Like many moms, Jennifer Shu, MD, a pediatrician in Atlanta, feels guilty about the amount of TV viewing her 5-year-old son, Jack, logs. She broke the rule about not allowing kids to watch television before they turn 2, letting him tune in for half an hour on some days so she could make dinner. Now he watches about two hours a day.
"The American Academy of Pediatrics [AAP] recommends no more than two hours a day and no TV under age 2," Dr. Shu says. Infants and young children grow and develop best by experiencing the world through doing -- touching, smelling, tasting, and moving -- as well as by interacting with their parents and other caregivers, not by watching TV. "Sometimes you just need a break," Dr. Shu says. "Very few parents can do the whole no-TV-under-age-2 thing, but I still felt I was doing something wrong."
Dr. Shu has reconciled herself to the fact that her family likes TV and will have to struggle with limits. Jack watches age-appropriate shows but can easily do without by entertaining himself, she says. Still, it's not an issue she raises with other parents. "It's one of those things I'm kind of afraid to discuss with people because I don't want to find out that my son is watching way more than others," she says.
"Keep offering healthy foods even if they've turned their noses up at cooked carrots a million times" -- that's the advice Sara DuMond, MD, a pediatrician in Mooresville, North Carolina, gives parents when kids hit the picky-toddler stage. But when her own daughter, Anna, started refusing foods at age 2, Dr. DuMond found herself stuck between the hardwired instinct to feed a child no matter what and the mealtime meltdown only a hungry toddler can deliver. She lost the battle. "One day I woke up to find that I had a child who was basically subsisting on chicken nuggets, Goldfish crackers, Ritz Bits, and chocolate-chip granola bars."
In order to develop good eating habits for the long haul, kids need to learn to eat what you're eating. That means offering healthy foods but not forcing them, not using food as a bribe or a reward, and not picking a fight or fixing something else when kids don't eat what you're serving. Talk about a tall order!
Dr. DuMond has slowly improved Anna's eating habits by involving her in grocery shopping and by offering her some control at mealtime. "She's 4 now, so it's reasonable for her to pick between broccoli and green beans," Dr. DuMond says. "If I'm offering a new food or one she's refused before, I make sure there's at least one go-to food on her plate that I know she'll eat." When nothing appeases Anna, "we politely let her know it's her choice of whether or not to eat dinner."
When a 3-year-old like Dr. Brown's son, Andy, is faced with a big change at home, such as the arrival of baby sister Julia, it's natural to express frustration through whining. But his constant mewl so frustrated Dr. Brown that she found herself whining right back at her toddler -- the antithesis of her advice to parents. "I tell parents that whining is not a form of communication, so if you stop responding to it, kids will stop doing it."
Dr. Brown finally put a sign on Andy's bedroom door with a big red circle and a slash through the word "whining," which she would point to whenever he started. "It served as a reminder to him that his behavior was unacceptable, and it kept my own blood pressure under control," she says. "He moved on."
"I didn't fully toilet train my son until he was almost 4 because, frankly, it was easier to have him in diapers," says Dr. Shu. Not that she hadn't tried; Jack just wasn't interested in this milestone. "There were times when everyone else's kids were potty trained, and I thought, What is wrong with my son?"
The AAP's guidelines generally assume most children are starting to toilet train between 18 and 24 months and are fully trained by about age 3. But boys tend to take longer than girls, and every expert warns that if you try to push the process before a child is ready, you probably won't have much success.
The Shus were getting ready to move from New Hampshire to Atlanta. Dr. Shu decided that she needed to let Jack, who was then just over 3, settle into a new place and schedule before attempting potty training again. Jack's temperament also played a big role. "He likes to do things at his own pace," Dr. Shu says. When Jack's older friends were all using the potty, he finally decided one day that he would too. "Being a pediatrician helped me relax about it because I had the scope of knowing what the range of 'normal' is, and that to me was reassuring."
When his daughter, Grace, was 2, Robert Needlman, MD, suffered a meltdown of his own when he couldn't understand which book she wanted him to read. "I yelled, stamped my foot, and threw several picture books on the floor in utter frustration," says the associate professor at Cleveland's Case Western Reserve University.
It's scary for a child to watch all-powerful adults lose control. Dr. Needlman knows well that parents' anger leads kids to believe that they deserve to be yelled at; it tells them that their parents don't have control over the situation.
It's inevitable that your child will see you angry sometimes, Dr. Needlman says. What matters is how you handle the aftermath, as well as your future conflicts, to make sure it doesn't become a pattern. "It's not necessarily bad for your child to see you losing it and then being okay afterward; they can learn, Oh, that reaction was a little bit more than I intended!"
"We moved to the country and my oldest, who was 2 1/2, decided that when he needed to pee, he would do it outside. This worked fine until we were at BJ's Wholesale Club one day. While I was strapping his brother into the car, I saw him peeing on a tiny stick in an island of grass in the parking lot."--Susanne Tanski, MD, pediatrician at Dartmouth Medical School, in Hanover, New Hampshire
"My first child cried all the time. My husband and I kept thinking, We're pediatricians; we should know how to deal with this. And our third ended up sleeping on the floor of our bedroom whenever he was scared, which was almost every night until he was about 8 years old."--Joanne Cox, MD, pediatrician and director of the primary care center at Children's Hospital Boston
"My third child was 4 or 4 1/2. He walked into the living room carrying a gallon of milk, a cup, a lid, and a valve and said, 'Can you pour this for me?' That's when it dawned on me that he might not need the sippy cup anymore!"--Laura Jana, MD, pediatrician in Omaha
Originally published in the October 2008 issue of American Baby magazine.
All content on this Web site, including medical opinion and any other health-related information, is for informational purposes only and should not be considered to be a specific diagnosis or treatment plan for any individual situation. Use of this site and the information contained herein does not create a doctor-patient relationship. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.