Posted tagged ‘toddlers’

At what age should kids be able to wipe?

March 21, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

“At what age can children be expected to reliably wipe themselves – properly! –  after using the bathroom?”

Never fear the icky questions, that’s the first rule I see here in The Idiot’s Guide to Blogging. It also says to include a lot of pictures of kittens saying humorous things. If I could draw or photoshop, I could include here a pic of a kitten holding a wad of toilet paper. You’ll just have to imagine it yourself.

Anyway: I think “wiping properly” is sort of a judgment call, and it probably depends on mom and dad’s tolerance for a less-than-stellar performance. How much do skid marks bother you, versus how eager are you to drop tushie wiping from your list of daily chores?

Kids ought to learn to wipe themselves as part of potty training. Two year olds kind of pat around back there and don’t accomplish much, and even 3-4 year olds don’t do a particularly good job. Heck, lots of kids even in grade school could probably use a little supplementary wipage. It’s true: kids who wipe themselves don’t get particularly clean.

But, honestly, it’s OK. I don’t see infections, their skin is fine, and other than a bit of a whiffy odor now and then I don’t think a lack of good rumpal hygeine is causing any sort of problems for our kids. Wiping is just one of many things they don’t do really well at first. Congratulate them anyway, and move on.

When it’s time to get children clean, toss ‘em in the tub and let ‘em wiggle around. They’ll smell nice afterwards, too.

Five tools to teach your child to behave

January 30, 2013

The Pediatric Insider

© 2013 Roy Benaroch, MD

Young children are naturally petulant, noisy, and self-centered. We’re all born with ourselves in the center of the universe, an impression reinforced by parents who must cater constantly to their young babies. But babies become toddlers, and toddlers become children. Sometime during this transition, parents have to teach their children that they are part of a family. For a family to function and thrive there must be rules and expectations for everyone to follow.

There are no “magic solutions” to every behavior problem, and there is no “one-size-fits-all” approach. Different kids and different parents have their own personalities and quirks, and what works well for one family might not work for everyone. However, I think there are still some basic tools that are essential for any family to use. The exact way you use these may depend on your situation, but teaching children to behave is going to include all of these ideas:

  1. Love. Children must feel loved and secure. Without an atmosphere of love and support, parents cannot teach their children anything.
  2. Clarity. Children will only learn rules if they’re applied clearly and consistently.
  3. Modeling. Parents should demonstrate good behavior, and also show kids what to do when their own behavior isn’t perfect.
  4. Rewards. Friendly words and encouragement, along with occasional and unexpected tangible rewards, are the best way to reinforce good behavior.
  5. Punishment. Some parents think discipline is only about punishment. That’s a mistake. Relying on punishments alone will not lead to long-term success. But parents should use effective punishments as one way to discourage bad behavior—along with the other 4 items on this list.

How should parents apply these five principles? There really are endless ways. I’m going to cover all of them in a little more detail, and give you some ideas to get started. Have you found other ways to teach your children? Please share in the comments!

Love

I know you love your children. No one’s doubting how you feel. But love, here, isn’t about what the parents feel inside—it’s about how parents act, most of the time, and how children perceive how their parents feel. To put it bluntly: if your child feels like he’s in the doghouse most of the time, you’re not going to be able to use discipline tools effectively. Too much yelling and criticizing (even if Junior “deserves it”!) undermines progress.

If there’s a lot of negativity flowing around your house—if you’re criticizing and correcting all day long– try this method to get back on track: Magic Time. It works best for preschoolers, and is especially potent and helpful when you bring a new baby sibling home. Bonus: it’s not actually any extra work! It’s just a little extra psychology.

Magic time is a set period of time, usually fifteen minutes, where one parent must focus entirely on the child. It must begin with a special announcement—a parent looks at a clock and says, “Hey! It’s time for magic time!” For the next fifteen minutes, that parent can do nothing but play with the child. Mom or dad should show with body language that they’re really engaged—lean toward the child, and use touch to stay connected. No interruptions of magic time are allowed. After fifteen minutes, magic time has to end. An announcement has to be made with inflection and emotion: “Oooo magic time is over (Say this sadly). That was great! (Happy!) We’ll do it again tomorrow! (Even happier!)” Magic time doesn’t have to be with the same parent nor at the same time every day, but it has to occur every single day without fail. Extra magic time should never be given, even if the child has been extra good; magic time must never be taken away, even if the child has been terrible. Also, don’t give magic time backwards—that is, you’re not allowed to say “We’ve been playing for fifteen minutes. That was your magic time.” It doesn’t count unless magic time is announced at the beginning. Magic time is an expression of love. It’s unconditional, it’s fun, and it happens every day.

 

Clarity

Being clear is an essential skill for parents. Your children should know exactly what is expected of them. They should know the rules, and they should know what will happen if rules aren’t followed. They should know that a parent’s word is akin to the word of God: if a parent says it, that’s the way it is. With clarity, your children will learn to listen.

Parents need to “Say what you mean.” Social niceties guide how we talk to each other as parents, and there’s certainly a place for those kind of language conventions when you talk to your kids. But if you want your child to do something, especially when you’re in a phase of trying to teach better listening skills, you’d better be clear the first time. Not “Why don’t you clean your room?” or “How many times do I have to tell you to clean your room”—but a very command: “Go clean your room now.” That isn’t mean. It’s clear.

Work on not repeating yourself—in other words, “Mean what you say.” When you tell your child, clearly, to do something (or to stop doing something), say it once, and make it happen. Repeating and threatening only dilutes your message and gets your child used to not listening to you the first time.

Parents are the models

Kids learn far more from watching and imitating than from listening to lectures. Parents need to model both good behavior and bad behavior (and its consequences). For example, family meals are a great time to model table manners, and also the skills of social conversation (regular family meals also help prevent obesity, truancy, and teenage drug use. Really.)

Parents aren’t always perfect. When you do lose your cool or make a mistake, that’s a learning time for your kids. Everyone gets angry sometimes. What you want your children to learn isn’t “don’t get angry”—it’s what to do when you do get angry. Don’t just talk about that. Model it. Let your kids see that adults do make mistakes. And let them see how you handle that, in a good way that you’d like them to emulate.

 

Rewards encourage good behavior

By “rewards”, I’m including here the most useful, powerful reward: positive reinforcement. Kids need to hear when they’re being good, and why they’re being good, and specifically what they did to be good. The best rewards are immediate and specific. Rewards also work a little better if they’re unexpected—that means you don’t have to (and shouldn’t) give a reward every single time. If a reward is already expected, it’s less powerful.

One great method to help parents practice good postive reinforcement is “The Greenies”, which I’ve covered in more detail here.

 

Punishments discourage bad behavior

Again, as I’ve said, many parents equate discipline with punishment. They ask me, “How do I discipline my child?” – but the answer they’re expecting is really “How can I punish my child.” If you think discipline equals punishment, you’re not going to effectively teach your children anything. Discipline is one tool among the five I’m presenting, and it doesn’t work unless you’re also using the other four methods.

That being said, punishments are an effective tool when used well, and parents should feel comfortable using punishments when they’re appropriate. Punishment is never useful for babies, and between the first and second birthday should only be used to discourage physical aggression. Too much punishment, too early, will not be helpful. At any age, punishment should never be the main strategy of teaching behavior.

Punishments work best if they’re immediate and consistent. Threatening to punish is not a good idea—it weakens the message, and teaches kids they can get away with things a few times (or maybe more than a few) before anyone takes them seriously. If you do threaten a punishment, you’d better plan on following through and doing it.

One very effective punishment for preschoolers is the “Time Out”, which is removing them from the loving sphere of their parents for a short time. It works very well—if it is done correctly. Learn more about the best way to use Time Out here.

 

You can do it!

Children aren’t born knowing how and why to behave well. They need to learn this skill, just like they learn to write or ride a bike. Their most important teachers are their parents. Using a combination of these five strategies, consistently, is the best way to teach your children to do the right thing. It can be exhausting, and there are no quick-fixes or ways to skip these tough years. Teaching them these essential life skills, though, is a parent’s most important job.

 

Adapted from Solving Health and Behavioral Problems from Birth through Preschool

The picky eater guide: Part 3. The Rule

March 5, 2012

The Pediatric Insider

© 2012 Roy Benaroch, MD

As we’ve seen, the problem isn’t the picky eating, per se. Kids are getting enough calories, and they’re certainly growing big enough. Even the skinniest kids in today’s world are far healthier and have far better nutrition than most of the kids from previous generations. And I certainly haven’t seen health problems in the slender kids in my practice. What I see very commonly, though, are health problems from overweight: diabetes, high blood pressure, depression, and social isolation.

So, no matter what else, the first principle of healthy family eating should be to help foster a child’s own normal sense of appetite and hunger. This is The Rule of mealtimes. It’s The Truth, and The One Ring to rule them all:

  • If you’re hungry, eat.
  • If you’re not hungry, don’t eat.

(OK, so it’s two rules. Close enough.)

Humans have a built-in mechanism to control food intake, and it works well at every age. It’s called “hunger.” Often, though, we unintentionally raise our kids in ways that teach them to ignore their appetite cues and eat for all sorts of other reasons.

Think about it. In American culture we don’t just eat when we’re hungry. We eat to celebrate. We eat when we watch a movie, we eat when we’re on the phone. We eat when we’re upset, and we eat when we’re bored. We eat when we’re happy and we eat when we’re sad. Often, we eat because others encourage us to eat. Family and friends ply us with food, and mom loads up our plate. We also have to contend with an ever-present marketing effort to get us to eat even more. Most two-year-olds already recognize “The Golden Arches”, and TV and computer banner ads are a near-constant barrage encouraging us to eat. And eat. And eat.

In a way, I’m surprised obesity isn’t more common.

Let’s not make matters worse. From a very early age, encourage your children to manage their own appetite. This means that a nine-month-old who becomes less interested in nursing should be allowed to wean. And a two-year-old who wants to explore instead of cleaning his plate should be allowed to leave the table. When a child doesn’t have an appetite to eat more, do not try to trick or fool or guilt or otherwise “get him” to continue eating. Lacking hunger means the child has eaten enough. Meals shouldn’t end when mom or dad thinks Junior has had enough; meals should end when Junior thinks he’s had enough.

In fact, from The Rule flows two other rules which guide the roles of children and parents at mealtimes:

  • Parents should offer healthful foods in an appropriate manner.
  • Children decide which foods to eat, and how much to eat.

Simple! Or at least simple to say, and simple to understand. That doesn’t necessarily mean it’s always easy to do!

Next up: more about the job that parents and kids have at mealtimes.

 

The picky eater guide: The whole enchilada:

Part 1. What’s the problem?

Part 2. The “Don’ts”

Part 3. The Rule

Part 4. The jobs of parents and kids

Part 5. Special circumstances, vitamins, and a muffin bonus

The runaway toddler

November 21, 2011

The Pediatric Insider

© 2011 Roy Benaroch, MD

For November, I’m concentrating my writing chops on National Novel Writing Month. Fun! So I’m re-running revised versions of some classic posts. And by classic, I mean “old.” This one was originally from August, 2008. Enjoy!

Holly asked, “Do you have behavior modification suggestions for children who think it is funny to run away when you call them?”

The key here is to practice success—get her used to the fact that when you call her, she will come to you. At the same time, stop practicing failure—don’t instigate or encourage a situation where she can run away from you. In time, she’ll be so used to doing this correctly that you’ll no longer have to be strict about these steps. But for now, this is what you should do:

  • Don’t play any “tag” or chasing games, or any other game that encourages her to run away. I know these games are fun, but it’s practicing what you don’t want her to do. For the time being, play something else.
  • If you’re in a situation where she can run away from you, don’t call her name. First, move closer to her, or move yourself so she’s cornered. Do what it takes so that when you do call her name, she can’t get away. Avoid setting up a situation where she gets to practice running away.
  • As soon as you call her, grab her so she comes close to you. Then thank her for doing it (I know this sounds weird, but make it as if she chose to do the right thing, not that you forced her to.) Say, “thanks for coming quickly when I asked you to!”
  • Only ask her to come to you once. Do not repeat yourself.
  • Try to make it fun for her when she does come when you call. Say “come here sweetie” with love and affection, and if it seems like she really was heading your way, give her extra noogies and affection. Help her realize that it’s more fun to come when you’re called than to run away by stopping the run-away games completely.
  • If by some chance she does “get away,” grab her if possible without saying a single word. Don’t chase her unless you have to (if she’s somewhere unsafe.) Rather, walk towards her without really meeting her gaze or engaging her. You should seem bored and uninterested. Hold her away from you in an unloving way, and put her in her room, alone, for about 3 minutes. Afterwards, open her door, give her a hug, and say with love “don’t run away.” Don’t stay mad at her.

It will probably take about 2 weeks for her to get used to the new expectation of what a “come here” means. There will probably be setbacks, but stick with the plan! Let me know how it works out.

The best parenting advice you’ll ever get from a two word post

June 26, 2009

Be patient.