Control issues: A screaming toddler

The Pediatric Insider

© 2011 Roy Benaroch, MD

Alice wrote about her 14-month old toddler’s new screaming habit: “I am going crazy! When my 14-month old daughter doesn’t get what she wants, she lets out this high pitched scream until I give in. It seems as though she is gaining a little more control over me and I am are losing control of her. I really do not want this need for control to escalate to other things in the future, which is why I really need to take action now.”

A 14 month old is supposed to be figuring out how to control her environment, including the people in her life. These are crucial skills for children to learn. Parents should not be in complete control of toddlers, and a parent’s control is supposed to get lower and lower as children mature. The whole goal of parenting is to help a child become an independent, competent, and happy adult—not a little robot controlled by the parents. It’s not always easy, but if you wanted easy you should have gotten a goldfish.

There are some things, though, you can and should control: mainly, what YOU do. If you don’t want her to learn that screaming at you is the best way to get you to “hop to it,” you’d better change the way you react to screaming. She’s learning her lessons well, that the best way to get what she wants is to scream her head off.

When she screams, make sure she’s safe first. Then ignore her. Leave the store. Go where you won’t feel pressured or embarrassed. If she’s screaming at you from her crib, leave her there and go somewhere else. Do this without anger or retribution– this isn’t payback, this is the way it is. You scream at me, I do not help you. Period.

Try to stay away from thinking that you can control her, or that there is some magic parenting method that will keep you in control longer. In the long run, that’s not what parenting is supposed to be about.

Picking scabs

The Pediatric Insider

© 2010 Roy Benaroch, MD

S.A. asked, “What kind of discipline strategy can I use to get my daughter to stop picking at scabs. She’s three years old, and she has a lot of scars already.”

I don’t think a traditional “discipline strategy” is really what you’re looking for—at least no one based on rules. You shouldn’t “forbid” the picking, or make a rule that says “No Picking,” because you won’t be able to enforce that kind of rule. For young children, it’s important that any rule you make is 100% enforceable, all of the time. That’s the best way for children to learn that rules are rules, and rules can’t be broken. If you make a “don’t pick” rule, as soon as you turn your back the picking will resume. So what your daughter will learn is “I don’t have to follow rules when mom isn’t watching.” And she’ll still be picking!

Instead of trying to forbid the picking, try distraction instead. When you see picking, give your daughter a toy, or suggest something else to do. Something that’s new or different is more likely to get her attention, and a game with mom is always fun.

You can also make a positive reinforcement chart. You can work out the details, but you could start with something like: If a day goes by without picking, she gets one sticker. Three stickers earns a trip to the dollar store; six stickers ears a trip out for ice cream.

Once wounds heal, they won’t attract picky fingers. Help minor skin wounds heal faster by washing them gently every day with soapy water. Afterwards, rinse, dry, put on a dab of antibiotic ointment (like Polysporin), and cover it with an adhesive bandage. Colorful or cartoony Bandaids might be more likely to discourage picking. If any of the sores are draining, painful, or spreading, take her to her doctor.

Though picking can make sores and scabs more prominent, and can learn to dark spots, it’s rare for these spots to be permanent. They may take a while to fade, but superficial sores, even picked-at ones, rarely leave any permanent marks. If your child is truly digging at these things aggressively and constantly, talk with her doctor to make sure that there isn’t a more-serious developmental issue going on.

The Poopy Party

The Pediatric Insider

© 2009 Roy Benaroch, MD

Hey! Based on comments, I rewrote & updated this. Here’s the newer version: 

How to get your child to poop on the potty: The Poopy Party

The Pediatric Insider

© 2018 Roy Benaroch, MD

Julie’s 3 year old son uses the potty great—at least for urine. For poop, well, he’d prefer to use a diaper. What she needs to know about is the poopy party, and how to create some fun and excitement to get her child to take that last step!

Keep in mind: there are three ironclad rules of parenting. You can’t make ‘em eat. You can’t make ‘em sleep. And you definitely can’t make ‘em poop. Kids can hold their poop for a shockingly long time when they’re feeling stubborn, and you may end up with a very stubborn child if you try to force her to poop on the potty. So no forcing, no punishing, no humiliating, and nothing at all negative is going to work if you want your child to be successful on the potty.

Fortunately, all kids inherently want to succeed and learn new things. As soon as they’re sure you’re not pushing, and they start to get an inkling that—hey, this is the way to go!—they’ll do it. For kids who are a little late to the party, here’s one way to jump-start the process.

 

“The Poopy Party”: A method to encourage using the potty for stool

This works best at age 3 and above. It’s important to “ham it up” and really play with this to create a sense of fun and excitement about the potty. At no point should you be direct—never say “Don’t you want to use the potty now?” The point is to create excitement, but only to indirectly talk about what the potty is for.

You’ll need: a willing parent or caretaker, two hardhats, two bright orange construction worker vests, and two big chunky flashlights. Feel free to add in some kind of wrench looking thing, and a tape measure, and whatever other mechanical-plumber sort of equipment inspires you. If you want, you can involve your child in a trip to the tool store to load up on your equipment.

The parent puts on an outfit with hat and vest, then (while dressed up!) goes to get the child so she can put her set on. Child and parent have both got their own big flashlights, vests, tools, whatever. Dad or mom says something like, “Something’s up with the toilet, we’ve got to get it fixed so the poop can go to The Poopy Party!”

Don’t talk more about The Poopy Party…yet. Let the excitement build!

Then go to the toilet and take it apart, or as much of it as a parent feels comfortable putting back together. Talk about the parts, the flusher, the bobber thing, the insides, and where the poop goes down. Then, if you can, go to the basement and pull down some tiles, and shine your light along the big drain pipe all the way outside the house. Go out to the street and pull off a manhole cover (or the utility cover over the water main, or just peer down a storm drain) and shine your lights down there. Then talk about The Poopy Party. Yep, that’s where the poop goes, down there. There’s dancing and singing, and it’s a great place for poop to go!

If you want to go a step further, take the child to the county wastewater treatment plant. You’ve got to keep the hardhat and vest on. Explain there that you want to show your child where the poop goes. Then check out the big tanks and turbines and other fascinating things. Then go out for ice cream.

Afterwards, hang up the vest in the bathroom where the child will see it, but – and this is very important – do NOT talk about this any more. You set the stage, make it exciting, but do not remind or suggest. Anything like that will further delay potty success.

And be prepared, once she’s using the potty, to bring the vest everywhere you go.

Got (raw) milk?

Jill said, “My pediatrician recently had a bit of a fit when she learned we were feeding our 4 year old raw unpasteurized milk. I don’t understand why this is such a big deal. Can you explain? We get our milk from my father in law who raises cattle so this is the only milk my four year old has ever drank.”

I had a hard time with this question—most of the information I could find was either from very pro-raw milk advocacy groups, or from rather bland statements from health authorities urging people to “just say no” to unpasteurized milk. I’d like to say I’ve found some good science and statistics comparing the risk of straight-from-the-farm, unpasteurized milk to commercial milk. But I haven’t.

Pasteurization itself is a fabulous way to disinfect natural foods like milk and juice. It usually involves heating milk to 165 degrees for 15 minutes (there are other protocols), which dramatically reduces the bacterial content of the milk. And there are some nasty bacteria that can thrive in milk, including forms of tuberculosis, listeria (a potential cause of miscarriages), and diarrhea-causing campylobacter, to name a few. Pasteurization reduces, but does not eliminate, the risk of infection from consuming milk. The terms “unpasteurized” and “raw” milk are pretty much used interchangeably.

I did find this statistic: between 2002 and 2007, the Centers for Disease Control tracked 1007 illnesses traced to raw milk or cheese, including two deaths. During that same time period, there was an outbreak of listeria from pasteurized milk in Massachusetts that killed three men and probably led to at least one miscarriage.

The FDA recommends avoiding unpasteurized milk, and several states have banned its sale. Some states allow it if an unappetizing gray color additive is added (it can still be used safely to feed animals.)

It’s important that farms that collect milk for consumption without pasteurization practice very clean, hygienic farming. Unfortunately, I doubt most large commercial farms do this; they probably rely on the pasteurization to “make up” for their crowded, factory-like conditions.

If families are going to consume raw milk, I would certainly recommend that they investigate the farm thoroughly, and stick with a small local source. Good hygiene is essential at every step. The milk has a short shelf-life, even when refrigerated. People with immune-compromising conditions, the elderly, pregnant women, and babies would all be at special risk for more severe infections, and should stay away from unpasteurized products.

Toddlers and dogs

A question from Sophie about dogs: “Do you have any recommendations on how to discipline a 14 month old who is continuously abusive to the dogs in his home? We are having serious issues with our son literally attacking and hitting our small dogs. He laughs and giggles if we say no in a firm voice. We aren’t sure if he is old enough for time out? We are scared eventually the dogs will fight back or he will really harm the dogs (the dogs only weigh 9ish pounds). Thank you!”

Another dog question! That makes me wonder what ever happened to Beth and her doggy wishes. Hopefully her parents won’t see this post and change their minds!

You’ve really got two issues here: how to teach your child to behave with the dog, and how to keep your child safe. At 14 months, I’m not sure you can rely on discipline strategies with your son to make sure that he doesn’t get hurt. Even a 9 pound dog can give a child a nasty bite, especially on the face. So even once you’ve implemented the teaching part of the plan, you’ve still got to ensure that your son doesn’t get attacked by keeping him and the dogs under close supervision.

Teaching a toddler how to behave with a dog isn’t very different from teaching a toddler other skills. Use a combination of these tools:

• Modeling—be good with the dogs yourself, and show with your actions how you treat animals with respect.

• Positive reinforcement—give your son good feedback when he does the right thing. Your positive comments should be immediate and very specific. Since your son in so young, you probably won’t find it helpful to make a more elaborate positive reinforcement strategy like a sticker chart. Just positive comments and affection to reinforce good behavior should help.

• Punishment—you shouldn’t tolerate cruelty, which includes hitting people or animals. Review the action plan for stopping aggressive behaviors in this post, and follow those directions whenever he strikes one of the dogs. Do it immediately, with no warnings or count-downs.

Even with all of these teaching steps in place, you’ll need to be careful. A dog who feels threatened will bite, and even your little dogs could really hurt your son. Until he’s old enough for you to depend on his judgment and behavior, he should not spend unsupervised time with your dogs.

Further reading

Time-out: a user’s guide

Here’s a question from Gretchen: “My 17 month old has been scratching, hitting my face, and pulling my hair whenever he is frustrated. This behavior has been going on for about a month. He does not behave this way with his father but does occasionally with his grandmother. I’ve tried saying “NO” firmly, timeouts, even slapping his hand. My gut feeling is that timeout is the best way to go but sometimes is not possible, for example, when I am picking him up to change his diaper which he hates. He is clearly acting out because he doesn’t want me to change his diaper but it needs to be done and a timeout will prevent me from changing him. Do you have any suggestions as to how to stop this before it gets any worse?”

A previous post based on a similar question was about how to stop a toddler from hitting. Rather than repeat that material, I’m going to use this question to talk about one method of punishment for children, the time-out.

“Time-out never works!”

I hear that all the time. Yet, when it’s done correctly, time-out can be a very effective tool for teaching improved behavior for children. Unfortunately, parents seldom get a good chance to learn how to use time-out the right way, and how to make a time-out work. Here’s what you need to know.

Time-out is meant for toddlers and young children, not for older kids or teens. It won’t work if they’re used too frequently, and it won’t work if you try to use time-outs for every behavior problem. It’s best to choose one behavior at a time that you’re trying to stop. In Gretchen’s example, she could choose stopping the hitting as her one goal to work on at first.

As with all punishments, time-outs should not be “warned” or threatened. If your child has crossed the line and deserves a time-out, do it—don’t talk about it, don’t threaten it, don’t act like you’re going to do it and then back off. If you haven’t got the time or energy to punish your child for the behavior, it’s better to ignore it than to do a meek or half-hearted attempt. Be the boss. Make it so.

Time-outs should not be accompanied by talking, explaining, or rehashing. If your child hits, say the rule in two words: “No hitting.” Say this forcefully, and only once. You can use a mean face, but don’t scream and don’t lose control. Then pick up the child and put him in the closest corner, facing away from you. You might have to hold him there. Alternatively, for a younger child, you can hold her in the air facing away from you, perhaps balanced on your knee. The child should not be able to see your face. Don’t say anything else.

After an appropriate time (say, 2 minutes for a toddler), turn the child around to face you. Repeat the rule, once, with love in your voice, and give the child a hug. Don’t stay mad. Show with body language that the time-out is over, and that the child is welcome back into the family.

The most common reasons time-out doesn’t work:

· They’re threatened and warned rather than just done. Every time you threaten, your child is learning that your rules can be ignored, most of the time.

· They’re accompanied by too much talking and explaining.

· They’re used too often, or almost continuously. For a time-out to work, the child has to be in “time-in” most of the time. That way time-out feels very different, and unpleasant, and even a little scary.

Time-outs work very well when paired with a reward for improved behavior. For instance, let’s say your child has developed a habit of grabbing toys away from other children. To fix this, you can both start doing time-outs when grabbing occurs, but also give positive, tangible reinforcement when the child shares nicely.

To teach your child to behave requires more than effective punishments—in fact, especially for younger children, punishments should be the least-used technique. More important tools include love, consistency, clarity, modeling, and positive reinforcement. For more about these important ways to help your child learn, see the chapters on discipline in my book, Solving Health and Behavioral Problems from Birth through Preschool.

Poison carrots?

Andrea posted, “I recently made carrot puree for my 7 month old baby. I was so proud of myself for doing something I thought was good for my baby, making food without preservatives. However, while looking for additional puree recipes online, I came across a lot of information that recommended against feeding babies homemade carrot puree. There seems to be varied opinion about these things online. I am looking for a reputable resource to sort through what is ok versus not. Can you help?”

What you were reading about refers to a baby’s risk of poisoning with nitrates, which are natural compounds that occur in all plant-based foods. Excessive nitrates can cause a potentially serious blood disorder called “methemoglobinemia” or “blue baby syndrome.” Though internet sites will scare you about the risks of homemade baby foods, these risks are phenomenally small if you take a few simple precautions.

The highest risk for nitrate poisoning in the United States has nothing to do with baby food, homemade or jarred. It’s from contaminated well water. If you are preparing a baby’s formula with well water, you should contact your county about the risks of nitrate exposure in your area, and consider having your well water tested. Or, use bottled water.

The younger your baby, the higher the risk of poisoning from nitrates. As babies get older, they’re more able to metabolize nitrates like adults do. The highest risk is under three months of age, with much lower risks extending past six months.

All plant foods contain enzymes that convert natural proteins into nitrates. These enzymes are released when you chew the food, or when you use a blender or food processor to puree the food. So there is essentially no risk from freshly-made baby food—the enzyme takes time to create the nitrates. Also, the process of nitrate production is slowed considerably by freezing. You can avoid the risk of nitrate poisoning by either using pureed homemade vegetable-based baby foods right away, or freezing them. Don’t leave veggie purees in the refrigerator for longer than 12 hours.

Jarred foods could well contain the same nitrates, but the manufacturers routinely monitor for them. I couldn’t find any reports of nitrate poisoning from jarred foods in the United States. Once the jars are sealed, nitrate production will stop. Jars of commercial baby food should be discarded 24 hours after opening.

So: Feel free to keep making your own baby food! Homemade carrot puree is fine, as long as you make it fresh or freeze it. Just don’t keep pureed vegetable foods in the fridge, whether commercial or home-made.

Mmmmm…eggs!

Mark wants to know: “How many eggs can a child eat each day? Is there some kind of guideline about this?”

As far as I know, there is no established guideline on how many eggs children should eat. A few years ago egg consumption was discouraged for adults, because they do contain a lot of cholesterol. Since then it’s become more clear that it isn’t the cholesterol you eat that ends up in your blood, but rather the saturated fats and especially trans fats that cause increased “bad cholesterol.” So perhaps eggs got a bit of a bad rap, back there.

As an aside: dietary guidelines to reduce blood cholesterol in the 1990’s were over-simplified and woefully misguided. They discouraged all fats and eggs. It turns out that some fats can lower cholesterol (mono-unsaturated fats like olive oil and canola), and that actually not all kinds of cholesterol are bad for you (HDL-cholesterol prevents heart attacks!) The best dietary advice to help reduce your risk of coronary artery disease is to avoid saturated fats (usually, this means fats from animal sources) and avoid trans-fats (things that include the phrase “partially hydrogenated”, usually processed foods).

Eggs are cheap, and a great source of calories, protein, and iron. They’re easy to make a bunch of different ways (see below!), and if your child likes ‘em, I say let him enjoy.

Roy’s French Toast Sticks, with Special Dippin’ Sauce

Cut up challah bread into stick shapes, and soak them in scrambled eggs. If you scramble the eggs with a stick-blender, they soak into the bread more evenly and you don’t end up with trailing brown stringy ends that make kids turn up their noses. Fry ‘em up on all sides, rotating every few minutes, until tasty.

Special dippin’ sauce: melt a stick of butter in the microwave, and then add a good squirt of maple syrup. Stir in a little vanilla extract, a teeny pinch of salt, and maybe a dash of cinnamon. Whip it together with a fork.

Rocky Mountain Eggs

Take a slice of wheat bread, and tear out a circle in the middle, about 2 inches across. Eat the bread circle (it’s bad luck if you don’t, I’m told.) Melt butter in a non-stick fry pan, then fry the bread on one side. Flip it over, and crack an egg in the hole. Let it set for a few minutes, then flip it and cook on both sides back and forth for a total of maybe 5 more minutes.

White noise at bedtime

Lara posted, “My husband and I have always put our son, who is 10 months, to sleep with white noise in the background. It went from the exhaust fan in the bathroom, to a humidifier and now a sound machine. We even take the sound machine with us when we travel for our baby to sleep with. My husband’s family all use fans to sleep with and some have a difficult time sleeping without one. I am concerned that our son will always need white noise in order to sleep if we continue to use the sound machine long into the future. What happens when he goes to sleepovers and there isn’t one there? Should we keep using it or let him learn to sleep without one?”

I’ve written before about the importance of good, fixed sleep associations as an important way to help kids sleep independently through the night. Junior will get used to cues from the environment to know when it’s time to go to sleep and stay asleep. These can be things like being held, a gentle rocking motion, being swaddled, or a dark room. The best sleep associations are those that do not depend on a parent being present. So a white noise machine, running all night, can be an excellent way to help a child learn to sleep solidly and independently.

I’m not too worried about a baby being too dependent on a device like this. They’re easy enough to use every night, and can run on batteries or A/C. They’re cheap, they’re harmless, and I can’t think of any reason not to bring one traveling. In fact, they’re especially good during travel, as the familiar sounds drown out new and foreign sounds that would otherwise keep a baby awake. If a child wants to continue to hear soothing white noise when older, what’s the harm?

If you really want to wean this later, it can be done: just turn down the volume, gradually, so over several weeks Junior will get used to less and less noise, then finally turn it off. But I wouldn’t worry about this kind of habit now. It’s safe, and will help everyone get a good night’s sleep.

When Gummys attack

Darcy asked: “I was once told(by a pediatrician) gummy type vitamins were bad for a child’s teeth and I should use the Flintstones type vitamins as a better alternative. What is in gummy vitamins that are making them so horrible for a child’s teeth? Honestly, if it the same type of “bad” for my daughter’s teeth as a regular gummy bear I would much rather give her these. She hates the Flintstones type vitamin. Thanks!”

I’ve got here a bottle of Gummy Vites, and the first two listed ingredients are “glucose syrup (corn), sucrose”. Either of these are essentially sugars, which aren’t great to have on your teeth. But they aren’t very big; each 2-gummy dose contains about the equivalent of one teaspoon of table sugar. You could give these before toothbrushing at bedtime, or have your child wash ‘em down with water. In the big picture, I doubt this amount of sugar would make much difference. I can’t imagine what would make a Gummy Vite worse than a regular gummy bear.

The first ingredient of Flintstones is sorbitol, a poorly-digested sugar that doesn’t contribute to tooth decay. What it can contribute to is loose stools and gas—sorbitol is a laxative. But, again, the amount in Flintstones is pretty small, and I doubt anyone would notice the difference.

If your daughter prefers the Gummys, go ahead and use them. They’re perfectly good vitamins, and fighting to get her to chew on Fred or Barney every morning doesn’t sound like it’s worth the yabba dabba doo time.