Hard-won Lessons

6 Things Nobody Told Me About Potty Training

by Carol Sjostrom Miller

When it's time to potty train your child, there is certainly no shortage of advice. You'd think there would be no surprises left. Yet – even with all the books, articles and suggestions from friends, relatives and even complete strangers – I often found myself wondering, "Why didn't anyone tell me this?" when I potty trained my daughter. Now that Stephanie has passed this milestone, I offer these hard-won lessons you won't hear from anyone else.

• Don't worry about terminology. The books advise starting the process by choosing a "potty vocabulary," and parents can spend hours debating the merits of "pee" vs. "tinkle" and "poop" vs. "BM." This is a waste of time. No matter what you choose, the first time your child watches the Once Upon a Potty video (and, trust me, your child will watch it until everyone in the house hears "The Potty Song" in their dreams), it will forever be "wee wee" and "poo poo."

• Summer may not be the best time to train. I can definitely see the logic behind the common advice to potty train children in the summer. When it is warm, the theory goes, a child can spend entire days bottomless, inside or outside, and he will learn to use the potty quickly.

  Well, I bought right into this and pictured Stephanie spending summer days naked in the backyard, potty by her side. Big mistake! As soon as summer came, our yard was infested with gnats and mosquitoes. Since there are some places you can't put insect repellent (not to mention sunscreen), Stephanie, the potty and I were stuck in the house. If we had to be inside anyway, it would have been much more bearable in rotten weather.

• After you empty your child's potty into the toilet, put the toilet seat down. If you are like me, you have spent your entire marriage nagging your husband to put the seat down. Every time you forget to do this is his chance to get revenge. Need I say more?

• The first time your child does "poo poo" in the potty, you will want him to stay in diapers forever. Think about it. A diaper can be changed quickly and disposed of without a second thought. The potty, on the other hand, needs to be emptied, wiped out, cleaned thoroughly and (if you're neurotic like me) sprayed with disinfectant. Diapers really are easier.

  

• You should practice running as fast as you can, while holding your child in the air and yelling, "Coming through! I have a 2-year-old who can't wait!" This skill will come in handy when you have to sprint past the line in a public restroom because your child has to go "Right now, Mommy!" Don't feel guilty about bypassing the line in this situation. Just don't abuse the privilege, which brings us to...

• Your child will then start a riot as you exit the stall by announcing, "Mommy did wee wee, too." Since you have to stay in the bathroom long enough to wash everyone's hands carefully, you have no choice but to laugh and say in your loudest voice, "That's right, Mommy did wee wee just before we left the house." And then whisper, "And we will have lunch at McDonald's if you don't say another word while we're in the bathroom."

The Big Finish to Potty Training

How to Keep Potty Training Fun

Potty training is pretty exciting in the beginning. Everyone's on board with this big step toward becoming a big boy or big girl. Potty chairs pop up everywhere. Underwear is bought. Successful trips to the potty are praised and celebrated. But what to do when the thrill is gone; when it's not so exciting to interrupt a fun activity to go to the potty; when wearing diapers seems to be as easy as anything else?

There are kids who sail through potty training without ever a look back. Others lose interest after a week (or two or three) and then step back into the ease of the diaper and forget all the excitement of those early potty training days. These kids may need a little more fun surrounding the process to keep them interested in keeping up with potty training until they're proficient.

Starting from Scratch?

If your child seems to have lost interest in the whole idea of potty training, starting over and using a different approach may help spark that interest again. Reinforce the whole idea of potty training with some of the many books and videos that are available for children to get them used to the idea of going on the potty. There are also books and videos that come with a doll or stuffed animal that also "goes potty" and is an excellent modeling tool for the child.

Then, plan for a potty-related activity that will be ongoing until the child is reliably using the potty. Mom and potty training expert Vicki Lansky suggests a chart that rewards the child with stickers for successful trips to the potty.

"You can use something as simple as a calendar," Lansky says. "Letting your child pick out his or her own stickers makes it even more interesting."

For slightly older children, Dr. Michael F. Wasserman, a pediatrician with Ochsner Health System in New Orleans, La., suggests making potty training fun by offering a little prize at the conclusion of each potty training session. He suggests a jar of pennies, nickels or quarters kept near the potty.

"Older children recognize that money is important and it can be very motivating," Dr. Wasserman says. "But I would caution any parent not to make it too large of a monetary reward or you can go broke."

Lansky also notes that the jar can be filled with wrapped gifts, boxes of raisins or a favorite candy.

Fine-tuning Technique

Some kids may be coming along fine with their potty training but need a little fun for fine-tuning their potty training techniques. Boys, in particular, have an extra step when it comes to potty training as they learn to stand and pee. Jan Kreider, of San Diego, Calif., made this fun for her son, Aaron, by putting cereal pieces in the toilet bowl and having him aim for them. "This is an inevitably messy process so I also had him help clean up after he was done when he missed," Kreider says. "I think that motivated him even more to aim well so he didn't have to get out his little bucket and sponge."

For kids of all ages, be sure that hand-washing techniques are emphasized throughout the process of toilet training. This is particularly important for little ones because they may not have the coordination to keep their hands from touching their bottoms when wiping. Consider a "fun" soap and their own little set of towels.

Ready or Not?

It would be great if a child was like a battery: when it was fully charged, a signal would appear. Or, in the child's case, when he or she was ready to start using the toilet a little light would go on for all to see. However, signs of readiness are a little more subtle. That's why the parent of the backsliding potty trainer needs to first reexamine the situation and be sure that the child isn't being pushed or encouraged to potty train before he or she is ready.

"People often make decisions about potty training based upon a child's age, but, regardless of what Grandma says or friends' kids may have done, there is no magic age when potty training should begin," Dr. Wasserman says. "A child who is not ready to train may get caught up in the excitement at first, but will not be able to succeed over the long term."

Dr. Wasserman speaks from experience. One of his children was nearly 4 and still in diapers and the doctor and his wife were beginning to question how far they should push the issue. Then, one day when his wife was changing their son, she asked him if he didn't think it was time to start potty training. The tot looked her in the eye and said, "I'm not particularly interested in being potty trained."

Some kids may not be able to articulate their preferences quite so clearly, but a good grounding in potty training readiness, which is available on the Pull-Ups® Web site, can be invaluable.

Long-term Commitment

In addition to age myths, parents need to avoid being caught up in the idea that potty training should be instantaneous. Some children may potty train in a day, but that's certainly not the norm, Dr. Wasserman says.

"Potty training is a process that will take weeks and you have to think of staying with it over the long term," Dr. Wasserman says. "Thinking this will be accomplished in a matter of days can lead to too much unrealistic pressure on everyone."

Looking at potty training from that point of view can help a parent shape their games, rewards and activities to keep them realistic so kids can finish up strong.

Boys Will Be Boys

Here are a few other ideas for helping boys learn to aim:

• In the tub, have him pee into a cup.
• Allow him to go outside when there's no one around. Have him aim for a leaf or rock.
• Let him "write" in the snow.
• Have Dad show him how it's done.

Award-winning Potty Training Products

Here are some fun potty training products that have earned the iParenting Media Award:

Peter Potty by Visionaire Products: Peter Potty is a flushable toddler urinal that makes potty training fun for boys – with less clean-up.

Zeets Disposable Potty Seats by Grandma Dot LLC: Take potty training on the road with these portable, single use, kid-sized potty liners. Neither you nor your child will have to touch the public toilet seat!

Potty Elmo by Fisher-Price: If children get Elmo to the potty in time after he drinks from his sippy cup, he sings a reward song, accompanied by fun sound effects.

Potty Time Tinkles by Goldberger Doll Co.: Tinkles the doll drinks water then holds it in, like a real child. When you want Tinkles to wet, you squeeze the tummy and the doll can tinkle in the included potty seat or the real toilet.

Childhood Respiratory Illnesses

When Baby Sneezes and Wheezes

by Donna Smith

Year round, hospital emergency rooms are filled with children suffering from respiratory tract infections. Many of these illnesses can be treated successfully at home, but it's important for parents to know when to seek more aggressive treatments. When is a cold just a cold – or something more?

The Common Cold

Millions of people each year are affected by the common cold. Children seem to be more prone to getting "the sniffles" because of school and daycare settings, where germs get passed around as often as notes and toys.

"[The common cold] is caused by a variety of viruses in the rhinovirus family," says Dr. Stuart Abramson, assistant professor of pediatric immunology at Baylor College of Medicine and staff physician at Texas Children's Hospital in Houston, Texas. The symptoms, which can be one or all, include stuffy nose, runny nose, sneezing and cough.

Dr. Abramson says that in young infants, overmedicating should be avoided. "Sometimes just a bulb suctioning of the mucus to help open up the airway, so that [they] can breathe" is effective, he says. For older children, decongestants are often prescribed, such as Sudafed or topical sprays like Neosynephrine. "Those are short-term treatments for just a few days," says Dr. Abramson. "Sometimes just washing the nose with saline – an over-the-counter saline spray – can be helpful."

Respiratory Syncytial Virus (RSV)

RSV is a virus that Dr. Abramson says almost everyone will eventually get, but the concern is for children under 2. Premature infants, infants with heart problems, such as congenital heart disease, and anyone with underlying immune deficiencies all need special attention to prevent RSV.

"The recommendation is that these patients should get an antibody injection that prevents RSV," he says. Synagis (palivizumab) is the medication that has been approved for preventing serious complications from RSV in high-risk infants.

The symptoms of RSV start by mimicking a cold, but then lead to increased coughing, difficulty breathing and lethargy. RSV can lead to pneumonia and cause other complications requiring hospitalization. "If the symptoms are severe and they have poor oxygenation from the pneumonia, that can be a complication," says Dr. Abramson.

The Croup

While there is treatment for RSV, there is no home treatment for croup (laryngotracheobronchitis), another viral infection associated with coughing and difficulty breathing. "One can hear a noise called 'strider,' which is a noise that's noisy breathing when one takes in a deep breath or exhales, because the trachea is swollen," says Dr. Abramson.

Croup requires supportive care. "Humidified air is sometimes helpful, certainly if the child is not oxygenating (breathing) well," says Dr. Abramson.

Difficulty breathing is criteria for being admitted to the hospital for more aggressive treatment. Breathing treatments are given to help reduce the inflammation and to facilitate breathing. But Dr. Abramson says hospitalization is usually not necessary unless the child is tiring out from coughing or dehydrated. "These are all potential complications," he says. "But an older child who has just a little bit of a croupy cough generally will get over it in a few days."

Influenza (Flu)

With the increased number of cases and deaths attributed to it, influenza has found itself in the news lately. Influenza, another virus, can cause severe symptoms such as high fever, muscle aches and chills and can lead to pneumonia, which can be life threatening. "We have a particularly bad strain here in the early season," says Dr. Abramson of the 2003-2004 flu season.

Dr. Abramson says it's very important for everyone over the age of 6 months to get a flu shot. The immunization, which is a not a live virus, does not give you the flu, but it can give you some fever and muscle aches. Despite that, it is still the best way to avoid the flu. "And if you haven't done it before, you need two shots, one month apart," he says.

Unlike other viruses, Dr. Abramson says there are some medications that can be given if the flu is detected early. "There are rapid tests for this that can be done at a doctor's office or clinic," he says. "If one has it and it's noted within the first 48 hours, there are some medical treatments, some medicines, that can be given for the flu." The medications are all by prescription only, so a trip to the doctor is required.

Bronchitis

Unlike RSV, influenza, croup and the common cold, bronchitis can be caused by a bacteria or virus. Another deferential is that bronchitis affects the lungs. "Bronchitis is more the lower airway," says Dr. Abramson. "You have the upper airway, which is the nose, and then we have the lower airway, which is the lungs. In younger infants we call it bronchiolitis, because it can involve the smaller airway as well."

Symptoms include breathing problems, coughing, shortness of breath, chest tightness and chest pain, so it can also be a feature of asthma. "If there's wheezing, or what we call reactive airway disease, then the child may benefit from some breathing treatments in the hospital for a while," says Dr. Abramson. If there are no complications, bronchitis can, and usually is, treated at home.

While respiratory tract illnesses can sometimes be serious and require hospitalization, they are also quite common and can routinely be taken care of at home. "If a parent has questions, they should call their primary care physician," says Dr. Abramson. "Certainly infections associated with high fever should seek medical attention. And if they have increasing respiratory difficulties – worsening cough, chest tightness, chest pain – those sorts of things are red flags that one should seek medical attention."

Swine Flu and Babies

Symptoms, Prevention and Treatment for the Swine Flu

By Shannon McKelden

Moms of infants are generally hyperaware of germs and keeping their baby healthy anyway, but when something like the swine flu becomes headline news, it's hard not to panic just a little bit. However, knowing how to lower the chance of you or your baby becoming infected will go a long way to help prevent further spread of the swine flu – and give you peace of mind.

What Is Swine Flu?

According to New York pediatrician Dr. Anatoly Belilovsky, swine flu – technically influenza A (H1N1) – is a strain of flu previously only seen in pigs. "In fact, all flu strains arise in pigs and poultry, and cause human epidemics when they become transmissible between humans," he says.

When the virus that causes swine flu in pigs combines with human influenza virus and then mutates to allow itself to infect humans, we're left with a new strain of flu. Swine flu, like other flu viruses, is an airborne illness spread through the respiratory tract. The symptoms of swine flu are similar to other influenza illnesses, including high fever, body aches, headaches, coughing, sore throat, diarrhea, vomiting, fatigue and chills.

Dr. Heather Armstrong, an emergency medicine pediatrician in Florida, adds that infants may not have all of these symptoms but may manifest fever, irritability, poor appetite, cough or diarrhea.

"We don't know yet if swine flu will behave exactly like seasonal flu, but most doctors assume that children, especially infants, the elderly and people with chronic medical conditions like asthma or heart disease will be more severely affected," says Dr. Armstrong. "As with all flu, the risk is especially great for babies less than 6 months old."

The younger the child, the more susceptible they are to any illness, including the flu. "A newborn has not had any experience being exposed to germs which strengthen the immune response, nor [have they] had any vaccines and are at higher risk," says Dr. Armstrong.

It's important to remember that any flu, either "typical" or swine flu, has the potential for serious illness in infants that may warrant hospitalization or even cause death. "In any situation, a fever should be taken seriously in an infant under 2 months and warrants medical attention," says Dr. Armstrong.

Dr. Belilovsky recommends seeking medical attention if you notice your baby has a fever, cough, poor appetite, is cranky or lethargic, or appears sick and run-down.

Prevention

Prevention of swine flu is uppermost in people's minds these days, especially parents of young children. "Parents should be particularly careful to keep babies and children away from people who are showing symptoms of illness," Dr. Armstrong says. "If you are in a public place and someone is coughing don't feel rude by keeping your infant away! If a family member is sick it may not be the right time for them to cuddle the baby or to make up the bottles. Even a simple cold can be serious for a young infant."

Flu viruses are spread most often by coughing and sneezing or by touching surfaces that have been coughed or sneezed on – including tabletops, hands, money and even grocery carts.

Prevention basics for swine flu are the same as for any other flu, according to Dr. Armstrong. They include the following:

• Cover your nose and mouth with a tissue when you cough or sneeze. Throw the tissue in the trash after you use it. (Additionally, don't handle used tissues, such as those of your children.)
• Wash your hands often with soap and water, especially after you cough or sneeze. Alcohol-based hand cleaners are also effective.
• Avoid touching your eyes, nose or mouth. Germs spread that way. Wash your hands after you blow your nose, touch your mouth or wipe mucous from your child's nose.

Though Kari Matthews of Rossville, Ill., home schools her older boys, which limits their exposure to other kids, she knows she must still be careful about what they are exposed to when they are in public. Whatever they touch can be transmitted to their baby sister. So she follows many of the above recommendations.

"We are very careful to wash our hands, to carry boxes of tissues, to have the discipline to keep our hands away from our faces, and to skip shaking hands with people in public, like at church," says Matthews. "I generally follow these guidelines anyway, but during a scare like this potential swine flu pandemic, I am extra-vigilant."

It's not always possible to remain as isolated as we'd like. Parents still need to work, and many kids spend time in school or daycare. "Influenza spreads most rapidly within schools and daycares because children have poorer hand-washing skills and share drinks and mouth objects," says pediatrician Dr. Melanie E. Mouzoon, who is also director of immunization practices and travel medicine at Kelsey-Seybold Clinic in Houston, Texas.

For unavoidable times, like grocery shopping, where infants and toddlers have a habit of touching or tasting everything in sight, you may have to step up your efforts. "I have purchased a cart liner for the baby," Matthews says. "She is 16 months old, and she loves it. It is a large padded blanket with leg holes that fits in carts and highchairs. I use it every time we need to take the baby into a store or restaurant, and we wash it often. It covers every surface that the baby can reach, so I can shop relatively worry free."

Nursing mothers may offer a bit of extra protection to their infants, but may still need a bit of a boost. "Vitamins A and D should be supplemented in mothers, especially those who are breastfeeding babies over 2 months old, as they are vital in maintaining appropriate immune response, and are most often deficient," says Dr. Belilovsky.

Again, while care is necessary, panic is counterproductive. "Despite the warnings, I don't feel as though I need to be on any sort of lockdown," says Sara Abbott, a mom from Boston, Mass., who not only has a 13-month-old but is pregnant with her second child. "Local reports indicate there's likely already a strain of swine flu in the Boston area anyway, so I've decided to stay out of Boston proper and keep closer to home."

Treatment

Unlike some other strains of influenza, the swine flu has no vaccination for prevention. However, there are antiviral medications to combat influenza once a patient has been diagnosed. "Tamiflu (oseltamivir) appears to be effective," says Dr. Belilovsky. "You and your doctor will decide if it is appropriate."

Previously Tamiflu has only been approved for use in children over the age of 1 year. However, in situations such as the current swine flu pandemic, it is considered a special circumstance. An Emergency Use Authorization (EUA) has been issued by the Centers for Disease Control and Prevention (CDC) to allow use of Tamiflu in treatment of children under the age of 1. Again, this is something you would have to discuss with your doctor in the event your baby becomes infected with the flu.

"This situation is changing daily, so even if you have read up on it recently, keep checking," Dr. Mouzoon says. She recommends checking the swine flu page at www.cdc.gov.

That's Mine!

The Difficult Art of Toddler Sharing

Kristen Mosser was mortified to hear from the other parents in her son Bradley's nursery school that her son "wasn't a good sharer. It's the most horrible feeling in the world," she says. Mosser is not alone in her despair. There probably isn't a mother alive who hasn't cringed in embarrassment at least once when her child refused to share, or worse pulled a toy from a playmate's hand.

The battle doesn't have to be entirely uphill, though. It's important to remember that toddlers are just beginning to learn social skills. From the moment babies are born, their adoring parents rush to satisfy their every need. To expect them to suddenly and spontaneously give generously of themselves is more than a little far-fetched. Rather, parents should keep their expectations realistic, and encourage their children to share by doing so themselves.

Take sharing slowly, in small steps. Punishing a young child for not sharing is counterproductive.

"I made a point of sharing things with my kids," says Debby Hecht. "If I eat an apple, I offer to share slices with them. If they crawl into my bed on Saturday morning, I share my pillow with them. I tell them I'm sharing because I love them."

Simply exposing your toddler to other children will help him learn to share. "There was one child in my daughter's daycare who absolutely wouldn't share," Hecht says. "The other kids let him know how unhappy they were loudly. I think peer pressure forced him into sharing."

Ann Rombauer, herself a licensed home daycare provider, knows what it's like to be the mother of the one kid who won't share. "My son refused to share with anyone. At first I saw it as a personal failure I make my living taking care of kids, and here mine was behaving so badly."

After speaking with other child educators, Rombauer took an ingenious approach she gave her son a taste of his own medicine. "I sat down with his favorite book and started to read," she says. "Of course, he wanted to sit and read with me, but I told him I wanted the book all for myself. It almost broke my heart to see him standing there, looking at me, but I forced myself to keep reading. And after a minute or two, he brought over some toys and asked me if I wanted to play with him. He still doesn't always share as much as I'd like him to, but we're definitely making progress."

When Mosser sought the advice of her son's teacher, Mary Brock, "my heart was in my throat. I was sure she'd tell me that I was a clearly a terrible mother." But Brock was reassuring. "Just because a three year old doesn't want to share doesn't mean he'll grow up to be a terrible, selfish person. I suggested that Kristen give Bradley something specifically for sharing. We started with grapes. Bradley was supposed to give each child a grape, and we made sure that he'd still have some leftover for himself. Once he got past the fear that sharing would leave him with nothing, it got a lot easier for him."

In general, Brock advises parents to take sharing slowly, in small steps. Punishing a young child for not sharing is counterproductive, she says. "If the first thing a child thinks of when he hears the word 'sharing' is 'That's what got me into trouble last time,' he's not likely to warm up to the idea." Rombauer adds, "I like creative approaches to problem solving you have to think in a toddler's terms. Help them understand why it's important to share not with complex theories, but with simple actions."

Most importantly, Brock and Rombauer agree that not sharing is a normal part of children's development. Their advice is to give it some time. Often, toddlers will come around of their own accord as a natural part of the growth process.

Mosser's son Bradley is living proof that children who are slow to share do eventually get the hang of it. "He's five now," Mosser says, "and his younger sister is three. The other day, I walked by the playroom and I heard him tell her, 'You're a very good sharer. I'm very proud of you.' So I guess I'm getting something right in my parenting!"

Curbing Toddler Biting

One day last year, Jeffrey Marsh, a family therapist, was working in his Los Angeles office with his dads' group. Their children, two and three years old, were playing quietly in the same room, when a loud scream pierced the air. Two-year-old Brittany, frustrated that Evan was playing with the truck she wanted, had decided to bite the little boy.

"She bit him hard and he was crying. The dad was clearly humiliated. He yelled, 'That's bad!' at his daughter, and picked her up, getting ready to leave. But all the other dads chimed in with, 'No, don't go! This is why we're here. Let's talk about it.' It was a great group," says Marsh.

Why Do Toddlers Bite?
While Brittany's dad was clearly shocked by his daughter's behavior, biting is not as uncommon as one might think. The majority of toddlers engage in some biting between their first and third birthdays.

"Young children bite for a number of reasons," explains Heidi Murkoff, co-author of What to Expect -- The Toddler Years (Workman, 1996). "Probably the most common reason is that it is one of the few ways of communicating that's effective for them, before verbal skills are developed." She adds that not all kids bite, and that some choose other forms of communication, such as grabbing, shoving, or punching.

Another reason toddlers bite is to express frustration, a feeling which is very common with toddlers, because both their communication skills and their motor skills are so limited. According to Murkoff, some very young kids bite just because of the response it produces.

"While words may fail to get a reaction, biting never fails to get a reaction. And with a young toddler, negative attention is better than no attention at all," she says.

"They are also entertained by these reactions -- it's funny, or intriguing, to see mom jump up, or for a playmate to start crying." Toddlers may also bite because they're teething or because they put everything in their mouths anyway, so why not someone's arm? Or it could even be that they are hungry.

Responding to Biting
While parents may understand that biting is a phase many toddlers go through, it can still be upsetting when it happens to their child. Christina Elston, from Altadena, Calif., remembers vividly when her daughter was the victim of a biter.

"It was at her preschool, and they had this one particular child who was a biter. It wouldn't even happen necessarily in the middle of any confrontation. Sometimes, during naptime, he would sneak out of his cot, and go over and bite other children," states Elston. "He bit Lauren one time and she ended up with a horrible bruise on her arm. I, of course, was furious and quite upset with the teachers, that they hadn't managed to prevent it." And in this case, with no skin broken, there was no question of any major health risk. "But biting is different from when another child pushes or hits your child," Elston adds. "It seems like so much more of a premeditated act."

Controlling Biting
If you do have to deal with your toddler biting, what is the best way to proceed? "The one thing you should never do, although it's a common mistake that parents make, is to bite back, so that the child knows what it feels like," says Murkoff. "All that does is reinforce the habit."

Instead, she suggests that if your child bites another child, you should first give the attention to the child who has been bitten. This will make it clear that biting is not a good way to get attention. In Murkoff's daughter's case, "the other child got the attention, which sort of caused the whole thing to backfire," explains Murkoff. "Since a very young toddler really doesn't understand that other people have feelings, it's the parent's job to explain that."

Tracey Porter, from Los Angeles, Calif., describes her experience dealing with her son Sam's tendency to bite as "horrifying." When Sam was two, he went through a biting episode for about three months. During that time, he occasionally bit other children, with maybe three or four incidents altogether. "Sam never bit Sarah, his older sister, or us -- his biting only came out at daycare," Porter says.

She talked to her son a lot, telling him every day when she dropped him off that she wanted him to be a good boy, that biting hurts people, that mommy and daddy didn't like it, and that he was not allowed to bite. "And eventually he got there, and he stopped. I don't know if all the talking helped, but we really focused on it, as a daily thing," says Porter.

According to Murkoff, Porter was doing exactly the right thing with her child. "While biting may be a normal phase for kids to go through, parents need to let them know that it is unacceptable behavior," Murkoff explains, adding that parents should take time to explain that no, we don't bite, we use words to express our feelings. "If your child couldn't figure out what words to use, you might suggest some for the future."

Experts agree that parents should try not to give biting so much attention that it becomes an attention-getter. This is true of all behavior that you don't want to see repeated. For example, it is not a good idea to laugh, because the child sees that she is getting a response, and she will do it again. A negative or a positive reaction is still a reaction. "You want to say firmly, matter-of-factly, 'No biting,' or 'We don't bite,' and then move on to something else," explains Murkoff. "And if you think the child might be hungry, suggest biting on some apple slices!"

Infants: Child Development (0-1 Year Old)

Infants: Child Development (0-1 Year Old)

* What are developmental milestones for infants?
* Where can I find tips for caring for an infant?
* How can I ensure my infant's safety?

Developmental Milestones

Cognitive development for your baby means the learning process of memory, language, thinking and reasoning. Your baby is learning to recognize the sound of your voice. She is also learning to focus her vision from the periphery or the corner of her eyes to the center. Language development is more than uttering sounds ("babble"), or mama/dada.

Listening, understanding, and knowing the names of people and things are all components of language development. During this stage, your baby is also developing bonds of love and trust with you. The way you cuddle, hold, and play with your baby will set the basis for how he will interact with you and others.

For more information on developmental milestones and warning signs of possible developmental delays, visit Learn the Signs. Act Early. (http://www.cdc.gov/ncbddd/autism/ActEarly)

Positive Parenting

* Talk to your baby. It is soothing to hear your voice.


* When your baby makes sounds, answer him by repeating and adding words. This will help him learn to use language.


* Read to your baby. This helps her develop and understand language and sounds.


* Sing to your baby.


* Play music. This helps your baby develop a love for music and math.


* Praise your baby and give him lots of loving attention.


* Spend time cuddling and holding your baby. This helps her feel cared for and secure.


* The best time to play with your baby is when he's alert and relaxed. Watch your baby closely for signs of being tired or fussy so that you can take a break.


* Parenting can be hard work! Take care of yourself physically, mentally, and emotionally. It is easier to enjoy your new baby and be a positive, loving parent when you are feeling good yourself.

Child Safety First

Now that your newborn is at home, it is time to make sure that your home is a safe place. Look around your home for household items that might present a possible danger to your baby. As a parent, it is your responsibility to ensure that you create a safe environment for your baby. It is also important that you take the necessary steps to make sure that you are mentally and emotionally ready for your new baby. Here are a few tips to keep your baby safe during her first year of life.

* It is important that you never shake your newborn baby. Newborn babies have very weak neck muscles that are not yet able to support their heads. If you shake your baby you can damage his brain and delay normal development.


* To prevent SIDS (Sudden Infant Death Syndrome), it is recommended that you always put your baby to sleep on her back. For more information on SIDS, visit National Institute of Child Health and Human Development.


* Place your baby in a car safety seat every time he rides in the car. The safest place for his safety seat is in the back seat of the car. Children who are less than one year OR are less than 20 pounds should be placed in a rear-facing care seat.


* To prevent your baby from choking, cut her food into small bites. Don't allow your baby to play with anything that may cover her face or is easy for her to swallow.


* Never carry hot liquids or food near your baby or while holding him.


* Immunizations (shots) are important to protect your child's health and safety. Because children are susceptible to many potentially serious diseases, it is important that your child receive the proper immunizations. Please consult your local health care provider to ensure that your child is up-to-date on her childhood immunizations. You may visit the CDC immunization website, to obtain a copy of the recommended immunization schedule for U.S. children

SOURCE:

National Center on Birth Defects and Developmental Disabilities, U.S. Centers for Disease Control and Prevention

Plastic chemicals 'feminise boys'

Male hormones drive boyish play

Chemicals in plastics alter the brains of baby boys making them "more feminine", say US researchers.

Males exposed to high doses in the womb went on to be less likely to play with boys' toys like cars or to join in rough and tumble games, they found.

The University of Rochester team's latest work adds to concerns about the safety of phthalates, found in vinyl flooring and PVC shower curtains.

The findings are reported in the International Journal of Andrology.

Plastic furniture

Phthalates have the ability to disrupt hormones, and have been banned in toys in the EU for some years.

However, they are still widely used in many different household items, including plastic furniture and packaging.

There are many different types and some mimic the female hormone oestrogen.

This feminising capacity of phthalates makes them true 'gender benders' Elizabeth Salter-Green, director of CHEM Trust

The same researchers have already shown that this can mean boys are born with genital abnormalities.

Now they say certain phthalates also impact on the developing brain, by knocking out the action of the male hormone testosterone.

Dr Shanna Swan and her team tested urine samples from mothers over midway through pregnancy for traces of phthalates.

The women, who gave birth to 74 boys and 71 girls, were followed up when their children were aged four to seven and asked about the toys the youngsters played with and the games they enjoyed.

Girls' play

They found that two phthalates DEHP and DBP can affect play behaviour.

Boys exposed to high levels of these in the womb were less likely than other boys to play with cars, trains and guns or engage in "rougher" games like playfighting.

PHTHALATES There are many different types and the most commonly used are deemed entirely safe by regulators DEHP - used to make PVC soft and pliable and used in products like flooring DBP - used as a plasticiser in glues, dyes and textiles

Elizabeth Salter-Green, director of the chemicals campaign group CHEM Trust, said the results were worrying.

"We now know that phthalates, to which we are all constantly exposed, are extremely worrying from a health perspective, leading to disruption of male reproduction health and, it appears, male behaviour too.

"This feminising capacity of phthalates makes them true 'gender benders'."

She acknowledged that the boys who have been studied were still young, but she said reduced masculine play at this age might lead to other feminised developments in later life.

But Tim Edgar, of the European Council for Plasticisers and Intermediates, said: "We need to get some scientific experts to look at this study in more detail before we can make a proper judgement."

He said there were many different phthalates in use and the study concerned two of the less commonly used types that were on the EU candidate list as potentially hazardous and needing authorisation for use.

DBP has been banned from use in cosmetics, such as nail varnish, since 2005 in the EU.

Vaccination Schedule

What childhood vaccines are recommended, and at what ages they should be given?
Hepatitis B vaccine:

1. First dose at birth to 2 months
2. Second dose at 1 to 4 months
3. Third dose at 6 to 18 months

Hib vaccine:

1. First dose at 2 months
2. Second dose at 4 months
3. Third dose at 6 months
4. Fourth dose at 12 to 15 months

Polio vaccine:

1. First dose at 2 months
2. Second dose at 4 months
3. Third dose at 6 to 18 months
4. Fourth dose at 4 to 6 years

DTaP vaccine:

1. First dose at 2 months
2. Second dose at 4 months
3. Third dose at 6 months
4. Fourth dose at 15 to 18 months
5. Fifth dose at 4 to 6 years
6. DTaP is recommended at 11 years

Pneumococcal vaccine:

1. First dose at 2 months
2. Second dose at 4 months
3. Third dose at 6 months
4. Fourth dose at 12 to 18 months

Rotavirus vaccine:

1. First dose at 2 months
2. Second dose at 4 months
3. Third dose at 6 months

Hepatitis A vaccine:

1. First dose at 12 months
2. Second dose at 18 months

Influenza vaccine:

1. First dose at 6 months (requires a booster one month after initial vaccine)
2. Annually until 5 years (then yearly if indicated or desired, according to risks)

MMR vaccine:

1. First dose at 12 to 15 months
2. Second dose at 4 to 6 years

Varicella vaccine:

1. First dose at 12 to 15 months
2. Second dose at 4 to 6 years

Meningococcal vaccine:

1. Single dose at 11 years

Human papillomavirus vaccine (adolescent girls only):

1. First dose at 11 years
2. Second dose two months after first dose
3. Third dose six months after first dose

Vaccinations for Children, Why and When

None of us wants to see our children get sick. If we could, we would protect them from any illness, no matter how small - even the sniffles.

Now suppose you could make your child safe from some of the most deadly diseases in history....And suppose that at the same time you could also help protect your neighbors' children and other children around the country from the same diseases....And finally, suppose you could actually help to rid the world of some of these diseases that have been crippling and killing children for centuries.

Vaccines are an amazing success story.

* Up through the early 1920's, diphtheria was one of the most dreaded childhood diseases in the United States, killing over 10,000 people every year. We started vaccinating children against diphtheria in the 1930's and 40's, and the disease started disappearing. Today it is rare for a doctor even to see a case of diphtheria, much less have a child die from it.


* In 1962, the year before measles vaccine was introduced, almost 500,000 cases of measles were reported in the U.S. Ten years after we started vaccinating there were about 32,000 cases, and ten years after that there were fewer than 2,000. In 1998 and 1999, only about 100 measles cases were reported each year.


* Until the middle of the 20th Century, smallpox was one of the most devastating diseases the world has ever known. Millions died from it every year. In 1967, the World Health Organization declared war on smallpox with an intensive, worldwide vaccination campaign. Twelve years later, smallpox was wiped out - gone from the Earth forever.


* Parents in the 1950's were terrified as polio paralyzed children by the thousands. Then we learned how to prevent polio using the Salk and Sabin vaccines. Now the fight against polio is nearly won, and soon it will join smallpox as nothing but a bad memory.

Before we discuss the 12 routine childhood vaccines and the diseases they can prevent, let's take a brief look at what vaccines are and how they work. Then we will answer some of the questions parents ask about childhood shots.

How Immunity Works

You get sick when your body is invaded by germs. When measles virus enters your body it gives you measles. Whooping cough bacteria cause whooping cough. And so on.

It is the job of your immune system to protect you from these germs. Here's how it works:

* Germs enter your body and start to reproduce. Your immune system recognizes these germs as invaders from outside your body and responds by making proteins called antibodies. Antibodies have two jobs. The first is to help destroy the germs that are making you sick. Because the germs have a head start, you will already be sick by the time your immune system has produced enough antibodies to destroy them. But by eliminating the attacking germs, antibodies help you to get well.


* Now the antibodies start doing their second job. They remain in your bloodstream, guarding you against future infections. If the same germs ever try to infect you again - even after many years - these antibodies will come to your defense. Only now they can destroy the germs before they have a chance to make you sick. This process is called immunity. It is why most people get diseases like measles or chickenpox only once, even though they might be exposed many times during their lifetime.

This is a very effective system for preventing disease. The only problem is you have to get sick before you develop immunity.

How Vaccines Help

The idea behind vaccination is to give you immunity to a disease before it has a chance to make you sick.

Vaccines are made from the same germs (or parts of them) that cause disease - measles vaccine is made from measles virus, for instance, and Haemophilus influenzae type B (Hib) vaccine is made from parts of the Hib bacteria. But the germs in vaccines are either killed or weakened so they won't make you sick.

Then the vaccines containing these weakened or killed germs are introduced into your body, usually by injection. Your immune system reacts to the vaccine the same as it would if it were being invaded by the disease - by making antibodies. The antibodies destroy the vaccine germs just as they would the disease germs. Then they stay in your body, giving you immunity. If you are ever exposed to the real disease, the antibodies will be there to protect you.

Immunizations help your child's immune system do its work. The child develops protection against future infections, the same as if he or she had been exposed to the natural disease. The good news is, with vaccines your child doesn't have to get sick first to get that protection.

Questions & Answers

How many shots does my child need, and when?

Some children should get their first shot (hepatitis B) before leaving the hospital after birth. Others begin at 2 months of age. You will have to return for more shots several more times before the child starts school. Your doctor or nurse will tell you when to come back.

Why do children need so many shots?

There are 12 potentially serious diseases that vaccines protect against: Measles, Mumps, Rubella (German Measles), Diphtheria, Tetanus (lockjaw), Pertussis (Whooping Cough), Polio, Haemophilus Influenzae type b (Hib Disease), Hepatitis B, Varicella (Chickenpox), Hepatitis A, and Pneumococcal disease. At least one shot is needed for each of these diseases, and for some of them several doses are required for the best protection.

This adds up to a lot of shots, and several are usually given at the same time. Some parents worry that it is not safe to give several shots at once, or that they may not work as well, or that they will overload the child's immune system. But studies have shown these fears to be unfounded. Vaccinations are just as safe and just as effective when given together as they are when given separately. The immune system is exposed to many foreign substances every day, and will not be overburdened by vaccines.

Several "combination vaccines" already exist (such as MMR and DTaP) in which multiple vaccines are given in a single shot, and this reduces the number of shots needed. More combinations are being developed, so in the future, even fewer shots will be needed for the same number of vaccines. Why are vaccines given at such an early age? Vaccines are given at an early age because the diseases they prevent can strike at an early age. Some diseases are far more serious or common among infants or young children.

For example, up to 60% of severe disease caused by Haemophilus influenzae type B occurs in children under 12 months of age. Infants less than 6 months of age are at highest risk for serious complications of pertussis - 72% of children under 6 months who get pertussis must be hospitalized, and 84% of all deaths from pertussis are among children under 6 months. The ages at which vaccines are recommended are not arbitrary. They are chosen to give children the earliest and best protection against disease.

How serious are these diseases?

Any of them can kill a child. It's easy to forget how serious they are because - thanks largely to vaccines - we don't see them nearly as much as we used to. Measles used to kill thousands of people in the United States every year. In the 1940's and 1950's tens of thousands of children were crippled or killed by polio. As recently as the mid-1980's, 20,000 children a year suffered from meningitis and other serious complications as a result of Hib disease.

These diseases aren't as common as they used to be, but they haven't changed. They can still lead to pneumonia, choking, brain damage, heart problems, liver cancer, and blindness in children who are not immune. They still kill children every year, even in the United States.

What will happen if my child doesn't get these shots?

Basically, one of two things could happen:

1. If your child goes through life without ever being exposed to any of these diseases, nothing would happen.


2. If your child were exposed to any of these diseases, there is a good chance he would get the disease. What happens then depends on the child and the disease. The child could get mildly ill and have to stay inside for a few days. He could get very sick and have to go to the hospital. At the very worst, he could die. In addition, he could also spread the disease to other children and adults who are not immune. If there were enough unprotected people in your community, the result could be an epidemic, with many people getting sick and some dying.

What are my child's chances of being exposed to these diseases?

It's hard to say. Some of these diseases are very rare in the U.S. today, so the chances of exposure are small. Others are still fairly common. Some are rare in the U.S. but common elsewhere in the world. Don't assume your child is completely safe from these diseases, even the rare ones. For instance, a child in the United States has only a tiny chance of catching diphtheria. But several years ago a boy in California did catch diphtheria and he died. He was the only child in his class who hadn't been vaccinated.

Are shots safe?

Shots are very safe, but they are not perfect. Like any other medicine they can occasionally cause reactions. Usually these are mild, like a sore arm or a slight fever. Serious reactions are rare, but they can happen. Your doctor or nurse can discuss the risks with you before your child gets her shots. The important thing to remember is that getting the diseases is much more dangerous than getting the shots.

Do shots always work?

Shots work most of the time, but not always. Most childhood immunizations give immunity to 90%-99% of the children who get them. But occasionally a child will not respond to certain vaccines. This is another reason why it's important for all children to be vaccinated. A child who has not responded to vaccination has to depend on the immunity of others around her for protection. She could be infected by a child who hasn't been vaccinated, but not by one who is immune.

What if my child didn't start her shots on time, or gets behind schedule? Will they still work?

Yes. If your child has gotten behind in the schedule, it is not too late. Most of these shots can be given at any age, and a child who has gotten behind does not have to start over. The shots already given will still count, and the child will still develop immunity. Just contact your doctor or health department clinic.

Isn't getting all these shots expensive?

It doesn't have to be. Vaccines are free if you take your child to a public health clinic (for instance, a state or local clinic), although you might have to pay a small fee for the nurse to give the shots. If you go to a private doctor, vaccines might be covered by your health insurance. Or a program called "Vaccines for Children" (VFC) might pay for your shots if you are enrolled in Medicaid, don't have health insurance, or are an American Indian or Alaska Native.

Ear Infections - A Primer

by Mayo Clinic staff

Middle ear infections, also known as otitis media, are among the most common illnesses of early childhood. Three out of four children have had at least one ear infection by age 3, according to the National Institute on Deafness and Other Communication Disorders.

Although ear infections worry parents and make children uncomfortable, most ear infections clear up on their own within a few days. Most children stop having ear infections by age 4 or 5.

Adults rarely get middle ear infections. The treatments for adult ear infections are similar to those for children, although surgery is seldom necessary.

Symptoms
By Mayo Clinic staff

Ear infections in children can be hard to detect, especially if your child is too young to say, "My ear hurts." Knowing what to look for can help. Children with ear infections may:

* Complain of pain in their ears
* Tug or pull at their ears
* Cry more than usual
* Have trouble sleeping
* Fail to respond to sounds
* Be unusually irritable
* Develop a fever of 100 F (38 C) or higher
* Develop a clear fluid that drains from the ears
* Have headaches

Don't stick anything in your child's ears to check for an ear infection.

Adults who have a middle ear infection may have these symptoms:

* Earache
* Fever of 100 F (38 C) or higher
* A feeling of blockage in the ear
* Dizziness
* Temporary hearing loss

When to see a doctor
Ear infections aren't usually an emergency — but they can make you or your child uncomfortable. If the signs and symptoms last longer than a day, call a doctor. In children younger than age 2, watch for sleeplessness and irritability after an upper respiratory infection, such as a cold.

If you see a discharge of blood or pus from the ear, call your family doctor or pediatrician. This could mean your child has a ruptured eardrum. While this might seem like an urgent emergency, the rupture of the eardrum may actually relieve your child's pain, and you can usually safely see the doctor within a day or two for treatment.

If your child has been diagnosed with an ear infection, call the doctor if your child's signs and symptoms don't improve or they get worse after three days.

Causes
By Mayo Clinic staff
CLICK TO ENLARGE
Illustration of middle ear Middle ear

Ear infections usually start with a viral infection, such as a cold. The middle ear lining becomes swollen from the viral infection, and fluid builds up behind the eardrum.

Ear infections can also be associated with blockage or swelling in the narrow passageways that connect the middle ear to the nose (eustachian tubes). When fluid gets trapped in the middle ear when the eustachian tubes become blocked during a cold, it can cause ear pain and infection.

Because children's eustachian tubes are narrower and shorter than those of adults, they are more likely to develop ear infections than do adults.

Another factor in ear infections is swelling of the adenoids. These are tissues located in the upper throat near the eustachian tubes. Adenoids contain cells that normally fight infection. But sometimes the adenoids themselves get infected or enlarged, blocking the eustachian tubes. Infection in the adenoids can also spread to the eustachian tubes.

In addition, children don't have fully developed immune systems. So it's easier for them to develop many illnesses, including colds and ear infections.

Risk factors
By Mayo Clinic staff

Major risk factors for middle ear infections in children include:

* Age. Children between ages 6 and 18 months are the most susceptible to ear infections, although ear infections are common from ages 4 months to 4 years.
* Group child care. Children cared for in group settings are more likely to get colds and ear infections than are children who stay home, because they're exposed to more viruses causing colds, which may then cause or complicate an ear infection.
* Feeding position. Babies who drink from a bottle while lying down tend to have more ear infections than do babies who are held upright during feedings.

Both children and adults are affected by these risk factors:

* Season. Ear infections are most common during the fall and winter. Sometimes, seasonal allergies may also congest your sinuses, making you or your child more likely to develop a middle ear infection.
* Reduced air quality. Children exposed to tobacco smoke or higher levels of air pollution are at higher risk of ear infections.
* Family history. Your child's risk of ear infections increases if another member of the family has had ear infections.
* Race. American Indians and Inuits from Alaska or Canada tend to have more ear infections.

Complications
By Mayo Clinic staff

Many ear infections clear on their own after about three days with no complications. However, long-lasting or recurrent ear infections can lead to:

* Short-term hearing loss. Fluid buildup can temporarily affect hearing. That's because it's harder for the eardrum and the tiny bones in the middle ear to send sound vibrations through fluid.
* Long-term hearing loss. Usually the fluid disappears on its own in a few weeks. But sometimes it remains in the middle ear for months, which can damage the eardrum and bones in the middle ear. Persistent middle ear fluid was once thought to contribute to speech or developmental delays in children, but researchers now say this isn't true.
* Ruptured eardrum. During ear infections, fluid and pus may press against the eardrum. This can be painful. Rarely, the pressure ruptures the eardrum. If this happens, you may see a discharge of pus and blood from the affected ear. This can be alarming. But the rupture actually relieves the pain, and in most cases the eardrum heals on its own. If the eardrum ruptures repeatedly and doesn't heal, surgical repair may be needed.

Untreated ear infections can also lead to a type of sinus infection known as mastoiditis, which affects a space in the bone of the skull that's behind your ear. Rarely, infections can move from the ear to other parts of the head.

Tests and diagnosis
By Mayo Clinic staff

The doctor will examine you or your child and ask some questions about the ear infection. During the exam, the doctor will look for inflammation in the middle ear with a lighted instrument known as an otoscope.

The doctor may also use an instrument called a pneumatic otoscope, which allows him or her to gently puff air on the eardrum. Normally this causes the eardrum to move. Any fluid in the middle ear will prevent that movement.

Sometimes additional, often pain-free tests for ear infections are recommended - especially if you or your child has had fluid in the middle ear for some time:

* Tympanometry. This test measures eardrum movement. A soft plug is inserted into the opening of the ear. The plug includes a device that changes air pressure inside the ear.
* Acoustic reflectometry. During this test, the doctor uses a hand-held instrument to project sounds of varying frequencies into the ear. How the sounds are reflected off the insides of the ear can tell the doctor how much fluid is inside the ear.

Based on the test results, you or your child may be diagnosed with:

* Acute otitis media (AOM). In AOM, parts of the ear are infected and swollen, and fluid and mucus are trapped inside the ear.
* Otitis media with effusion (OME). Effusion refers to fluid. In OME, fluid stays in the ear after the infection has cleared up. The presence of fluid increases the risk of a new infection, and you or your child may need additional treatments to clear the fluid from the ear.

Treatments and drugs
By Mayo Clinic staff

Many cases of ear infection don't need treatment such as antibiotics. What's best for your child depends on many factors, including your child's age, medical history and the type of ear infection.

A wait-and-see approach
Before prescribing antibiotics, most doctors will wait to see if the infection clears up on its own. The American Academy of Pediatrics and the American Academy of Family Physicians recommend a wait-and-see approach for the first 72 hours for children who:

* Are older than age 6 months
* Are otherwise healthy
* Have mild signs and symptoms or an uncertain diagnosis

Most ear infections clear on their own in just a few days — and antibiotics won't help an infection caused by a virus. In fact, about 80 percent of children with middle ear infections recover without antibiotics. Adults' ear infections also may clear on their own.

Your family doctor or pediatrician may recommend an over-the-counter pain reliever such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) to help with the pain from the infection.

If your child doesn't have drainage from the ear or ear tubes, prescription eardrops containing numbing medication may be an option, too. The drops won't cure the infection, but they may relieve pain. Warm the drops slightly by placing the bottle containing the drops in warm water. Then gently lay your child on a flat surface with his or her infected ear facing up. Don't give the drops with your child in your arms or on your lap.

Antibiotic therapy
Treatment with antibiotics is recommended for each of these groups of people:

* Children younger than 6 months old
* Children and adults who have had two or more ear infections in the past 30 days

Some doctors believe people who have otitis media with effusion (OME) should also be given antibiotics. However, it's not universally agreed that antibiotics are necessary or will work to prevent an ear infection for people with OME.

The first choice antibiotic of many doctors is amoxicillin, although other antibiotics are effective if you or your child is allergic to amoxicillin.

If the medication is effective, you or your child should start feeling better in a few days. Be sure to take the antibiotic for the full length of the prescription. Stopping medication too soon could allow the infection to come back.

Remember, antibiotics won't help an infection caused by a virus — and the overuse of antibiotics contributes to strains of the bacteria that resist these medications. Side effects from the medications — such as vomiting, diarrhea and allergic reactions — are possible as well.

Drainage tubes
If fluid in your child's ear is affecting his or her hearing or recurrent ear infections don't respond to antibiotics, your child's doctor may suggest surgery. Surgery is not a common treatment for adults.

The most common surgery for ear infections is a myringotomy and the insertion of tubes in your child's ears. During this procedure, which requires general anesthesia, a surgeon inserts a small drainage tube through your child's eardrum. This helps drain the fluid and equalize the pressure between the middle ear and outer ear.

Your child's hearing should improve immediately. As your child grows, the tubes normally will come out on their own and the drainage holes will heal — often within a year. In the meantime, your child may need to wear special earplugs in the pool and bathtub to keep water out of his or her ears.

Some children continue to have ear infections after surgery. Sometimes this leads to another set of tubes. If the ear infections continue after age 4, the surgeon may recommend removing your child's adenoids.

From Birth, Engage Your Child With Talk

I recently stopped to congratulate a young mother pushing her toddler in a stroller. The woman had been talking to her barely verbal daughter all the way up the block, pointing out things they had passed, asking questions like “What color are those flowers?” and talking about what they would do when they got to the park.

This is a rare occurrence in my Brooklyn neighborhood, I told her. All too often, the mothers and nannies I see are tuned in to their cellphones, BlackBerrys and iPods, not their young children.

There were no such distractions when my husband and I, and most other parents of a certain age, spent time with our babies, toddlers and preschoolers. Like this young mother, we talked to them. We read to them and sang with them. And long before they became verbal, we mimicked their noises, letting them know they were communicating and we were listening and responding. (And we’ve done the same with our four grandsons, all born after the turn of this wireless century.)

I am not the only one alarmed by modern parental behavior. Randi Jacoby, a speech and language specialist in New York, recently told me in an e-mail message: “Parents have stopped having good communications with their young children, causing them to lose out on the eye contact, facial expression and overall feedback that is essential for early communication development.

“Young children require time and one-on-one feedback as they struggle to formulate utterances in order to build their language and cognitive skills. The most basic skills are not being taught by example, and society is falling prey to the quick response that our computer generation has become accustomed to.

“Parents need to be reminded of the significance of their communicative model.”

Communication Starts Early

Not all parents, of course, are routinely tuning out their young children. Two of my female friends in their 30s who have toddlers talk to them, and with them, incessantly.

One, a former Spanish teacher, speaks to her three little boys only in Spanish; her husband and almost everyone else in their lives speak to them in English. The oldest, now 3, is fluently bilingual and readily translates into English what has been said to him in Spanish. If I ask him something in Spanish, he responds to me in English (he quickly recognized my limits with Spanish) and even corrects my mispronunciations of Spanish words.

So much for the notion that learning two languages simultaneously delays a child’s language development.

Ms. Jacoby’s general advice to parents: “Reward your little one’s communicative attempts with your heightened attention to his/her conversation. Be prepared to put down your cellphone and look them squarely in the eye as they share their thoughts with you.”

Communication begins as soon as a baby is born. The way you touch, hold, look at and talk to babies help them learn your language, and the different ways babies cry help you learn their language — “I’m wet,” “I’m hungry,” “I’m tired,” “I hurt,” “I’m overwhelmed” and so forth.

“Talk to your baby whenever you have the chance,” the American Medical Association advises parents. “Even though he doesn’t understand what you’re saying, your calm, reassuring voice is what he needs to feel safe. Always respond to your newborn’s cries — he cannot be spoiled with too much attention.”

The American Speech-Language-Hearing Association urges parents to reinforce communication efforts by looking at the baby and imitating vocalizations, laughter and facial expressions.

“Talk while you are doing things,” the association suggests. “Talk about where you are going, what you will do once you get there, and who and what you’ll see.”

You might say things like, “Now we’re going to put on your socks,” “We’re going in the car to see Grandma,” or, “When we get to the playground, I’ll push you on the swing.”

And you can’t introduce books too early. I remember my niece at 3 months paying rapt attention as her mother “read” picture books to her, pointing out objects, their colors and what the characters were doing.

Likewise for the toddler. Advice from the speech experts: “Talk while doing things and going places. When taking a walk in the stroller, for example, point to familiar objects and say their names. Use simple but grammatical speech. Expand on words. For example, if your child says ‘car,’ you respond by saying: ‘You’re right! That is a big red car.’ ”

Not Verbal, but Understanding

Keep in mind that preverbal children understand far more than they can say. One of my grandsons was a late-talker. When he wanted something to drink or eat, he went to the refrigerator or pantry and pointed. Our job was to ask, “Do you want water, milk or juice, cereal or raisins?” and wait for his response. When we guessed right, we reinforced the verbal message by saying, “Oh, you want cereal.”

Avoid “baby” words and baby talk, which can confuse a child who is learning to talk. Teach your child the correct words and names for people, things, places and body parts, including “breast,” “penis” and “vagina.” If your child uses a baby word (“din-din,” for example), you can repeat it but also use the correct one (“dinner”).

Play word games like “This Little Piggy” or “The Itsy-Bitsy Spider” and encourage your child to do the accompanying motions and perhaps some of the words.

Count the steps as you go up or down. My twin grandsons’ math skills flourished long before they could speak in sentences because they live in a third-floor walk-up. At whatever age your children start talking, let them know you are interested in what they are saying by repeating and expanding upon it and asking them to repeat what they said if at first you do not understand them.

Ask questions that require a choice, like “Do you want milk or juice?” or “Do you want to walk or ride in the stroller?” (An important aside: Too many city children are transported in strollers well beyond the time they can safely walk and run. Young children need to exercise their bodies as well as their minds. The theft of our stroller when our twins were 19 months old was probably the best thing that happened to them.)

Help expand your child’s vocabulary by talking about what is done with various objects or why a particular food helps to build healthy bodies.

Sing songs and recite nursery rhymes, and encourage your child to fill in the blanks. When reading a book together, which should be a daily activity, ask your child to name or describe the objects or talk about what the characters are doing.

Avoid verbal frustration. When your children try to talk to you, give them your full attention whenever possible. And before you speak to them, make sure you have their attention.

MacLaren Stroller Recall

Stroller maker Maclaren is expected to recall about 1 million umbrella strollers sold in the U.S. since 1999, according to the report. The move comes after 12 children reportedly had their fingertips amputated by the strollers.

“Parents should stop using these strollers right away,” a source familiar with the recall told the newspaper.

Maclaren, which dubs itself as “a premier British parenting lifestyle company that produces the world’s most safe, durable, innovative and stylish baby buggies and strollers,” is planning to provide a free kit to cover the stroller’s hinge mechanism, the newspaper reported.

The affected models include Volo, Triumph, Quest Sport, Quest Mod, Techno XT, Techno XLR, Twin Triumph, Twin Techno and Easy Traveller.

The voluntary recall is being conducted in cooperation with the U.S. Consumer Product Safety Commission.

In a press release, the company said: “Safety is our first priority and through this voluntary effort we urge consumers to contact us immediately to obtain the kit which consists of hinge covers designed specifically to fit all Maclaren strollers.”

What are the vaccine-preventable diseases?

Hib vaccine

* This vaccine protects against infection with the Haemophilus influenzae type b bacteria.
* These bacteria cause meningitis (an inflammation of the covering membranes that surround the brain) and may cause brain damage. Also these bacteria can infect the blood, joints, bones, muscles, throat, and the cover surrounding the heart. This is especially dangerous for babies.

DTaP vaccine

The D in DTaP stands for Diphtheria

* Corynebacterium diphtheriae is a bacterium that attacks the throat, mouth, and nose. This is a very contagious disease (easy to get), but occurrences have been rare since the vaccine was created.
* Diphtheria can form a gray web that may completely cover the windpipe and cause someone to stop breathing.
* Also, if this disease is not treated right away, it could cause pneumonia, heart failure, or paralysis.

The T in DTaP stands for Tetanus

* Tetanus is an infection caused by a type of bacteria found in dirt, gravel, and rusty metal. It usually enters the body through a cut.
* Infection with the tetanus bacteria causes the muscles to spasm (move suddenly). If tetanus attacks the jaw muscles, it causes lockjaw, which is the inability to open and close your mouth.
* Tetanus can also cause the breathing muscles to spasm, with potentially fatal consequences.

The P in DTaP stands for Pertussis

* Bordetella pertussis is the type of bacteria which causes whooping cough. It infects the airways and destroys the cells responsible for clearing mucus and other debris. This results in an infection associated with a severe prolonged cough and typical "whoop." The cough can last for more than two months and typically causes severe illness in the very young and very old.

Polio vaccine

* Polio is caused by a virus. It can cause paralysis of the legs and chest, making walking and breathing difficult or impossible.
* The first symptoms of polio are fever, sore throat, headache, and a stiff neck. Polio is very rare in the United States since the vaccine became available.

MMR vaccine

The first M in MMR stands for Measles

* Measles is a highly contagious (easy to get) virus that causes a high fever, cough, and a spotty rash all over the body. It may also cause ear infections and pneumonia.

The second M in MMR stands for Mumps

* Mumps is a virus which causes painful, swollen salivary glands, which are under the jaw, as well as a fever and a headache.
* Mumps also may cause serious problems including meningitis or hearing loss. It can cause inflammation of the testicles (orchitis) in males.

The R in MMR stands for Rubella

* Rubella, also known as German measles, is caused by a virus. It is most dangerous for women who are pregnant. Rubella can cause a mother to have a miscarriage or deliver a baby with heart disease, blindness, hearing loss, or learning problems.
* Rubella is a fairly mild disease in children.

Hepatitis B vaccine

* Hepatitis B is a virus which causes inflammation of the liver. Signs and symptoms are extreme tiredness and jaundice (all the white parts on your body, like your eyes, teeth and nails, turn yellow). It may cause the liver to stop working and has been associated with lifelong infection, liver failure, liver cancer, and even death.

Varicella vaccine

* Varicella is a virus which causes chickenpox. It causes an itchy rash and a fever. You can catch it from someone who already has it if you touch an open blister on that person's skin or if that person sneezes or coughs around you. Varicella infection, though usually believed to be mild, also causes pneumonia (lung infections) and encephalitis (brain infections).

Pneumococcal vaccine

* Streptococcus pneumoniae is a bacterium which causes pneumonia (lung infection), sepsis (blood infection), and other infections. It is very dangerous to the very young and very old.

Hepatitis A vaccine

* Hepatitis A is a virus similar to hepatitis B. Transmission occurs by coming in contact with contaminated food or drink. Early symptoms of the disease are nonspecific and may include fever, diarrhea, and abdominal pain. It causes acute liver disease. It can affect anyone at any age, and in the United States, it can occur as isolated cases or even in epidemics.

Meningococcal vaccine

* Neisseria meningitidis is a bacterium which causes meningitis (brain infection), sepsis (blood infection), and other infections. It is very a very dangerous infection and can cause seizures and death. Often outbreaks occur in epidemics.

Rotavirus vaccine

* Rotavirus is a virus which causes severe diarrhea in very young infants. It causes over 55,000 hospitalizations each year in the United States and over 600,000 deaths worldwide. Children with this virus develop vomiting and watery diarrhea, which causes them to become dehydrated.

Human papillomavirus vaccine

* Human papillomaviruses cause genital warts and cervical cancer (the cancer diagnosed by regular Pap testing). Annually, over 10,000 women develop invasive cervical cancer, and almost 4,000 die from this disease.

Influenza vaccine

* Influenza is a virus which causes severe respiratory illness. There are two major types, A and B. Each year, a new influenza vaccine is required because of the virus' tendency to mutate (change). The flu, as the disease is commonly called, causes the most severe illness in the very young and the very old.

Portions of the above information has been provided with the kind permission of the Food and Drug Administration (www.fda.gov) and the Centers for Disease Control (www.cdc.gov).