If you have a young child at home and you are expecting your second you’re probably wondering how to help ease the transition into life with a new baby. Your toddler is used to having your undivided attention and now she has to share it with someone new.  This transition phase can be challenging for both parents if they are not prepared.  It’s even harder on your toddler if you haven’t spent quality time helping her understand how life will change.  I will note that you can never completely take away the change and stress your first child will feel with a new baby but you can definitely help ease her transition by making her feel more secure and loved.

Here are some tips to help your child and you adjust:

Before Baby is Born

• If your child is old enough take her to a sibling preparation class. This class is usually held at your local hospital or healthcare facility designed for children two years of age and older.  It helps siblings prepare for the emotional and physical realities of the arrival of a newborn. Activities can include arts and crafts, role-playing, and a mini-tour of the nursery and maternity unit to see where mom will be spending the night.
• Give her a baby doll to play with
• Expose her to other babies and let her see you interact with a baby
• Children’s picture books can help your toddler visualize how life will change with a new baby
• Have your child help you pick out gifts for the baby
• Make sure to spend quality one on one time with your toddler helping her understand how things will change once baby is born
• You can tell your preschool age child that you are going to have a baby by sharing the preparation activities and also showing her your growing belly
• If your toddler will be transitioning out of her crib and giving it to the new baby make sure to do this a few months before the birth so the adjustment of losing her crib is not such a huge deal

After Baby is Born

• When baby is born have your toddler come in to spend time with you first before she’s introduced to the new baby
• Use the baby’s name so that the toddler knows the baby is a person rather than “the baby”
• Encourage your toddler to touch the baby and show her how to do so in a gentle manner
• Make sure to continue your toddler’s regular schedule once you come home with baby (ask for help from family members to assist you)
• It is important to maintain the same rules and discipline even after the new baby arrives so your toddler has consistency
• Include your toddler in usual routines for the baby such as diaper changing, feeding time or bathing
• Each parent should make quality one on one time with the toddler so she still feels that she has your love and attention
• Have your toddler become your little helper by asking her to get a diaper for the baby or find the baby’s toy
• If your child is older it will be easier for her to adjust to a newborn sibling because they can understand what is happening and be actively involved.
• You should encourage involvement in helping with the new baby but not force it.  Offer to your older child that she can attend an infant CPR or child safety course designed for children who will become a new big brother or sister.  If your child feels like she has the skills and confidence to help care for her newborn sibling it will make it an easier transition on all of you.

Resources: Keys to Preparing and Caring for Your Second Child by Meg Zweiback Siblings Without Rivalry by Faber & Mazlich

It’s taken a long time for science to quantify what mothers have always known: the skin of babies and toddlers is very different from the skin of older children and adults. Babies’ skin is softer because the outermost protective layer, the stratum corneum, isn’t mature until at least age two. In babies and toddlers the total epidermis is also thinner, with increased absorption:

Ultraviolet radiation can penetrate more deeply.

This can damage skin DNA, trigger inflammation, accelerate aging, and suppress the immune system in the skin. (Our skin is a key, active part of our immune system – not just the physical barrier we’ve long assumed.) Radiation-induced skin changes can start accumulating during a baby’s first summer.

Sunscreen chemicals penetrate more easily as well.

Many of the chemicals used in sunscreens to absorb radiation act like estrogen hormones. These could end up throughout a baby’s body in the blood, and later be detected in the urine. This hasn’t been proven to cause a problem. Or proven safe.

How do you balance the health of young skin, where just a few sunburns can double the melanoma risk later in life? I recommend a few simple steps:

1. Avoid midday sun, when practical.
2. Choose sun-protective clothing for everyday wear when babies or toddlers will be outside. K&J clothing has a UPF of 50+, using no chemicals. And it’s adorable! In contrast, a typical tee has a UPF of only 5 or 10.
3. Seek shade with your little one.
4. Use a mineral sunscreen to physically block UV radiation. Zinc and titanium are the two common mineral active ingredients. Micron-particle-size minerals are small enough to go on clear and large enough not to be absorbed through the skin.

And don’t forget a pair of stylin’ baby sunglasses!

Paller AS, Hawk JLM, Honig P, Giam YC, Hoath S, Mack MC, and Stamatas GN. “New Insights about Infant and Toddler Skin: Implications for Sun Protection.” Pediatrics. 2011; 128(1):1-11.

Breaking News
Tylenol Doesn’t Relieve Pain for Babies and Toddlers!?

The FDA’s Nonsprescription Drugs Advisory Committee and Pediatric Advisory Committee have together recommended that “pain relief” be removed from the label of Tylenol and other brands of acetaminophen because there is no reliable evidence that it relieves pain better than placebo in children under age two.

This will surprise many parents who reach for these common pain relief drops when their little ones are teething or have an earache or a sore throat. Not surprisingly, the over-the-counter drug industry trade group (CHPA) objects to the findings of the expert panel.

Tylenol Does Reduce Fever – But Why?

The advisory panel recommended that the acetaminophen label should say it’s for “fever reduction” and nothing else. But here’s the thing – in most cases the fever is helping the child by activating the immune system and fighting the infection. I don’t recommend treating fever unless it is interfering with a child’s ability to sleep or to drink liquids (both are even more important for healing than the fever).

If we don’t give acetaminophen to babies and toddlers for pain, and we rarely give it for fever – this will change the landscape of over-the-counter medications for young children.

Tylenol Is Not As Benign As Many People Think

Acetaminophen is the most common cause of acute liver failure in the US. It has been estimated to cause three times as many cases of liver failure as all other drugs combined. While the serious problems usually come from overdoses, in babies and small children the dose that can cause harm may be not many times more than the recommended dose.

Tylenol Dosing Should Be Based on Weight

Most dosage charts that parents see list a dose based on age, or suggest that parents ask a doctor for the dose. And dosage concentrations have varied in various formulations. Together, this confusion has led to overdosing and to fatalities in several dozen healthy young children over the last decade.

The FDA panel has recommended that all liquid acetaminophen come in the same concentration, that all packages contain dosing information for children down to 6 months of age, and that the dose be based on the child’s weight.

Powerful Recommendations

I applaud these recommendations and hope they will be formally adopted by the FDA. If so, I expect they will result in safer children. As parents we don’t have to wait, though, to change our own practices.

OTC Industry Supports FDA Advisory Committee Recommendations on New Dosing Instructions May 18, 2011.

Lee WM. “Drug-Induced Hepatotoxicity.” New England Journal of Medicine, July 31, 2003, 349:474-485

We’ve known much of this for over a decade: http://www.nytimes.com/2000/01/25/health/personal-health-with-…

As parents, we consider many factors when selecting a childcare situation for our children – among them cost, convenience, philosophy, hours and the ratio of caregivers to kids. But how many of us give a thought to environmental health? We should, because young children’s developing bodies are very susceptible to chemical exposures.

To make it a little easier, Environmental Working Group put together these tips on how to create a green childcare environment, with an emphasis on the steps that matter most. We’re all about strategic changes that make the biggest difference to kids’ health. Parents can use these tips to assess childcare facilities – and share the downloadable tip sheet with staff to help them create a greener space. Remember, a few simple actions can reduce many exposures to toxic chemicals. Why not start today with this great list?

Most important for infants:

Mix formula with fluoride-free water, as the American Dental Association recommends. If your tap water has fluoride, buy non-fluoridated water.

Don’t serve ready-to-eat formula – it contains more BPA (from the can lining).

Never microwave food or heat milk in plastic. Use glass or ceramic instead.

Use glass or BPA-free baby bottles. Discard older plastic ones, especially if scratched.

Use fragrance-free wipes, diapers & diaper cream.

Create a healthy space

Seal or remove arsenic-treated wood decks & play structures. Those built before 2003 likely contain arsenic. Don’t allow children to eat at older picnic tables (or cover them with a cloth).

Have kids wash hands after playing near these surfaces, or avoid them altogether.

Watch for lead paint. Older paint may contain lead. Kids face health risks from loose chips and lead in dust. If your building was built before 1978, use a certified lead-safe contractor for any repairs.

Don’t use bug spray or weed killer inside or out.

Clean greener & disinfect when kids aren’t around. Choose certified green cleaning supplies, dust & vacuum often (with a HEPA filter), use fragrance-free laundry detergent and skip air fresheners & dryer sheets. Disinfectants can be toxic. Where necessary, disinfect with safer peroxide-based products or bleach. Always follow product directions.

Remove or repair furniture & mattresses with exposed foam. Before 2005, most foam was treated with toxic fire retardants.

Take care with compact fluorescent light bulbs. Don’t put them in lamps that can fall, releasing mercury. If a bulb breaks, clear the room, air it out, put on gloves, safety glasses and a dust mask, seal the waste, wash up. Replace mercury thermometers & thermostats with mercury-free options.

Eating & drinking

Offer healthy snacks. Choose fruits & veggies from EWG’s Clean 15 list or buy organic – and always wash them. Don’t microwave food in plastic. Microwave popcorn bags contain toxic chemicals – try air-popping instead. Choose organic dairy and meat when possible; buy rBGH/hormone-free milk. Use BPA-free dishware.

Wash little hands before eating – with plain soap & water. Skip anti-bacterial soaps – they’re no better than plain soap and contain toxic triclosan. If you use alcohol-based hand sanitizers, choose fragrance-free.

Drink safer water. Filter tap water as needed to remove contaminants. Check EWG’s Tap Water Database to find an effective filter. Test water fountains for lead.

Playtime!

Avoid soft plastic toys & metal jewelry. Many plastic softeners are toxic. Choose items labeled PVC- and phthalate-free. Avoid metal trinkets and play jewelry, which can contain heavy metals. Skip face paint unless you know it’s free of lead and other contaminants. Natural, unpainted wood toys are a good choice.

Use safer art supplies. Don’t use rubber cement, permanent or dry-erase markers or materials meant for adults. Stick with paper/cardboard, yarn, wood & homemade play dough. If you don’t know what’s in something, skip it.

Apply safer sunscreen. Use EWG’s Sunscreen Guide to find ones with SPF 30+ and zinc or titanium. Skip oxybenzone, retinyl palmitate, sprays, added bug repellent. Wear hats & avoid mid-day sun.

Adjust outdoor play based on local air quality using AIRNow.gov. On high pollution days, limit high-energy outdoor play for kids, especially those with asthma.

Another resource for parents and care providers is the national eco-healthy childcare program, which helps childcare facilities shift to safer practices through a self-certification system.

One of the best ways to keep your toddlers healthy during flu and cold season is to keep their hands clean. A good washing with soap and water is very effective in reducing the spread of contaminants that may make your kids sick. But frankly it can be tough to get our little ones to wash up, and even tougher to get them to scrub thoroughly and often enough to do get the job done – especially when you’re out and about.

Hand sanitizers, recommended by the Centers for Disease Control, are both a time-saver and hassle-reducer for busy parents. With a little squirt of gel, about 99.9 percent of the germs that cause illness can be history – even the H1N1 virus. These are a great advance for keeping families healthy.

Not all hand sanitizers are the same. Some depend on ethyl alcohol, some on the quaternary ammonia chemical benzalkonium chloride (sometimes labeled “Alcohol Free!” to imply that it’s safer), and some on Thymol, a safe, plant-based ingredient that gets the job done. Of the three types, I prefer Thymol for thumb-sucking toddlers, although I’m not opposed to using alcohol-based sanitizers on young children if that’s what’s available.

If you’re using any hand sanitizers on your little ones, I suggest you supervise. Rub the gel in thoroughly and keep your child in sight until it dries. Evaporation is your friend. If your child’s thumb starts moving towards the mouth immediately after application, don’t panic, but do try to distract him for a few minutes if you can.

For effective hand washing, I teach kids to sing “Twinkle, Twinkle, Little Star” or “The Alphabet Song” while washing to remind them to scrub long enough and hard enough to make a difference. Besides washing before meals, the most important times to wash are after sneezing or coughing, after using the toilet, upon leaving “high-risk” places such as doctors’ offices, daycare centers, playgrounds, etc, and always upon arriving home.

Question: Who took cough and cold medicines the most?
Answer: Kids aged 2 through 5 years – the very group for whom the FDA expert panel voted to ban them last year (although the FDA has not done this as of August 2008).

Who took cough and cold medicines the second most?
Kids under age 2, for whom they are even more dangerous.

In general, about 1 in 10 kids were treated with an over-the-counter cough and cold medicine on any given day in the US, according to a study published in the August 2008 Pediatrics. About 1 in 3 kids have taken cough and cold medicines in any given month.

We’ve known that cough and cold medicines for children have been widely advertized and widely sold, but before this study, based on 1999-2006 data, we didn’t have a clear picture of how frequently they were being used. Their use is decreasing, but still quite widespread. Among the various ingredients, decongestants were the most often taken, followed by antihistamines and then cough medicines, but multi-drug combinations were by far the most common.

Almost 90,000 calls to poison control centers each year, more than 7,000 ER visits each year, and about 3 unnecessary deaths each year have been linked to over-the-counter cough and cold medicine use in children. And they are not effective.

With scant evidence that these medicines help young children any better than would a placebo, and with mounting evidence of reasons for concern, I hope the FDA does move to ban them for kids under age 6 before this cough and cold season soon gets underway.

^{Vernacchio LV, Kelly JP, Kaufman D, and Mitchell AA. Cough and Cold Medication Use by US Children, 1999-200: Results From the Slone Survey. Pediatrics. August 2008. 122:e323-329.}

An astonishing forty percent of healthy babies and toddlers in a recent study had low levels of vitamin D. Results of this important study appear in the June 2008 Archives of Pediatrics and Adolescent Medicine. Children can get vitamin D in the diet, but the skin can also make vitamin D in response to time in the sun. Optimal levels of vitamin D are important not only for bone health, but also for helping to prevent cancer, infections, and other important diseases. Severe vitamin D deficiency can cause rickets, a bone condition that has been increasing around the world (even in sunny California, Nevada, Texas, and North Carolina, among other US states).

What predicts low levels of vitamin D? The child’s gender? Their nutrition? The amount of time spent in the sun? The season of the year? Sunscreen use? The darkness of the skin? Parents’ health habits? The current study looked at healthy children up to age two who went to Children’s Hospital Boston for a routine health visit over the course of a year and a half. Vitamin D levels were measured by blood tests. The 40 percent found to have low levels is similar to what a previous study found in US teens (42 percent not getting enough). About 12 percent of the healthy babies and toddlers in this study had levels low enough to be called vitamin D deficient. Their bones were checked by x-ray, and about a third of them already had decreased bone density. And 7.5 percent of them already had the bone changes of rickets.

Overall, the season of the year didn’t correlate with the children’s odds of vitamin D deficiency (although, unexpectedly, average vitamin D levels in the babies were higher in the winter!). There was no affect on vitamin D levels found based on the amount of time spent outdoors, skin color, sun sensitivity, or sunscreen use – considered individually or together. Nor was there any difference based on gender. Breastfed babies, though, who weren’t getting vitamin D drops, were 10 times more likely to be deficient.

Among toddlers, vitamin D levels closely mirrored how much milk they drank. Eating fortified cereal had no impact on vitamin D levels. In toddlers, vitamin D did vary a bit with body weight. Obese toddlers were somewhat more likely to have lower vitamin D levels.

Bottom line: I support the American Academy of Pediatrics recommendation that breastfed babies all start taking at least 200 IU of vitamin D within the first two months of life. I think 400 IU may even prove to be better. It’s not that breast milk is lacking; it’s that throughout most of human history babies spent a lot more time outdoors than they do today, without sunscreen, and with bodies adapted to the latitude where they lived. In this Boston study, the child who was outside the most averaged only 3 hours outdoors per day. When my parents were young, a lot of children lived on farms and were outside most of the day during the summer months Because of the changes in the earth’s ozone layer, though, it’s no longer safe to spend so much time in the sun without sunscreen, which puts the brakes on making vitamin D. Some sunshine is great for kids, but in this century it’s important to protect kids from too much sun exposure. –What about older kids? For children age one through eight who don’t drink 2 cups of vitamin D milk a day, or for those over nine years old who don’t drink 3 cups of vitamin D milk a day, I recommend ensuring another source of vitamin D.

Gordon CM, Feldman HA, Sinclair L, Williams AL, Kleinman PK, Perez-Rossello J, Cox JE. Prevalence of Vitamin D Deficiency among Healthy Infants and Toddlers. Archives of Pediatrics and Adolescent Medicine. 2008; 162:505-512.

Today’s generation of children is growing up unlike any previous generation in history. In the last 10 years there has been an explosion of digital and electronic media available to and even targeted at children – even our very youngest children. Lots of DVDs are aimed at kids 0 to 18 months old. Television networks for toddlers, handheld video games for preschoolers, and computer games for children as young as 9 months. And of course, there is the Internet… What’s the impact of all this media on the young? Is it decreasing their time spent reading or playing outdoors? A preliminary study published in the May 2007 Pediatrics at least catalogued what is going on in today’s kids aged to 6 months to 6 years. Children in the study were reported (by parents) to watch an average of 1 hour 19 minutes on a typical day (more if there was a TV in the child’s bedroom, or in single parent families). In addition, children averaged 1 hour 18 minutes of DVDs. According to the parents, most kids do not play any form of video games on a typical day (only 16 percent of 5-6 year oldsdo), but those who do spend about an hour a day playing. By contrast, the kids were much more likely to spend time at the keyboard, either playing computer games or other computer activities – taking about another hour. This is starting to add up!

And the kids are quickly becoming comfortable using these media by themselves. More than half of the 6 month to 2 year olds were already turning on the TV themselves. Many were already inserting and watching DVDs on their own. By age five, more than 70 percent were comfortable navigating a computer with a mouse. They are off to a different start than we were.

We live in a digital world, and I am glad that kids are getting an early exposure to this ‘language’ of our new century – as long as it does not crowd out other important ‘languages’ to learn to understand and love at an early age: outdoor play, reading, and spontaneous and imaginative creation.

This study measured reading time and outdoor play time. Not surprisingly, some kids got plenty, others not enough. What was surprising, though, was that there was no difference in these items overall between those who spent many hours with digital media and those who did not. Media did not seem to be a culprit here! My take home: be sure kids are enjoying the important parts of childhood that we and our parents before us grew up with. Modern marvels can enhance their lives without crowding these out.

What’s your take? Many parents in the study were fans of bedroom TVs to help their kids sleep. Ironically, it seems that the televisions often worsen sleep in the short-run and lead to sleep problems down the road. They just keep our overtired children quieter.

Vanderwater, E.A., Rideout, V.J., Wartella, E.A., Huang, X., Lee, J.H., and Shim, M. “Digital Childhood: Electronic Media and Technology Use Among Infants, Toddlers, and Preschoolers.” Pediatrics. May 2007, 119, pp. e1006-e1015.

I often hear from parents who expect that their cute, chubby young children  will naturally thin out as their height spurts up. Unfortunately, it doesn’t tend to work out that way. Instead, making changes as a family is usually needed to help kids thin out as they grow.

Researchers followed the growth of over 1,000 healthy American children from their second birthday to their twelfth. The results were published in the September 2006 Pediatrics. Those who were overweight at even one check-up during the toddler/preschool years were more than 5 times more likely to be overweight at age 12. Overall, 60% of kids who were overweight at even one visit before kindergarten, and 80% of kids who were overweight at even one visit during the elementary school years  were overweight at the end of the study – and with each additional check-up at which the child was overweight, the odds of remaining overweight increased further. In contrast, no child who had a BMI < 50% at age 7, 9, and 11 turned out to be overweight at the end of the study.

The bottom line is that most kids get larger rather than smaller – body fat accumulates like compound interest – unless changes are made in how active the family is and how the family eats. What do I want parents to know?

It doesn’t matter what age your child is now. Don’t worry about yesterday, but pay attention to today. Today is a better day to make changes than tomorrow. It’s easier to start changing unhealthy eating patterns right away than if you were to wait until the habits had become more ingrained. And there is greater benefit the earlier you start building habits of active fun and delicious healthy food.

One month after eating an earthworm on a dare, a 16-year-old girl developed a fever and nausea that lasted about 2 or 3 days, along with some mild swelling around her eyes. These symptoms went away, but over the next two weeks she also had a worsening cough and lost 5 pounds. The diagnosis? She had developed lung abscesses from parasites that were moving through her lungs. Her story is told in the February 2006 Pediatrics. Her story is unusual because she is a teen. But the worms she was infected with are common in the U.S., usually infecting toddlers and preschool-age kids. These worms, called Toxocara species, are common roundworms of dogs and cats (especially puppies and kittens). In developed countries, infections with these worms in kids are second only to pinworms. What’s the usual story?

In the typical scenario, a young child (age 1 to 4) is happily playing in a sandbox or a playground or soil that contains tiny Toxocara eggs. These eggs may be found wherever infected dogs or cats defecate (common throughout the contiguous U.S., especially in the southeast). Then the child puts dirty fingers in the mouth, or eats some sand or dirt. Once swallowed, the eggs hatch and the larvae begin to migrate through the body, where they can invade any organ. This sounds scary and gross, but.

The good news is that most kids who are infected with Toxocara species will get better on their own, without any treatment, and without ever having any symptoms or awareness of the infection. The higher the number of eggs ingested, the higher the chance of symptoms. Fever and increased white blood cells (especially white blood cells called eosinophils) are the most common signs if any signs are present. Migration to the liver may cause liver enlargement. In some kids, though, the worms will migrate through the lungs, leading to cough or wheeze. Some kids diagnosed with bronchitis, pneumonia, or asthma actually have Toxocara infections. Usually, simple anti-parasite medicines will take care of the problem. Far less common, but far more serious, is migration to the heart, brain, or eyes.

How can Toxocara infections be prevented? Proper pick-up and disposal of pet poop at parks and playgrounds helps in public areas. Treating puppies and kittens with recommended worm medicines, especially during the first 8 weeks, helps prevent infections from your own pets. It makes sense to cover sandboxes where your child will play when they are not in use. Keep fingernails from getting too long, and clean the hands after playing in sand or dirt and before they go in the mouth. And, of course, try to avoid eating earthworms – even on a double dog dare.

Earthworms are wonderful friends to have in our soil. They aerate, detoxify, and enrich the soil as they move through it, swallowing the soil, and leaving behind marvelous, rich soil castings. But in the meantime, Toxocara larvae can be found throughout the length of the earthworms if they have been eating infected soil. Eating earthworms can make dogs, cats, or people sick.

So, contrary to the lines of the old song, even if nobody loves you, everybody hates you – don’t go eat some worms.