Q&A: ARE CHILDREN SAFE PLAYING ON ARTIFICIAL TURF?

Is artificial turf safe? The debate is heating up:

The Connecticut legislature is reviewing a new bill to ban crumb rubber playgrounds across the state.

California state scientists are evaluating the “potential human health effects associated with use of recycled waste tires in playground and synthetic turf products.”

Last month three federal agencies launched a joint investigation into the safety of popular crumb rubber surfaces on playgrounds and playing fields.

Dr. Robert Wright, chair of the Department of Preventive Medicine at the Icahn School of Medicine at Mount Sinai, in New York City, answers our questions about how artificial turf may pose concerns for children’s health.

HCHW: The Mount Sinai Children’s Environmental Health Center has called for a moratorium on the use of artificial turf made from recycled rubber tires. Why?

Robert Wright: We are advising against the use of crumb rubber fields until safety is proven. This is because the product is made from recycled automobile tires, which are well known to contain metals and other toxic chemicals. Some components of tire rubber are linked to cancer and others are toxic to the nervous and other systems.

The risks of exposure have not been fully studied, especially in the context of the wide range of potentially harmful chemicals, which are found in rubber tires. Ironically, if a field was filled with discarded tires it would be considered a hazardous waste site. The primary difference is that the tires were ground up in the crumb rubber field.

What makes children uniquely vulnerable to harmful exposures from crumb rubber surfaces?

RW: There are many reasons to think children will be more vulnerable:

Children on average are lower to the ground and therefore closer to the source of off-gassing.

Children have higher ventilation rates relative to adults and if significant off-gassing occurs, they will inhale a larger amount relative to their body size.

If ingested, a crumb rubber pellet would represent a larger per kilogram dose in a child versus an adult, because of their smaller size.

Many of these fields are in schools and therefore used almost exclusively by children.

Young children are not able to regulate their body temperature as well as adults, making them more vulnerable to injury from the extreme heat exposures that are possible on crumb rubber fields.

Children are commonly more susceptible to environmental chemicals, biologically, because their bodies are developing and the chemicals or toxic insults can offset the normal developmental trajectory.

What responsibilities do schools, communities and sports organizations have in making play surfaces safe for kids?

RW: The decision to purchase a particular type of field is not in the hands of parents, which we believe means that these organizations must take these issues into consideration.

At a minimum, these institutions need to address the concerns of parents and whether there are alternatives that can be mutually agreed upon as safe. There are such alternatives for fields – cork, for example. In addition, while grass fields can have pesticide applications, such applications are not mandatory and can be controlled or minimized with proper planning.

The U.S. Environmental Protection Agency, Centers for Disease Control and Prevention and Consumer Product Safety Commission have teamed up to investigate the safety of crumb rubber surfaces on playgrounds and playing fields. What do you hope their investigation achieves?

RW: The research on off-gassing and exposure is very incomplete, and does not consider the full spectrum of chemicals that are found in crumb rubber, either individually or as a mixture.

We hope to see comprehensive studies that consider, at a minimum, exposure assessment under realistic playing conditions, all possible routes of exposure (inhalation, ingestion and absorption through skin) and potential health effects not only of individual chemicals, but also of mixtures of chemicals. Mixtures are the real life scenario.

What can concerned parents do to safeguard children who play on crumb rubber surfaces?

RW: Concerned parents should spring into action even before a crumb rubber field is installed. The most effective strategy is for parents to join with each other and also to form alliances with medical societies, nursing organizations, elected officials and anyone else in the community who is in position to raise vociferous opposition to the installation of these untested products.

Once a field has been installed, parents can minimize their children’s risk by always making their children shower as soon as they return home from playing on the fields in order to remove any crumb rubber.

A second step is to avoid playing on the field on very hot, sunny days when temperatures can reach dangerous levels.

A third step is to meticulously clean any cuts or abrasions caused by the field, because there have been outbreaks of [staph bacteria] skin infections associated with such cuts and scrapes.

PREMATURE BIRTHS LINKED TO TOXIC CHEMICALS

The rate of premature births in the U.S. is among the highest in the developed world, with nearly one in 10 babies born in 2014 arriving before 37 weeks of pregnancy.

It’s also the number one cause of infant mortality. Very premature babies who do survive often endure serious problems for the rest of their lives, including diabetes, cerebral palsy, intellectual disabilities and breathing and vision problems, among other issues.

It’s difficult to pinpoint what causes pre-term birth, but many obstetricians as well as federal health authorities strongly urge pregnant women to avoid smoking, alcohol and illicit drugs. Poor nutrition, infection and carrying twins or triplets can also trigger early births. But research indicates the cause of roughly half of all premature births is unknown.

An emerging body of research is connecting pre-term birth to in utero exposure to toxic chemicals. You can learn more in this terrific video, Little Things Matter: The Impact of Toxins on Preterm Birth, by Bruce Lanphear, M.D., Ph.D, one of the world’s leading experts in children’s environmental health.

EWG was a pioneer in investigating industrial pollution in the womb, documenting the presence of toxic chemicals in the bodies of newborns.

EWG co-founder and president, Ken Cook, brought the findings of this landmark research to tens of thousands of people through a widely seen presentation titled 10 Americans. It’s a little over 20 minutes long – worth every second of your time if you’re worried about the impacts of toxic chemicals on our children’s health. 

Author,

Alex Formuzis

HOW TO IMPROVE AIR QUALITY AT YOUR CHILDREN’S SCHOOL

A healthy, resting adult takes 12 to 20 breaths per minute.

Children, from school-age to preschoolers and younger, take many more. It’s normal for a toddler to take twice as many breaths as an adult, and an infant may take a full three times more.

Every breath matters, especially for their developing lungs, and approximately 75 million Americans live in communities with unhealthy air. In addition, the EPA reports that half of the 115,000 schools in the United States have problems linked to indoor air quality. So it’s not too surprising that 6.8 million American children have asthma, and the number is climbing.

How can parents and teachers help children breathe easier? Here’s what you need to know about air quality in and around schools and what you can do to improve it.

Indoors

Almost 55 million students and 7 million staff members spend their days in school facilities across the country. If you and your loved ones are among them, you might be inhaling a host of indoor pollutants including building materials (such as asbestos), cleaning products, radon and even mold. In addition to triggering health problems such as headaches and asthma, indoor air quality can affect children’s academic performance and increase absenteeism.

The good news: Administrators, teachers and families have tools to improve indoor air quality (IAQ) in schools. Many are similar to those you may use in your own home.

EPA offers an IAQ Tools for Schools Action Kit that provides guidelines, best practices, sample policies and a sample management plan. Areas to focus on include improving HVAC systems, maintaining filters and carbon monoxide detectors, controlling moisture and mold, managing pests and carefully selecting cleaning and building materials.

EPA does not require schools to monitor their air quality, submit information about it or use these voluntary tools, so it’s important for parents to speak up. Share the action kit with your school and talk to decision makers about what they’re doing to improve indoor air quality. Here are additional recommendations for parents, particularly those whose children suffer from asthma.

Some states and school districts have specific policies or regulations to improve indoor air quality. To learn about your area, visit the Environmental Law Institute’s database of state indoor air quality laws or contact your state’s IAQ or IAQ Tools for Schools coordinator.

Outdoors

When students step outside school buildings for fresh air, that air might not be so fresh. Pollutants such as smoke, road dust, car exhaust and factory emissions can all add up to poor quality air. And some days are better than others.

How can you tell the difference? Check your local Air Quality Index. The daily index reports how polluted your air is and what it means for your health. Among other pollutants, the index tests for ground-level ozone (smog) and airborne particles, the two most hazardous types of air pollution.

Children are particularly sensitive to air pollution, so when air quality is rated orange – “unhealthy for sensitive groups” – it might be wise to limit prolonged periods outdoors and avoid heavy exertion, including outdoor sports.

Some school districts adjust recess and outdoor play based on air quality. Ask your children’s school about its air quality policies and share the EPA’s Air Quality Index Toolkit for Teachers. To find your Air Quality Index, search by zip code on AirNow.com, sign up for email alerts on EnviroFlash.info or check local weather reports on television or in the newspaper.

Do you see buses idling outside your children’s school? Diesel exhaust can damage lungs, irritate eyes and throats and trigger asthma or allergies, so check out these tips and tools for reducing bus idling. These resources are designed not just for schools, but for students, parents and community members as well. Talk to your kids about why air quality matters and encourage them to get involved, too.

Author,

Megan Boyle

FEEDING ANTIBIOTICS TO HEALTHY ANIMALS RISKS CHILDREN’S HEALTH

The influential American Academy of Pediatrics, which numbers 64,000 pediatricians, has added its voice to the growing movement of public health professionals who are demanding an end to the dangerous overuse of antibiotics in meat and poultry production.

A new technical report by Dr. Jerome A. Paulson and Dr. Theoklis E. Zaoutis of the AAP Council on Environmental Health and Committee on Infectious Diseases described how the widespread agricultural practice of dosing healthy, if overcrowded, livestock and poultry with antibiotics to induce weight gain and prevent disease has contributed to the proliferation of antibiotic-resistant microbes.

“Infants and children are affected by transmission of [antibiotic-resistant, disease-causing pathogens] through the food supply, direct contact with animals, and environmental pathways,” they wrote. “…For most [food-borne] infections, incidence was highest among children younger than 5 years.” And when antibiotics fail, these children are in a fight for their lives.

Paulson and Zaoutis took aim at the U.S. Food and Drug Administration, whose guidelines urge meat producers to take voluntary measures to curb the use of antibiotics on well animals. “Because the lines between disease prevention and growth promotion are not always clear,” they wrote, “the current FDA policy may allow drug manufacturers to continue using ambiguous language on labels of antibiotic drugs.”

“The message is to change the practice of agribusiness, either through government changes or marketplace changes, so everybody is safer,” Paulson told CBS News. “I think if people vote with their pocketbooks, then industry will be required to change. Hopefully the USDA and the FDA will require them to change. I think this is something that with a large enough movement in society, the industry will be forced to change.”

Antibiotic-resistant bacteria cause about 23,000 deaths and 2 million illnesses in the U.S. each year, according to the federal Centers for Disease Control and Prevention. And about one in five antibiotic-resistant infections are caused by germs from food and animals.

The public community’s demands for action intensified recently, when, according to the Reuters news agency, Chinese scientists reported that they had discovered a new “superbug” gene in people and pigs that could render useless “last resort” antibiotics called polymyxins. Medical professionals consider polymyxins, widely used in agriculture, the last line of defense against certain antibiotic-resistant pathogens that cause serious illness in humans.

What can families do reduce their risk?

Take antibiotics only when necessary and use them precisely as instructed by your doctor. Click here to learn more tips from the CDC about antibiotics use.

Children, who are especially vulnerable to pathogens, can be exposed to antibiotic-resistant bacteria by eating contaminated meat or through contact with the animals. Treat all meat as if it is contaminated: cook it thoroughly and avoid cross-contamination in the kitchen.

When shopping for meat, look for labels that confirm no antibiotics have been used on healthy animals. These include:

USDA Certified Organic

Certified Humane

Animal Welfare Approved

American Grassfed Association

Food Alliance Certified – Grassfed

Global Animal Partnership

When dining out, ask restaurants where they buy their meat and their suppliers’ antibiotics policies. Some fast food chains such as Panera have already begun serving meat exclusively from animals that have not been treated with antibiotics.

NATURAL REMEDIES FOR EAR INFECTIONS?

Fever, headache, tugging at the ear, crying more than usual and trouble sleeping – most parents recognize that these dreaded symptoms mean an ear infection.

More than 80 percent of children will get at least one ear infection by age three, the National Institute on Deafness and Other Communication Disorders estimates. That makes them the most common reason parents take young kids to see a doctor.

These days, however, pediatricians are intervening less in the healing process and prescribing far fewer antibiotics. Globally, taking antibiotics when they aren’t strictly necessary is contributing to the buildup of antibiotic-resistant bacteria, a problem that threatens the health of both children and adults.

If your child has an ear infection, pediatricians may suggest medicated eardrops, nasal spray or over-the-counter pain relievers to ease your child’s discomfort. Tylenol and Motrin are often recommended for fever pain.

Consult a health care professional first if you suspect your child has an ear infection or if your child experiences new or escalating symptoms, especially a rising fever or fluid seeping from the ear. For more natural steps you can take, here are some options to consider. Note that these approaches have varying degrees of effectiveness.

Things that work

Time

In most cases, time is the best cure. Symptoms often clear within 72 hours. Warm compresses and steam inhalation may alleviate pain as you wait it out.

Prevention

These steps can lower the odds that your child will develop an ear infection in the first place:

Avoid secondhand smoke. Studies show that children exposed to cigarette smoke develop more ear infections.

Practice good hygiene. Encourage kids to wash their hands frequently. Avoid playtime with sick children. Thoroughly clean bottles, which harbor more bacteria than sippy cups.
Breastfeed if possible. Breastfed babies are less likely to contract viral or bacterial infections, including ear infections. For bottle-fed babies, sitting or being held upright while eating has been shown to decrease infection rates.
Limit pacifier sucking by babies over six months old. Evidence suggests that it increases the risk of recurrent ear infections.
Vaccinations are also protective. Studies show that kids who are up to date with their shots – especially for pneumonia, meningitis and flu – get fewer ear infections.

Things that might work

Researchers have explored a variety of alternative measures to prevent ear infections. Although clinical data shows mixed results, these are generally safe to try.

Vitamin D

Studies suggest that children with recurrent ear infections are more likely to have low vitamin D levels. When researchers gave vitamin D supplements to kids with recurrent infections in two separate studies (here’s one), they got fewer new infections during the study period.

Researchers still lack evidence to show cause and effect, but many kids are low in vitamin D, so a supplement will likely offer other health benefits. Babies need 400 IU (10 mcg) per day, and daily supplements are especially important for breastfed babies. Everyone else needs 600 IU (15 mcg) per day, which generally requires taking a daily supplement during the winter months.

Probiotics

Researchers have also studied oral probiotics and nasal sprays for preventing ear infections. More research is necessary to determine which strains of bacteria might be most helpful, whether it’s best to administer them as a spray versus oral supplements, and the best dose. But probiotics are generally low-risk and offer other health benefits, such as aiding digestion.

Vitamins and Nutrients

Some studies suggest that common vitamins and nutrients such as zinc, vitamin A and omega-3 fish oils may help kids stay healthy and prevent ear infections, but the evidence is mixed. Be sure to read bottle labels carefully for the appropriate dose for children.

Xylitol

Surprisingly, several studies have shown that this natural fruit sugar, common in sugar-free foods, can also help prevent ear infections. Xylitol inhibits bacterial growth, which is one reason why toothpastes and gums made with xylitol are good for teeth.

Several studies found that giving kids xylitol – as gum, syrup or nasal spray – prevented recurrent ear infections, but mainstream doctors caution that they need more data before they’ll routinely recommend it.

To produce a preventive benefit, most of the studies to date have found that it is necessary to give xylitol to kids five times a day (approximately 10 grams per day total). At this dose, kids generally had a 30 percent decrease in recurrent ear infections. Gum and lozenges appear to be more effective than syrup, although syrup may be the only realistic option for young children.

Physicians and parents know that such frequent treatments can be a challenge for busy families, and lower doses may not be helpful. A recent study that gave kids xylitol three times a day (15 grams total) did not show any preventive benefit.

Be aware that some kids may develop digestive problems when given xylitol, particularly in higher doses.

Not enough evidence

Other herbs and alternative treatments

Most herbal supplements have not been rigorously tested for preventing or treating ear infections. The NIH Center for Complementary and Integrative Health offers these tips for parents considering herbal supplements for children.

Osteopathy, chiropractic and traditional Chinese and Japanese medicine all suggest alternative approaches for ear infections. These options have been little studied and may vary from one provider to the next. High cost or low availability may make them impractical for some families.

Don’t go there

You may see resources that recommend trying ear candling or herbal preparations that include mercury, goldenseal or colloidal silver to prevent ear infection. These are not safe for children. Don’t try them.

Author,

Megan Boyle

BABIES AND SUN EXPOSURE: A PARENT’S WATCHLIST

Is your family spending a lot of time outdoors this summer?

Babies join their parents and siblings for all kinds of outings, and the sun exposure adds up. The littlest members of your family are also the most vulnerable to sun damage.

Only a few blistering sunburns in childhood can double the chance a person will develop skin cancer in over a lifetime.

Protect your babies by looking out for these three things:

Direct sun

Babies’ young skins have not yet developed melanin, the pigment that protects us from harmful UV rays. Keep them out of direct sun—particularly infants under six months. Stay in the shade, cover up with hats and clothing, and extend the hood on your stroller and car seat.

If you can’t keep her out of the sun, as a last resort you can apply a small amount of sunscreen to your baby, the American Academy of Pediatrics says. Zinc and titanium-based sunscreens are best, but talk to your doctor first.

Harmful ingredients

When selecting a sunscreen for your child, check the label for retinyl palmitate, a form of vitamin A that has caused lesions in test animals, and oxybenzone, a synthetic estrogen that penetrates the skin and can disrupt the hormone system.

Another ingredient to avoid: methylisothiazolinone (MI). Manufacturers commonly add this preservative to baby wipes and other personal care products, including sunscreen. A potent allergen, MI is linked to painful allergic skin rashes. Although some manufacturers are beginning to phase out MI, it could still be hiding in your products, even those labeled hypoallergenic.

Visit the EWG Sun Safety Guide to find a good sunscreen for your family and steer clear of the 11 worst sunscreens for kids.

Vitamin D

Sun exposure has health benefits, too. Vitamin D forms naturally in our bodies when we’re exposed to sunlight. People with limited sun exposure—particularly babies—may be deficient in this essential hormone, which strengthens bones and protects against several cancers. Consult your doctor about your child’s intake: Breastfed infants need supplements, and many others do as well. Learn more about whether your family is getting enough vitamin D.

Special reminder for parents: be sure to model good behavior when spending time in the sun. From infancy, babies learn by watching you. Cover up, seek shade, apply sunscreen and reapply after you get wet.

Find more tips in the Healthy Child Healthy World 2015 Sun Safety Guide for Children.

MARS PLEDGES TO DROP ARTIFICIAL COLORING

Mars Inc., the multinational corporation that produces iconic candies such as M&Ms, Milky Way and Snickers, announced last week that it will phase out artificial colors from its products over the next five years.

Mars chief executive officer Grant F. Reid said the company made this market-changing decision in response to growing demand for natural ingredients in food, even though he insisted that artificial colors “pose no known risks to human health or safety.”

“Our consumers are the boss and we hear them,” Reid said. “If it’s the right thing to do for them, it’s the right thing to do for Mars.”

We at EWG welcome Mars’ move. We question Reid’s assertion that artificial colors and dyes are harmless. Some research studies show that they may affect the behavior and attention spans of children. Though these studies are not conclusive, parents have seen enough to worry – and Mars has responded responsibly by taking parents’ concerns seriously. Learn more in our Dirty Dozen Guide to Food Additives.

The Mars move, which will involve 50 of the company’s food brands,  follows the food industry’s “clean label” trend, in which industry leaders are abandoning artificial colors, dyes, flavors and preservatives. Other mega-companies, including Kraft Foods, Campbell’s Soup Co. and Nestle USA have pledged to make similar changes.

The announcement by Mars, best known for its sweets, comes just shy of Valentine’s Day, when Americans are projected to spend more than $1 billion on chocolate.

Wildly popular for its taste, chocolate may also offer health benefits. Studies suggest that a small amount of dark chocolate may contribute to heart health, cognitive health and improved mood, thanks to a class of antioxidants called flavanols also found in onions, curly kale, leeks, broccoli, blueberries, red wine and tea. Chocolate liquor and cocoa powder contain high concentrations of flavanols.

When it comes to a sweet treat, moderation is key. See how your favorite chocolates compare by searching EWG’s Food Scores.

Our top tips for choosing chocolates:

Eat:

Very dark chocolate, 60 percent cocoa or higher

Little or no added sugar

Nuts or fruits, as you like

Don’t eat:

White chocolate, which doesn’t contain heart-healthy flavanols

Chocolate whose label lists sugar as the first ingredient

Partially hydrogenated oils

Artificial colors or flavors

“Yogurt covered” candies, which are commonly made of sugar, partially hydrogenated or palm oils and artificial color – not yogurt

Try these:

Dark chocolate:

Taza Chocolate, 95% Dark Stone Ground Wicked Dark

Scharffen Berger Dark Chocolate

Alter Eco, Organic Chocolate Dark Blackout

Green & Black’s Organic, 85% Dark Cacao Bar

Dark chocolate with fruit or nuts:

Wild Things, Skinny Dipped Almonds + Glazed Dark Chocolate Cocoa

Mitica Chocohigos, Hand Dipped Dark Chocolate Figs

Chocolove, Cherries In Dark Chocolate Bar

NEW FINDINGS ON PEANUT ALLERGY PREVENTION

Eating peanuts during infancy – rather than avoiding them – may be the key to preventing long-term peanut allergies in children.

The benefit of early exposure persists even if kids later take a year-long break from eating any peanut foods, according to a new study from the National Institute of Allergy and Infectious Diseases (part of the National Institutes of Health), conducted by the Institute-funded Immune Tolerance Network.

The new study builds upon a landmark clinical trial called LEAP, or Learning Early About Peanut Allergy, which concluded last year. LEAP showed that eating peanuts from infancy to age five reduced the likelihood of developing a peanut allergy by 81 percent in high-risk children. (Children are considered “high-risk” if they have eczema, other food allergies or if peanut allergies run in the family.) Children in the study ate foods containing peanuts, since the nut itself is a choking hazard for children younger than four.

The latest study, called LEAP-On, was published this month in the New England Journal of Medicine and extended the research to find out whether kids who later stopped eating peanut foods for a year would be more or less likely to develop the allergy: They were less.

In a second study, led by King’s College London for the U.K. Food Standards Agency and released the same day, researchers tested whether the same approach could prevent other common food allergies, but the results were less conclusive.

Just six food groups cause a whopping 90 percent of children’s food allergies: peanuts, tree nuts, milk, eggs, soy and wheat. Rates of peanut allergy in particular have risen dramatically in the past 15 years, afflicting an estimated 2 percent of American children. Symptoms range from hives and wheezing to life-threatening anaphylaxis, prompting schools, community centers and even airlines to adopt strict policies aimed at protecting allergic kids from peanut products.

For years, parents have tried to ward off peanut allergies in their children by avoiding the food altogether. Beginning in 2000, doctors and allergists advised parents of high-risk children that they should not eat potentially allergenic foods before age three. By 2008, however, health care professionals realized the advice wasn’t helping, and retracted the recommendations.

The landmark LEAP study changed everything, shifting the prevailing wisdom from avoidance to exposure. After LEAP was published last year, 10 medical organizations, including the American Academy of Pediatrics, agreed on new interim guidance that recommended early exposure. If your child is at high risk, however, talk to your doctor first. Click here for the Academy’s recommendations.

Now parents, health care professionals and the public have a chance to weigh in on what may become new, formal recommendations for peanut allergy prevention. The federal allergy institute, the agency that funded LEAP and LEAP-On, has drafted an update to its 2010 Guidelines for the Diagnosis and Management of Food Allergy in the United States. The update, which specifically addresses how to prevent peanut allergies, is open for a 45-day public comment period ending on April 18. All are welcome and encouraged to participate. Here’s how.

While the recommendations remain under review, parents should talk to their pediatrician or allergist about peanut exposure, especially if their child has ever had a reaction to peanuts; has other food allergies, particularly to eggs; has eczema or a family history of allergies.

Author,

Megan Boyle

Game Plan for Positive Parenting Your Preschooler

Ages three to five have been called The Wonder Years, and wondrous they are, ping-ponging from whining and tantrums to politeness to cuddling to exuberance to exploding intellect.

Preschoolers are explorers, scientists, artists. They're learning how to be friends, how to engage with the world, how to control their bodies, emotions and minds. With a little help from you, these years will build a fertile foundation for your son or daughter's entire childhood.

What Your Preschooler Needs to Thrive:

1. Structure.
Regular routines help kids feel safe, and are vital for preschoolers, who grapple with big fears on a daily basis. The world is chaotic and scary to them; their household should be predictable. A calm, orderly and fun atmosphere, with regular meal and bedtime routines, will produce happier children who have the internal resources to meet daily developmental challenges.

2. Enough sleep.
Preschoolers may resist bedtime, but without sufficient sleep, three to five year olds simply do not have the resourcefulness to cope with the demands of their day. Develop a regular routine that helps her wind down and start relaxing well before bedtime. When he gives up his nap, be sure he still gets some downtime to rest every day.

3. Control over her own food intake.
You decide what food is accessible in your house, but your child needs the responsibility to decide how much she eats. Remember that children need frequent small meals, and if you don’t provide that, they’ll end up snacking all day. If you always provide a variety of healthy food, you can feel comfortable letting them choose which foods they eat and how much.

Worried about a picky eater? Serve a variety of healthy foods and avoid power struggles; your child will eventually enlarge her choices as her taste buds mature. As long as sweets aren't available (except as rare -- not daily -- treats), preschoolers will naturally choose healthy foods that meet their physical needs, over a period of time. Never set up a clean plate as the goal; instead, when they say they're done, ask them how their body feels. (Obesity starts in preschool!) If you're bothered by throwing the food away, ask yourself why not wasting food is more important than your child's future physical health and body image?

4. Help with Emotions.
While your child may no longer have frequent melt-downs, he still has big feelings, and he still needs you to "listen" to those feelings on a regular basis. All kids need daily laughter to vent the anxieties that inevitably build up in a small person grappling to manage herself in a big, often overwhelming world, so be sure to build daily roughhousing into your schedule. And you can expect your preschooler to sometimes express his needs as an attack, meaning that a child who is hurting may well yell "I hate you; I want a new Mom!"

Don't take it personally. Instead, empathize even while you set limits. "You must be so upset to speak to me that way...I guess you're very disappointed...You really wanted to, and I said No....I'm sorry this is so hard, Sweetie."

5. Empathic limits.
If you want well-behaved kids, resist any impulse to punish. Kids this age need guidance and limits, because they are actively learning the rules and how the world works, and naturally they will test to see just where those limits are. Remember, though, that their brains are still developing. They get flooded with emotion very easily. When you set limits, they get upset, partly because they want what they want, but partly because they worry about your disapproval. It helps them to calm themselves if you empathize with their disappointment or anger. Doing this now will help them learn to control their own emotions over time, and to maintain their equilibrium in the face of upsets as they get older. Research shows that when young children are punished, their behavior actually worsens. (For more on why, see Why Positive Parenting ».) Instead, set limits and empathize with feelings to help your child WANT to behave. This helps him develop self-discipline, rather than relying on you to regulate him.

6. Interaction time with parents.
Your preschooler's brain is experiencing rapid growth and consolidation, both in learning facts and in learning emotional self-regulation. Lots of intimate time with physically and emotionally affectionate parents is critical for your preschooler's emotional -- and even brain -- development. This means what psychologists call "Floor Time," which is getting down on his level to work together building that train track or tower. The point isn't the intellectual work of the building, but the emotional connection you make over it -- and the nurturing support you offer when the project inevitably runs into snags. Daily, unstructured "Special Time" with your child during which you let your child take the lead will build your relationship. If you can't bear one more game of superhero or dollhouse, offer your child "Cozy Time" instead. Just snuggle up on the couch with a pile of books for a lazy half hour, and make sure you take plenty of time out to talk about what you're reading, or about her day. Here's a whole page of Games to build closeness & emotional intelligence! »


7. To be Heard.
Preschoolers are famous for asking questions, from the incessant "WHY?" to badgering parents to change their minds about a limit. This can drive a parent crazy, unless you look under the surface at the reason for the question. Your child wants more than information; he wants to feel heard, to be acknowledged, to tell you what he thinks, to weave together his world view with your help, and to have you respond to the turbulent emotions that often threaten to overwhelm his emerging intellectual control. When your child pesters you with WHY? questions and doesn't seem satisfied with your answers so she keeps on asking, turn it around and ask her the question.

8. Help in learning to express herself without whining.
Whining can drive even the most patient parent crazy. But whining is a signal that your child needs help, either in processing emotions that are weighing on her, or in meeting other needs. She's not just trying to get her way; she's expressing the need all preschoolers have to begin to master their environment by asserting some control. Luckily, there are some secrets to stop your child from Whining.

9. School.
Children three and older usually thrive at school, and for most of them, it is preferable to a full day at home with a parent or caregiver. But we need to remember that kids under the age of five have to work very hard to hold it together in a group setting. Their cortisol levels -- that's the stress hormone -- become elevated when they stay at school in the afternoon, compared to children who go home after lunch, indicating that they're under stress. In high quality settings, where the caretakers are stable and the child feels connected, this is less pronounced. But if a child is experiencing elevated cortisol levels on a regular basis, that's associated with less effective immune response, sleep issues, crankiness, and other risk factors. That's why many three and even four year olds do better with a nap and the afternoon at home after school. And no child under the age of seven is ready to be in an institution until 6pm daily. If your child isn't thriving with full-day school, the cost of a babysitter to be with your child at home half days after school will more than pay off in a calmer, happier, more cooperative child.

10. Social Time.
Preschoolers are biologically designed to look up to older kids. In the tribal cultures natural to humans, young children who are old enough to leave the parent tag along with the big kids and learn social skills. Since our children are usually in groups of same-age peers, they often need adult help and modeling to learn to "take turns" or refrain from bossiness. Four year olds are experimenting with appropriate use of power, so they're famous for bossiness and even bullying. Don't feel bad about stepping in at the playground to model appropriate social behavior. How else are they supposed to learn?
For help with social skills »
For help with bossiness »
For help when your child is starting to bully »
To empower your child against bullying »

11. Downtime.
Everything is stimulating to your preschooler, from seeing the dump truck on the street to the candy in the grocery store. While playdates and field trips stimulate his emotional and intellectual development, he needs substantial unstructured time at home to simply play and regroup in the safety of his cozy home base, where he can let his hair down and take a deep breath in a quiet place.

Parents of preschoolers in our culture face a big challenge. Most three, four and five year olds don't have lots of siblings or cousins readily accessible to play with, and they can't read yet. Parents have other things to do. How to keep kids constructively occupied?

Many parents solve this by letting their kids spend many of their awake hours watching TV or playing computer or video games. Because preschoolers' brains are still in a critical developmental phase, engaging with screens changes the way their brains develop, literally shortening their attention spans for life. Screens are also so easy to use that kids who come to depend on them for fun are less likely to become motivated readers. What's more, creating this habit early in life deprives children of the essential skill of structuring their own time. But there are alternatives to screen time for your kids, and the good news is that once kids get used to structuring their own time, they'll be much less interested in screens.

Encouraging Longer Naps

Is your child a cat-napper? Does your baby fall asleep being fed, while in a car seat, sling, rocker, or someone’s arms? When transferred to bed, does your baby then sleep 30 to 50 minutes? That’s the exact length of one sleep cycle. These factors combined define the main cause of mini-naps: an inability to fall asleep or stay asleep without aid – your baby wakes fully at the end of the first sleep cycle, resulting in a too-short nap. I refer to this problem as One-Cycle Sleep Syndrome (OCSS). This leads us to understand the reason that many babies are cat-nappers and also directs us to potential solutions.


Cycle-Blender Naps

One way to help your baby sleep longer is to put him for a nap in a setting that will lull him back to sleep when he wakes between sleep cycles. Cycle-Blender naps occur in slings, cradle-swings, rocking cradles, or baby hammocks. Any of these can help cat-nappers extend their sleep time because when Baby begins to awaken the rhythmic motion can lull him back to sleep.

You can also create a Cycle-Blender nap in a stroller. Take a daily walk outside (it’s good for both of you!) or bring your stroller in the house. Walk your baby until she falls asleep, and then park the stroller near you. If she starts to move about, resume walking or give her a bit of a bounce and jiggle.

Once your baby gets used to taking a longer nap in the stroller, you can make a transition to bed naps. Start by reducing the movement, rolling slower and for less time. After your baby is asleep, park the stroller, using the jiggle if she wakes mid-nap. Over time, let your baby fall asleep in the stationary stroller parked next to his crib, and when the nap habit is in place, change to naps in the crib.

Create a Sleep-Inducing Bedroom

To encourage longer naps, keep the sleeping room dark so bright light doesn’t keep him alert between sleep cycles. To soothe your child through sleep cycle changes, use white noise (a recording of nature sounds), or relaxing music. Keep this on all through naptime. This creates a sleep cue and will mask noises that can wake a child who is shifting through sleep cycles.

Build a Better Bed

To entice your baby to have a longer nap, recreate the crib into a cozier nest. Use softer sheets, such as flannel, plus a thicker, softer crib mattress pad. You can also warm the bed surface before naptime with a towel fresh from the dryer (remove this and test the surface before laying your baby down.)

Make the Bed a Familiar Place

Let your baby have several play sessions in his crib during waking hours. Stay with him, engage his interest and introduce a few new toys. Let him see you as a part of the crib experience so that he gets a happy feeling being there. This way, when he is put in his crib for naptime and wakes up mid-nap it won’t be a lonely, foreign place, but one that carries familiar memories of fun times with you. This can help him accept it as a safe place for sleep and allow him to fall back into slumber after that first sleep cycle.

Interpret Signs of Tiredness

If you put your child for a nap before he is tired, or when he is overtired he won’t sleep as well as when you hit that ideal just-tired moment. Observe your child for signs of tiredness, such as losing interest in toys, looking glazed, becoming cranky, or slumping in his seat. Put your child for a nap the moment you see any sign of fatigue. If you take note of the time that this occurs over a week you should see a pattern emerge. This can help you set up a daily nap schedule that suits your child’s tired times perfectly.

Gauge time spans between naps

In addition to signs of tiredness also watch to see how long your child has been awake. Children can only stay happily awake for a certain period of time until they receive a biological pull towards a nap. Once that “pull” begins your child becomes fatigued and his cheerful mood begins to deteriorate. Each child has unique sleep needs, but this chart shows the typical span of time a child can stay happily awake:

Age                  Awake Time Span

Newborn           1 – 2 hours

6 month old       2 – 3 hours

12 month old     3 – 4 hours

18 month old     4 – 6 hours

2 year old          5 – 7 hours

3 year old          6 – 8 hours

4 year old          6 – 12 hours

Keep in mind that children grow and change and their nap schedule should change with them. What’s perfect today may be different than what is perfect next month. Keep your eye on your baby and on the clock.

Author,

Elizabeth Pantley

What's Best for Baby Brain Development?

" Dr. Laura, Now that my daughter is seven months old, I'd like to know how to best spend each day with her: how much alone play, interactive play, what activities, are there any essential toys, and so on. I pretty much follow her lead throughout the day, but I want to make sure I'm including beneficial activities for her. She is bright, and I'd like to help cultivate that without being overly structured. I'd like to ensure that every moment spent with her is a quality one. Thank you!"

How lucky your daughter is to have a mom so committed to her healthy development. I admire your intention to make the most of every moment with her.

Babies need the presence of an adult who is responsive to their needs, but it doesn't benefit them to have all of life revolve around them. Human babies are designed to develop by interacting with their loved ones and observing family and community life. That means that what your little one most needs is to interact with you in a loving, warm, joyful way, and to observe as you go about the tasks of daily life. So please share your life with your baby, but don't focus on her every single moment.

In other words, she needs to know that you'll be there for her if she needs you. But it's not helpful to her to feel that she's always the focus of attention. You might think of this as responsively parenting your baby. You respond to her needs and set up her environment so that she can explore and thrive. But you don't make every moment about her -- that kind of pressure would make any child anxious!

So being responsive to your daughter's needs is important, in the sense that you feed her when she's hungry and create the opportunity for her to nap when she's tired, and let her explore by watching the bug on the sidewalk. But you don't want her to feel that you're often looking at her and saying "What shall we do now?" She needs to know that someone bigger than her is in charge; it would feel scary to her to feel like she's calling the shots. Instead, set up a schedule that will work for her, and be sure she has the security of knowing what to expect ("In the morning mom does the dishes while I play nearby with my toys; then we go out to do errands.")

Then, while you go through your day, warmly engage with your baby. A baby's brain does not need sensory bombardment; she will find plenty to stimulate her cognitive development in the activities of daily life. But a baby's brain does need to be interacting with her special people during most of her waking hours. She uses you as her secure base from which to explore the world, and she looks to you to know how to interpret what she experiences. As she interacts with you, her brain makes the neural connections that will shape it for life.

So a baby's intellectual development is built on the foundation of emotional security. That means your primary attention needs to be on enjoying her, engaging with her, responding to her, showing her the world, and reassuring her when she expresses concern about things. Studies show that infants who are the most advanced intellectually, emotionally and physically are the babies whose mothers are more attentive, responsive, and warmly engaging with them.

She definitely does not need you to focus on her intellectual development in the sense of counting, ABC's, or any conventional intellectual tasks. She will find great intellectual stimulation in games of hide 'n seek, in pulling all the pans out of your cupboard, and in seeing the world from the safety of a backpack or baby carrier as you grocery shop or interact with other people. You may have heard that reading to a baby is good for her, and it is. But even better is talking to and with her. Involve her and speak with her as you move through your daily tasks: folding laundry, washing dishes, cooking dinner.

Soon your daughter will be at the crawling stage, and she'll want to explore everything. It's worth mentioning that babies who are told "No" a lot learn not to think inside the box. If you want to give your daughter's intellect a boost, baby-proof well and supervise, but give her curiosity free reign to explore. It will mean a couple of months of restoring your books to the shelves every day, but she'll soon be past this stage and onto the next, having concluded that the world is well worth exploring and nothing need stop her.

Babies love changes of scenery. If she's tired of sitting in her seat mouthing her toys, take her for a walk. If she's squirmy in her sling, let her play on the floor, practicing turning over and hoisting herself up onto her hands and legs. If she's not happy being left to her own devices while you clean the bathroom, take a break and let her play with the water with you. Babies love to see how things work, which is second in fascination to them only to interactions with their parents.

Should you play brain development games with her? There's certainly no harm in it, but make it interactive and age appropriate--which means sensory, not just cognitive. Sing to her, play pat-a-cake type games, massage her, play music of different kinds for her, dance with her. Make sure that she gets plenty of opportunities to see other babies and children.

If you run out of ideas, spend half an hour at the bookstore browsing the baby shelves. There are a lot of books out there that offer specific ideas for games, that you probably don't need to own to be inspired by. I did notice recently that used copies of Julie Hagstrom's classic Games Babies Play were on sale online. (She also wrote Games Toddlers Play.)

Should you let her watch Baby Einstein videos? Experts warn against it. First, babies who watch any video are spending less time interacting with actual humans, so studies show that their language development is delayed and we suspect there are other delay effects. Second, watching screens changes brain development. We don't know enough yet, but screen use in the early years when the brain is taking shape so rapidly has definitely been associated with shorter concentration spans.

Making every moment count is an admirable idea, but you don't want to teach your baby that being productive every moment is what matters most. Making every moment with your daughter high quality should not mean making every moment busy. Babies don't benefit from over-stimulation. They need plenty of interaction with us, but they also need plenty of time to play with their toes, listen to music, stare at the dust motes in a shaft of light, and just figure out how their own muscles work. They don't need us at those times to rush in and justify our own existence by teaching them anything or occupying them; they're already occupied. All babies need time to play in the security of our presence, but without our interference. Learning to do that is an important developmental accomplishment.

Your daughter is a lucky baby. Since you follow her lead, you will be able to attune to what she expresses, and able to give her what she needs. Enjoy her, and treasure this time with her. Knowing we enjoy them is probably what babies need from us most of all.

5 Things Every Toddler Mom is Grateful For

Oh, toddlers. There's so much to love about the wonderful, complex little beings that are neither baby nor kid. There are the words beginning to come together into sentences, the slobbery kisses and hugs that turn into snuggles, and the way those little voices sound the first time they say “I love you” without being prompted. There's the sound of little feet stomping across the kitchen and the way they look at you, every minute or so, just to see what you're doing. Along with all the wonderful joys of toddlerhood though come all the dinners strewn across the floor, the red-faced shouts of “do-it-by-self!”, and the tantrums on the floor of the grocery store. As much as we know that these hard parts of toddlerhood are good, that they are discoveries of independence and testing of boundaries, they can also be really dang hard. As those hard parts arise, toddler moms find themselves particularly grateful for many of the modern conveniences of mom life.

Along with all the wonderful joys of toddlerhood, though, come all the dinners strewn across the floor, the red-faced shouts of “do-it-by-self!”, and the tantrums on the floor of the grocery store. As much as we know that these hard parts of toddlerhood are good — that they are discoveries of independence and testing of boundaries — they can also be really dang hard. As those hard parts arise, toddler moms find themselves particularly grateful for many of the modern conveniences of mom life.

Dry shampoo

Good old dry shampoo. I bet you thought that your long nights and showerless days would end as your newborn grew and transitioned to a baby and then to a toddler. Alas, the challenges of having a newborn are different than that of having a toddler, but you still might find yourself tired, un-showered, and in deep need of that can of dry shampoo your ever-so-kind sister gave you when you brought the baby home.

Grilled cheese, strawberries, and Cheerios

Remember when you were pregnant and spent hours researching how to make your own baby food?

Yeah …

By this point in parenthood, you've probably adjusted your expectations a few times, but it can still feel uber frustrating when you prep that fabulous spaghetti squash dinner for your toddler and it, again, ends up nowhere but the floor. At times like these, toddler moms are beyond grateful for their little one's “always” foods — for my kid, that's grilled cheese, strawberries, and Cheerios.

Grandparents who let Mama sleep in on the weekends

For toddler parents, there's nothing like a weekend at home with Mom and Dad. Home-cooked meals (cooked by someone else), a fire in the fireplace (made by someone else), and the RARE chance to sleep in while someone else watches your little one. Parents of any age are thankful for extra sleep, but toddler moms count their blessings, thank their lucky stars, and pull the covers up over their head when it actually happens.

Clifford the Big Red Dog

Or Curious George or Elmo or Pooh … Toddler moms are thankful for their little one's favorite character for the love, comfort, and giggles they give them. When everything is going wrong in a toddler life — the lunch isn't right, the nap is too late, the socks are just too scratchy — their favorite character, in book, lovey, or TV form, always offers comfort that toddler moms are beyond grateful for.

Hand-me-downs and kid thrift shops

Everyone told you they grow up fast, but what they didn't tell you was to never, ever buy clothes new. I learned this lesson when my 9-pound, 9-pound newborn never got the chance to wear a single item of the newborn layette I bought him. Toddler moms know that their kids grow way too quickly for new clothes and are thankful for all the hand-me-downs that come their way and the kid thrift shops they use to complete their kiddo's wardrobes.

Easy Potty Learning for Toddlers

The simple truth about toilet training is that if the child is ready, it happens very easily. If not, a power struggle often ensues -- and we all know that no one wins a parent-child power struggle. Fights with your child about his or her body are fights you will never win.

Luckily, there is a never a reason to fight with your child about this. Moving from diapers to being self-sufficiently able to use the toilet is a natural process. Humans have been doing it for a long time. They all get out of diapers sooner or later.

So you don't actually need to "toilet train" your child. Instead, set up conditions so your child can learn. Your goal is to make it as easy and effortless as possible. Think of this as a process of learning that unfolds over time, like all other learning and mastery.

Here's a step by step guide for child-led potty learning.

1. Begin by reading books about toileting with your child.

One great one is Toilet Learning by Alison Mack. Potty training dolls can also be very helpful. Most kids love them.

2. Remember that most of what kids learn is through our modeling.

Start talking about what you're doing in the bathroom. Let your child watch. Boys will benefit by watching other boys or their father use the toilet.

3. Kids love to copy other kids;

Slightly older cousins or friends who are willing to use the bathroom in front of your toddler can be invaluable in modeling. For boys, you might make a game of it by putting a small bulls-eye in the toilet for them to aim at.

4. I strongly recommend having a potty in each bathroom of the house.

That way, kids can practice sitting whenever they want, including while they keep you company in the bathroom.

5. Don't be in a hurry to start.

Just encourage your child to sit, fully clothed, on his potty. It builds muscle memory for your child to get on and off the potty, and you want her to feel comfortable sitting there. Make sitting on the toilet festive and fun, well before she even thinks about peeing in it. For instance, be sure there is a stash of books next to the potty. Sing silly songs or give special cheers each time she gets on and off the potty. But never force your child to sit on the potty, or to stay there.

6. After he's used to sitting on the potty clothed...

...ask him regularly if he wants to sit on it naked. Sometimes he will say yes, and sometimes No. Don't make a big deal of it. Your goal is just for him to get completely comfortable. Read potty books and other books to him while he sits there. Toddlers are busy. You have to make the potty a place they love being if you want them to spend enough time there to let anything come out.

7. Once she's totally used to sitting on her potty...

...begin dumping the contents of her diaper into the potty each time you change her diaper. Explain that every day her body is making poop and pee, and they belong in the potty. Tell her that whenever she is ready, she will begin peeing and pooping right in the potty. Admire it there, don't be in a hurry to dispose of it. After awhile, let her help you empty the potty into the toilet and be the one to flush it. Cheer happily each time and wave goodbye to the poop.

8. When he does pee or poop in the potty...

...be sure to celebrate with a special song and dance or parade through the house. But be sure you're celebrating other things, too, like his climb to the top of the play structure or the sun coming out. Don't make such a big a deal of his using the potty that the pressure on your child makes him anxious. He isn't confident yet of his abilities; don't make him feel like he has to repeat his use of the potty -- this should be his choice. Remember, your child should be in control of the process. No pressure.

9. Don't make the move into underwear until your child insists.

In fact, try to avoid mentioning underwear until your child brings it up. Let it be her idea, let her choose it herself, and don't rush it, or you're just asking for accidents.

10. Notice when she gives signs that she is about to defecate:

Becoming quiet, withdrawing to squat in private. Give her language for what's happening:

"Are you ready to poop? Do you want to do it in the bathroom?"

Humans naturally like privacy when they defecate, and it's fine if she wants to go off by herself. Remind her that the bathroom is a great place for poop, that you will help her take off her poopy diaper whenever she is ready. It may take her awhile to begin telling you, but she will begin to learn the concept that when she feels like this, it's time to go into to the bathroom. Eventually, she will probably be pooping in her diaper in the bathroom. Once that's a habit, you can ask if she wants to try sitting on the potty to poop, even with her diaper on.

11. Be open if she requests a toilet seat.

Many toddlers squat to poop and prefer a potty that allows them to assume a similar position. They prefer a potty because they are afraid of falling into the big toilet or are afraid of the flush. Some kids, however, will want to get a seat that goes right on the big toilet. If so, be sure her feet rest securely on a stool. Dangling legs tighten rectal muscles and make defecation difficult.

12. If you're buying a seat to go on the potty, find one they love.

Flip seats have a regular toilet seat plus a training seat. Some kids will love a seat that makes music when something is deposited in it. Just google potty training seats and you'll have lots of choices. I particularly like the ones at the end of this article, which my clients have used with great success.

13. Institute regular times when you both use the potty:

First thing in the morning, after breakfast, before snack, before and after lunch, etc. Your child doesn't have to go, just to sit with you while you go, and to try himself. Make clear that the rule applies to you, also, so your child doesn't feel singled out. This will help your child's body move onto a schedule, which will be a bit easier for him to manage. Of course, if he asks to go on his own schedule, cheer him on for listening to his own body. Usually, over time, he will ask more and more, gradually taking on the responsibility.

14. Every time your child actually uses the potty...

...celebrate with your potty song and dance or parade. But don't assume she's toilet trained until she's initiating. Toilet-trained is when she knows when she has to go and gets herself there.

15. Expect accidents.

Don't express any disappointment at "accidents," or you'll make the stakes too high and your child may rebel or give up. Instead, respond to accidents by shrugging, and saying with a warm smile:

"Oh well, accidents are how we learn. Soon you'll get it in the potty every time. Let's go in and try again."

16. Accidents are a step in the right direction...

...when your child learns from them without getting discouraged. If your child has herself noticed the accident as soon as it started, but hasn't made it to the bathroom, encourage her:

"You noticed as soon as you started to pee! Good for you! Let's go quick to the bathroom in case there's more to come out. Then we'll clean this up together. You noticed yourself when you needed the potty! Next time you'll probably notice sooner and get all the way to the bathroom!"

17. Be enthusiastic but never pushy.

Pushiness complicates toilet training. NEVER punish or disapprove of your child when he has an accident, or it will backfire.

18. If your child poops in her pullup or pants...

...help her to put the poop into the potty and admire it there.

"Look at that wonderful poop your body made! Poop belongs in the potty. Soon you'll remember every time."

19. Make it a habit.

At first your child will probably need help recognizing the signals that mean it's time to head to the bathroom. If you notice him getting antsy, or starting to squat behind the couch, you'll need to remind him. Every time your child does notice and tell you that he needs to use the bathroom, even if he doesn't make it in time, is an opportunity to admire his progress in the right direction.

20. What about pull-ups and Pods?

Many parents feel that pull-ups are too much like diapers and mask the feeling of the accident, but Pods are useful. Sometimes pull-ups are a good intermediate step but toilet learning can get stalled until you get into real underwear. There's certainly less clean-up with pull-ups than bare-bottomed, but they tend to drag out the whole process because they confuse the child. My recommendation would be to try bare-bottomed, but I should add the obvious caveat that this is not practical with a carpeted floor. If you can roll up your rugs for a month, that's often a good solution.

21. Troubleshoot.

Usually bowel training is easiest to control and happens first. If your child has mastered peeing in the toilet but not bowel training, he is probably afraid of the toilet and needs some reassurance. Or, he is used to the feeling of squatting and needs more support under his feet so he can push.

22. If your child is afraid to use the potty...

...help her with her fears. Any silly, playful games that get your child giggling about the potty will help her let her anxieties about the potty evaporate. 

23. Don't begin toilet learning under pressure.

Wait till you have some time when you can be relaxed and attentive to your child. Many preschools demand that children are toilet trained; that kind of pressure can only be bad for you and your child.

24. Watch for constipation.

Many children--especially those who don't eat as many vegetables or whole-grains, or who don't get as much exercise-- tend toward harder stools. That makes them more likely to put off pooping for as long as possible. This can happen even before a child is out of diapers but it is especially prevalent once a child is using the potty, because it requires him to stop what he's doing and go to the bathroom. The more the child gets in the habit of procrastinating, the harder the poo gets, and the more painful to pass, and the more the child avoids it. 

The problem with this is that even children who eliminate on a daily basis often build up fecal matter inside their bodies. This can deaden the usual sensitivity of the child to the need to use the toilet, so the child doesn't even know he needs to go. And since it pushes on the bladder, it can also cause pee accidents and even bed wetting. Unfortunately, most parents whose child is in this situation don't even know their child is constipated and don't understand why he's having accidents, until an xray reveals the extended rectum. (For more info on this issue, I recommend Dr. Steve Hodges' book It's No Accident: Breakthrough Solutions to Your Child's Wetting, Constipation, UTIs, and Other Potty Problems.)

25. Potty training is a partnership, and you're the junior partner.

You can set the stage, but your child has to do the work. I'll say it again: The MOST important secret for stress-free potty learning is that the child be ready. If you push your child, you may end up with serious issues, from a child with constant accidents to power struggles to a child with fecal retention. WAIT until he's ready. Does it really matter when that is? Sooner or later, everyone uses toilets.

Handled with good cheer and confidence that he will master it in good time, the process of toilet learning can be enormously empowering for your child. This is a big step for your son or daughter. Your job is to make it a positive one.

***

Q: Should I punish my child for accidents?

A: Adults have spent years using the toilet, so we forget how hard it is for a child. For a toddler who has spent their entire life in diapers thus far, noticing their urge to eliminate takes great attention and hard work. Consistently controlling that urge until they get to the potty is a major achievement. Some children are motivated to master this because they don't like the feeling of being wet or messy. Others are motivated by their urge for mastery or their desire to be like older children. The rest are motivated by their desire to emulate their parents, who they love and whose lead they want to follow.

Because all children master this developmental step sooner or later, we can think of this as "potty learning." Like all learning, the child needs to be ready to learn, and to proceed at their own pace, but parents can provide encouragement and conditions for success.

"Potty training" assumes that we need to "train" the child, like a dog, and substitutes rewards and punishments for the child's own natural desire for growth and achievement. While rewards can be effective to incentivize a child who is fearful about taking this big leap, punishment just increases the child's fear. Punishment actually makes it more difficult for the child to control his body because fear shuts down the learning centers of the brain.

What's more, punishment erodes the relationship with the parent and therefore eliminates the child's desire to follow the parent's lead, which is his main motivation to do the hard work of potty learning. When we punish a child who is not succeeding in learning to use the potty, he feels humiliated, ashamed, and like giving up. He already didn't know how to do this, and now he feels like a failure. He also feels wronged and angry. All of these tangled emotions make it more likely that the child will have more accidents. 

Punishing kids about toileting ALWAYS seems to result in more accidents. Most likely this is because the child stops seeing toileting as an opportunity for mastery -- which all kids want -- and starts seeing it as a source of stress. We know that stress causes children to regress, and punishment is a huge stressor. 

According to the American Association of Pediatricians, potty training is the time in a child's life when they are most vulnerable to abuse. That's because the punishment doesn't work; it actually makes it more difficult for the child to control the accidents. The parent gets more frustrated, and the punishment escalates. The situation spirals out of control, and tragedies are more likely.

In short, punishing your child for potty accidents will NOT hasten potty learning. In fact, it will lengthen the process, and it will damage your relationship with your child. Just don't do it.