Potty Training

Potty Training 101

    I really think we should keep tabs on how many diapers we change!  When these guys are teenagers with attitude, we should just keep reminding them of just how much we did for them!  It is indeed a major celebration for every parent when we can convince these strong-minded toddlers that the coolest thing in the world is indeed to sit on that throne and say bye-bye to diapers.  

    I really believe that each child is so unique, and the truth is that in this particular endeavor, the parents feelings and attitude matter a lot as well.  There are so many new and groovy books that are written nowadays, and I don’t discourage you from reading them as some have really fun and novel ways of approaching this sometimes stressful process.  But after working with children for over 31 years, I hope to offer you some general pointers that just may help.

    I think parenting is a lot about choosing your battles.  And although I want you to scream when something is dangerous, and really make them brush their teeth, I just don’t think you can force them to poop on the potty.   So I would begin by saying that this process is almost 100% child-led.  This idea of a naked boot camp weekend, and by Monday Johnny is full potty trained just doesn’t work in most cases.  When Johnny was just about all ready, a stronger nudge might done the trick, but if children really don’t want to use the potty, they will often play their card, rebel, hold it in, and get constipated.  Constipation is actually a very common and sometimes chronic problem.  It becomes intensely behavioral, but it starts with a physical feeling that is annoying and painful, and then your little guy says, “I am just not going to go!”  And then things get worse.  

    So please always avoid or at least help with constipation, especially around these potty training months.  Keep it soft and flowing, and that at least will prevent an obstacle and give you the best chance to have your little one keep an open mind about the process.

    As it is really child-led, some people wait, and literally don’t even discuss the idea of the potty.  And that is ok!  I mean no pediatrician should tell a parent when to potty train.   I think each interaction is a delicate and unique balance, and I want both child and parent to go at their own pace.  But in most cases, the child around 15-18 months is actually becoming more aware of their bodily functions.  They may make certain faces after they go, or point to their diaper as if to tell you they just went.  Well, this may be called the first step!  I think potty training is like driving a stick shift car.  Your child is controlling the speed at which they will be willing to drive, and you are unfortunately often stuck in first gear for a long time!

    But if your child is showing signs they are willing to go into the next gears, then you should be ready to help them shift gears and allow the car to drive a bit faster!  When your child is first showing interest, or at least a willingness, you should get that first potty, and just make it oh so cool!

    You can decorate the potty with stickers, and perhaps save special activities that you do, whether it’s reading a book, playing a quick game, or telling a fun made-up story while they sit on the potty.  No actual result is needed, but you are celebrating their willingness to sit and befriend the potty.  Of course, the moment they resist or show a fear, just take a break.  Change something up, and try again.  I like the ideas of sticker charts, and reading books about potty training, or watching videos, but don’t use all of your tricks before they seem more ready.  Indeed it can take a full year before they are willing to feel the urge, hold it in, run to the potty and do their business!

    Many like to take the portable potties on the go, just to keep things consistent.  Try to keep it as light-hearted and without pressure.  You just don’t want them to rebel and develop an aversion to it.   You’ll see them go in spurts, where things seem like they are really getting closer, and then it will lag or slow down for a few weeks.  In many cases, it takes them seeing a buddy or cousin who can do it.  And all of a sudden they just decide they want to go for it!

It honestly runs the full gamut, where some kids are full trained at 2, but many are still not fully trained by 3.  

    In some cultures they find a way to read the child’s cues and faces so well, that the child can be trained closer to 9-12 months old!  But this is really the parent training themselves to read the baby, and doesn’t fully mean the child will go on their own when fully mobile.

There are of course the stubborn ones, and often these kids are the incredibly intelligent and super strong minded ones, who refuse to use the potty until 4, but this is not common.  

For most, number one is easier, and number two comes later.  Many will still wear a pull up at night for a full year more, or until around 4.  I aim for daytime control first, and really don’t push the night time - let that come naturally.  

    Sticker charts and even M&M’s are all fair game when it comes to convincing these guys.  I say don’t push, but a little nudge is fine.  You plant the seeds, water and nurture it gently, and it will grow I promise.  They won’t go to college in diapers! 

    So explore your feelings on it, as you count too!  And be sincere.  Don’t just follow one specific book or model - follow your heart.  This is just one of many stages where your child wants to feel your true support and encouragement, and not see your stress or feel like a failure.  So keep it light and fun and keep the faith!  It will happen…when they are ready.

Hey Gav...you doing poop on the potty yet?

Hey Gav...you doing poop on the potty yet?

Flu Vaccine

FLU VACCINE

All of the pediatricians here agree that the flu shot is very important and worth getting.  Influenza can be a severe infection, especially in young children, those with asthma or other medical conditions.   It is not just a cold – it is much worse, and can lead to hospitalization and severe complications.  Each year, children in the United States and abroad die from influenza infections, so even if the shot is not always effective, it is worth attempting to decrease the risk of this potentially dangerous disease.

The flu shot is safe and can’t cause the flu. It is completely inactive, and can’t make someone sick.  It can cause fever or localized muscle pain that night, but it has nothing to do with colds or getting sick weeks or months later.  It is specifically trying to prevent the influenza strains, but can’t lead to more or less “colds” from other cold viruses.   It is not 100% effective, but helps to prevent or lessen the effect of the flu in most cases.  

The nasal flu spray is not an option this year, unfortunately, as studies showed it was not be effective for the current circulating strains.  We won’t have any at all this year.  

Flu shot is safe and effective starting at 6 months old.

We recommend that all adults caring for a baby (family, nannies etc) get their flu vaccines.

 We give flu shots from September until May, but the earlier in the season, the better.  

If your check-up/physical exam is up to date, you can just call to schedule a shot-only visit with us.    

The first time you get a flu shot, you need a booster a month later, but then every future season, you only need one.  You need a new flu shot each winter!

Getting any shot or giving any medicine is not an easy decision.  But after seeing the effects of influenza on young children for over 21 years, I have learned to respect and fear the flu!  My daughters get it each year, and I think yours should as well!

 

 

 

 

 

 

 

 

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Summer Safety

I just love it when it gets warm here!  Flowers blooming, birds chirping and getting darker later! Unfortunately there are also some scary things that can happen to our little ones during spring and summer – so let’s go over a few pointers and guiding principles to keep your little ones safe and smiling. 

Sun

Maybe we have swung too far in sun avoidance.  Some experts actually want us to get a bit more natural sun, and Vitamin D levels can get pretty low even in kids.  Nonetheless, especially with the little ones, I think it’s best to aim to avoid most sun, and allow for the incidental sun.  Any time we know we are going to be outside, we should put sunscreen on all over a good 15 minutes before leaving the house.  Use a good kid’s brand, and not one with parabens.   An excellent source for looking at all the potential toxins in creams and sunscreens can be found at the environmental working group (ewg.org).  I really trust them, and they will list and rank all the brands out there.  You can’t go wrong with California Baby, Blue Lizard, Badger, and Babyganics, but there are a ton of excellent brands for kids.  Remember to reapply every 2-3 hours and sooner if they get wet. 

If you do get a sunburn, usually it will be mild, and you can use over the counter moisturizers such as vanicream, cerave for baby, or aquaphor, but if there is blistering and skin breakdown it is time to see the doctor. 

Bug bites

Summer in Brooklyn can be absolutely treacherous when it comes to mosquitos.  We try organic natural bug sprays, and these critters laugh at us.  It feels horrible when our little ones get bitten up, but almost always they will get better on their own, so in most cases there is no medical concern.  Any time you get a bite, it can swell, and some kids have a huge reaction to bites.  You can use Benadryl (check drgilgoff.com for proper doses according to their weight), liquid after-bite preparations, hydrocortisone 1% or calamine lotion for their comfort. 

Some bites cause actual infections – spreading redness and even pus – so see your doctor if any bite is getting worse and spreading.  Taking pictures can help show the progression, but it can be tricky!  Some bites are not infected, but are actually large, red, and tender – and those are actually the same signs of a cellulitis or abscess – types of skin infections.  So if you are worried, it’s best to come in for a same day visit to catch a potential infection early.

Zika virus is a work in progress in terms of our knowledge and recommendations, but as of 2017, we really don’t see much to worry about in terms of serious effects on a healthy child.  If you are pregnant it can be a different story, and there are updates every week or two in terms of prevention and testing, so check out the www.cdc.gov website for the latest info.  West Nile Virus is so scary, but is quite rare, and if your child has that illness they become very sick and weak, so see your doctor if you have concerns about that.  We do worry about our little ones so much – so I can’t tell you NOT to worry about these rare diseases with each mosquito bite.  In other countries they have malaria and other diseases to think about each day.  But luckily those are very very rare over here, and there is nothing you can do with each individual bite to prevent the mosquito from having West Nile or Zika or not, so it’s safe to just watch and wait and assume it isn’t anything serious. 

The organic child bug spray is the safest to use, but as kids get older ,and stop putting everything in their mouth, it is safe to try a low strength of DEET, especially if it is only on the clothes and not the skin.  Certain times or locations are also just asking for trouble – like at dusk on a humid day, or being near a body of water.  But it seems in Brooklyn you just can’t avoid getting attacked no matter where you go!

Not all that bites are mosquito bites – so remember to see your doctor if the bites are literally all over or spreading or don’t look like mosquito bites.  We continue to see patients with bed bugs, fleas and scabies, so come and see us for any rash that looks like it is spreading and getting worse.

Water Safety

This is an area where every parent is aware and cognizant of the risks, but I fear we don’t all take it serious enough.  The risk of drowning is so enormous with our little ones.  Even a bath could be a huge risk, but certainly a pool or large body of water is a set up for a disaster.  There are few summer scenes more enjoyable than hundreds of kids at the pool or beach, but please always take the proper precautions to ensure your child is 100% supervised, and this is even after they have aced all their swim lessons and have the independence of a teenager in their soul.  Children should never be unattended near any body of water.

Having your little newborn in your arms in a pool or ocean can be fun for a minute, but don’t let them ingest the water.  There have been some very scary stories about secondary drowning, but that is luckily extremely rare, and children get water in their mouth all the time.  If there was a significant ingestion of water, along with choking or the need for resuscitation, of course come see us immediately.   We usually say 6 months is a safe age for swimming classes. 

For some, the chemicals used can irritate the skin, or get those eyes red, but in general, there is nothing more fun for our kids than 8 hours in a pool!  So get out there, be safe and enjoy the summer!