Cards and posters are being distributed parents and caregivers of toddlers at daycare centers and preschools. A list of safety steps parents and caregivers can take are printed on the handouts. They are:

·      Buy and install low-cost anchoring devices to prevent TVs, dressers, bookcases or other furniture from tipping.

·      Avoid leaving items, such as remote controls and toys, in places where kids might be tempted to climb up to reach for them.

·      Store heavier items on lower shelves or in lower drawers.

·      Place TVs on a sturdy, low base and push them as far back as possible, particularly if anchoring is not possible.

·      If purchasing a new TV, consider recycling older ones not currently used. If moving the older TV to another room, be sure it is anchored properly to the wall.

The “Anchor It” campaign’s website (www.Anchorit.gov) shows you how to anchor furniture and television sets properly, with easy to follow instructions. Keep your little one safe and Anchor It!

 

Your Toddler

Shy Toddlers: Language Skills Delayed?

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Some toddlers are little chatterboxes, and some are shy and barely speak at all.  New research suggests that shy kids understand what is being said to them, but choose to clam up when it comes to responding

The study looks at why shy children seem to develop language skills more slowly than other toddlers. This issue comes up quite often because delayed speech has been linked to social struggles later in life. 

Are these shy little ones unable to produce language or simply choosing not to speak? According to study researcher, Soo Rhee, a psychologist at the University of Colorado in Boulder, the shier kids don’t show any language attainment delays.

Quite a few toddlers have shy temperaments, about 15 percent. The 12 to 24 month-olds exhibit what is known as “behavioral inhibitions.” They tend to be bashful around other people, cling to and hide behind their parent’s legs, and shy away from new experiences.

Why do shy children seem to speak less proficiently than their more extroverted peers? Scientists have their theories. Perhaps these children avoid interaction, so they get less practice speaking. Or the language struggles may come first, making children reluctant to interact with others. Another theory held that shy children aren't delayed at all; rather, extroverts are ahead of the curve.

Finally, some studies hinted that shy toddlers aren't really delayed — they "know it, but won't say it," Rhee and her colleagues write in an upcoming issue of the journal Child Development.

The study involved 408 families with same – sex twins in Boulder County, Colorado. They conducted home visits and had the children come into the psychology laboratory at 14 months of age, 20 months and 24 months.

At these visits, the researchers assessed each child's temperament by observing how much they cried, clung to their parent or exhibited self-soothing behaviors such as thumb sucking. They also tested language development by asking each child to imitate sounds, ask for help and follow directions. These tests determined how much language a child could produce, and separately, how much he or she could understand.

The shy children did show delays in their spoken language compared with more outgoing kids, the researchers found. But there was no such link between temperament and receptive language, or how much language a child understands.

The good news is that the lack of speaking wasn’t related to any actual language impediment.

The researchers looked at the growth in language skills over time relative to each child's behavior. If they found that initial shyness led to initial language struggles and to less growth, it would suggest the kids weren't practicing speaking enough, explaining their deficits. 

On the other hand, if the link between shyness and language showed up in expressive (spoken) language, but not in receptive (understood) language, it would support the notion that shy kids are functioning at the same language level but not displaying their talent. The latter was the case in this study.

And while delayed speech can be a sign of undiagnosed developmental problems, parents of shy kids may not need to worry. The researchers didn't look at brain development directly, but the patterns they found suggest there wasn't anything wrong with the shy participants physically or developmentally. 

"One worry that we have is that shy children might just be underestimated in terms of their language abilities, so parents and teachers might not make as much of an effort to speak with them," Rhee said. "It seems perhaps that with children who are shy, one needs to make more of an effort to help children develop their expressive language abilities."

Other tips for helping your shy toddler develop a more outgoing personality are:

-       Don’t refer to your child as “shy” in front of him or her or others. Being labeled often feels like a criticism. You might try saying “He takes his time getting comfortable with people he doesn’t know or sees often.”

-       Offer encouragement. Praise your child if he or she reaches out to others. Ask friends and family members to focus on the act and not how long it took to do it.

-       Be sympathetic. Let your little one know that you understand how they feel. Sometimes even adults feel a little shy when they meet new people.

-       Don’t avoid social situations. You might think you’re protecting your child from uncomfortable feelings, but in reality they need to learn – even if slowly – that being around others is normal and a part of life. You may want to arrive early – for larger gatherings (such as birthday parties) – to give him or her more time to relax and settle down.

-       Choose familiar locations. Choose activities that involve smaller groups in quieter and familiar environments. A story hour at the library is a good option. Museums that have dedicated children’s areas are also fun.

-       Most importantly, don’t criticize or belittle your child. You might think this is a given, but having a very bashful toddler can be frustrating for a parent. Nothing crushes a child’s confidence faster than unkind words. Teasing your child can also make them feel more vulnerable and hurt. There’s nothing positive about making your child feel bad. Let them know you love them just the way they are.

Sources: Stephanie Pappas, http://www.livescience.com/43100-shy-toddlers-speak-late.html

http://www.babycenter.com/0_shyness_11563.bc

Your Toddler

Parents: Read to Your Young Children!

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The American Academy of Pediatrics (AAP) recommends that pediatric providers advise parents of young children to read aloud and talk about pictures and words in age-appropriate books to their kids.  The AAP says that these activities can help strengthen a child’s language skills and literacy while promoting parent-child relationships.

Pediatricians have long encouraged reading to children, but the guidelines are the first official policy from the American Academy of Pediatrics telling doctors to talk to parents about daily reading to their children, from the first year of life until kindergarten.

Reading with young children “stimulates optimal patterns of brain development and strengthens parent-child relationships at a critical time in child development, which, in turn, builds language, literacy and social-emotional skills that last a lifetime," the AAP guidelines said.

Studies have shown a wide economic divide when it comes to parents reading to their children. Only one in three children living in poverty have parents that read to them consistently.  Children who aren’t read to often have “a significant learning disadvantage” by the time they get to school age, the AAP added.

Even wealthier families do not always make reading a ritual, with 60 percent of those with incomes 400 percent of the poverty threshold saying they read to their children from birth to age five, according to a 2011-2012 survey.

Some pediatricians worry that technology – from television to smartphones- may be taking the place of reading to little ones.

The AAP has previously said babies under age two should be as screen-free as possible, and that the best kind of learning takes place through unstructured, interactive play with humans and toys.

Even babies can benefit from being read stories, said the AAP.  “We can stimulate greater brain development in these months and years," said Peter Riche, a fellow of the AAP and Chief of Pediatrics at Northern Westchester Hospital in New York.

"I do see earlier word recognition, earlier phrases and sentence formation, and singing—I always recognize that in those who are exposed to daily reading."

Many families do not have the money for books so the AAP said it "supports federal and state funding for children's books to be provided at pediatric health supervision visits for children at high risk."

Another important benefit of parents reading to their young children is the blooming of a child’s self-confidence and independence.

Child development experts say that when parents read to their children not only do kids feel more secure but words and pictures also ignite creativity and imagination; two valuable components of a well-rounded life experience.

Sources: Kerry Sheridan, http://medicalxpress.com/news/2014-06-doctors-urge-parents-babies.html

Your Toddler

Sleep Loss & ADHD

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Preschoolers who do not get enough sleep are more likely to be hyperactive and inattentive in kindergarten, exhibiting ADHD-like symptoms.As an adult, you already know how difficult it is to focus on even the simplest task when you haven’t had enough sleep. The same holds true for young adults, children and even kindergartners. According to a new study, preschoolers who do not get enough sleep are more likely to be hyperactive and inattentive in kindergarten, exhibiting ADHD-like symptoms.

The study involved about 6,860 children with analyses controlled for gender, ethnicity and family income. "Children who were reported to sleep less in preschool were rated by their parents as more hyperactive and less attentive compared to their peers at kindergarten," said lead author Erika Gaylor, PhD, senior researcher for SRI International, an independent, nonprofit research institute in Menlo Park, Calif. "These findings suggest that some children who are not getting adequate sleep may be at risk for developing behavioral problems manifested by hyperactivity, impulsivity, and problems sitting still and paying attention." According to the authors, attention-deficit hyperactivity disorder (ADHD) is not generally diagnosed until the school-age years, but the onset of developmentally inappropriate inattention, hyperactivity and impulsivity is often much younger. Sleep problems, particularly difficulty falling asleep and staying asleep, are frequently reported in children and adolescents with ADHD. Total nighttime sleep duration was calculated using parent-reported bedtimes and wake times, which were obtained via interview at both time points. Parents also rated their children's behavior on brief measures of attention/task persistence and hyperactivity/impulsivity. According to the National Sleep Foundation, sleep is especially important for children because it directly impacts mental and physical development. Preschoolers typically need 11-13 hours of sleep each night and most do not nap after five years of age. As with toddlers, difficulty falling asleep and waking up during the night are common. Some tips to help preschoolers sleep better are: - Maintain a regular and consistent sleep schedule. - Have a relaxing bedtime routine that ends in the room where the child sleeps. - Your child should sleep in the same sleeping environment every night, preferably in a room that is cool, quiet and dark – and without a TV. Since the preschool age group is developing active imaginations, they commonly experience nighttime fears and nightmares. They also may sleepwalk, and experience sleep terrors. A little extra attention from a comforting parent or caregiver can help ease some these fears. Sleeping is the primary activity of the brain during early development. An important component to a good night’s sleep is Non-Rapid Eye Movement (NREM) or "quiet" sleep. During the deep states of NREM sleep, blood supply to the muscles is increased, energy is restored, tissue growth and repair occur, and important hormones are released for growth and development. Once again, another study points out how important sleep is to being able to function and think well – no matter what your age! The study’s findings were presented at the 25th Anniversary Meeting of the Associated Professional Sleep Societies LLC in Minneapolis.

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