IT WAS ONLY YESTERDAY, or so it seems, that you brought that precious little bundle home-only yesterday that you gazed at those teeny-tiny feet, changed that first diaper, smoothed lotion on that silky newborn skin, witnessed that first toothless grin, and watched in amazement as those numbers on the scale crept up at each baby weigh-in. Fast-forward one year (my, how time flies!) and those tiny feet are now a whole lot bigger, sometimes look a little funny (what’s up with that tiptoeing?), and are in need of some walking shoes. That toothless grin has turned into a mouthful of teeth that have to be cared for. That silky skin, part of a body always on the go, is exposed to a plethora of skin-chafing elements. And diaper contents are a little more mysterious these days (is that blue poop?), even as diaper changes become ever more challenging. But as much as your little one has grown (all too fast), he or she still has plenty of growing left to do... leaving you with a growing list of questions about everything from head to toe-and in between.
Whether it’s a mass of ringlets or a fine coating of down, every toddler’s hair needs some daily care, if only to remove lunch from it. Here’s what you need to know:
Shampoo only as needed. Since oil glands on the scalp, like oil glands elsewhere on the body, don’t become fully functional until puberty, daily shampoos are rarely necessary–except for toddlers who tend to get a lot of food, sand, or dirt in their hair, or those who have particularly oily scalps. Many toddlers-especially those with African hair, or those with very dry hair or scalps-are best off with just a weekly shampoo (they may benefit from a little oil rub every now and then, too). Others require a shampoo every other day or even every third day-though more frequent shampooing is often needed in hot weather, when hair gets sweaty and sticky faster. Be sure to rinse well-a soapy residue can become a magnet for grime.
Choose the right tools. Think gentle when you select brushes and combs. A brush should be flat, rather than curved, and have bristles with rounded ends. If your child has tight, curly hair, the bristles should be long, firm, and widely spaced. A comb-very useful for detangling, and a must-have for children with extra-thick, frizzy, or African hair-should have widely spaced, nonscratchy teeth.
Brush up. Brushing helps to bring oil to the surface of the scalp, and that can be especially helpful if your toddler’s scalp or hair is dry. It can also remove much of the food and dirt that works itself into toddler hair. But use a light touch when brushing or combing your toddler’s hair, avoiding tugging or yanking. See the question that follows for detangling tips.
Don’t share when it comes to hair. As far as hair care implements are concerned, sharing isn’t a virtue. Each member of the family should have his or her own comb and brush, and, to prevent transmission of head lice or other problems, should keep these styling tools to themselves. Combs and brushes should occasionally be washed in suds made with a dash of shampoo and warm water.
“My daughter puts up a fight whenever I try to brush her hair. But when I don’t brush it, the tangles just get worse and worse.”
Getting the brush-off when you try to brush your toddler’s hair? Few toddlers like to sit still for styling, or even for the most cursory comb-out-and some start screaming and struggling the moment they spy a hairbrush headed their way.
Even though many 1-year-olds don’t have a whole lot of hair to contend with, the hair they do have is often fine, delicate, and sometimes fragile–making the daily chore of brushing even more challenging. Multiply the hairs (some tots have a headful), and multiply the challenges.
To take the trauma (for both of you) out of detangling:
Open a salon. Set up your toddler on a chair or high chair in front of a mirror and play “hair salon.” While you’re primping your client, allow her to primp one of her own: Supply her with a favorite long-haired doll or stuffed animal and a hairbrush to style with.
You may look forward to those salon trims (if only for the scalp massage that comes with the shampoo), but toddlers often aren’t such fans. A more likely scenario: Your toddler starts squirming or bawling the minute the stylist (a perfect stranger) approaches with the scissors (an implement you’ve probably warned is dangerous) and a squirt bottle (whoa... what’s that for?). And if you think about it, isn’t that shear anxiety perfectly reasonable? Is it really any wonder that your tot’s a moving target?
Even so, if your toddler has a fair amount of hair, the time will come for a trim. These tips may help keep haircutting from getting too hairy:
Choose a hair salon that aims to please kids. Bright smocks, fun-shaped chairs or boosters, balloons, toys, and videos to distract children while their hair is getting snipped are a big plus. But even more important is a stylist who’s patient, experienced in the squirmies, and willing to entertain and trim at the same time.
Choose your words carefully. You’re probably better off calling it a “trim” or “style” instead of a “cut.” After all, your very literal little one associates cuts with pain, bleeding, and crying.
Skip the suds. A few spritzes of water can dampen hair enough so the stylist can cut right to the trim, without the added trauma of shampooing.
Be your toddler’s booster chair. If your toddler balks at sitting alone on that big, high seat, ask if your lap is an option. Sitting on your lap may not be easy for you or for the stylist, but it may make this first experience more comfortable for your toddler. Hold your child on your lap facing the mirror while the front’s being cut, then turn him or her around so he or she is facing you for the back trim. (You’ll need a smock, too.)
Try a trick. When you get to the salon, put stickers on your toddler’s shoes, so that there will be something interesting to look at when the stylist says “look down.” Make funny faces in the mirror when it’s time for your toddler to look straight ahead. What to do if the squirmies have struck? Play “statue” (try practicing in advance for best results)-you’ll both get a giggle out of watching your images freeze in the mirror. And of course, don’t forget to bring toys-especially the ones your toddler loves clutching.
Follow a trim with a treat. Remember, the haircut is your idea, not your toddler’s. To make it a win-win, tie the haircut in with a favorite destination or special activity ("Today we’re going to the play gym, but first we’ll stop to get your hair trimmed.”). This may help take your toddler’s mind off any anxiety-hopefully he or she will be too busy anticipating the fun. If your toddler hesitates at the salon, offer a reminder: “Let’s hurry, so we can get to the play gym before it closes!”
Take two to untangle. Your toddler will be less likely to resist hair brushing if she’s participating in it. When she gets tired of brushing her doll’s hair, let her brush her own. You take the left side, and let her take the right. Then switch sides so you can go over what she’s done. Or simply take turns ("Now it’s my turn to brush”). Just be sure you get last licks. If you’re brave enough, you can even let her tackle your hair with a comb or brush (but be ready to do some major detangling afterward).
Tackle tangles gently. A toddler’s scalp-like all of her skin-is tender, especially if it isn’t protected by much in the way of hair. So have an extra-gentle touch. Use a wide-tooth comb (fine-tooth ones can tug and tear) or a brush that has bristles with rounded tips. To reduce pulling, hold the hair at the roots while you work on the ends. For longer hair, try a spray-on detangler to help untangle between shampoos.
Curtail tangling. Sometimes the easiest way to deal with a problem is to get rid of it. If your toddler’s tresses are on the long side, consider a short, low-maintenance haircut-it’ll make untangling a breeze. Or try braiding (but don’t pull too tightly-it can cause hair loss) or putting it up in pigtails. Hair that’s worn loose isn’t just vulnerable to tangles, but to sticky globs of food, mud, paint, and more-all of which can dry into major roadblocks for the comb and brush.
Allowing your toddler to brush her hair while you work on the tangles may make the job easier.
No matter what your child’s hairstyle, combing out tangles before each shampoo will make combing out after the shampoo less of a trial. So will smoothing suds through the hair (instead of vigorously working hair up into a snarl when lathering), and using a tangle-reducing conditioner (or a shampoo-conditioner combo) that’s designed for babies and toddlers.
Take bows (or barrettes) when it’s over. Do her hair up with pretty accessories (let her choose them) as the reward for sitting through the brushing. And don’t forget to reward your toddler’s “client” the same way. Do be sure, however, that your tot can’t take off any small (and potentially chokeable) accessories from her hair on her own. For safety’s sake, remove small barrettes or bows from your toddler’s hair before putting her to bed, and store them safely out of her reach.
“To say washing our son’s hair is a struggle is an understatement. Is there any way to make it less of a hassle?”
Hair washing can be hair-raising when you’re trying to suds up and rinse a toddler. But you can minimize the struggles if you keep these shampoo-surviving techniques in mind:
Keep your cool. If you anticipate a struggle, you’re sure to get one-so approach hair washing calmly. You may get the struggle anyway, but the more unflappable you are, the less flap you’ll get.
Keep it streamlined. Have everything at the ready when you begin (water at the perfect temperature, shampoo and a towel nearby) so that neither of you needs to endure the shampooing ordeal any longer than necessary. To reduce the number of hair-washing steps, use a one-step conditioning shampoo instead of shampoo plus separate conditioner. Or spray on a no-rinse detangler after you’ve rinsed out the shampoo.
Keep it short. The shorter the hair, the shorter the shampoo. If your toddler’s hair is long or hard to deal with, consider an easy-care cut.
Keep it gentle. Always choose a shampoo that won’t irritate skin or eyes (most baby and toddler shampoos are gentle, but sensitivities vary from child to child).
Keep it fun. To minimize the struggles, maximize the fun. Choose foaming shampoo with appealing natural aromas (always offer a sniff) or a brand with favorite characters on the bottle to keep your tot diverted.
Stay tangle-free. There’ll be less tangling if you “pat” the shampoo through the wet hair gently, rather than fiercely working up a lather. Working out tangles before you hit the bath will also facilitate a smoother post-shampoo comb-out.
Keep those eyes covered. Even a “no-tears” shampoo (even plain water, for that matter) can produce tears if it gets into your toddler’s eyes. Protect his peepers by having him hold a washcloth across his forehead to protect his eyes. Or use a shampoo visor or child-size swimming goggles to keep his eyes dry.
Control the rinse. A handheld spray nozzle offers more control, and less risk of a misdirection mishap. If you don’t have one, use a child’s plastic watering can or cup. After shampooing, your toddler can play with it in the tub.
Give him a turn. Your toddler may feel less victimized if he’s allowed to shampoo a waterproof doll or other water-friendly toy.
Let him watch. Mount an unbreakable mirror in the tub so shampooing can become a spectator sport. Making “suds sculptures” with your toddler’s hair can also be diverting.
When rinsing out shampoo, lean your toddler’s head back so the soap deostn’ get into his or her eyes.
From the moment they pop open in the all-too-early morning until the moment they finally, reluctantly, close at night, your toddler’s eyes are busy soaking up-and learning about-the world around him or her. To protect your little one’s precious peepers for a lifetime of sight, start now with:
Regular checkups. It’s important to catch vision or eye problems early, so be sure your toddler’s eyes are checked at all regular checkups, and call between checkups if you have any vision or eye concerns at all (Do his eyes appear crossed? Does she seem to have a hard time recognizing small objects from across the room?). If the doctor turns up anything out of the ordinary, your little one may be referred to an eye specialist, or ophthalmologist, for evaluation. In general, children who were born prematurely are more vulnerable to vision problems, so they may need more frequent eye exams. Check with the doctor.
Protection from the sun. Even if you’ve applied sunscreen to vulnerable skin, your little one’s still not sun-ready. Those adorable eyes need to be protected from the sun, too. Get your toddler used to wearing a wide-brimmed hat when outdoors in strong midday sun. Sunglasses can also be a good option, and wearing them is a great habit to get into early, though it may be difficult to get your toddler to keep them on (you’ll have a better shot at it if you wear a pair, too-toddlers love to copy their parents). When buying sunglasses, be sure to choose ones with UV-blocking lenses, which block 99 percent of both UVA and UVB light. Unlabeled or toy sunglasses may be cheap, but they’re probably worse than no sunglasses at all, since they can provide a false sense of protection. Keep sunglasses from sliding off during play by attaching them with a specially designed child’s glasses band (see the illustration, page 30).
Since toddlers can’t complain about not being able to see well-and have no way of knowing that their vision isn’t normal-vision problems that aren’t discovered at a regular checkup can easily go undiagnosed. That’s why it’s so important for you to keep an eye out for symptoms of vision problems in your little one, especially if eye issues run in your family. But even if they don’t, you should know the behaviors and symptoms that can tip you off to a vision problem that needs checking out. Call the doctor if you notice any of the following in your toddler:
An obvious inability to see well: Your toddler is extremely clumsy or stumbles a lot (beyond normal toddler clumsiness; see page 73), or seems not to notice or recognize objects or people, either close up or at a distance.
Frequent squinting unrelated to bright sunlight, or face scrunching when trying to perform a visual task. (Either of these can also be a temporary habit that has nothing to do with vision-many toddlers go through experimental squinting and scrunching phases.)
Apparent sensitivity to light (your toddler seems to squint in discomfort when a light is turned on in a dimly-lit room or when stepping outside into bright sunlight) or frequent staring at lights.
Eyes that bulge or seem to “bounce” in rapid, rhythmic movements.
Frequent tilting of the head to one side, as though trying to see better.
Holding the body rigid or at an angle when trying to look at distant objects.
Repeated covering or shutting of one eye in apparent discomfort (as opposed to covering or shutting an eye periodically to see how the world looks with just one eye open, which is just a sign of normal toddler curiosity).
Holding books, toys, and other objects close to the face in order to see them better, or consistently sitting or standing too close to the TV (though this, too, can just be a toddler’s fascination with the world from different perspectives, not necessarily a vision issue).
Entirely avoiding activities that require good vision (such as looking at books-though some toddlers just can’t sit still long enough for these activities, anyway).
Eyes that look crossed or wandering, or that don’t move in unison.
Pupils (the small black spot in the center of the eye) that are sometimes or always unequal in size (they should work simultaneously: getting larger in dim light, smaller in bright light) or that appear white instead of black.
Protection from injury. Sure, your toddler’s always prone to bumps and bruises-but eyes can also be injured at play. Never allow your child to play with toys that have sharp points or rods, with sticks, or with pencils and pens, except under close supervision (never allow these items in a moving car); cushion sharp corners on furniture (especially tables that are eye-level for your toddler); teach your toddler never to run with toys in hand; keep all toxic substances (such as cleaning supplies, dishwasher detergent, and lawn care products, many of which can cause eye damage on contact) out of your toddler’s reach; and keep your child away when the lawn is being mowed or snow or leaves are being blown.
Protection from television. While (contrary to your mother’s warnings) no amount of TV watching will actually damage a child’s eyes, prolonged viewing can cause temporary eye-strain. If you let your toddler watch TV, keep the viewing to no more than 30 minutes a day to minimize the strain on those beautiful little eyes. For more reasons to skip TV entirely or limit viewing to a lot less than those 30 minutes, see page 281.
For information on eye injuries and infections, see page 448.
“My toddler has been blinking a lot lately. She doesn’t seem to be in any discomfort, but should I have her eyes checked out?”
Most toddlers go through a brief blinking phase at some point. Often, it starts when a tot notices that opening and shutting her eyes quickly makes for an interesting visual perspective. Sometimes, it’s a copycat behavior—picked up (like so many other habits) from siblings or day care peers. Either way, when it’s not accompanied by other symptoms, blinking is nothing to worry about—generally, the behavior runs its course within a month or two, as it loses its fascination. Nagging or otherwise calling attention to your little one’s blinking will only give it longer-lasting appeal.
If the blinking is virtually nonstop or seems to bother your child, or if she’s blinking and doing a lot of eye rubbing that’s not related to sleepiness, check with the doctor. Occasionally, blinking is a sign of a tic. These repetitive muscle twitches are common in children, generally benign, but worth mentioning at the next checkup. If you think your toddler is blinking because there’s something wrong with her eye, see the box on the facing page.
Like eye color and shape, vision problems are also often passed down from Mom and Dad—so if you wear glasses or contacts, you’ll want to watch your toddler even more closely for signs that he or she isn’t seeing clearly (see facing page for symptoms to look out for). While abnormal sight is often difficult to spot in a toddler (who not only can’t complain about having a vision problem, but has no way of knowing it’s a problem in the first place), early diagnosis and treatment can keep a condition from getting worse. Here are the vision problems that occur most commonly among toddlers:
Nearsightedness (myopia). More common in children who have a nearsighted parent or parents, myopia is the inability to see objects clearly when they’re more than a short distance away. Though some children become nearsighted in the second or third year of life, the condition more often develops later. Signs and symptoms include squinting, holding books and other objects very close, and having difficulty identifying distant objects. If your child is nearsighted, he or she will need glasses (see page 29).
Cross-eyes: When one eye (or both) wanders inward. You may only notice this in photos.
Farsightedness (hyperopia). All babies and young children tend to be somewhat farsighted (unable to see objects clearly when they’re very close), but in most, vision normalizes by age 5. Kids who remain farsighted usually have a family history of the condition. Signs and symptoms are difficult to detect in younger children (since they all have some trouble with up-close vision). Glasses aren’t necessary unless farsightedness is extreme, interfering with play and other activities.
Astigmatism. Astigmatism causes vision that is blurred or wavy (it’s sort of like looking in a fun-house mirror). Children who are either nearsighted or farsighted are the most likely to have astigmatism, which is usually present at birth. Like nearsightedness, the signs and symptoms of astigmatism are squinting, holding books and objects close to the face, and sitting close to the TV. Glasses can usually correct astigmatism.
Walleyes: When one eye (or both) wanders outward.
Cross-eyes (strabismus). Strabismus is when the eyes can’t focus in unison, and it’s more common in children with a family history of the condition and in those who are farsighted. Infants often appear cross-eyed for the first few months of life for a variety of reasons (including that cute newborn puffiness), and sometimes their eyes seem not to work as a coordinated pair. But by the middle of the first year, the eyes should be able to move right and left and up and down in tandem, and focus together all of the time. In about 4 percent of children, however, the lack of eye coordination persists. The wandering eye (or eyes) may drift inward toward the nose (cross-eye), or outward (walleye), or up or down—some of the time or all the time. The condition may be subtle, and in some cases it’s only noticeable in photos. If your toddler rubs or covers one eye frequently, tilts his or her head to try to coordinate vision, or is reluctant to play games that require judging distances (such as catching a rolling ball), mention it to the doctor. Treatment may include medicated eye drops to blur vision in the stronger eye or placing a patch over it (for short periods each day) to force the use of the weaker one, glasses to equalize vision, and sometimes, exercises to strengthen the eye muscles.
Lazy eye (amblyopia). Lazy eye is when vision is lost in one eye because it’s being chronically underused (or not used). The condition is the most common cause of vision loss in children and can go unnoticed by both child and parent. It can happen in one of three ways:
Cross-eyes (strabismus). In this case, a toddler’s eyes don’t move or focus in unison because of a slight muscle imbalance. To avoid seeing double, he or she subconsciously opts to use only one eye. The brain eventually loses the ability to recognize images sent from the unused (or seldom used) eye.
Farsightedness (or astigmatism) in one eye. The toddler uses only the eye with the clearer picture. The brain eventually stops accepting signals from the unused eye.
A condition that blocks vision (such as ptosis; see below), if it just affects one eye.
At this age, lazy eye—no matter what’s triggering it—is nearly always correctable, usually with an eye patch, eye drops, and/or glasses. By the time a child has reached school age, however, it may be too late to correct the condition, because the brain has already decided that it isn’t ever going to pay attention to the images produced by the affected eye. That’s why it’s so important to get a vision screening for your toddler if you even suspect lazy eye or another vision problem.
Droopy eyelids (ptosis). Some children are born with ptosis (which is often inherited), while others develop it later. Signs and symptoms include an enlarged, heavy, or drooping eyelid, though occasionally both eyelids are affected. In some cases, the lid totally covers the eye, inhibiting vision, or it distorts the cornea, causing astigmatism. Ptosis requires evaluation and treatment by an ophthalmologist to prevent the development of lazy eye (when the child and the child’s brain learn to depend on the eye with the normal lid and ignore the images from the droopy-lidded eye). When the problem is weak eyelid muscles, surgery (usually performed when the child is 3 or 4) can strengthen them and give the lid a normal appearance.
“We just got word that our 20-month-old needs glasses. He’s so active, it’s hard to imagine him wearing them.”
While it might be hard to imagine those baby blues, browns, or greens covered up by glasses—or those glasses staying put on a toddler who never does—corrective lenses will make a remarkable difference in how your little one sees the world, and can have a major impact on all developmental fronts. And the logistics aren’t as tricky as you might think, either. In fact, getting used to glasses as a 1-year-old is generally easier than acclimating to them later.
Given your toddler’s on-the-go, likely collision-prone lifestyle, you’re best off with lenses made of regular plastic or of polycarbonate (a lightweight, strong, and shatterproof plastic, which reduces the risk of accidental eye injury). When selecting glasses, consider, too, how they’ll stay in place. For infants and young tots, elastic straps are usually substituted for the earpieces. They hold the glasses in place and will allow your little one to lie on his side, roll around, and otherwise act his age without knocking the glasses off. Another age-appropriate option is comfort cables (also called cable temples), which secure glasses with earpieces that curl around the ears rather than pressing against the head (see illustration on the following page). Flexible hinges are also a good idea, since they tolerate more abuse (which they’ll get).
Be patient but persistent while your toddler adjusts to wearing glasses. If the glasses are whipped right off, try again a little later. But don’t allow too much wiggle room. Your toddler needs to understand that wearing the glasses isn’t optional or negotiable. And while it’s likely to be several years before you’ll be able to count on him to care responsibly for his glasses, it’s never too early to begin the training process. Teach your toddler how to take off the glasses with two hands, without touching the lenses, and show him how they should stay in their case when they’re not being worn.
On infants and young toddlers, glasses are generally kept in place by an elastic strap (left) that subs for the ear pieces. Some toddlers do well with comfort cables, which curve around the ears (right).
They come in all shapes and sizes (though they’re uniformly cute)—and like that pair of peepers, your toddler’s two standard-issue ears must last a lifetime. Though genetics and other factors can also play a part, how well those ears will function over that lifetime depends a lot on the care they get in the early years of life. To keep your toddler’s ears in the best working order possible:
Be alert to signs of hearing loss (see box, facing page) and report any concerns to your child’s doctor. It’s likely your toddler was tested for hearing issues as a newborn, but many problems aren’t present at birth—they develop over time. That’s why a parent’s observations are extremely important, too, and can often detect an as yet undiagnosed hearing deficit. Formal hearing tests at the doctor’s office usually begin at age 4 (unless a hearing problem is suspected earlier).
At bath time, clean the outside crevices of your toddler’s ears with a damp, soft cloth or cotton swab, and check ears carefully for foreign objects (toddlers are known to stick items into their ears). Do not probe the inside of the ear with a finger, a cotton swab, or—as the expression goes—anything smaller than your elbow. Probing, even in the name of cleaner ears, could puncture the eardrum and/or push wax farther into the ear (where it can encourage infection or interfere with hearing).
Many toddlers may seem not to hear at least half of what their parents say, but in most cases, it’s just a matter of selective listening or inattention. The child who truly doesn’t hear well usually exhibits one or more of the following signs of hearing loss (although some of these may also be exhibited by a child with normal hearing):
An apparent inability to hear what is said by others, all or part of the time.
Difficulty hearing when a sound comes from the side or the rear, or when the child is not directly facing the person who’s speaking. Many hearing-impaired children instinctively learn some rudimentary lip-reading and understand more when they can see the speaker’s lips.
A consistent lack of response when spoken to quietly.
A consistent inattentiveness to any verbal or other auditory cues.
An apparent inability to follow any directions (more so than is age-appropriate).
A vocabulary—both receptive (the words that are understood) and spoken—that is more limited than it should be for the child’s age.
A lack of response to music—a child doesn’t clap, sing along, or move rhythmically to music, or enjoy or recognize frequently played tunes, even those designed especially for children.
Lack of response to the nuances of language (can’t seem to tell from the tone of your voice whether you’re angry, sad, excited, and so on).
Lack of response to sounds in the environment (the ring of the telephone or doorbell; the sound of the garage door opening, signaling mom or dad’s arrival home; the buzzer on a timer; the rain on the roof; the howling of the wind).
A tendency to favor one ear when turning toward a sound.
If you have the slightest suspicion that your little one has a hearing problem, get it checked out quickly with the doctor—even if routine testing at birth was completely normal. Sometimes, a hearing deficit that shows up in the second year is a result of persistent fluid in the ears (due to repeated infections), in which case treatment can resolve it; see page 384. In other cases, it’s due to another type of infection or syndrome, an injury, a medication, or a previously undiagnosed congenital defect. See page 401 for more on hearing impairment.
Wax, though icky to look at, isn’t usually something that needs removing. Secreted by glands in the ears, that gooey gunk actually serves an important purpose—helping to protect the sensitive ear canals by trapping potentially harmful dirt and debris that would otherwise find its way in, then working its way out, taking that trash with it. It is possible, however, to have too much of this good thing—excessive amounts of earwax can occasionally build up in the ear canal. If you’re concerned about a waxy buildup that you’ve noticed in your toddler’s ears, check with the doctor, who may remove it, recommend drops to help loosen it up, or suggest you ignore it. Never try to remove wax yourself, even with a cotton swab. Not only could you push the goo up farther into the ear canal, but there’s a very real risk of puncturing your toddler’s eardrum (yes, with a cotton swab). As for wax that’s hanging around the outer ear, wipe it away gently with a wet washcloth.
If you suspect an ear infection (see page 382), check with the doctor.
While your little one’s ears can handle most day-to-day sounds, exposure to excessive noise is linked to hearing loss. So it makes sense to keep your toddler’s environment as free of extraneous, loud noise as possible. Here’s how:
Steer clear of toys that make loud sounds (you should be able to speak normally over the noise).
Monitor the volume of television and music in your home and in the car. Maximum volume should never be louder than normal speech—and if you can’t talk easily over it, it’s too loud.
When buying new appliances or power tools, look for those that are quieter.
Limit your toddler’s exposure to very noisy situations where you need to shout in order to be heard (at a fireworks display or large sports event, around drilling, lawn mowing, snow blowing, and so on). When it’s unavoidable, have him or her wear soundproofing ear muffs.
Teach your child to cover his or her ears when hearing a loud noise, like a passing fire engine’s siren. Make this more fun by covering your ears, too, and calling your hands “ear muffs.”
Teach your child never to shout in anyone else’s ears or to let someone shout in his or her ears. And practice the sound control you preach. Don’t scream loudly, at least not in or near your toddler’s ears.
If you think your toddler may be exhibiting signs of hearing loss, see page 31, and check with the doctor.
“I’d like to pierce my daughter’s ears. Is she too young?”
Technically, a girl’s never too young—or too old—to join the pierced ear club. Still, whether you’re eager to pierce for cultural or family tradition reasons, for the fashion statement, or for the gender announcement (as in, “I’m a girl, people!”), there are some issues to consider before letting the piercing gun near your little one’s lobes:
The possibility of infection. Infections are common in the first few months after a piercing (for people of any age), and because your toddler probably won’t have the words to tell you that her ear is itchy, sore, or tender, an infection can get out of hand pretty quickly—and before you’re even aware of it.
The danger of small parts. Your toddler could manage to take off her earrings to play with (look at this neat toy!), or they could accidentally fall off and wind up in her hands. The potential problem? She could stick herself with a stud or swallow (or choke on) one or more of the parts.
The possibility of allergy. Some people are allergic to the metals in earrings, though it’s often possible to avoid this problem by using only 14k gold or surgical steel earrings and posts.
In some toddlers, scarring. If your little one tends to get lumpy scars (a.k.a. keloids), she may be prone to them after piercing, too.
For these reasons, most doctors recommend holding off on piercing until a child is at least 4, and preferably closer to 8 years old (about the age she can take care of her pierced ears herself). Still, it’s a perfectly safe procedure for young children—as long as it’s done under sterile conditions by someone who is qualified (your daughter’s doctor may be able to pierce them in the office) and—here’s the biggie—if you can get your toddler to sit still long enough to get them done. Keep in mind, too, that piercing hurts (remember that day at the mall?).
If you choose to pierce now, be extra careful to follow the normal post-piercing protocol: Clean her lobes daily by dabbing them with a cotton ball saturated with rubbing alcohol or the solution given to you by the piercing place and rotate the earrings each morning and evening (to keep them from sticking to the holes), using clean fingers. If you notice any signs of infection (redness, swelling, pus or crusting, tenderness, or bleeding) call your child’s doctor.
One last caveat: Save dangling and hoop earrings until your tot is grown up—they can be pulled by other children (or by your child herself), possibly tearing the earlobe. If your little one starts trying to remove her earrings or play with them, stop inserting the earrings and let the holes close up. You can always have her ears repierced when she’s a little older and more responsible.
The second year is a busy, busy time in a child’s mouth. By the time they turn 2- to 2½-years old, most tots will sport a full set of 20 primary teeth. Though these baby teeth aren’t for keeps, they’ll take your child through the next 5 to 10 years—in fact, the last of them won’t be replaced by permanent teeth until somewhere between ages 12 and 13. And since each tooth is vulnerable to decay from the moment it breaks through the gum (in fact, decay is most common in the first 6 months after a tooth erupts), it’s definitely important to make good dental hygiene a priority early on.
So, if you haven’t already done so, get your toddler into the habit of brushing—and being brushed—regularly each morning (after breakfast) and evening (after any bedtime snack). Here’s how:
Select a toothbrush designed for young children, with a small head and soft, rounded bristles. To make tooth-brushing more palatable for your tot, choose a brush that’s decorated with favorite characters or with lights that flash and/or music that plays for 2 minutes (the recommended amount of time to spend brushing). Keep in mind, however, that bells, whistles, and a hefty price tag don’t make a toothbrush inherently more effective. The secret to a thorough tooth cleaning is in the brushing technique, not the brush.
Be the designated brusher. Until your child is up to the challenge of thorough brushing (which can happen anytime between ages 5 and 10, depending on the child), you’ll be in charge of brushing. Working one tooth at a time, use a gentle back and forth motion across the chewing and inner surfaces (finish one side first before going on to the other so you don’t lose track). Switch to a circular motion along the sides and the outer gum lines (with the brush at a 45-degree angle). Lightly brush the gums where teeth haven’t yet erupted, or wipe them with a gauze pad, baby finger brush, or washcloth, and also do a gentle once-over on the tongue (where a lot of bacteria can hang out). If your toddler resists brushing altogether or your help with brushing (and most will), see the next question.
Start teaching your little one how to rinse after brushing (most toddlers master the rinse and spit around age 2). As always, it’s easiest to teach through example: Show him or her how you lean over the sink and say “ptooey.” Rinsing is important not only because it removes the toothpaste before it’s swallowed, but it also eliminates bits of loosened food that would otherwise resettle on the teeth.
Consider skipping the toothpaste until your toddler can be relied on to rinse and spit. Though it can definitely make brushing more appealing (a major plus, for sure), it doesn’t necessarily make it more effective. If you use toothpaste earlier on, choose an infant/toddler formula that’s fluoride-free to avoid ingesting too much fluoride (overdosing can lead to teeth that are permanently stained). Once rinsing and spitting are mastered, you can begin to put a pea-size or smaller amount of fluoridated toothpaste on the brush, but watch out for toothpaste eaters. Some kids will gobble the stuff when you’re not looking.
Once any two teeth have grown in side by side—even if they’re not exactly touching—it’s time to start flossing. Yes, really, flossing. Flossing is as essential to good dental health as brushing and rinsing—and a really important habit for your tot to get into. Once again, you’ll be on floss duty until your child’s much older, at least 7 or 8. Which is easier said than done, both because it’s difficult to maneuver large adult hands around such a tiny toddler mouth, and because most tots will not sit long enough to be fully flossed. Realistically, unless you have an unusually cooperative toddler, you probably won’t get through the entire mouth every day, and that’s okay—it’s more about getting into the habit than it is about getting the job done. Focus first on molars—if there are any—and work your way back to front. Gently does it.
Won’t be near a toothbrush for a while and your little one’s just eaten a cookie or another sugary treat? A quick swipe with a xylitol toothwipe (available at drugstores and online, and easily stashed in your bag) can remove plaque from your toddler’s teeth while safely fighting cavity-causing bacteria.
Don’t forget to explain. No, toddlers aren’t always motivated by messaging, but it’s good to build the benefits of good oral hygiene into the conversation anyway. When you’re brushing and flossing, remind him or her that keeping those teeth clean helps them stay strong and healthy, so they won’t get “boo-boos.” Also point out that strong teeth will let him or her eat yummy food. When your little one drinks milk or eats cheese or yogurt, reinforce: “Healthy foods make your teeth healthy, too!”
“My toddler clamps his mouth shut when I try to brush his teeth. I’m tempted to give up trying.”
The tussle of the toothbrush is just another skirmish in your toddler’s stubborn struggle for autonomy—in this case, autonomy over his mouth (which, he’s discovered, is a cinch to control). Since surrender on his side is unlikely, and surrender on yours isn’t smart—after all, even baby teeth need to be protected from cavities—a little creative compromise is called for:
Brush in style. Let your toddler choose two or three colorful child-size toothbrushes at the store (be sure the bristles are soft and of good quality). Then let him select the one he wants to use at brushing time. This helps defuse the control issue (even though he can’t decide whether or not to brush, he can decide what to brush with) and may distract him enough so that he’ll forget to protest.
Approaching your tot from behind and tilting his or her head back slightly may give you the best visibility and maneuverability for toothbrushing. Or you can sit on the floor, seat your child in your lap, and have him or her lean back against you.
Strike the right position. It’ll be easier to maneuver around your toddler’s mouth if you’re positioned right. Cradle his head in one arm while you brush with the other, or for even more control (and a better view of what you’re doing), have him lie on the floor with his head in your lap. Or sit on the floor with him on your lap, his head leaned against you (see illustration on the previous page).
Let him do it himself. Though you’re the brushing boss, you’ll get more cooperation if you double-team. First, give your toddler his own brush to do some preliminary brushing. Or, if you find he cooperates better with the promise of a reward ahead, reverse the order: you start, he finishes. Don’t worry about his technique or the condition of his toothbrush (the bristles will soon become flattened and misshapen from being chewed on)—just let him get the job done the best way he knows how. Praise his efforts, even if the toothbrush doesn’t really make its mark. As he becomes a more skilled (and thorough) brusher, you may be able to let him take over the morning brushing completely, while you continue to help out at bedtime. But don’t expect really proficient, independent brushing for many years to come.
Letting your toddler “brush the teeth” of a stuffed animal or doll (using a toothbrush reserved for play) or even brush yours may make him more amenable to having the brush wielded on him.
Then do it yourself. After you’ve told your toddler what a great job he’s done on his teeth, take your turn—using a different brush. Letting him hold the toothbrush along with you will let him maintain some control over the process, as will giving him a complete brush-by-brush as you go (“These two teeth look nice and clean, let’s try the next two”). Injecting a little levity may also loosen your toddler up a bit. Pretend to go for the wrong body part: “It’s time to brush your tummy!” Or try the old favorite: “I see a giraffe (or an elephant, or a turtle) in there—let’s see if I can get it out with the toothbrush.”
Check each other. When the brushing’s done, it’s time to check your work and his. Challenge him to open his mouth as wide as he can so you can inspect his teeth for lingering bits of food (an older toddler may enjoy checking his teeth in the mirror, too). You can also have him check after you’ve brushed your own teeth, or after other family members have brushed theirs. Dub him the official tooth checker.
“Our 15-month-old seems to be getting molars now. He’s a lot more miserable with them than he was with his other teeth.”
He’s miserable for good reason. Because of their large size and double edge, first molars (which usually make their appearance sometime between 13 and 19 months) are at least twice as hard to cut as incisors—and for many children that means at least twice as much ouch.
To soothe your toddler’s pain, turn to some of the same standbys that helped him through earlier teething episodes, like rubbing his gums with a clean finger or letting him chomp on a refrigerator-chilled teething ring. Chilled applesauce or frozen banana may also soothe those sore gums, as may a cup of icy cold water (don’t leave ice in it, though). Other old teething relief favorites should be shelved now that your tot has teeth (a chilled carrot, for instance, because he’s capable of biting off a chokable chunk, or teething biscuits, because their high carbohydrate content could lead to tooth decay if they’re mouthed all day long). A topical teething soother (like Orajel) can numb gums briefly (usually for about a half hour), but probably shouldn’t be applied more than four times a day—which means it won’t provide around-the-clock relief. Your child’s doctor might also recommend ibuprofen or acetaminophen when the pain is at its worst, probably at bedtime, and especially if teething pain interferes with your little one’s eating and sleeping.
Speaking of sleeping, often a toddler who’s cutting molars may start waking during the night (or may wake up more frequently). While you’ll want to provide comfort, keep in mind that this kind of waking can become chronic—continuing long after the pain has left the building—so try to minimize those midnight comfort runs.
While teething can definitely trigger crankiness, lack of appetite, even a slightly elevated temperature, report any symptoms of illness that warrant a call to the doctor. They could be completely unrelated to teething and may need treatment.
Tooth Timetable
There’s a wide range of normal when it comes to tooth eruptions—some babies and toddlers start cutting their teeth very early, while others take their own sweet tooth time. Here’s when you can expect your tot’s teeth to appear—on average:
12 to 15 months. By now, most tots will already be sporting some teeth in their adorable little mouths, including the upper and lower central incisors. The upper and lower lateral incisors should also be making their debut about now if they didn’t already erupt during the first year. First (or front) molars begin to appear early in the second year, though some late tooth eruptors may not start cutting those molars until age 2½.
15 to 18 months. Watch out, Dracula—here come your toddler’s fang teeth (better known in dental circles as canines). The upper canines usually make their appearance a few months before the lower ones do.
18 to 24 months. Second (or back) molars can start appearing at the end of the second year, but many toddlers don’t get that extra set of chompers until after they bite into their second birthday cake.
Be on the lookout: If your toddler hasn’t cut a single tooth by 16 to 18 months, talk to the pediatrician or a dentist. Also bring to the attention of your toddler’s doctor or dentist any discolored teeth, or chipping or softening of the teeth.
“I’m guessing our daughter is going to need braces because there is so much space between her teeth.”
Often, the front primary teeth debut with big gaps between them—and that could actually be a good thing as far as a perfect smile is concerned. That’s because the front adult teeth are bigger than baby teeth, and they’ll need the extra space when they eventually move in. Those primary front teeth are also apt to shift closer together as adjacent baby teeth erupt, pushing their way into place. The comforting bottom (and top) line: There’s no direct correlation between irregularly spaced baby teeth and a smile that needs fixing later.
“Do I need to take my 1-year-old to a dentist? I can’t imagine he’ll ever sit still in the chair.”
Your toddler definitely doesn’t need a full set of chompers to qualify for the dentist’s chair. In fact, the American Academy of Pediatric Dentistry (AAPD) recommends a first dental checkup by the age of 1, and sooner if you suspect there’s a cavity or another problem. But while getting off to an early start with dental care is always a smart idea, realistically, that first checkup may not take place at a dentist’s office. First, because not all dentists—even pediatric dentists—will see 1-year-olds (you may have a hard time locating one in your area who does). Second, while all 1-year-olds need their baby teeth checked, not every 1-year-old needs the specialized care of a dentist just yet. No sign of cavities or other problems? No pressing need to book that first dentist’s appointment. The pediatrician can also perform basic dental exams and is probably already doing this at regular well-child appointments—checking for problems that require a referral to a dentist, and counseling you about keeping your little one’s teeth healthy.
Why is it so important that a dentist or doctor is on tap for tooth duty this early on? Besides getting your toddler into the dental hygiene habit early, professional attention to those tiny teeth can prevent or identify decay (which could lead to premature loss of baby teeth) and diagnose mouth irregularities that may interfere with speech development. The dentist or doctor can also be an excellent backup authority when it comes to convincing your toddler to cooperate with brushing, or to give up the bottle, thumb, or pacifier. Plus, either one can answer the questions you may have on teething, brushing and flossing (you can even ask for a demo), fluoride intake, and all those sucking habits.
Opting out of the dentist for now? Definitely make sure your toddler sees a dentist by his third birthday, if not before (the sooner the going-to-the-dentist habit is established, the better). Most first visits are basic—more like an introductory icebreaker than a full-fledged dental visit. The dentist will count your little one’s pearly whites, examine his jaw, bite, and gums, and do a gentle tooth cleaning.
See the box on the previous page for tips on preparing your toddler for the dentist.
Keeping a baby’s skin baby soft and protected is child’s play (a little after-bath lotion and judicious care in the diaper area and an infant is cuddle-ready). Keeping a toddler’s skin soft and protected, however, can be, well, a little rougher. Toddlers are constantly on the go, indoors and out (meaning more exposure to skin-chafing elements) and they have a knack for getting dirty (both dirt and dirt cleaning can irritate tender skin), giving their skin a tough time. And because the sebaceous glands, which will eventually lubricate and protect the skin, don’t kick in until the hormones start flowing just before puberty, young skin is especially prone to dryness and irritation. To keep your toddler’s skin clean but as soft and touchable as a baby’s, treat it with care. Look for very gentle soaps or cleansers that promise not to irritate your little one’s sensitive skin (hands off your body wash, bubble bath, or soap bars unless they’re super mild). Also avoid antibacterial soaps because they can be unnecessarily irritating (and also aren’t necessary). Use even the gentlest of soaps sparingly, soaping up only as needed (where dirt is most obvious, and around the diaper area). And when it comes to toddler skin care, less is more. There’s no need to smooth on lotions or creams (unless your little one has very dry skin; see page 44).
“My son has always loved his bath, and he isn’t afraid of water at all. So I can’t understand why he’s suddenly refusing to get into the tub.”
As you’ve probably already noticed, refusals of every kind are big in the second year. A toddler may refuse to eat, refuse to wear a coat, refuse to go outside, refuse to come back in—simply for refusal’s sake, without apparent rhyme or reason. The truth is, however, there is a reason—a very good one: his struggle for independence. Here’s how to get your toddler back in the tub—or, at least, help you find other ways to clean up his act:
Bring on the toys. Like the fleet of plastic boats. And the funnels and cups. And the bath books. And colorful soaps. And any other waterproof diversion you can come up with. Let the toys and fun—and not the washing—be the focus of the tub experience. Instead of announcing bath time with, “Time to get in the tub,” announce it with, “Look at all these boats you can play with!” or “Let’s paint tiger stripes on you with this funny soap!”
Schedule a change. If bath time comes at an unexpected hour, rather than at the accustomed battle time, it’s possible that your toddler’s surprise may ease his opposition. Admittedly, a change in schedule may mean that your child won’t be getting clean when he’s his dirtiest (if bath has been switched to mid-morning instead of after dinner, for instance), but in the short run that’s better than not getting clean at all. Until he becomes more amenable to bathing, and bath time can return to a more sensible time slot, a quick session with a washcloth on the more glaringly grimy areas can get him passably clean before he gets into his pajamas.
Try a little togetherness. The rub-a-dub-dub may be more appealing if there’s more than one in the tub. Mommy or daddy make perfect tub buddies (don a bathing suit if you’d rather not bathe in the buff with your toddler). An older sibling or a friend on a playdate makes an ideal bath mate, too (prior parental permission suggested). Or try a washable doll—he can wash his baby while you wash yours.
Hit the showers. If it’s the tub that’s triggering the rebellion, let your toddler accompany you in the shower instead. Adjusting the water-flow rate to gentle will help make the overhead stream less threatening, as may holding your toddler until he feels confident enough to stand under the shower on his own. A rousing round of “It’s raining, it’s pouring” can provide a playful note. As with tub water, shower water should be warm, rather than hot, for toddlers.
Keep it short and sweet. Since you’re still the one in charge, and because your toddler will need to get clean every once in a while (whether he likes it or not), you may just have to pull rank. A quick in and out of the tub or a fast sponge bath may still prompt protests from your bath balker, but if you keep it short and sweet, and move on to another diversion as soon as the deed is done, you’ll end up with a clean toddler no worse for the wear. Keep your cool, too (no taking the bait when your little fish puts up a fight). And remember—this too shall pass.
“Our toddler’s hands get unbelievably dirty during a morning of play. But she won’t let us wash them before she eats.”
No matter what the season, it’s what all the toddlers are wearing: blackened knees, filthy forearms, grimy elbows, sticky faces, and dirt-encrusted fingernails.
But though most of the dirt a toddler attracts during a morning’s play can stay put until her nighttime tubbing, the dirt on her hands should be removed before she eats—particularly since she’ll be using them to feed herself. Making sure her hands are scrubbed before every meal won’t only keep dirt out of her food (and her mouth)—it’ll get her in the healthy, hygienic hand-washing habit.
Easier said than done? Not if you arm yourself with these hand-washing tips:
Put hand washing in her hands. The more control toddlers have over an activity, the less likely they are to resist it. Turn the soap and water over to her, and much of her resistance may go down the drain with the dirt. Don’t make a fuss about the splashy mess she’ll inevitably make—it can be mopped up afterward. Do adjust the water temperature for her, though, to avoid burns. (As a safety precaution, keep your home water heater set below 120°F.) Check her handiwork when she’s finished—if her hands don’t look much cleaner than when she started, have her try again. Or let her wash your hands while you wash hers.
Make hand washing fun. Because a two-second hand wash won’t do the trick (in terms of both dirt and germs), your tot will need a solid 20 seconds of rub-a-dub-dubbing to get clean. Sounds like an eternity (to a toddler)—unless you also make it fun. Sing “Happy Birthday” or the ABC song twice through while washing up, use a kid’s foaming or colorful soap to keep things interesting, or go for naturally scented—coconut or lavender, for instance—to keep things sweet (and don’t forget to ask for a whiff after she’s washed up).
Put hand washing within her reach. One of the most frustrating parts of hand washing for a toddler is the stretch—literally. Providing your toddler with easy access to the bathroom sink (via a steady step stool) and placing accessories (soap and towel) within reach can help her feel more in control of the process.
Switch to liquid soap. Bar soap is not only slippery and difficult for little fingers to lather, but it collects almost as much dirt as your toddler’s hands. So stick with the liquid or foaming kinds of soap.
Wipe it away. When you’re away from home, disposable wipes may be the easiest and most sanitary way of giving hands a quick wash, and even a fairly young toddler can use them. Encourage her to make the wipes as “dirty” as she can, so that more of the grime will come off her.
If you do use antibacterial hand gel when you’re out and about with your toddler (after a trip to the petting zoo, for instance, or after touching the supermarket cart handle), keep in mind that while such gels or rinses do a decent job of sanitizing the hands, they won’t get the dirt off. So use a wipe first to scrub off the grime, and then, if you choose, use a child-safe hand sanitizer (one that’s free of alcohol and strong chemicals).
“My son’s skin always seems so dry. What can I do to protect it?”
Many toddlers go through dry skin spells—and some continue to be a little rough around the edges throughout early childhood. Fortunately, there are ways to replenish the moisture that life-on-the-go can steal from tender skin, softening things up in no time:
Be soap-savvy. If your toddler has very dry, extra-sensitive, or rash-prone skin, choose a cleanser that’s fragrance free or even soapless (like Cetaphil).
Cut back on bath time. Thirty minutes in the tub may seem like a dream for your toddler (so much splashing, so little time!), but too much soaking in water can remove the skin’s natural oils along with the dirt. Limiting baths to 10 minutes will allow enough playtime, without paying the price in dry skin.
Don’t rub-a-dub-dub in (or after) the tub. Be gentle when sudsing up and rinsing your toddler’s skin—no scrubbing with the washcloth. Always pat skin dry instead of rubbing it when your little fish is out of the water.
Moisturize. Top off every bath (while your little one’s skin is still slightly moist) with a generous layer of moisturizer. Reapply as needed, especially when the weather’s really cold or your toddler’s skin is really parched. The best moisturizers for a toddler’s skin contain both water (to replenish moisture) and oil (to seal it in). Extra-sensitive or extra-dry skin will be soothed best by a moisturizer that has few chemical additives and is free of fragrances. Eucerin, Aquaphor, Moisturel, Neutrogena, Cetaphil, Aveeno, and Lubriderm are all top pediatrician and dermatologist picks—though keep in mind the only reaction that matters is your child’s skin. Sometimes, even “baby,” “hypoallergenic,” or “all-natural” products can trigger irritation or a rash—which means it’s time to pull a moisturizer switch (choose one with a different formulation).
Keep those fluids coming. Inadequate fluid intake can lead to dry skin (that moisture comes from the inside out), so make sure your little guy gets his fill. Be especially aware of fluid intake if your toddler has just been weaned and is still working out the kinks of drinking from a cup, if it’s hot out, or if he’s been sick.
Feed healthy fats. Getting enough of the right kinds of fats can lubricate your little one from the inside out, too. Think avocados, canola, flax, and olive oil, almond or cashew butter (if there’s no nut allergy, and spread very thinly). A generally healthy diet also helps promote healthy skin.
Avoid overheating in cold weather. When the mercury dips outside, it’s always tempting to send the mercury rising inside. But dry, overheated air leads to overdry skin, particularly for toddlers. So keep the temperature inside your home comfortable, but not overly warm. Keep your toddler cozy in sweats or sweaters during the day and warm sleepers at night.
“What can I do about my son’s red, chapped cheeks?”
On an average day, a variety of substances (ranging from saliva and mucus to jelly and tomato sauce) manage to find their way onto a toddler’s face, where they’re promptly smeared from cheek to cheek, causing redness and irritation—especially in winter, when skin is already extra dry. Frequent face washings (to remove these substances) often compound the chafing.
If your toddler’s cheeks turn apple red with the first frost and stay that way until the tulips come up, some special attention is needed. To minimize facial chapping:
Gently wipe your child’s face with warm water immediately after meals to remove any traces of food, then pat dry promptly. If you notice that a particular food or beverage is especially irritating to the skin (common offenders are those that are high in acid, such as citrus fruits and juices, strawberries, and tomatoes or tomato sauce), avoid serving it to your toddler until the chafing has cleared.
No rubbing. When washing those chubby cheeks, be extra gentle. And always pat dry. Don’t use scratchy cloths or rough paper towels or napkins.
Avoid using soap on your toddler’s face. When more than water is called for, use a soapless cleanser.
Pat his face dry with a soft cloth whenever he’s been drooling (try to catch him before he wipes the drool all over his cheeks). Gently wipe that snotty nose frequently for the same reason.
Soothe chapped skin with a mild moisturizer. Spreading moisturizer on cheeks, chin, and nose before going out in cold weather may also be protective, especially for a teething toddler who is drooling a lot or a toddler with a runny nose. For tough cases, you may have to opt for an ointment (like Aquaphor), which acts as a barrier while it moisturizes.
“I noticed a red rash inside my toddler’s elbow, and she’s scratching it a lot. Could it be an allergic reaction to something, like soap—or could it be eczema?”
Actually, it could be both. Eczema is the blanket name that technically covers the two most common skin conditions in children: atopic dermatitis and contact dermatitis. While both cause rashes—and either could be triggered by an allergic reaction—atopic dermatitis is often chronic, while contact dermatitis usually comes and goes. Initially, they’re not easy to tell apart (though the doctor may be able to clue you in). Here’s the breakdown on the causes, symptoms, and treatments for both types of eczema:
Atopic dermatitis. When most people (including doctors) talk about “eczema,” this is the condition they’re typically referring to. Most common in children with a history (or family history) of allergies, hay fever, or asthma, eczema has been aptly described as “an itch that rashes.” Once the itch begins, scratching or rubbing the area triggers the rash. In a toddler, the rash usually consists of red small bumps that often weep (or ooze) and crust over when scratched. The rash usually starts on the face and cheeks, spreading to the trunk of the body, the wrists, and body folds (inside groin and elbow creases). This type of eczema is often (though not always) outgrown by age 2 to 3.
What triggers the itch? For most kids, it could be any of the following triggers: dry skin, heat or cold exposure, perspiration, wool and/or synthetic clothing, friction, soaps, detergents, and fabric softeners (though these could trigger contact dermatitis as well; see the next column). Eating certain foods (most often eggs, milk, wheat, peanuts, soy, fish, and shellfish) can also cause a reaction.
Treatment usually includes topical steroid (hydrocortisone) creams or ointments for inflammation and oral antihistamines for itching (especially to help a child sleep). The pediatrician will prescribe or recommend the medication that’s right for your toddler. On the home front, it’s important to:
Clip your toddler’s nails to prevent scratching.
Limit baths to no more than 10 to 15 minutes, and use an extra-mild or soapless cleanser (Dove or Cetaphil, for example) only as needed.
Limit dips in chlorinated pools and salt water (fresh water is okay).
Apply plenty of rich hypoallergenic moisturizer after baths, when the skin is damp.
Minimize exposure to extremes in temperature, indoors and out.
Use a humidifier as needed to prevent dry air indoors (but don’t overdo the humidity, since too much moisture in the air promotes the growth of mold and mildew, common allergy and asthma triggers).
Dress your child in cotton (rather than wool or synthetics), and avoid scratchy, potentially irritating clothing.
Contact dermatitis. A contact dermatitis rash occurs when skin repeatedly comes in contact with an irritating substance (such as citrus, bubble bath, soaps, detergents, foods, medicines, even a toddler’s own saliva or urine—as with diaper rash). The rash, which appears as mild redness and/or small bumps (sometimes with accompanying swelling), is often more localized than atopic dermatitis and usually clears when the irritant is removed (if it doesn’t, you may have a case of atopic dermatitis on your hands) and the rash is treated with hydrocortisone creams or ointments. The rash can also crop up when skin comes in contact with an allergen (like nickel jewelry or snaps on clothes, dyes in clothes, plants like poison ivy, or some medications).
“Our toddler’s skin seems so rash prone. Just when his diaper rash seems under control, another rash pops up somewhere else. How can I tell one rash from another and what can I do about them?”
Rashes come and go on toddler skin, but in some toddlers, they seem to come more than they go. Most of the time, a dry patch or a crop of elevated bumps on your tot’s skin is nothing more than annoying (especially if it’s ruining your toddler’s close-ups), and sometimes it’s just a reaction to a fragrance or another chemical in a soap or shampoo. But once in a while it’s an indication of a skin condition that needs some attention. If your toddler’s skin is scaly, itchy, blistered, or oozing, check with the doctor to find out what is causing it and how to treat it. The most common skin rashes in toddlers include:
Ringworm (a.k.a. tinea). This mildly contagious fungal infection (don’t worry, no worms are actually involved) shows up as round, red, raised, itchy, and scaly patches that can be as small as a dime or can grow up to an inch or more in diameter. Ringworm can be spread by direct person-to-person contact (one toddler who’s been scratching touches another—and bingo) or by sharing towels, brushes and combs, clothes, and anything else that touches skin, as well as through surfaces in warm moist areas (like swimming pools). Your little one can also catch ringworm from a pet (clues that your pet has ringworm and needs treatment: scaly, hairless patches, lots of scratching). Ringworm can turn up anywhere on the body, including the face and scalp (where it can be mistakenly identified as a stubborn case of cradle cap) and can be spread from one part of the body to another by scratching. Since it can be confused with other types of rashes, including eczema and seborrhea, proper diagnosis is key. Ringworm on the body can be easily treated with an antifungal cream, but on the scalp it may require an oral antifungal medication, as well as an antifungal shampoo.
Sun may be fun—and it sure beats rain or snow when you’ve got to head outside—but it’s no picnic for the skin. The sun’s ultraviolet A (UVA) rays cause tanning, aging of the skin, and skin cancer, and the ultraviolet B (UVB) rays cause sunburn and skin cancer. That’s why all children (even dark-skinned children) need protection from the sun, and those who are most vulnerable to sun damage (children with red or blonde hair and fair skin, those with blue, green, or gray eyes, those with a family history of skin cancer, those with a large number of moles, and those with freckles) need even more. Research shows that serious sunburns during childhood are a more significant factor in the development of adult malignant melanoma (the most serious form of skin cancer) than total lifetime exposure to the sun. To prevent sun damage, take these precautions whenever your toddler steps outside:
Be sunscreen-savvy. When shopping for a sunscreen, start by targeting those that are:
Labeled “broad-spectrum.” This means that a product will screen out both ultraviolet B (UVB) and ultraviolet A (UVA) rays.
Easy to apply. Creamy products are less drying and stay on the skin longer. But sprays are usually easier to apply—and since a sunscreen can only be effective for your toddler if you manage to get it on him or her, ease of application is a prime consideration.
Nonirritating. Sunscreens designed for kids usually have more appealing packaging and easier application, but they’re not necessarily gentler or less likely to trigger a reaction on tender skin. So it’s always a good idea to test your little one for sensitivity to a sunscreen product you’re applying for the first time—before you hit the playground or beach. Do this with a patch test: Spread or spray a thin layer on a small patch of your toddler’s skin. If redness or a rash develops, head back to the store and choose a product with different ingredients.
Sporting a high SPF (sun protection factor). The SPF tells you just how much protection a sunscreen product offers. Choose an SPF of at least 30, which theoretically (as long as the sunscreen is applied properly and then reapplied after several hours) allows a user to remain in the sun 30 times longer before burning than would be possible without protection. But since you have no way of knowing exactly how long it takes your little one to burn, or how intense the sun is on a particular day, it’s best to be on the safe side. More is more when you’re choosing an SPF, so when in doubt, go higher on the SPF scale. Of course, even slathered with sunscreen, an hour or so at a stretch in direct, hot sun is long enough for most toddlers (you definitely don’t want to stretch that SPF to its potential protective limits). And don’t assume you can safely wait for your toddler’s cheeks to start showing some color before you bring him or her under cover. Pinking of the skin is not generally apparent in the sun. In fact, most sunburns don’t reach their peak color until 6 to 24 hours after sun exposure.
Slather up. Sunscreen is a must-wear whenever your toddler is headed outside. Make applying it as routine as getting dressed and as non-negotiable as sitting in the car seat and you’re less likely to face sunscreen resistance in the future.
If it’s possible, apply the sunscreen 15 to 30 minutes before going out into the sun, since it takes that long to be thoroughly absorbed into the skin. If you can’t manage that, applying it right before going out—or even once you’re out—is far better than not applying it at all. Spread the sunscreen generously (err on the side of excess—most people apply far too little) and be careful not to miss any exposed skin—including the back of the neck, the ears, and the feet, three areas often overlooked. When applying to the face, be careful not to get the sunscreen into your toddler’s eyes. Since wind and water both thin out protection, reapply every 1 to 2 hours or so if it’s windy, if your toddler is sweating a lot, or if he or she has been splashing in a pool or running under a sprinkler. You can reapply it less often—every 2 to 3 hours or so—if you’re using a waterproof product (read the label for recommendations). But keep in mind that even a waterproof sunscreen can be rubbed off by a lot of towel drying and will need to be reapplied more often under such conditions.
Lips need sun protection, too. Make applying a children’s sunscreen lip balm (which should be lickproof) before going out in the sun as routine as applying sunscreen. It will also shield your toddler’s lips from wind and cold in the winter, reducing chapping.
Protect year-round. Sunburn’s usually associated with summer, but the sun can also burn in the winter—especially when there’s snow on the ground. In fact, the sun’s rays reflected on the snow can be as intense as those from summer sun. And, although less of the burning UVB reaches the earth in winter, the also-harmful UVA rays remain constant year-round, no matter what the weather. Don’t skip the sunscreen when it’s hazy out, either, especially if you’re at the beach. Much of the sun’s ultraviolet light, especially UVA, can penetrate cloud cover.
Schedule outdoor time wisely. When practical, try to limit your child’s exposure to the sun—even when he or she is properly protected—during the hours when its rays are at their most intense, between 10 A.M. and 3 P.M. (4 P.M. during the summer months), or when your shadow is shorter than you are.
Play in the shade. Look for playgrounds that are well shaded, and set up play areas in your own yard, if possible, that are in shade all or part of the day.
Beware of glare. On the beach, a beach umbrella can shield you and your toddler from the sun’s rays. A beach tent can provide even more protection. But don’t stop there. Sunscreen is still a must to help protect skin from the reflected glare of sun on sand. Be mindful, too, of the sun’s reflection on snow, concrete, and water (the toddler who’s splashing in the pool is more vulnerable to sunburn than the one who’s playing beside it).
Cover up. When your toddler is out and about during the hours when the sun is most intense, keep the rays at bay with a stroller canopy or umbrella, a wide-brimmed hat, as much clothing coverage as is comfortable, shoes and socks (bare feet burn quickly), and sunscreen on exposed parts of the body. Keep in mind, however, that the sun’s ultraviolet rays can penetrate sheer and lightly woven, light-colored fabrics. The typical T-shirt has an SPF of only 7 or 8, which means that toddlers (darker-skinned children included) may need a layer of sunscreen under their thin tees when they are going to spend extended time outdoors. To test a fabric, hold it up to a light; the less light that shows through, the better protection from the sun. If your child takes a medication or has a condition that makes exposure to the sun particularly risky, consider special sun-protective clothes.
Diaper rash. Stating the obvious, diaper rash is a rash or irritation anywhere in the diaper area. See page 58 for more.
Impetigo. Impetigo is a bacterial infection of the skin that occurs when bacteria, such as streptococci or staphylococci, enter the skin through a break, such as a scratch, bite, or irritation. It can also affect eczema-damaged skin. Either blisters or honeycomb-like crusts form, then weep and ooze yellowish fluid. Impetigo can spread quickly to other areas of the skin, making medical treatment necessary in many cases (topical antibiotics and gentle washing for very mild cases or oral antibiotics for a rash that is more widespread)—the doctor will determine which medication is needed after examining the rash. Keeping skin wounds clean with soap and water, and then applying an antibiotic ointment, prevents impetigo.
Prickly heat. Known mainly as heat rash on the sandbox circuit, prickly heat occurs most commonly in babies, but toddlers, children, and even adults can develop the rash as well. Prickly heat, which results when sweat glands clog up, looks like tiny pink pimples on a reddened area of skin that may blister and then dry up. The rash occurs most often around the neck and shoulders, but it can also appear on the back and face, or anywhere skin rubs against skin or clothing constricts. Since the rash is caused by overheating or overdressing, be sure not to overdress your toddler, and keep indoor spaces comfortably cool.
“I know I’m supposed to put sunscreen on my toddler, but that is way easier said than done. She fights it every time.”
Toddlers, as you’ve definitely noticed, fight a whole lot of things that are good for them (say, vegetables)—and even some things that are essential for them (among them car seats, doctor visits, and sunscreen). As always, your best plan of action is distraction. When it’s time to slather up, break out a favorite toy for your toddler to clutch or break into a silly (just-for-sunscreen) song. Try some fast talk, too (“Let’s get this sunscreen on fast so we can go play in the playground!”), lots of good humor, and a positive, upbeat attitude (approach looking for a battle and you’re bound to get one). Being a model of sunscreen smarts will also help (apply your sunscreen, then apply your toddler’s). As your toddler’s comprehension grows, so can an explanation (“Sunscreen keeps the sun from burning our skin”). Most of all, make sunscreen (just like the car seat and the doctor visits) a non-negotiable issue—no sunscreen, no go. The more wiggle room you give now (you skip it because you’re running late, or because she’s having a tantrum), the more struggles you’ll get in the future.
For telling clues to a toddler’s daily activities, look no further than the fingernails. There you’ll find, among other things, mud (from the morning spent digging at the park), play clay (from that playdate), glue (from that collage project), remnants of breakfast, lunch, and dinner, and often, even less savory substances.
Unless you protect them with gloves (good luck with that plan), there’s no way you can keep your toddler’s fingernails clean all the time. But since dirty fingernails can harbor germs along with all the collected grime, you should try to:
Keep them short. The shorter the fingernails, the less they can collect. Short is also best for toenails, which left to grow ungroomed, can curl under and become ingrown. See below for clipping tips.
Clean them daily. Make nail cleaning part of the regular end-of-the-day routine. Regular hand washing usually does the trick, but if it doesn’t, help your child to use a small nail brush in the tub or when washing hands before bedtime. Carefully remove particularly stubborn stuff with a rounded wooden toothpick.
“My toddler’s fingernails and toenails get very long and dirty. But she won’t let me trim them.”
Try to see nail trimming from your toddler’s perspective and you’ll see why she fights it tooth and... nail. First, having parts of her pared off by a clipper or a pair of scissors (even when they’re wielded by a friendly parent) is unsettling. A young toddler isn’t likely to understand (or remember) that nails don’t hurt when they’re cut or that they grow back afterward. Second, the process, for safety’s sake, requires restraint—something she doesn’t like to show, never mind have imposed on her. Not only must she sit still (that most dreaded pose), but she must have her hand and fingers held captive—and motionless—by an adult hand. And third, what’s in it for her?
Still, nails need trimming. Long nails can harbor dirt (gross) and germs (double gross) even when hands are clean. What’s more, a long, sharp nail can cause harm (intentionally or accidentally) through a scratch, pinch, or barefooted kick—and if your little one has an itchy skin rash, like eczema, having the nail power to scratch it can also make the rash worse. Though nail trimming may continue to be a hotly disputed issue for many years to come (until it’s replaced by nail nibbling or cuticle picking), these tips may trim some of the resistance—or at least help get the job done:
Use a blunt instrument. Baby scissors, with their blunt safety tips, or small nail clippers, are good for trimming a toddler’s nails. Don’t trade these in for pointed nail scissors, at least until your child’s old enough to be counted on to hold still.
Turn the scissors on yourself first. Make a point of trimming your own nails (as well as those of other willing family members) in front of your toddler. Make it look like fun and it’s possible she’ll want to be next in line for a trim.
Perform when wet. Warm water soothes toddlers and softens nails, both of which may make nail trimming less of a trial—so try scheduling your toddler’s next manicure when she’s fresh out of the tub. (Don’t try trimming in the water—she’ll be too slippery.)
Play a game. A made-for-nail-trimming version of “This Little Piggy” may be distracting and help replace screams with giggles. Or tell her a story about the “mommy, daddy, and baby” fingers of her hand family while you work (“Baby piggy is going to a party and she wants to look pretty!”).
Thinking about tackling that nail trim when your toddler’s sleeping? While chances are she’ll be far more cooperative when she’s snoozing than when she’s awake, such sneaky attacks can sometimes backfire—say, if she wakes up mid-trim, especially if she jerks her hand away at the critical moment (leading to an inadvertent nick). If your little one is a rock-solid sleeper (once she’s out, she’s out), you can give it a try. But if your toddler—like many toddlers—is a restless sleeper, you may not want to try this time-honored trick at home.
Keep in mind that nibbling a young child’s nails off with your teeth is not a good idea. Not only could your nibbles tear the cuticles, but you’ll be teaching your toddler that nail-biting is an acceptable habit.
Is your toddler on his or her feet, or soon to be? Either way, it’s a sure bet that those tiny tootsies will get quite a workout in the months and years to come. Compared to other parts of your little one’s body, though, feet don’t need much in the way of care—in fact, less, for the most part, is more. Aside from outfitting them in the right socks and shoes, washing them off every now and again, and entertaining them in the occasional game of “Stinky Feet” or “This Little Piggy,” your only job as far as your toddler’s feet are concerned will be trying to keep track of where they take your toddler (and trying to keep up with them).
“Sometimes my toddler likes to walk on her tiptoes. And when she does walk flat on her feet, they look, well, like flat feet. Is all of that normal?”
As your toddler grows, changes in those chubby little legs, knees, and feet can keep you on your toes. Among the normal but sometimes peculiar-looking stances you may see your toddler taking are the following:
Toeing-out. Does your toddler walk like a duck, with those piggies pointing out? For new walkers, waddling is normal—and even necessary, allowing them to improve their balance and staying-up power. Gradually, toes will start to straighten out, and by the time most kids are 5 or 6, their feet face forward. A few kids will continue to toe-out, but that’s not usually a problem.
Most toddlers toe-out in the second year, but some walk with their toes in (see above).
Toeing-in (pigeon toes). Is your toddler less duck, more pigeon? Toeing-in early in the second year is usually related to a slight twisting of the tibia (or shin bone), which generally straightens out on its own. But even if it continues into adulthood—as it does in a small percentage of children—it’s not considered a problem unless it’s extreme. Wouldn’t mind a little extra reassurance? Point out the toeing-in at your toddler’s next checkup.
Bowlegs. Just about every baby and toddler has a major gap between the knees, though the size of the gap varies (it’s definitely going to be more visible in a slimmer tot than a chunkier one). That’s because their tibias—the shin bones—are still curved, a leftover reflection of how they spent uterine time: folded up. New walkers also tend to bend their knees to help keep their balance, another reason why their legs appear bowed. With growth, more weight-bearing, more walking, and more steadiness on two feet—usually by the time they toddle into their second birthday party—your toddler’s legs will straighten up. Bowing disappears, typically followed by mild knock-knees, which often last for a lifetime (it’s just more subtle in grown-up legs). In the meantime, make sure your toddler is getting enough vitamin D from milk or from a supplement, since a D deficiency can lead to rickets and permanent bowing. If bowing appears to be worsening after independent walking begins, show the pediatrician so he or she can rule out rickets or a knee problem.
Not to worry—a toddler’s legs are normally bowed until sometime late in the second year.
Flat feet. Toddler feet are flat feet—or at least, feet that appear flat. One reason: Those tiny feet have bones and joints that are still very flexible, and muscles that are still very underdeveloped. A toddler’s own weight pushes the loose joints and the weak muscles toward the ground, making that arch (what arch?) disappear. Toeing-out, which most toddlers do so they can balance better as they walk, puts extra weight on the arch, flattening it still more. Yet another factor is the baby-fat pad that rounds the toddler foot, camouflaging any curve that might be there. By the time your child marches off to first grade, she is likely to be the proud owner of two well-defined arches. And if for some reason flat-footedness prevails, that’s nothing to worry about, either.
Toe walking. Many toddlers—and not just for those destined for The Nutcracker—enjoy toe walking. To a novice walker, tiptoeing is an adventure, a brand-new perspective—and a rest for the rest of the foot. But tots don’t stay on their toes forever. Most give up the toe step entirely and switch over to heel first about midway through the second year. If your little one always walks on her toes, though, and/or continues to toe walk well into the second or third year, mention it to the doctor.
Occasional toe walking isn’t cause for concern.
“What are the best shoes for my toddler now that he’s on his feet so much?”
The best shoes for a little walker are no shoes at all. But there comes a time and a place in every toddler’s life when bare feet or socks won’t cut it—like in a busy store (where tiny toes can be stepped on) or the playground (where tiny feet can step into something yucky—or worse, onto something that hurts). The next best thing to no shoes (or slip-proof socks) are shoes that are as close to bare feet as possible. Look for:
Just-right fit. Your toddler’s feet fit him just right—and so should his shoes. Too big and your toddler may slip, slide, and even trip in them. Too small and they’ll pinch and restrict. (See the box on the facing page for shoe-fitting tips).
Lightweight. Toddlers have a hard enough time putting one bare foot in front of another. The weight of a heavy shoe can make this tricky new skill even more challenging. So think lightweight: canvas or soft leather.
Breathable uppers. Walking is a workout for tots. Uppers of plastic or imitation leather keep feet from breathing and trap perspiration. Yet another good reason to choose shoes made from natural, lightweight materials that let air in and moisture out.
Trying shoes on a squirming toddler can be a trying experience. But getting the right fit will get your toddler off on the right foot. Here’s how:
Start with the right socks. Try shoes on with the same kind of socks your toddler typically wears—and make sure they’re the right ones for a new walker. Stretch socks with some cushioning are best, but make sure they fit without restricting the foot, and that they don’t bunch up or wrinkle. When socks start leaving marks on the feet, it’s time to move up to the next sock size.
Fit both feet. Feet can differ in size. Just because the right shoe fits right, doesn’t mean the left will. So be sure both feet get measured, and both shoes get tried on.
Don’t fit while your toddler sits. Shoes should be fitted while your toddler is standing with his or her weight on both feet. When checking fit, make sure those tiny toes aren’t curled up—a very common habit in little tykes, particularly those who aren’t used to wearing shoes. Rubbing your hand along your toddler’s calf will help relax leg muscles and uncurl toes.
Check the width. Pinch the side of the shoe at its widest point. If you can grasp a tiny bit of it between your fingers, the width is just right. If you can pinch a good piece of shoe, it’s too wide—and if you can’t pinch any, it’s too narrow. Another sign of a too narrow shoe: You can feel the little toe or the outside bone of the foot when you run your finger along the side of the shoe.
Check the length. Press your thumb down just beyond the tip of the big (or longest) toe. If there’s a thumb’s width (about half an inch) of room, the length is right. Press down, too, to make sure the toe box has enough height so that toes can be curled and wriggled comfortably.
Check the heel fit. Slide your pinky finger between your toddler’s heel and the back of the shoe. It should fit snugly. If you can’t slip your finger in at all, or if it’s a tight squeeze, the shoe is too small. If you can move your pinky around freely—or if there are gaps around the ankle—the shoe is too large.
Try before you buy. The best way to tell whether the shoe fits is to see it in action. If your tot’s not walking yet, help him or her take a few assisted steps. Be sure toes don’t drag and heels don’t slide up and down with each step.
Be sure you don’t see red. Before you take the shoes to the register, see if they’ve left any red marks on your toddler’s feet. If so, the shoes don’t fit.
Don’t buy ahead. Considering how fast toddlers outgrow shoes, there’s always the impulse to buy shoes “with room to grow.” But extra-large shoes, like too small ones, can lead to irritation and blisters, cause unnecessary tumbles, and make walking even more challenging for a newbie.
Use your thumb to check for the right fit.
Flexible soles. Feet are flexible, and shoes should be, too. You should be able to bend the toe of the shoe up (about 40 degrees) easily.
Nonslip soles. This time, let your tires be your guide... seriously. A good tire has good traction to keep a car on the road. Likewise, a good shoe has good traction to keep your toddler on his feet. Nonskid rubber soles, equipped with grooves, will keep your toddler from slipping as he walks and won’t be so ground-gripping that it’ll be hard for him to lift his feet. When only a dress shoe will do (the kind that has smooth soles), rough the bottoms up with sandpaper or on pavement to improve traction before your toddler toddles off.
Firm, padded heel backs. The backs (or counters) of the shoes should offer firm support—but should also be padded, to prevent rubbing.
No heels. Tempted by heels designed for fashion-forward tots (and their parents)? Resist. Even a slightly raised heel can throw a toddler’s posture and balance out of kilter.
Long enough laces. Make sure any laces are long enough to double knot. And then keep them double knotted—otherwise, there’s a good chance your toddling tot will trip over undone laces. Velcro is an easy-on option, but keep in mind that it’s also easy-off (once your toddler figures out how to undo it, there won’t be any keeping shoes on him—and that’s not even factoring in the headache you’ll get from the sound of ripping Velcro). Or one-two buckle those shoes.
Reasonable price. Shoes should be built to take it, but they don’t have to be built to last forever. After all, your toddler will be growing out of them every three months or so. Buying two pairs at a time makes sense, though, since little feet sweat a lot—and switching off will give the shoes a chance to dry out between wearings.
Vaginas do a pretty good job of taking care of themselves, but your toddler’s will definitely need some help staying healthy. Keeping the vaginal area clean, dry, and irritant-free helps fend off infection. Here’s how:
Change diapers as soon as possible after they become wet or soiled.
Always wipe your daughter front to back when changing her diaper. Point this out to her, too—so when the time comes for her to tend to this herself, she’ll already be familiar with this essential hygiene habit.
When changing a soft poopy diaper, check around the labia and gently wipe away any stool that may have collected in the crevices. No need to dig around if the area is clean or if you’re changing a wet diaper.
Once she’s out of diapers, dress your toddler only in all-cotton underpants to minimize perspiration and maximize ventilation in the area.
Avoid bubble baths, bath oils, perfumes, harsh soaps, and diaper wipes that contain alcohol and/or perfumes, any of which may trigger an allergic reaction or irritate or “burn” the vagina. After the bath, it’s time for a fresh-water rinse (the water she’s been soaking in is a dirt-and-soap cocktail). Rinse her vaginal area with a handheld shower spray, a cup, or a dripping washcloth—and then take her out of the tub so she doesn’t sit down again in the dirty water.
Shampoo your little girl at bath’s end so that she won’t be sitting in potentially irritating shampoo suds. Have her stand as the water drains, and rinse her hair with a hand-held showerhead or a cup.
If you notice your toddler’s vaginal area looking red, or if she seems to be in pain after she pees, it could be a sign of vaginitis—essentially a fancy word for an inflammation of the vagina and/or the vulva. Such inflammation is usually caused by irritation (from bath water, wet diapers, harsh laundry detergents or soap, poor hygiene, and so on). You can treat the irritation with diaper-rash cream or ointment and by making sure to keep the area as dry as possible. The tips above will help prevent a recurrence. If you suspect a urinary tract infection (signs include fever and/or stinging while she’s peeing—not after), see page 391.
Even though there’s extra equipment, a boy’s genitals are far easier to care for than a girl’s (boys don’t have folds and hidden creases like girls do). Here’s how:
The circumcised penis. Routine washing with soap and water is the only care a circumcised penis requires.
The uncircumcised penis. No special care is required for the uncircumcised penis, either. Since a toddler’s foreskin doesn’t usually retract easily, don’t try to pull it back. It isn’t necessary to clean under it yet anyway. You also don’t have to worry about that cheesy-looking material under the foreskin—this is the normal residue of cells that shed as the foreskin and glans begin to separate. These cells gradually work their way out on their own, via the tip of the foreskin, and continue to be shed throughout life. And keep in mind that any adhesion (tissue that keeps the foreskin attached to the penis shaft) will likely loosen by the time your son is 5 years old.
There are a couple of genital-related issues to watch out for in your little boy. First, an undescended testicle, in which one testicle (or less commonly both) has not descended into the scrotum (in other words, it can’t be felt in his scrotum) by his first birthday. In this case, it’s unlikely it’ll come down on its own, so surgery (often laparoscopic) to move the testicle into the scrotum is usually done before he’s 15 months old. A retractile testicle (one that comes down into the scrotum occasionally, only to pull back again when exposed to cold temperatures or other stimulation) usually settles permanently into the scrotum closer to puberty, without any treatment.
Another problem to be on the lookout for is urinary flow that’s impeded (you’d notice a narrow or dribbly urinary stream and difficulty urinating). This can be caused by a blockage or a narrowing anywhere from the bladder to the opening of the penis, or meatus (this condition is called meatal stenosis). Let the doctor know about any urination issue—he or she will probably want to evaluate your son’s stream by watching him pee. Urine should come out in a good strong stream (it should look like it could put out a fire). If it doesn’t ever look that way when your little boy pees, it’s important to find out why.
They’re cute and sweet as can be—but the same can’t be said for what comes out of them. Consequently, toddler bottoms need some cleaning and care to keep them fresh, soft, kissable—and free of nasty diaper rashes. To accomplish this—as well as to treat a simple diaper rash—reduce moisture and exposure to poop (both of which can irritate tender bottoms). Here’s the bottom line on bottom care:
Change your child’s diaper as soon as you know it is wet.
Always pat the bottom dry completely after wiping it and before applying diaper cream or ointment.
Allow your toddler to wander about the house bare-bottomed when possible and practical—a little air time can help prevent or clear up diaper rash.
Perfumes and alcohols in soaps, scented baby wipes, and other products that come in contact with your toddler’s nether region can irritate his or her skin. Opt for a water-only approach or choose alcohol-free, unscented products if your little one seems particularly prone to rashes.
Sometimes superabsorbent disposables are so efficient at trapping moisture they lead to more rashes. Try experimenting with different types of disposables to see if that helps prevent diaper rashes.
For diaper rashes that don’t clear up after a few days, medication may become necessary, so be sure to put in a call to the pediatrician. For seborrheic dermatitis (a deep red rash with yellow scales) and intertrigo (a reddened area where skin touches skin that may ooze white to yellowish gunk), a steroid cream may be necessary; for impetigo (large blisters or crusts that weep, then ooze yellowish fluid, and then crust over), oral antibiotics; and for candida (a fungal or yeast infection that turns the skin bright red and sometimes crops up after a course of antibiotics), a topical antifungal cream or ointment.
“Now that my son has some teeth, I expected he’d be able to chew up what he eats. But I’m still finding whole pieces of food in his poop.”
The contents of your toddler’s diaper will continue keeping you guessing for some time to come (is that really a blueberry?). That’s because those much-celebrated first few teeth are pretty useless when it comes to chewing. Biting (and looking adorable) is more their business. Until a full set of molars (top and bottom) comes in, a toddler chews with his gums, which means that food doesn’t get much of a grinding before it’s swallowed. And since a toddler’s digestive system is relatively short, what’s swallowed passes fairly rapidly through the digestive tract. So it’s not surprising that some mouthfuls exit looking more or less the same as when they entered—blueberry in, blueberry out. Among the other interesting tidbits you may spy in your child’s stool: whole green peas, small chunks of cooked carrot, deep-red slivers of tomato skin, and golden kernels of corn.
As your petite gourmet accumulates a mouthful of molars, he’ll be able to chew what he bites off. And as his gastrointestinal transit time slows down, his meals will be more thoroughly digested and his bowel movements less telling (they’ll be brown and boring no matter what he eats). In the meantime, be sure that the food you serve is soft enough to be gummed easily (test a new food by trying to mash it in your mouth without using your teeth) and that it’s been cut in very small pieces (the smaller the food particles start out, the smaller they end up). If your child, like many toddlers, doesn’t seem to bother much with gumming, and prefers the shovel-and-gulp method of eating instead, try encouraging him to chew before he swallows. Take a bite when he does and show him how it’s done (“See, I’m mushing up the food in my mouth. Can you do that?”).
“My toddler won’t hold still for diaper changes—she fights me the whole time.”
Ah, the battle of the bottom. You fight to clean and cover it—she fights to keep you from doing either. She has no patience for lying still, you have no patience for the kicking and rolling around that makes every diaper change a squirming skirmish. Yet, when it’s time for a change, it’s time for a change. Here’s how to quell the diaper revolt:
Check for sore spots. Maybe your little rebel has a diaper rash that hurts when you clean her—so she resists your advances. And maybe her sore bottom feels better when she’s bare—so she tries every tactic to stay stripped down. If you think this might be the case with your little one, a little treatment (and a gentle touch) may help. See the facing page.
Come to the table prepared. If you have everything—wipes, ointments, and diapers—at the ready before you scoop her up, diapering can be accomplished 1-2-3, giving her less time to realize what’s happening and less time to rebel.
Create a diversion. Pull out a special stash of playthings reserved for diaper changes—the more diverting, the better. Sure, the board book that makes animal sounds drives you to distraction (and drove you to hide it from your toddler last week), but those shrill moos and oinks may distract her, too—long enough so you can get her diaper on without a fight. Ditto a CD of sing-along songs, a talking stuffed animal, a play cell phone, even the keys you’re always trying to keep out of her hands. Or divert with a game of “show me your belly... show me your nose...,” punctuated by some belly raspberries and loud toe kisses. Or appoint your toddler the “diaper helper” and have her hand you supplies (with tops on) as you need them. A little humor can go a long way, too—drape the clean diaper over your head, or pretend to put it on yourself... or the dog.
Move the offensive. If the changing table has turned into a battlefield, maybe it’s time to retreat to neutral territory. Protected by a towel or waterproof pad, almost any flat surface can be used for diapering. Try the living room floor, a large beanbag chair, the crib, your bed, the bath mat.
Attack vertically. Once a child is toddling on two feet, it’s an affront to be forced onto her back. So you may face less rebellion if you diaper her where she stands—as long as she’s standing on a washable surface, of course (don’t try this on an unprotected sofa or carpet). Approach the behind from behind. And make sure those diversions are close by as you close in.
Skip the element of surprise. Toddlers don’t like surprises. So give a heads-up that it’s time for a clean bottom. If your toddler is in the middle of an activity, try to wait until she’s finished, or take the toy along to the changing table. And try to keep the mood upbeat. You’re less likely to face a fight if you don’t anticipate one.
Try a change of command. If mommy with a diaper signals a struggle to your toddler, it may be time to call up some new troops. Put daddy on diaper duty, or recruit anyone else who’s willing and able.
Take control. If none of the above seem to work, hold your toddler down (or better still, have an ally restrain those swinging feet) and get the job done as quickly as possible. Be matter-of-fact and friendly as you pull your diaper coup—yelling or threatening will only add fuel to your toddler’s fury. Remember, it’s easier for your tot to fight when someone’s fighting back.
“My son has found a fun game: pulling off his dirty diaper and playing with its contents. Needless to say, I’m not enjoying the game.”
Toddlers will play with (and sometimes put in their mouths) just about anything they can get their hands on. And if it’s squishy, squeezable, spreadable, and forbidden—all the better. Now that your toddler has discovered the delights of diaper-dumping and poop art, it won’t be easy to keep his hands out of his stash. Until he loses interest in this pastime (which can take a few days to a few months), you can minimize the problem by:
Limiting access. Your toddler can’t get his hands on his feces if he can’t get his hands in his diapers. So secure his diaper tightly (but not so tight that it leaves red marks) and dress him in clothes that limit access, such as overalls, clothes that button at the crotch (instead of snap), pants that are buttoned and difficult to remove, or one-piece outfits. If you get really desperate, put his diaper on backward so it’s harder for him to take off, or use packing or duct tape to secure the diaper.
Heading him off. Many toddlers keep to a fairly predictable bowel-movement pattern (one moves his bowels after each meal, another just once a day after breakfast, another always wakes up with a mess in his diaper, and so on). If you’ve figured out your toddler’s pooping pattern, try catching him in the act (or immediately after) as often as possible. That way you can get to his diaper before he does.
Providing a substitute. Squishing, squeezing, and spreading are irresistible tactile experiences for toddlers. Supply your toddler with plenty of alternative opportunities for that kind of play, and he may not feel as compelled to look for them in his diaper. Give him squishy, squeezy toys (make sure they’re age-appropriate and safe), and opportunities for finger painting, sand play (especially satisfying when water is mixed with the sand), and playing with Play-Doh. (Most of these activities will require careful adult supervision.)
Remaining unfazed. Chances are excellent that, in spite of all your efforts to discourage or distract, your toddler will still find the will and a way to pursue his diaper probing. And chances are even better that the more attention (either negative or positive) you pay to his dirty little game, the more eager he’ll be to keep playing it. So keep both the smiles and the scowls off your face, and don’t make a stink about the stink (disparaging his bowel movements may lead to future potty problems). Instead, calmly but firmly make it perfectly clear that the behavior is unacceptable (“Don’t touch the poop. It’s dirty”).
Telling him where to put it. Teachable moments are everywhere when you have a toddler—even on those poop-smeared hands. While his feces fascination isn’t a sign that he’s ready to start using the potty, it is an ideal opportunity to introduce the toilet to your toddler—and to show him where poop ultimately belongs. Take him into the bathroom, empty what remains of the contents of his diaper into the toilet, and explain, “Poop goes in the potty.” You can even let him flush, if he seems interested, and if the noise doesn’t frighten him. Then finish the cleanup in the bathroom—including, of course, a thorough hand washing (along with another reminder: “We always wash our hands when we touch poop, because poop is dirty”).
Offer a snack if he goes for a sample. Did your toddler go in for a lick? Again, don’t freak. Matter-of-factly say, “Poop isn’t for eating. Food is for eating. Let’s clean up and then have a snack.”
When is the right time for toddlers to ditch those diapers and take a seat on the potty? Actually, there is no right time. Like all developmental achievements, children pick up potty skills at their own speed, and when it happens has no correlation with other areas of development (like walking, talking, or teething). On average, most toddlers master toileting between the ages of 2 and 3½. The average for girls is 35 months, the average for boys is 39 months, with peeing usually ahead of pooping for both genders.
Studies show that there’s no inherent advantage to starting toilet learning early. In fact, it typically takes longer to completely train an under-2-year-old than to wait until the beginning of the third year to get the potty party started. That said, there’s no reason to postpone the potty program if your toddler seems eager and ready to roll—and in fact, there’s no better reason to get started. Since cooperation is key in toilet training (this is definitely one agenda you can’t force), you’re bound to get better results when your little one’s on board, both developmentally and emotionally. Most toddlers show signs of readiness between 20 and 30 months, though some children will hop on board earlier and others later.
In other unscientific words (because potty training definitely isn’t a precise science), kids are ready when they’re ready. That’s why it’s important to let your child set the potty pace—if the timing isn’t right, even the best toilet-training tactics won’t get the job done.
Here are some signs of potty readiness:
You’re changing fewer wet diapers. Until the age of about 20 months, kids pee so frequently that expecting them to control their bladders is probably unrealistic. But a toddler who stays dry for an hour or two at a stretch—and occasionally awakes without wetness—may be physically ready to take the next step.
Your toddler starts giving a BM blow-by-blow. Some children happily announce when a bowel movement is about to make an exit (“Me poop!”). Others communicate through less verbal means—by retreating to a corner, for instance, or producing a preemptive grunt. Either way, your little one’s aware that a poop’s about to pop—and is letting you know.
Your toddler dislikes those dirty diapers. Is your little one eager to escape a diaper as soon as it’s wet or soiled? That could be another signal of readiness to ditch the diapers.
Your toddler can undress for potty success. When nature calls, the potty won’t be of much use unless your child can quickly yank down his or her pants and pull-ups or underwear.
Your toddler can talk the potty talk. Whether you prefer kid-friendly jargon like “poop” and “pee” or technical terminology like “defecate” and “urinate,” it’s important that your child understands and can use the family’s words for bathroom functions and any associated body parts. Communication is key to potty success.
Keep in mind that even if all signs point to your toddler being “ready,” there’s still the “able” component to consider. Key to potty proficiency is being capable of performing a challenging 10-step potty process:
1. Feel it coming
2. Hold it in
3. Get to the potty
4. Pull down pants
6. Push
7. Wipe (with help)
8. Get off the potty
9. Pull up pants
10. Flush (though this step isn’t a deal breaker)
In other words, even if all the readiness signs are there, it doesn’t mean your toddler is going to take to toileting in no time at all. Your little one can be “ready” to start the process for months before he or she has what it takes to perform it completely without your assistance. Take your cues from the expert—your toddler.
The second year may be too soon for most toddlers to embark on a full-fledged potty training mission, but it’s also never too early to start laying the groundwork. While you shouldn’t push a tot who clearly isn’t interested or ready to try a toilet (it could backfire—and the mission could end up taking a whole lot longer than it has to), if your toddler is definitely showing signs of readiness, you can begin setting the stage for some practice runs. Here’s how:
Gear up. Choose either a kid-size potty (look for a model that’s durable and won’t tip over when your child jumps up to check progress) or a potty seat that simply attaches to the grown-up toilet. Then remind your toddler what the potty is for: “Whenever you feel ready, you can use this potty instead of a diaper to pee and poop in.” Buy some fun underwear, too, and point to it occasionally: “One day, you can wear underpants, like Mommy and Daddy do!”
See it, suggest it. When you notice that your little one is about to poop or pee (most tots show obvious signs that a poop is coming, while around half indicate they’re about to pee), suggest to your toddler that he or she do it on the potty instead of in the diaper. If the answer is a resounding “no!”, leave it alone.
Give a demo. Sure, you could explain to your child how to squat, push, wipe, and flush, but it’s much more effective—not to mention efficient—to simply bring your potty pupil to the bathroom and demonstrate. Not all parents are comfortable doing their business with an audience, though, so don’t feel bad about skipping this step if it’s not quite your speed. Of course, the demonstration will be most helpful if the parent who has the same plumbing as your toddler performs it.
Play up the potty positives. Well before your first diaper-free trial run, highlight the perks of using the potty. You might say, “Wearing underwear is fun!” or “Pretty soon you can flush, just like Mommy and Daddy!” But don’t knock diapers or call your child’s old habits babyish—or the contents of a diaper stinky. That could provoke the kind of trademark negativity that’s likely to lead to real resistance (“You want to see baby... I’ll show you baby!”).
Read all about it. Seek out a potty-training book geared to toddlers and read it together. (Check out Everyone Poops, Once Upon a Potty, The Potty Caddy, or What to Expect When You Use the Potty.) But don’t feel you need to hammer home a lesson or compare your toddler to the characters. Just hearing about other kids using the potty and seeing them do it will help your little one feel more comfortable when making the leap onto the seat.
Bridge the gap between diapers and the potty. If possible, start changing your toddler’s diapers in the room where the potty is stashed (probably the bathroom)—this subtly reinforces the connection between the two. After a BM deposit in the diaper, bring it to the big toilet so your tyke can watch you flush the poop (or you can flush it together). You can even add a “bye-bye, poop” ritual, which many toddlers enjoy. If your child is frightened of the flushing sound, just dump together and flush later.
Let your child be the teacher. Buy or borrow a special doll that wets and encourage your child to help the doll use the potty. This can boost understanding of the process, provide practice, and give your toilet learner a greater sense of control over a pretty daunting process.
Provide easy access. Get in the habit of dressing your toddler in easy-on, easy-off bottoms (pants that pull up and down without any fiddling—no overalls or tricky buttons), and then practice the all-important pull-down maneuver. Ask your toddler to pull down his or her pants before diaper changes and then pull them back up after. You can even have a contest: “Let’s see if you can pull down your pants before I count to three!” or “Let’s see who can pull pants down faster!” Remember, there will be no time to spare when nature calls your potty newbie, so the more practice, the better.
Prevent potty overload. If all the potty talk starts rubbing your toddler the wrong way, boredom starts to set in, or it becomes clear that the time isn’t right after all—give it a rest for a while. Pushing the potty—whether you’ve started the training process or you’re just gearing up for it—rarely works.
All potty systems are go? Your toddler’s ready, you’re ready, the new potty or potty seat’s at the ready? While there are plenty of approaches to potty learning—from the super-scheduled to the really relaxed—there are five basic steps to potty proficiency:
1. Switch your toddler into pull-ups or training pants—or take the plunge to regular underpants (you’ll want a mop handy if you do). While pull-ups will make the process less messy (you won’t be cleaning up pools of pee like you would with training pants or underwear), it’ll also make it last longer. Like diapers, pull-ups whisk moisture away from your tot’s bottom, making him or her less likely to notice (or be bothered by) wetness. It also strips away some of the motivation for getting to the potty on time, though some pull-ups have kid-friendly features, like color or temperature changes, that alert little ones to wetness—and that can pump up interest considerably. Switching from diapers directly to cotton training pants or even regular big-kid underpants will definitely be messy (accidents will happen), but will likely shorten the training process for a potty-ready toddler. Another incentive with big-kid underwear: They’re for a big kid—something that most every toddler aspires to be. Want the best of both worlds? Use a combo of pull-ups (for times when an accident would be extra-inconvenient) and cotton underpants (for at-home training sessions).
2. Remind your toddler throughout the day to go to the potty when he or she has to poop or pee: “Don’t forget, Max. If you have to pee, do it in the big boy potty.” But don’t stop at just verbal reminders. Take your toddler to the bathroom at regular intervals and sit him or her on the toilet (you never know... something might come out). You can even encourage the flow of urine with a trickle of water: Turn on the bathroom faucet while your toddler sits on the potty (it’s an old trick but a good one). And watch for those cues (grunting, squirming, going off to a corner); if you pay attention, you’ll know just when to whisk your little one right to the potty. Even if you’re too late and your tot’s already done the deed, try having him or her sit on the potty anyway to reinforce the connection. And of course, if your tot poops at predictable times (such as right after he wakes up in the morning, or right after she eats her lunch), be sure to make a break for the bathroom at those times, too.
3. Boost your toddler’s awareness of body signals by allowing your little one to scamper about (in a private yard or a room with a washable floor) with his or her bottom bared. It’s hard to ignore the urine when there’s no diaper to hold it in. Keep the potty close by so your child can act on those body signals (or that trickling-down-the-leg pee) quickly.
4. Bring on the praise—and the stickers. Be a big potty booster, cheering on your toddler every step of the way, even when those efforts don’t always bring success. Playing up the “big kid” angle can be especially motivating (“You made a pee-pee on the potty, just like Mommy.... what a big girl you are!”), but avoid making baby references when your toddler’s attempts fail (“Only babies pee in their pants!”). Positive reinforcement (especially in the form of special rewards) can help spur on your little potty pooper. Each time he or she produces in the toilet, reward your toddler with a sticker, a big hug, a star on a toilet chart, and so on. Skip big-ticket rewards (your toddler will come to expect them) and food rewards (never a good precedent to set).
5. Let your toddler set the pace. Keep it casual when reminding your tot about using the potty—nagging will only provoke resistance. Ditto, when it comes to forcing. Never make your toddler sit or stay on the potty if he or she is ready to get up—even if you know there’s a poop about to happen. Squabbling over pottying is sure to prolong the process. If you meet with total defiance, it’s best to throw in the towel (and the toilet paper) for a while.
Nothing happening? Or has your potty student taken a turn for the reluctant, or even the rebellious? Maybe you pushed a little too hard. Maybe your tot’s not as ready as you thought. Either way, not to worry about false starts. Just bring back the diapers, back off from the potty, and wait till everyone’s had a break and the time’s just right.
