Jeremy Friedman: caring for your toddler
Comments (27)
Thursday, May 7, 2009 | 11:51 AM ET
Are you a relatively new parent? You're past the getting up three times a night to feed the infant stage but not quite at the it's off to school with you phase.
The next few years will bring you a host of new challenges like:
- When do we start toilet training?
- How do we introduce new foods into the diet?
- How much sleep does my toddler need?
- How do we deal with this emerging personality?
- Do we really need to child-proof everything?
Dr. Jeremy Friedman is the division head of pediatric medicine at Toronto's Hospital for Sick Children and an Associate Professor of Pediatrics at the University of Toronto. He has published articles in peer-reviewed journals and sits on the editorial board of general pediatric journals in Canada and the United States.
He's also the author of Canada's Toddler Care Book. He's joined us to take your questions on toddler care.
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Chat Questions (27)
stephanie
ontario
My daughter is potty trained and has been since she has been 1 1/2 years old. What signs or when do I begin training her for night time training with no diapers
she does take 2 hrs naps with no diapers no problem as long as she goes b/f she naps
Dr. Jeremy Friedman replies:
Stephanie – you are clearly doing well and probably ahead of schedule! Most toddlers will be dry during the day long before they can go through the night (night wetting still occurs in up to 20% of 5 year olds!) Get her to go just before bedtime and not to drink just before going to bed and when she begins to wake up with dry training pants in the morning you know she is ready to try to go through the night. Remember, there will be ‘accidents’ from time to time.
Meghan Miller
How do you entertain a demanding toddler when you have a new baby that needs so much of your attention and time as well??
Dr. Jeremy Friedman replies:
Meghan - you do need to be sensitive to your toddler’s needs and potential acting out and expect some mild regression in behaviour eg potty accidents and baby talk. Try to maintain a routine; this period of transition is not the time for further changes eg switching to a big-boy bed. Make your toddler feel included by asking him to help eg by getting things ready for the baby at bathtime or fetching the necessary equipment for diaper changes. Try to spend some individual time with him, even if it means reading to him while you are nursing. If you can hand the baby off for brief periods to your partner or other relatives then you can try to play one-on-one with your toddler. Use all of your ‘supports’; this is a great time for your toddler to spend quality time with his dad and grandparents at the park etc. Most important, make sure that he knows that he is loved and included.
Tamara
Toronto
My daughter is 15mths and still needs a nighttime bottle at 11:30-12 a.m. Some nights she drinks hardly anything, or nights alot. If I don't give her a bottle she wakes in the night and wants milk because she is hungry.
When do I ween her and how should I approach this?
Dr. Jeremy Friedman replies:
Tamara – at the age of 15 months, as long as your daughter is growing well and healthy, she actually doesn’t require any overnight feeding – she can take in all of her caloric needs during the day. In fact, her growth and development will likely benefit from a good nights sleep (and you may too!). I think if you want to, you could go ahead and start weaning her now. There are different techniques but essentially gradually decreasing the total amount you give her, plus/minus switching to a cup or using water instead of milk will ultimately allow her to get used to her new routine.
Melissa
Vancouver
We're not clean freaks, but our family follows the standard public health recommendations regarding handwashing. We rarely get sick: none of us got sick all winter, including our 15-month-old son, who is not in daycare.
Some folks feel it's necessary for kids to often have minor illnesses to develop their immune systems, and we're doing our son a disservice by washing our hands and teaching him to wash his. We don't keep him in a bubble: he eats Cheerios off the not-very-clean kitchen floor and plays at the playground with other kids. We simply wash our hands before eating or preparing food, and after using the bathroom or playing outside.
What do you think - are we doing the right thing, or will he suffer in the future for starting good hygiene practices at an early age?
Dr. Jeremy Friedman replies:
Melissa – we adopted a pretty similar approach with our kids, so I think you are doing the right thing! It is true that children will build up their immunity by being exposed to various infections – and your approach will definitely allow for this.
Caroline
Ottawa
How will we know when our child is ready to begin potty training? Is there a benchmark in development we need to look for, or a certain age that is appropriate to introduce the concept?
Dr. Jeremy Friedman replies:
Caroline – there is a broad range of normal, although most children in North America learn to use the toilet between 2 and 4 years. Your child is probably ready to start toilet training when she is showing at least a few of the following signs:
She can understand and follow simple instructions
Her diaper is consistently dry for 2-3 hrs at a time or after naps
Her bowel movements start to become somewhat regular and predictable
She can walk to the bathrooom and pull her pants down
She recognizes and tells or shows you that she needs to urinate or have a bowel movement
She seems uncomfortable with wet or soiled diapers and wants to be changed
She is interested and motivated to learn to use the potty or toilet
She shows interest in ‘big kid’ underwear
Janet
Toronto
How much food and how much homo milk should a 20 month old boy be consuming? Most days, it seems like my son hardly wants to eat at all, and when he does eat, his meals can drag on for an hour (literally). I find meal times to be the most frustrating times of day. He has always been in the 5th-10th percentile in both weight and height but the pediatrician says he is healthy.
Dr. Jeremy Friedman replies:
Janet – this is definitely a very common concern of parents in the toddler age group. There is unfortunately no exact amount of food that is prescribed for all 20 month olds. A toddler who is active, energetic and meeting his individual growth pattern (in his case 5-10th percentile) is generally receiving the ‘right’ amount of nutrition. Most authorities would agree that 16 – 20 ounces (500-625ml/day) of homo milk/day is the maximum. Try not to be frustrated by mealtimes. As long as you are offering your toddler a variety of healthy options, and encouraging the family to eat together and trying to be a good role model, then there is nothing more you can or should do. Don’t run after him with food, and when the rest of the family is done, the meal is over!
Jennifer Tame
My 18 month old boy is showing some signs of what I understand to be readiness for potty training, but not all signs. Is it too early to begin trying? I don't want to frustrate or confuse him.
Dr. Jeremy Friedman replies:
Jennifer – similar to all developmental skills there is a wide variation in normal and there are certainly some children who are ready for potty training by 18 months. Check the list I have included above, and if he shows many of those signs, then you can certainly give it a try. If things are not going smoothly and he (or you) are getting frustrated then you can always pack the potty away for a few months and try again later! In general, the longer you wait, the easier and quicker the process is likely to be.
Tanya Maffey
What are some good bedtime and naptime practices for 2 young boys who will share a bedroom?
My boys are 9mos and 26mos old. The 9 month old is just on the verge of sleeping thru the night in our room, so we are thinking we can have them share a bedroom soon. But how can we put them both in the bedroom at the same time and expect them to fall asleep? Won't there be too much stimulation with another wee guy in the room? I am considering putting one down first (little guy) and then the big guy could go in shortly after the little guy has fallen asleep.
Dr. Jeremy Friedman replies:
Tanya – I think you already have started to develop an approach that will work. There is no “correct” way to do this. I would recommend (if possible ) waiting until the 9 month old is solidly sleeping through the night before putting the 2 boys in the same room. Eventually there is no reason why they both cannot go to bed at the same time which will decrease the chances of the older one waking the little one. Ideally we likely all sleep better alone however in most circumstances this is not reasonable or possible and a few bumps in the road may be encountered before they both fall asleep and stay asleep.
Tanya
When is it appropriate (developmentally speaking) for a toddler to eat their meal with cutlery (fork/spoon) entirely instead of relying on their hands? We always give a little spoon to "practice" with but are not sure when it is reasonable to start insisting that it be used and that the fingers in mouth stop.
Dr. Jeremy Friedman replies:
Tanya – there is a wide variation in eating skills development. Between 1 and 2 yrs, toddlers can start to use a spoon and fork, although fingers are used most of the time. By 2-3 years, they can drink from a cup, put the spoon in their mouth, but are still spilling a lot. By 3-4 years, they can hold their cup by the handle, use a fork and even start to pour. By 4-5 years they are becoming quite good at feeding themselves. That said I have some adult friends who are still using their fingers more than they should, but seem to be doing okay in every other way!
bell
hamilton
At what point should you become concerned about a child meeting a published milestone with regards to speech or physical development?
Dr. Jeremy Friedman replies:
Bell – that is a tough question without knowing the specific milestone. I think what you are asking for is some ‘red flags’ that act as an early warning regarding delayed development, requiring at the least a thorough developmental assessment. This does NOT mean that there is definitely a problem as there is a wide range of normal; many children have areas of strength but weaker areas as well. Any concerns should at least be mentioned to your healthcare provider, who may be able to reassure you or suggest some strategies to help. Some examples of ‘red flags’ would include:
In motor development: no steps by 18 months, not walking up stairs by 2 yrs, showing clear handedness before 18 months, frequent falling or difficulty with stairs by 3 years
In speech development: is not trying to talk, make gestures or sounds by 18 months, started to use words but stopped, lacks awareness or interest in others by 2 years, uses very few words by 2 years or cannot make you understand what he is trying to say, failure to understand simple instructions or communicate in short phrases by 3 years.
Natalie
NS
My son is 15 months old. he seems to understand everything we say. I am wondering what is the most effective form of disciplining a toddler especially when he is doing something that could potentially be dangerous to himself (ie reaching for the stove, trying to pull the TV, etc.)
My friend has been using a 'time out' chair for her son, but I am not sure if this will work for my son.
thank you!
Dr. Jeremy Friedman replies:
Natalie – The “time out” method is indeed an excellent one, but is generally reserved for toddlers over 2 years of age. For your 15 month old, you can use the fact that he understands what you say to your advantage by employing simple commands accompanied by pointing and a stern look. For example, by repeating “hot – no touching” while you redirect him away from the stove each time he reaches toward it, he will quickly form the association between “hot” and the stove, and learn to stay away.
Carol
Calgary
My 28 month old son has a very sweet and even temperament, but we've had a couple of episodes of biting and kicking recently. What is the best way to deal with this? I'm fearful he may turn this behaviour on his new baby brother.
Dr. Jeremy Friedman replies:
Carol – I must admit that I was a bit mortified the first time my toddler bit or hit …but while the action is indeed inappropriate and requires discipline, remember that it is simply another outlet for your toddler’s frustration with no sinister implication. You need to try and remain as calm as possible, and certainly refrain from resorting to aggression yourself. Be firm, make him aware that this is serious, but try not to scare him, as the intended message will be lost. A definitive ‘no biting’ or ‘no kicking’ is appropriate, as is pointing out that biting and kicking hurts people. This is a good time to use the effective ‘time-out’ form of discipline.
THartwig
Vancouver
HOw do you toilet train a stubborn 3 yr old boy?
Dr. Jeremy Friedman replies:
By waiting until he feels like he is ready to be trained! Some 3 year olds are just not emotionally ready even if they are physiologically ready and you are more than ready. This is a stage of his life when he is trying to establish his independence. He is trying to gain control of his environment. Toilet training can become a focus of control and resistance for some toddlers. This is a phase, which resolves with time. The easiest solution is to back off entirely for a couple of weeks and then see if he becomes more motivated in graduating to ‘big boy’ underwear. On the positive side, the longer you wait, the easier and quicker the process is likely to be.
stacey
halifax
Our almost-three-year-old son shows little interest in potty training and seems to be upset by our efforts to encourage him in that direction. Should we stop trying and wait for him to take the lead?
Dr. Jeremy Friedman replies:
Stacey – I would give him a total break from training for a few weeks (see my answer above). The more emotional a parent becomes, the more some children will resist, thereby creating a vicious cycle of anger, frustration, and resistance.
Michelle
Manitoba
My 15 month old son has retractile testes which the doctor explained to me are like elastics, they come down sometimes but will pop up again. I'm wondering if they will ever be normal and stay down like they should or will he have to have surgery to correct this? Should I be worried about this or not?
Dr. Jeremy Friedman replies:
Michelle – I wouldn’t be concerned as long as your doctor can feel both testes in the scrotum when they are not ‘retracting’. Retractile testes are normal and with time will stay down permanently.
Emma
I am a stay at home Mom and have a 3 year old daughter that I take to Daycare 2 days a week , just so I have a break and she has some social time with other kids without mom. Ever since she started daycare 1 year ago she has had many viruses over the cold and flu season. Nothing of to much concern. I have recently not been taking her to daycare for the fear of the swine flu that has recently surfaced all over the country. I am over reacting in my not taking her.
Dr. Jeremy Friedman replies:
Emma – I think we all get concerned when we read about things like the swine flu epidemic in the media. Personally I would continue to take my children to daycare as I think the risks of contracting anything serious at this time is extremely remote. She will certainly be exposed to a bunch of common viruses at daycare and many toddlers are frequently sick with colds and stomach flus when they start attending daycare; this is quite normal and allows her immune system to develop some resistance. If you didn’t send her to daycare, she would probably experience the same colds and flu when starting school. The only thing you can do is to encourage everyone at the daycare to practice frequent handwashing.
Dan
Ottawa
My son is one year of age and is due for his MMR vaccination. My wife has expressed concern about a possible link between the MMR vaccine and autism, despite what seems to be ample evidence that there is no link. How can I get her on board with having our son get this important vaccination?
Dr. Jeremy Friedman replies:
Dan – this is an emotional topic for many parents. There are many scientific and population based studies from different countries over the last few years which have shown NO evidence of a link between the MMR vaccine and autism. The only scientific study which suggested this link that I am aware of and actually started the whole controversy, has since been retracted by the authors and journal. Nevertheless there are still quite a few parents out there that seem unconvinced. To me, one has to weigh up what we know against what we do not know. Overwhelming evidence suggests no link to autism but measles, mumps and rubella do still occur in North America, especially when vaccination rates are not optimal, resulting for example in a recent outbreak of mumps in Canada. Measles used to cause death in about 1/1000 cases; mumps can rarely cause meningitis, deafness and infertility, and rubella in pregnancy can lead to fetal death or severe deformities. Protecting our kids from these diseases is important.
The best that one can do is to research these topics from reliable sources eg the Canadian Paediatric Society, discuss your questions with a healthcare provider you trust and then make an informed decision about what is in the best interest of your child.
D S
vancouver
My son is 19 months old and still isn't speaking. He says "mama", "dada", and "no" but that is pretty much it for language. He said more words at one year of age but has stopped using words he used to know. We speak 2 languages to him and he seems to understand everything we say to him.
At what point should we take him to see a speech therapist?
Is our use of different languages to communicate with him slowing down his speech development?
Dr. Jeremy Friedman replies:
DS – Speaking more than one language at home probably does not cause language disorders in children. However, in the group of children who have language development disorders, exposure to more than one language in the household may add to the difficulties these children are already having. If you are concerned about your child’s language development or a regression in language skills, it makes sense to consult with your child’s physician and a speech therapist (preferably one who speaks the same language as your family).
Tammy Smith
Ottawa
What can we do to get and keep our twins on the same feeding schedule?
Dr. Jeremy Friedman replies:
Tammy – the best approach is consistency. This is no small task and it may be difficult to achieve. Toddlers are able to follow a feeding schedule as long as we as parents provide a consistent one. Setting out some sort of structure to your day will help your twins know when it is time to eat. You should schedule meal times and snack times and try not to vary too much from these times. While your twins may not always want to follow your routine once they get used to it, it should slowly improve.
Katie Spehar
Vancouver
Our 19 month old will not let us brush his teeth, no matter what we try! We get a couple of strokes maybe once a day. Any suggestions?
Dr. Jeremy Friedman replies:
Katie – this is the age of striving for independence so no surprise that he wants to brush his own teeth! You should encourage him to do so but try to share the job. Let him start the process and perhaps role model by brushing your own teeth so he gets an idea of the proper technique etc. When he is done, try to convince him to let you complete the job by brushing the parts that didn’t get done, and you can even let him complete your teeth as part of the ‘game’. Aim for 2 minutes twice per day, bearing in mind that will not always be achievable (before bed is most important – so make sure it is part of the bedtime routine). Make sure you have an age appropriate brush and just use a pea-sized amount of toothpaste.
Tracy
Our son is just over two years old and refuses to talk. He is potty trained and seems to learn quickly. He understands everything we ask him and when we talk to him but will not speek aside from a few words. He almost seems to shy away when we try to get him to use words. Are there any tricks to get him to open up and start talking or should we be worried at this point?
Dr. Jeremy Friedman replies:
Tracy – a child of 2 years is typically using 20 to 50 words and starting to put 2 words together in short phrases. It is good to hear that he seems to understand what you say to him, but it sounds like his expressive language (what he says) is behind and needs to be addressed. I would recommend discussing these concerns with your son’s physician and/or a speech therapist to try to understand why he is shying away from using words and how best to help him express himself.
Kevin
Vancouver
Our 21 month old daughter just started daycare about a month ago. Now when I am home alone and a friend or babysitter comes over to help care for her and I leave the room, after she is familiar with them and explain to her that I am resting my back in bed, she becomes really upset and won't let me leave the room. Ultimately, I have to rest on the floor in the living room so that she can be cared for by someone else. This is the same sort of problem my wife has before she leaves for work and when people first come over to the house - our daughter won't let my wife out of eye sight.
How long will this last and how may we remedy the situation as I and my wife both need rest sometimes?
Thanks heaps,
Kevin.
Dr. Jeremy Friedman replies:
Kevin – having started daycare, your daughter is going through a transitional period where she is adjusting to different people caring for her. It is only natural that during this time, she will do everything in her power to keep you and her mom around! Try not to feel guilty (I know it’s hard!) for leaving her for a period of time so that you can rest, go to work, or spend some time with your wife. By staying around each time that she “doesn’t let you” leave, you’re only reinforcing her behaviour and can expect her protests to continue. Instead, try leaving for gradually increasing periods of time, with consistent caregivers with whom she can become comfortable. Each time that you leave, be sure to say goodbye, give her a hug and kiss, and tell her you’ll be back soon. She may be upset, but this will surely decrease with time, and by hearing your consistent message and seeing you come back as promised, she’ll build up her trust and will adjust to the healthy practice of saying “bye-bye.”
Nadine
Whitby
My 2 1/2 year old fixates on things he wants and freaks out when we refuse him. Out and Out tantrum city. We never give in, and yet tantrums still persist. HELP!
Dr. Jeremy Friedman replies:
Nadine – this is probably top of the list of behavioural challenges at this age and while quite normal, they are certainly challenging! The basic principles are: stay calm, avoid inadvertantly reinforcing the behaviour, and provide reassurance and guidance once the tantrum is over. Sound easy? Not really! Here a few strategies to work on.
Some tantrums are precipitated by hunger, boredom, fatigue or overstimulation; if you recognise a pattern then nip it in the bud with eg a snack or nap. Avoid toys/games that will increase frustration. Ensure plenty of free time and space as an outlet for energy, anger and frustration. Provide your child with some control eg choices that you know he can handle. Help him to express his feeling of frustration then try to redirect him to a different activity.
Choose your battles, reserving ‘no’ for things that are truly important. Ignore him during the tantrum, and then comfort and redirect him afterward. Try not to give in to your toddler’s demands. Hope some of these ideas work for you!
Michelle
Manitoba
When I checked my 15 month old son's mouth for signs of teething I was shocked to see how swollen both sides of his top gum were and more so when I saw a bright blue spot on the right side of his gum about where the first molar tooth would come out. He's constantly tonguing that spot and has his fingers in his mouth too. Is this blue spot normal for teething or something else?
Dr. Jeremy Friedman replies:
Michelle – sounds like he is getting his first molar and what you are seeing is quite normal. You can try massaging his gums with your finger or allow him to bite on a cold teething ring or clean wet washcloth. Try to stay away from topical teething remedies; they generally don’t work very well and they do have some potential side effects.
Nancy
Sydney
Our 2 year old was sleeping through the night without any issues until we introduced him to his toddler bed. Now he constantly wakes up at midnight and will not stay in his own bed. If we bring him in the bed with us he's asleep within minutes and doesn't move for the rest of the night. How do we break him of this habit?
Dr. Jeremy Friedman replies:
Nancy – it sounds like your son would rather sleep with you than in his own bed – which is very normal but not good for your sleep or his. He needs to learn how to put himself back to sleep when he awakes and likely needs some limit setting from you. This may take a few sleepless nights on your part and I recommend tackling this when you don’t have to work the next day. I would recommend the chair sitting routine now that he is in a bed and not a crib. Essentially you will need to escort him back to his bed and sit in a chair beside his bed until he falls asleep. Slowly you move the chair out of his room to the point where you are no longer in his room. Canada’s Toddler Care book explains this method in greater detail.
Khush
Toronto
My 16 month old gets up random nights screaming for milk and will throw fits and stay awake until we give her milk. During the day she has 3 cups of milk and eats well. She falls asleep tossing and turning by herself, but why cant she put herself back to sleep without the milk at night? She will stay awake for more than an hour and if no milk will demand she is taken 'downstairs'. what to do?
Dr. Jeremy Friedman replies:
At 16 months your healthy toddler does not need milk or to ‘go downstairs’ in the middle of the night. In fact what she really needs for growth and development is a good night sleep and I am certain so do you. While she may scream and demand this is not necessarily in her best interest. She needs to be taught appropriate sleep associations and to fall asleep alone using graduated extinction techniques (timed waiting method) outlined in Canada's Toddler Care Book. She will sleep through the night but it may require a few sleepless nights on your part.
Eric
victoria
My three-year-old rhythmically bangs his head into his crib at night, and has been doing this since he was about 6 months old. We've checked with the pediatrician about this, and he says it will stop on its own, but when? Is there anything we can do to help?