Great Expectations: The Toddler Years

The toddler years are amazing: You start out with a completely dependent, crawling baby in diapers, and only a few years later, you’re rewarded with a walking, talking little person who can actually use the toilet, wash his hands, brush his teeth, bathe himself, dress himself and put on his own shoes and socks. (Whatever will you do with all of your spare time?)

The road to independence can sometimes be rocky, though, and it demands a lot of flexibility and patience on your part. Of course you want your child to become his own person, but your toddler’s stubborn insistence on doing things his way, complete with folded arms and pouting lower lip, can be a challenge for any parent.

This chapter offers time-tested and parent-approved tips for self-care instruction and techniques to help increase your child’s success and reduce his frustration, especially when it comes to his own dressing, grooming, and hygiene.

Your toddler doesn’t need a closet or chest of drawers stuffed with clothes, just a handful of mix-and-match items that are comfortable, washable, and fit well. Choose stretchy fabrics that allow for lots of movement without binding and will be easy for him to put on and take off. Avoid buying sizes that are too big, with the hope that you’ll get more wear out of them—too-loose clothes can pose a choking or tripping hazard.

• Wide necks. A toddler’s head is relatively larger than the rest of his body, and he has a short neck and sloping shoulders. Go for shirts or dresses that have a snap or button neck, either on the front or on the shoulder. Avoid turtlenecks, and shirts with excessive or tiny buttons or snaps.

• Comfortable waistbands. Choose pants or leggings with wide, soft elastic waists. Toddlers have short legs and round little bellies, so you want pants that can go from playtime to naptime and stay on without constricting. Baby yoga pants or sweatpants will be more comfortable and work better for potty training than styles that zipper and snap.

• Correct pants length. Don’t dress your child in pants that are too long in the hopes he will grow into them. Even if you roll up the cuffs, pants legs have a way of becoming unrolled and getting underfoot, creating a tripping hazard.

• Complementary colors. Bright colors and patterns are fun, but if you want your child’s clothes to coordinate keep in mind that the more neutral the colors and patterns of your child’s wardrobe are, the less effort it will take to put outfits together.

• Leg covers. Leggings or bloomers will protect the legs and bottoms of girls in dresses. Thick tights can work, too, and will spare you having to hunt down matching socks. But avoid nylon tights or hose, which bunch up, fall down, and are easily torn in the wash.

Check your toddler’s wardrobe for the following essentials:

• 7–10 pairs of pull-up pants, overalls, and/or leggings

• 7–10 T-shirts or play dresses

• Lots of socks in a matching, neutral color (pairs always get separated)

• About 40 diapers or training underpants for each week

• 1 seasonal dress-up outfit for holidays, weddings, or more special events

• 7 pajama sets

• Everyday shoes

• Rain boots, cold-weather boots, pool sandals, and dressy shoes

• 3 to 4 sweaters or front-zipping sweatshirts

• A waterproof coat that can double as a rain jacket

• Hats and mittens for cold weather

Though toddlers go through shoes really quickly, the good news is that they need only a few pairs at a time: an everyday pair, possibly a spare pair, and specialized or seasonal shoes, like snow boots or water shoes for the pool.

Too-small shoes will hurt and too-big shoes will be hard to walk in. Incorrectly fitting shoes can hinder your toddler’s proper foot development, so it helps to have your child’s feet measured at a shoe store every couple of months. You can also buy handy home shoe sizers for about $20 (search “children’s shoe sizer” on the Web). Having a home sizer comes in handy if you plan to buy shoes online or through catalogs. You can also measure your child’s foot with a ruler and refer to the chart below.

Taking off shoes is normal toddler behavior, but if your child pulls off his shoes at every opportunity or stops playing to take them off, consider that the shoes may not be fitting properly and it’s time to measure his feet again.

U.S. SHOE SIZE	FOOT LENGTH IN INCHES
4	4
4 ½	4 ½
5	4
5 ½	4
6	5
6 ½	5
7	5
7 ½	5 ½
8	5
8 ½	5
9	6
9 ½	6

Just when you master diapering and dressing a squirming baby, the child takes it to a whole new level: standing up, taking off what you just put on, turning the whole getting-dressed thing into a game of naked tag. His drive is there; all that’s missing is the coordination!

• Put on a happy face. Kids can pick up on a negative attitude instantly from your body language and tone and will mirror what you project. Even if the past few times you dressed your child were thoroughly aggravating, take a deep breath and start the process fresh, with a smile on your face and a calm and cheerful demeanor. Call it Project Getting Dressed Is Super Fun (even if that’s not exactly what you’re feeling on the inside)!

• Start with undressing. For toddlers, taking off clothes is easier than putting them on. As soon as your child shows signs of being able to take off shoes or jackets, at around 18 months or so, encourage his taking off his own coat each time you enter the house. Before bath time, let him take off what he can, such as his socks or his diaper. Taking off and/or putting on certain clothes will not just build fine motor skills but will also help reinforce that there are certain times when dressing or disrobing is appropriate (or not)!

• Allow plenty of time. There will always be days when you simply have to dress your child yourself to hurry out of the house, but try to build extra time into your daily schedule so that your child can practice his skills. Lay out clothing in advance, and put shoes and socks together in the correct positions for pulling on. Let your toddler do what he can—first putting his own arms through shirtsleeves and jacket sleeves and stepping in to pants, then progressing to pulling up pants, and finally pulling shirts or outfits over his head. It takes time to sort through the mystery of left versus right and top versus bottom. Give him an extra minute or two to figure out what should happen next, and gently offer suggestions or step in whenever he gets tangled up or frustrated. The goal is to foster independence, not to force it too early.

• Make getting dressed fun. Talk about each dressing step you’re about to do before you do it. This helps your child prepare himself for what’s going to happen next and also helps build language. Try to be lighthearted about the process: Make arm, leg, and neck holes a game of body-part peek-a-boo. (“Where are your fingers? There they are!”) When your child is old enough to understand, you can ask, “Do you want to get dressed yourself, or do you want me to do it for you?”

• Control escape routes. When your child has outgrown being dressed on the changing table (usually when he’s old enough to stand up), move your dressing operation to the floor. If your child tries to make getting dressed a game of “catch me if you can,” don’t play along. It will be cute the first few times but will quickly try your patience. Instead, put on your serious voice and find a smaller space to use for dressing. Limit his space: Locate your dressing spot in a corner of the room so he has to get past you to make his escape. Consider locking the door while you dress him if necessary.

• Indulge wardrobe whims. Even if colors clash, or he wants plaids to wear with stripes and dots, it doesn’t hurt to indulge your toddler’s wardrobe choices once in a while, so long as it’s not inappropriate. Everyone will understand, and it might even prompt a smile. If your son is into his superhero phase, allow him to wear his cape or his gloves. He may be more inclined to dress himself if you let him choose his wardrobe.

Most kids just love water! There’s no need to invest in lots of clever bath toys to keep your toddler entertained, though there are plenty of fabulous ones out there. All you need to do is fill the tub and provide a toy or some plastic cups. Then you can relax in the bathroom until your little darling turns into a prune, entertaining yourself however you want to as long as you’re within arm’s reach. You could also use bath time to trim your child’s fingernails—the water softens the nails, making them easier to cut.

Almost all toddlers hate having their hair shampooed. Kids’ eyes are especially sensitive, and water or shampoo can really hurt. A toddler’s natural reaction is to bend his head forward when water is poured on it, and that can make things worse. To rinse, a spray attachment for your tub faucet can help. Also try swim goggles or a bathing visor to keep soap out of his eyes.

Keep a towel on the side of the tub or hanging from a suctioned hook for ease of reach. Having a suction mirror on the side of the tub can help make shampooing more fun by letting him watch while you shampoo him. Silly, soapy “hairdos” are part of the fun.

Suctioned fishnet hammocks are available for holding and draining tub toys after the bath so they’re out of everyone else’s way.

When it comes to getting messy toddlers clean, nothing compares to a quick rinse-off in the shower. Showers save time, but the downpour of water can be scary to some kids, and the chemicals in water and shampoo can hurt their eyes.

It helps to introduce the shower experience to your toddler at a regular bath time, and not after a run-in with a skunk or a fall into a deep mud puddle.

Get in the shower first yourself, and use a hand sprayer attached to your tub faucet or shower head to gradually introduce the spraying effect, starting with your toddler’s feet and working your way up, avoiding his face. Some toddlers feel safer if you hold them while you shower them.

Avoid shampooing during a first introduction to the shower. Later, when you wash his hair, keep a dry washcloth within arm’s reach, just in case soap or water gets in his eyes.

Some toddlers go through phases when they become totally phobic about taking a bath or shower. Of course, a healthy fear of water is a good thing: You don’t want your child running full-speed into it. But sometimes children develop such a fear that it becomes difficult just to keep them clean. The strong aversion may happen after a child is accidentally placed in water that’s too hot, or he has had his eyes stung by water or shampoo.

And sometimes, what may at first look like a sudden and unexplained fear of water could be something else, like routine toddler limit testing just to see what will happen if he pitches a fit at bath time, or an end-of-day overtired meltdown. If he stages a meltdown when you turn on the tap, stand him in shallow water and give him a “tops and tails” (face and bottom, in that order) washing.

But if your child isn’t just fussy but clearly panicked at the sight of water, don’t force him into the tub or act angry or frustrated—this will only reinforce his fear. Instead, in a locked bathroom, undress him, then draw yourself a nice bath and hop in the tub with some toys, or even your toddler’s big brother or sister. (Wear underwear or a bathing suit if you’re weaning or not into self-exposure.)

Then play, smile, enjoy yourself, and blithely ignore your child (watching him out of the corner of your eye, of course). Eventually, his curiosity and drive to be the center of attention will get the better of him. Let him take his time. When he approaches the tub, let him play with toys in the side of the tub, placing him on your lap so he’s not touching the water. Then, slowly ease him into the water as he becomes comfortable.

Drowning and bathroom accidents are a big deal and send lots of toddlers to emergency rooms every year. Here are some important precautions to take to ensure your toddler stays safe and sound:

• Declare taps off limits. Lots of kids have been burned by turning hot water on themselves. Don’t let your child play with the faucet, and reduce his temptation for it by seating him with his back to the faucet, or cover it with soft spout guards.

• Stay close. Gather all of the bathing supplies you’ll need ahead of time. Never leave your toddler alone in the bathtub, even for a minute, until he’s at least 5. He could slip and injure himself, and children can drown in less than an inch of water in just a few minutes. Also, if your child sees you’re not there, he may try to climb out to find you and hurt himself in the process. Ignore the telephone or the doorbell, or if you must answer, wrap your child in a towel and take him with you.

• Turn down the water temp. The thermostat on your water heater should be set at 120°F, at most. Hot water can be dangerous: It takes only 5 seconds for a child to receive third-degree burns from faucet water set at 140°F. If you have one-tap faucets, reduce the risk of scalding by turning the cold on first and off last.

• Don’t overfill. Keep the depth of the tub water at about your child’s waist when he’s in the sitting position.

• Enforce the sit-down rule. Don’t let your child stand up in the tub unless you’re rinsing him off or washing him with a washcloth and have a hand on him to catch him if he slips.

• Avoid suctioned bathtub seats. They have figured in the drowning deaths of more than forty children.

• Save soap and shampoo for last. You don’t need to soap or shampoo your toddler every time—only when he’s visibly dirty or smells funny. Soaps and shampoo are drying to children’s skin and can cause irritation. When you do soap or shampoo, save it for the end of the bath so your child doesn’t spend long soaking in soapy water. Don’t use soap on your child’s sensitive face or bottom.

• Watch the appliances. Keep electric appliances, including hair dryers, curling irons, radios, and other plug-ins, away from the tub. They can cause electric shock.

As soon as your baby’s tiny tooth buds begin to emerge, it’s time to make a habit of cleaning off food particles using a square of damp gauze or a finger brush and a dab of baby toothpaste.

The first appearance of little teeth also marks a good time to start looking for a dentist. Many dentist practices treat children, but you can also search for a pediatric dentist (pedodontist)—ask your own dentist or your child’s pediatrician for a recommendation.

Most dentists will schedule the first exam at 1 year and the first cleaning between the ages of 2 and 3, but it’s nice to have someone in your phone book before then in case you have a question or a dental emergency, such as a knocked-out or chipped tooth.

In the meantime, keep his teeth clean to prevent cavities. According to the Centers for Disease Control and Prevention, 28 percent of children 5 and under have visible cavities, and tooth decay affects one in five 3-year-olds.

In fact, tooth decay is the most common chronic disease of childhood and one out of every two children have decay, which is caused by Streptococcus mutans, a bacterium that thrives inside the mouth. Not only is decay painful for your toddler, it can also affect how his permanent teeth grow in. That’s because the first teeth are space holders for the adult teeth that grow in between age 5 and early adulthood. Decay can migrate into the gums and affect permanent teeth.

Drilling and filling toddler cavities is also a relatively big deal because it usually requires sedation. So as much as your toddler might dislike having his teeth brushed, it’s important to do it anyway. He’ll eventually, grudgingly, get used to it if you do it consistently and don’t give in to squirming or fussing.

The AAPD recommends that a first dental checkup happen around age 1. It’s great if you can find a children’s dental specialist, called a pedodontist, who works solely with children. This means they’ll have a child-centered office, often with lots of toys, a child-scaled dental chair, and a staff specifically chosen to work well with children.

If you don’t have access to a children’s dental specialist, there are still plenty of dentists in regular practices who are sensitive to children, perhaps because they are parents themselves. Other parents are a great resource for finding a good dentist who’s skilled at working with young children. Signs of a not-so-good choice for children: no children’s playthings in the waiting room, trying to separate child from parent “because it makes children more cooperative,” using force, or chiding to have their way with an upset child.

Your toddler’s trip to the doctor’s office can be scary for him. Being touched and moved around or getting an oral injection feels like a frightful violation. You can help your older toddler to get through the ordeal by preparing him in advance, but a younger toddler won’t be able to handle a dental visit longer than an hour.

Let him know on the day of the appointment that you will be getting in the car to go see the doctor. Here are a few strategies for taking the fear factor out of that first appointment:

• Time it right. Try to schedule appointments for the best time of day for him, when he’s least likely to be hungry or tired.

• Play while you wait. Bring along a security object, a few small toys, a snack, or a favorite book to read in the waiting room.

• Hold him. If your toddler seems worried or anxious, ask the dentistry staff if it’s okay for him to sit in your lap during the exam. If not, then sit or stand beside him with your hand on him to help him feel less threatened.

• Coach the staff. Ask the nurse or doctor to explain what they’re going to do before they do it and what it’s for. They can also provide the names of the things used by the doctor and explain what they’re for in simple language.

Here are some parent-tested tips for maintaining your toddler’s pearly whites:

• Ban the bottle at bedtime. Toddlers might love having a bottle or sippy cup at bedtime, but going to sleep with a bottle of milk or juice can cause sugars to pool around your child’s teeth. The end result can be “baby bottle mouth”—white, chalky decay spots on your toddler’s teeth, causing them to eventually crumble and break off.

• Beware the sticky starches. According to the American Academy of Pediatric Dentistry (AAPD), crackers are actually worse for children’s teeth than caramels! The starches in crackers are just as harmful to teeth as the sugar in candy, but caramel sugars actually dissolve more quickly. So don’t let your child snack on starchy foods such as crackers, cookies, or cheese puffs all day long.

• Don’t share mouth germs. The group of germs that cause tooth decay can be transmitted by parents to their children through sloppy kisses and sharing eating utensils, which may make your child more prone to tooth decay. Maintain your own dental health, don’t kiss your toddler on the lips, and don’t share your child’s utensils.

• Encourage water drinking. Sugars and the plaque they cause are more likely to stay in dry mouths. Giving your toddler lots of water to drink helps to wash away sugars and tooth buildup, and fluoridated water will block acid production and help to remineralize teeth.

• Limit the juice. Keep his intake to 4 to 6 ounces per day, and don’t let him walk around with a cup of juice. If your child loves juice, stretch his daily ration by watering it down.

Most kids don’t like putting anything in their mouths that isn’t food or a bottle, and they’re likely to clam up as soon as they see toothpaste. Still, to keep your toddler’s mouth healthy, it’s important to persevere and keep at it!

For children older than 6 months, the AAPD recommends using a “smear” (about the size of a dried grain of rice) of toothpaste with fluoride, and wiping teeth off with a wet cloth afterward. Fluoride is a compound that attacks the bacteria that cause cavities, which helps prevent tooth decay.

Fluoride toothpaste for children under the age of 4 is a bit controversial, though. Swallowing fluoride can cause permanent tooth discoloration and can be toxic. Some pediatric dentists recommend using a fluoride-free paste until a child is old enough to be trusted to spit out all of the paste, or to skipping toothpaste altogether—the brushing action is the most important, they say. But, from a parent’s point of view, a flavored “practice” toothpaste may motivate your child to tolerate the toothbrush in his mouth. Ask your toddler’s dentist or health-care provider for a recommendation.

Scrubber options are a finger toothbrush, such as those by Safety 1st or Tiny Teeth, moist gauze or a damp washcloth wrapped around your fingertip, or a miniature baby toothbrush. If you choose a brush for your toddler to handle himself, select one that is small, and has a fat, easy-to-grasp handle and extra-soft, rounded bristles. There are also double-sided chewable toothbrushes, such as Brush-Baby brand, that work while your toddler chomps on them. They’re not readily available, and you may need to search online or at a specialty store to find one.

There are also child-sized, battery-operated vibrating toothbrushes. Don’t spend too much on one until you know how it works, because some children are terrified of the buzzing sound. Too, the brush may be messy and will spatter when it’s not inside your child’s mouth. But it could be a solution for toddler jaw clamping and getting at least some teeth clean.

When your child begins to show improved control over his hands at about age 4 or 5, then he may be ready to try cleaning his own teeth. With a tiny dab of children’s “practice” (nonfluoride) toothpaste on his finger, have your toddler practice “brushing” the front, the back, and the top of teeth in front of a mirror. He can also practice rinsing and spitting.

For a younger toddler, it may be easiest and tidiest to brush his teeth while he is in the bathtub. For an older toddler, a sturdy stepstool will help him reach the sink and view himself in the mirror. It should be high enough that there’s plenty of room to lean over for rinsing and spitting. Another option is to create a child-sized tooth brushing station using a low table with a mirror mounted on the wall and a nonbreakable kitchen bowl in place of a sink.

As best you can, try to brush away from the gum line, brushing down on the top teeth and up from the bottom teeth, to flick the bacteria and plaque away from gums and off of the teeth. Don’t go side to side, which can actually grind bacteria and plaque into the gum line and in between teeth. (Pick your battles: If he’s willing to try brushing and goes side to side, allow it.)

When it comes to rinsing and spitting, your little beginner is going to have difficulty getting water in his mouth without spilling it, drizzling it on himself, or swallowing it along with the toothpaste. With fluoride-free toothpaste (or no toothpaste) you can get away with not rinsing, but if you use fluoride toothpaste, proper rinsing is a must.

You can get the water in his mouth with a cup, water squeezed from a plastic (needleless) syringe, or a squeezable plastic water bottle with a nozzle. Convincing your child to spit water out without swallowing it is another story, though. Try showing him what to do and offer lots of praise when he gets it right.

Flossing is an important part of daily hygiene for teeth. Your child won’t be able to reliably get between all of his teeth on his own until school age. As soon as your toddler has enough teeth that they’re close together and bacteria can grow between them, it’s time to add flossing to your repertoire. Dental floss holders are especially helpful for getting floss into the tight spaces between molars. Flavored dental floss can make flossing more appealing.

Another option is a dental water jet (such as those made by Waterpik)—though, like electric toothbrushes, your child might be terrified of it, and water will be going everywhere. So only invest in one if you think you’ll use it, too.

Don’t be shocked if your child clams up, tries to grab the brush, or pitches a fit when he sees the toothbrush coming toward him. Most toddlers hate tooth brushing, though some kids are more tolerant than others. The AAPD recommends “cheerful persistence.” Try to stay positive and relax—don’t let your body language give away that you’re preparing for a battle, or you just might get one.

Tooth brushing works only if you do it consistently—at least once a day, and twice is even better. Brushing at the same time every day will also help your child get used to it. But if every brushing is becoming a battle between the two of you, here are some things to try:

• Change it up. Switch toothbrushes, switch to a washcloth, or try gauze instead of a brush.

• Give him some control. Invite your toddler to choose a new toothpaste from among a few that are appropriate for his age.

• Get a closer view. Use a mirror. Your toddler may be less resistant to brushing if he can watch what’s happening. (Magnifying mirrors can be particularly captivating.)

• Do a demo. Brush your own teeth in front of him first, and later the two of you can brush teeth side by side.

• Make it more fun. While brushing his teeth, try singing a song, recounting everything he ate that day (“There’s the beans! Let’s get them out of there!”), tell a story about a lion with big teeth, count teeth one by one, or do something else playful to keep him happy and distracted.

• Pretend on others. Invite your toddler to pretend brushing the “teeth” of dolls and stuffed animals with a dry brush.

A toddler with a healthy mouth and throat shouldn’t have bad breath. Cavities, tooth decay, and gum infections are primary causes of bad breath. Don’t try to mask a breath problem with mouthwashes or rinses, because toddlers are likely to swallow them.

Some possible other causes for bad breath include: (1) a throat or sinus infection or other low-grade inflammation, (2) gastroesophageal reflux (GER), which allows stomach acids to travel up the throat, (3) dry mouth, trapping bacteria in the mouth instead of washing it away in saliva, possibly caused by medications, (4) mouth breathing at night, or (5) having an object stuck up his nose, such as a dried bean, raisin, or part of a toy.

Just like a cherished cup of hot coffee in the morning, or your nightly serving of Ben & Jerry’s, getting your toddler to wean from his beloved breast or bottle can loom as a daunting task. He may be downright addicted to his familiar way of doing things and will scream for hours in protest when he is denied his primary source of comfort. But weaning is an important part of your toddler’s journey to more independence.

There is no gold standard for when and how to change your toddler’s drinking habits. And no matter what doctors or your mother-in-law say, weaning your baby-turned-tot from breast or bottle is purely a personal decision on your part.

Learning to drink from an open cup or glass is an art to be mastered. Your toddler has to figure out how to prop the edge of the cup on his lower lip and to use his tongue differently while he gulps liquid slowly enough so it won’t pour out the sides of his mouth and soak his clothes.

Plastic training cups with spill-resistant, snap-on lids with spouts are a great way to transition away from a bottle to beverage containers. Cups differ in how easy they are to use and how readily liquids leak when they’re turned upside down—something toddlers love experimenting with.

A bottlelike nipple on the top of the cup might work best for your beginner; then again, they may protest that it’s a clunky and unlovable bottle and demand the more efficient version back. Others respond well to cups, especially if they present appealing graphics and colors, such as action figures and the like.

Likely you’ll need to be flexible and try out a variety of cup brands until you find the one or two versions that work best with your toddler. Choose colorful, BPA-free cups that are visually appealing. (BPA, or bisphenol A, is thought to be an unhealthy component in some plastics.)

Whichever models you choose, they need to be unbreakable, and dishwasher safe with no sharp edges at seams that could cut small hands or sensitive lips. (A cut-off fat straw stuck through the lid of a fast food beverage cup can work in a pinch.) Use art materials to put his name on “his” cups to help reinforce them as important identity objects. Encourage visits with kids who have become cupdrinking experts, or think about throwing an intimate “sippy cup” party with a few other toddlers to help to enhance his interest in this new activity.

• Keep the focus on comfort. Don’t try to undertake any other major habit changes, such as toilet or sleep training, at the same time. Flood your child with ample cuddling and attention, accompanied with lots of chances for rigorous play and letting off steam to heighten the need for sleep. If he’s tired, he may be more willing to take a cup versus a bottle.

• Replace the least-needed bottles first. Some experts advise replacing a bottle with a cup at a “neutral” time of day, not at mealtime, because toddlers can get frustrated and overwhelmed if they’re thirsty but can’t figure out how to use the cup. When you start replacing bottle feedings with cups, try the first one in the morning, since that’s when your child is the most alert, lively, and thirsty and may be willing to take a beverage however he can get it. Next try the “wake-up” bottle from naptime, followed by the “settle-down-for-naptime” one, and finally the nighttime “necessity” bottle that so many toddlers resist giving up.

• Head off thirst. Try instituting substitute routines for the time your child normally would be cuddling up to the bottle. If he normally needs a bottle at naptime, try offering him liquids in his sippy cup before naptime nears. It’ll reduce his thirst and will introduce alternate, pleasant associations when it’s sleepy time.

• Make the bottle less interesting. One way to diminish “bottle appeal” for an older toddler is to slowly dilute the contents of the bottle with water. Do this over the course of several weeks, starting with 75 percent milk to 25 percent water, followed by 50 percent milk and 50 percent water, then 25 percent milk to 75 percent milk.

• Praise to the hilt. Make a big deal out of your tot’s successful use of the cup. Notice the sounds when he drinks, how he makes the milk go away, the way he holds it so tightly. Brag about his newly acquired drinking skills to others.

• Get “authorities” to help. Enlist the help of your child’s dentist or health-care provider to help convince your child that now is the time to let go of bottle drinking. That will enable you to take the neutral “We’re just doing what Dr. M says to do” stance.

• Plan a “no-bottle” vacation. Plan a family vacation with your child with bottles left at home but training cups on board so that he gets to try his wings at being bottle-free in a new setting.

You can probably postpone trying to break your toddler of his pacifier addiction until after the stormy and somewhat unpredictable toddler stage. Since most children give up their pacifiers voluntarily sometime between ages 2 and 4, many dentists don’t get overly concerned about toddlers’ pacifier habits until permanent teeth start coming in—though others feel they may contribute to ear infections.

Ultimately, because the upper jaw isn’t as dense as the lower jaw, extended and intense pacifier sucking can cause the upper jaw to change from a U to a V shape. When that happens, it can cause a child’s teeth to misalign with a visible opening in the front, and upper teeth may eventually protrude outward, changing how a child bites and chews foods. The misalignment can also put front teeth at risk for chipping or breaking. If your child continues to suck after his permanent teeth erupt, he may need braces.

To pull the plug on your toddler’s beloved mouth stopper, you can follow some of the same strategies for weaning from bottles by getting your health-care provider(s) to give their advice and for you to mimic that advice at home, encouraging “big-kid” behaviors with ample amounts of praise for success, and starting slowly but gradually phasing out the pacifier. Be prepared for possible setbacks, but stay the course.

It’s estimated that more than 3 out of 4 children suck their fingers through the first year of life, especially when they’re bored, tired, or upset, and about 1 in 5 children are still doing it by age 5.

Just in case you’re getting pressured by your in-laws (or elders) about your toddler’s thumb sucking, here are some things to keep in mind: Most experts agree that a thumb sucker younger than 5 shouldn’t be pressured to stop. The majority of children give up the habit on their own before they enter kindergarten.

Since, unlike pacifiers, fingers are permanently attached, pediatricians and dentists usually don’t recommend that parents try to stop a finger- or thumb-sucking habit during the toddler years. It’s an uphill battle, and it’s likely to raise resistance or even entrench your toddler more deeply into his habit.

Thumb sucking is an appropriate and useful behavior for babies and toddlers because it helps them comfort themselves. With children entering school, the habit can lead to being rejected by peers, and it might cause an overbite and problems with pronunciations. There are other problems that prolonged thumb sucking into childhood can cause, such as calluses on the thumb, chapped skin, and sometimes fingernail infections.

For a preschooler, a chart for the kitchen with sticker rewards for days and weeks without sucking that includes a prize at the end of the week for success works pretty well, but it’s not always a motivator for a toddler. Have a backup plan for slip-ups, which are bound to happen. Putting perfume or cologne chosen by your preschooler on the tip of his thumb will make it smell pleasant, but taste strange, which could serve as a gentle nighttime reminder.

Your toddler will need extra TLC while he is trying to overcome his sucking habit. That could be extra hugs, more praise and support for small victories, and offers of special outings and games to help take his mind off of the urge. And you may want to pay special attention to times when it’s more likely to happen, such as sitting in front of the TV or riding in the car, and plan alternate activities for helping him get over the hump.

If these strategies don’t work, there are special oral appliances that prevent sucking.

At the most basic level, potty training teaches a child how to control the two sphincter muscles that hold back elimination until it’s an appropriate time to relax them. The challenge for kids is learning to recognize the sensation of needing “to go” while there’s still enough time to get to the potty, get pants off, and get into the right position.

There is something called “infant potty training,” which is the norm in warm rural climates, like large parts of Asia and Africa. With infant training, the baby goes bottomless or in crotchless pants starting at about 2 months of age. Caregivers (usually mom, grandma, or older siblings) stay close at hand and watch for cues that the baby is about to go. When the caregiver picks up the cue, she holds the baby in a certain position over the intended target and makes a specific noise. Using this method, by age 6 months or so, most babies become conditioned to go when they get in the position and hear the noise. This method has been adapted by some parents in the West, too.

But for most parents, potty training begins when a child recognizes the “gotta go” feeling and acts on it—at 18 months of age or older. Statistically, the average age that toddlers achieve potty-training success in the United States is 30 months (2 ½ years), with girls training a few months sooner than boys do. That average age is going up, though, and according to recent surveys 1 in 4 kids aren’t trained by age 4.

It is thought this late-to-the-pot phenomenon probably has a lot to do with the wonderfully comfortable and absorbent disposable diapers in the Western world that let children reach toddlerhood without making the connection between the urge to go and the result. The convenience of disposables can also make parents less motivated than they were in cloth-diaper days when stinky diapers piled up in the diaper bucket.

When it comes to toileting, did you know that:

• Some children are ready for self-toileting by 2 or 2 ½ but others aren’t interested in the process until much later. The average potty-training age is 34 months for girls and 37 ½ months for boys.

• On the whole, girls master self-toileting as many as 6 months earlier than boys, so avoid comparing your son’s progress to that of, say, his female cousin the same age.

• Usually, but not always, having bowel movements in the toilet is achieved before gaining total urine control.

• Your toddler may be able to stay dry all day for a month or two before he stops wetting the bed at night.

• Mastery requires linking a series of smaller steps together, which usually takes time (and attention). While some rare (and usually very mature) children master self-toileting almost overnight, most take several months or even longer to become “trained,” with accidents still happening occasionally, especially at night.

• “One step forward, two steps backward.” Accidents and regression are more likely when there is illness, moving or traveling, a new baby’s arrival, or other family stresses, such as marital discord.

When it comes to potty-training readiness, age is just a number. Rather than counting months, it’s better to pay attention to developmental milestones:

YOUR READINESS	YOUR CHILD’S READINESS
You and other family members are ready to concentrate on this milestone and to be involved.	He stays dry through naps, likes to imitate parents or siblings, and talks comfortably about bodily functions.
There are no other major stresses or upcoming vacations that you know will interfere with the process.	He shows interest in using the potty and/or wearing big-kid underwear.
You’re willing to take your child to the potty every single time he has to go and stay with him until he’s through.	He squats, squirms, strains, or announces when he’s about to go and can follow simple one-step directions.
You’re willing to commit to staying positive and to resisting the urge to punish for accidents.	He has a somewhat regular stooling schedule and can pull down his pants and underwear.

It’s not unusual for toddlers (and their parents) to show some signs of readiness, but not all of them. Some kids see older siblings or parents using the potty and ask to use it too, so all that’s needed is a potty chair and some encouraging words. Then again, some kids never show interest in using the potty. If your child is developmentally on track in other ways and is at least 36 months old, then you may want to consider starting the process anyway. You may discover that he needs only a little nudge—and just a few supplies—to get started.

Disposable training pants are convenient, but like disposable diapers, they’re so absorbent and comfy they can keep kids from understanding the cause-and-effect of wetting their pants. Cotton training pants, which are like thick underwear, will help your child learn faster. One option is to use disposable Pull-Ups for a few weeks while your child is getting used to the concept, then with great fanfare make the switch to “big-boy” training pants, preferably those that have favorite characters “who don’t like to get wet” emblazoned across them.

It’s a personal preference whether you want to use a child-sized potty chair or a toilet ring and stepstool. The advantages of potty chairs are that they’re easier and safer for a child to use; toddlers going through their possessive, “It’s mine!” phase will enjoy having their own private throne; and you can tote and move it to wherever is convenient. Freestanding, flushable urinals, such as Peter Potty, are also available for boy training, but they are bulky, labor-intensive to maintain, and take up a lot of bathroom space.

On the downside, all potty chairs have to be cleaned out after every use, and realistically, at some point your child will need to learn to use an actual toilet. Units that have lots of bells and whistles, like lights, toilet paper holders, and ornate add-ons, may not work as well as simple, utilitarian pots, primarily because such gadgets only signal “playtime,” which may encourage your toddler to dawdle and fiddle with the gizmos rather than do his toileting “duty.”

If you go the toilet-ring route, be sure to also get a stable stepstool that is the right height for your child to rest his feet on when he’s seated on the toilet. (A second stepstool for hand washing at the sink will save a lot of lugging back and forth.) To prevent falls and getting fingers pinched, always “spot” him while he’s climbing up and down.

The ring adaptor should fit securely to the regular toilet seat, have no pinch points or sharp edges or seams that could scratch, and be convenient to remove and store so others can use the seat, too. A front shield or mound-like guard will be useful for catching a boy’s spraying accidents. Some companies, such as Potty Pal, make toilet seats that replace standard toilet versions with a hinged, child-sized ring that can be flipped into place when your child is using the toilet and flipped back up for everyone else.

For road trips, consider getting a portable, folding potty seat that you can keep in the trunk or backseat. You’ll also want to bring along a hand sanitizer and tissues or wipes. Plan to give public toilet seat surfaces a quick wipedown, or use a layer of toilet paper on the seat to help protect your child’s bottom from germs.

• Clothing that’s fast and easy to pull up and down (no tights, overalls, or overly snug waistbands).

• Support materials, such as potty-training picture books and DVDs, such as Alona Frankel’s Once Upon a Potty, available in both boy and girl versions (and as a DVD). Potty-training dolls come in girl and boy varieties, including Potty Scotty and Potty Patty, and there’s even a Sesame Street Elmo version.

• Washable or disposable waterproof car seat cover for “I can’t wait any longer!” moments, such as PeeWees Disposable Seat Savers.

Before you start potty training, take a week to prepare, with the goal of getting your child and the family comfortable with pottying words and concepts. This is the week to mount an all-out media campaign by reading those potty books, watching potty DVDs, and letting your child play with a doll that sits on a toy potty and wets.

Be sure to take your child into the bathroom to model pottying behavior, but don’t pressure him to use the potty himself, yet. Welcome his taking the initiative, though, since he may be more cooperative if he thinks it’s his idea, not yours.

Decide what words to use for various body parts and actions so that you can get in the habit of using the same words every time. It’ll be confusing for your child if, say, you call a bowel movement “poop,” your husband says “number two,” and your child’s caregiver uses the word “stinkies.” If your child is in day care, ask what terms caregivers use and use those at home as well, for continuity.

Some people have the opinion that you should always use the “correct” terms, such as “urinate,” “defecate,” and so on. The important thing at this stage is for you and your child and caregivers to be consistent and use terms that everyone can understand. (For the sake of clarity in this book, we’ll go with the most commonly used terms: “pee,” “poop,” and “potty.”)

On the other hand, it’s a good idea to use the proper terms for body parts, like “penis” and “vagina,” because if, later on, if your child encounters a physical problem, you want him to be able to explain to you or a doctor exactly what’s going on and where. Also, one person’s cute word can be someone else’s off-color language, and you don’t want your child to use terms that might offend others.

Practice using terms that will come in handy for the act of self-toileting while you (or another family member or sibling) demonstrate and talk it through:

Potty-prep week is also a good time to get into the habit of giving your child positive instructions, as opposed to “don’t” statements. Toddlers can get confused and may only remember what comes after the “don’t.”

So you’re toddler’s comfortable with the potty, you’ve stocked up on training pants and stretchy bottoms, and you’ve watched Elmo’s Potty Time and read Everybody Poops about a hundred times (or more). Do you really need a formal potty-training strategy?

There are a bunch of different methods out there, and pretty much anything that doesn’t involve punishment or shame and employs praise for successes eventually will get the job done. Some toddlers are visual learners who respond well to books and DVDs and demonstrations by parents. Others respond best by hearing spoken directions, and still others learn best by making potty time a predictable part of a daily routine (or a combination of all of these).

Your best bet is to find a method or a combination of methods that suit your child’s individual learning style. Here are a few of the most popular potty-training methods:

• The No-Pants School. Parents claim to have achieved accelerated potty training by devoting an entire day or weekend to having the child go bottomless around the house, and bestowing lavish praise when he uses the potty.

This is one way to kick-start training, and it can be especially helpful for kids who show no interest or motivation to potty-train even though they’re developmentally ready in every other way.

Needless to say, you’ll want to take up any antique rugs, throw a sheet over your sofa, and buy a bottle of upholstery cleaner beforehand.

This method is labor-intensive for parents, but it usually does work quickly, and if your child is ready for training, you may be able to have him largely trained within a weekend.

• Diaper Cold Turkey. Similar to no-pants training but slightly less messy, with diaper cold turkey you shop together for big-kid underwear or present underpants and a potty as grand gifts. Then, your toddler simply stops using diapers during the day.

There will be accidents, and pants leak, so you’ll want always to have a change of clothes, paper towels, and clean-up spray on hand. As with every method, successes are lavished with praise while accidents are treated nonchalantly: “Oh well, better luck next time!”

• Timed Potty Breaks. This method involves commitment to a timed schedule. You take your child to the potty at regular intervals during the day, such as 10 minutes after every meal and every half hour throughout the day. Again, success is highly praised, while accidents are minimized.

• Any Little Doll Can Do It. After you show your child the pottying routine, he then teaches his potty-ready dolly, or other toy or stuffed animal, how to do the same. Some specially made dolls will drink a water bottle, then pee into a doll-sized potty. Everyone claps and encourages both the toddler and the doll.

• M&Ms for BMs. Some parents find that material rewards like ringing a bell, pressing a clicker, singing a special potty song, or putting stickers on a chart for hitting the mark provide that extra bit of motivation that makes a difference in pottying success.

Some parents resort to candy, O-shaped cereal, or other edibles as rewards. Unfortunately, a lot of treats for potty tricks can add up to a lot of calories until your child gets the hang of it. Plus, you might be obliged to carry the reward with you wherever you go, or give it out at inopportune times, such as before bedtime after he’s brushed his teeth.

If your child is in day care or with a babysitter during the day, share ideas with his caregiver(s) to ensure that everyone stays on the same page and that any reward offered is consistent. You need to both agree on what the rewards will be and what will be rewarded—for instance, is there to be a reward for every potty trip whether it produces results or not? Will you reward only for successful results on the potty, or also for staying dry all day long? By collaborating, rewards will remain consistent.

Sometimes a cold or sore throat can cause a bad stomachache in children, and more rarely, so can appendicitis, but constipation is one of the most overlooked causes of severe stomach pain. It’s a common problem for infants and children and accounts for almost 3 percent of visits to pediatricians’ offices.

Signs of constipation included having fewer than three bowel movements in a week, passing stools large enough to keep the toilet from flushing, leaking stool, posturing to try to hold bowel movements, and experiencing pain when trying to have a bowel movement.

Your child’s doctor will be able to tell if he is constipated by pressing on his belly and by using his finger to see if there is a large stool in the colon. Significantly more girls seem to have this problem than boys.

Over time, changing your toddler’s diet to high-fiber foods, such as raw and unpeeled fruits and vegetables, beans (baked, kidney, navy, pinto, and lima beans), sweet potatoes, kale and turnip greens, and raw tomatoes might help. Vegetable soups provide lots of fiber, as does fruit, and so can bran, such as bran cereals, muffins, shredded wheat, whole wheat bread, and graham crackers. More water to drink and fruit juices, such as apple, pear, and prune, may loosen stools, too.

Meanwhile, your toddler may need a laxative or a stool softener to make bowel movements more effortless and comfortable.

It’s easier and far less messy if your little boy sits down to use the toilet. It won’t be long before he notices how his dad and older boys stand up to pee, and he’ll want to try that, too. That’s the time to step in and help him perfect his aim. You (or, better yet, Dad) will need to show him how to direct his spray.

Visual cues can help, such as a sticker stuck to the back of the toilet bowl or a floating piece of cereal as a target. A sturdy stepstool pulled up to the front of the toilet will make your little shooter tall enough to hit his mark. But even with practice, expect it to take a while for him to not sprinkle the seat or the floor.

It’s not unusual for little boys to develop a fascination with their body parts and both boys and girls to become quite fascinated with bodily fluids. When it comes to kids “discovering” their private parts, just like other behavior that might make you uncomfortable, it’s important to remain nonchalant and matter-of-fact.

If your son figures out that playing with his penis is a way to get you all bent out of shape, the extra attention will be a bonus! Instead, take his hand away and say something like, “your penis is a private part. That’s why we go to the potty in our private bathroom. So when you want to touch your penis, you need to do it in private, like in the bathroom or in your bedroom.”

If your toddler isn’t circumcised, it’s perfectly normal for him to try to stretch back his foreskin. Babies are born with foreskin, which gradually retracts and separates as a boy gets older, usually becoming fully separated by puberty. It’s common behavior for boys to want to “help out” the retraction process, but he shouldn’t try to forcibly retract the foreskin—this can cause damage or infection. Just as with any other socially inappropriate touching, remove his hand and distract him or steer him to the private place where touching himself is permitted.

Q: Our son hates wearing underwear and wants to keep wearing his diapers. When we dress him in underpants, he wets or soils them almost immediately just so we’ll put his diaper back on. How can we help him accept his “big boy” pants?

A: If he likes superheroes, try to find Batman, Superman, or other themed underwear available at most department stores. Help explain that the superheroes don’t like pee or poop on them, and that they are big guys who know how to use the toilet. That, plus some good parental role modeling from the same gender on the “how to” of pottying (plus lots of praise for successes) should do the trick.

Q: Our daughter seems to have an itchy, red vaginal area. She squirms a lot and often rubs herself as if she is uncomfortable. What’s the matter?

A: She may have a yeast infection or a reaction to detergent, bubble bath, or scented toilet paper, but more likely it’s irritation from not wiping correctly after peeing. Blotting works best. In addition, after pooping, she needs to learn to wipe from front to back to keep from spreading fecal matter to her vaginal area. Show her how to wipe after a bowel movement (flushable wipes may help) and then how to dry by patting herself using several folds of soft, unscented toilet paper. Avoid bubble baths that are irritating to tender areas, use only clear water rather than soap for cleansing, and have her wear absorbent, 100 percent cotton underpants instead of those made from synthetic materials, such as polyester, which can trap moisture inside. Apply a zinc-based diaper ointment or petroleum jelly to form a protective layer so the area can heal. If it doesn’t get better right away, or if she also has a thick, bloody, or foul-smelling discharge, it’s time to call your doctor.

Instead of saying this:	Try saying this:
Don’t stand up yet.	Sit down (using hand gesture for “down”).
Don’t pull your pants up yet.	Keep your pants down (pointing finger to ankles).
Don’t play with that.	Keep your hands up here (patting his thighs).
Don’t use so much toilet paper.	Just this much toilet paper (showing the amount).