Top Toddler Health Concerns

Q: My 15-month-old son is still learning to walk, so he's bumped his head a few times. Should I be worried about long-term damage?

A: All toddlers fall as they learn to walk, run, climb, and jump. Most of the bumps are mild, and there is no need to worry. So when should you worry? If there is any loss of consciousness, call your doctor immediately. If not, but the fall is big, watch for signs of head injury. Signs include: vomiting in the first six to eight hours after a bump is detected, disorientation, excessive sleepiness, pupils that don't look equal or normally responsive, slurred speech, or dizziness. Noticing any of these signs is reason to call your doctor immediately.

-- Dr. Heather Lubell, pediatrician at St. Christopher's Hospital for Children in Philadelphia

Q: My daughter gets so many ear infections that my pediatrician recommends putting tubes in. How do I know it's the right decision?

A: Whether tube placement is right depends on a handful of factors. Determine the goal of tube placement. If it is solely to reduce infections, tube placement is probably not right for your child. Tubes will not prevent infections but only allow them to happen less painfully, as the infection drains without pressure buildup. However, if your child has had fluid persistently behind her eardrum(s) for more than four months and is either developing impaired hearing, is already behind in language development, or has impaired cognition, then discussing ear tubes with your pediatrician and an otolaryngologist is a reasonable option.

-- Dr. Michael McKenna, pediatrician at Indiana University School of Medicine

Q: During playdates, my 18-month-old likes to mostly play by himself, and I'm worried he's antisocial.

A: Don't expect your child to play with another child until he is 3 years old. Before that age, children will play beside each other, but they usually do not play together. While you might notice your child watching the others in play, you shouldn't expect much interaction. And some kids are slower to warm up in a group setting, or they simply prefer independent play rather than jumping into the mix. As long he is playing purposefully, he is fine.

-- Dr. Ari Brown, pediatrician and author of Toddler 411.

Q: When do I bring my toddler to the dentist for a checkup, and how do I care for his teeth?

A: Most toddlers should see the dentist for the first time around age 1, but caring for your child's teeth at home can begin much earlier. After the first tooth appears, gently wipe it off with a soft washcloth or toothbrush before bed. Around 1 year, gently brush your toddler's teeth with water or a tiny bit of nonfluoride toothpaste. And talk to your pediatrician or pediatric dentist about fluoride, which is important for developing teeth. She might recommend using a pea-size amount of fluoride toothpaste, even though your toddler doesn't yet rinse and spit, or taking supplements if your drinking water does not contain fluoride.

-- Dr. Tanya Remer Altmann, pediatrician and author of Caring for your Baby and Young Child.

Q: My child is 2-1/2 and speaks with a slight lisp. When is it time to call a speech therapist?

A: For a child that age, it is fine to wait to see if she will grow out of it. Many children will lose their lisp; however, if your daughter hasn't by age 4-1/2, it is time to see a speech therapist. And remember: If your child has a lisp, you shouldn't call attention to it -- that can damage her self-esteem. Instead, simply repeat the word back to her with the proper pronunciation. Hopefully, she will pick up on that and correct the problem.

-- Dr. Michele Saysana, pediatrician at Indiana University School of Medicine.

Q: Some moms in my playgroup are not vaccinating their kids until they're ready for preschool. Should I be worried?

A: I'd find a new peer group whose philosophies are more in sync with yours. While your child is protected by his own vaccinations, there is still a small chance he could get sick from one of these kiddos. I would politely ask parents to not bring their child to playgroup if they are ill. But, more likely, you will probably not enjoy being around other moms who have divergent philosophies from your own. Most parents choose to vaccinate their kids (99 percent in the United States, in fact), so you can probably find some like-minded people!

-- Dr. Ari Brown, pediatrician and author of Toddler 411.

Q: My son is into hitting, and reprimanding doesn't seem to work. What should I do to get him to stop?

A: When he does hit, you need to address it right away -- not when you get home. Get down to his eye level and tell him, "No hitting." Then give him a time-out, and also ask him to apologize to the other child. While he might not quite understand what he's saying, you still need to reinforce that it's wrong to hurt someone. If he's continually hitting other kids during playdates, he might not be ready for them yet. Some toddlers find that being with a large group of kids is overwhelming.

-- Dr Gwenn Schurgin O'Keeffe, pediatrician in Boston, MA

Q: Is it OK to let my child watch TV?

A: The American Academy of Pediatrics states that children under 2 don't need to watch television, and the recent publicity surrounding the Baby Einstein videos is proof that even so-called educational programs don't really have an impact on a child's development. The official recommendation for children over 2 years of age is that they should not watch more than two hours of TV per day -- that includes DVDs, computer games, video games, etc.

-- Barbara Huggins, MD, professor of pediatrics at the University of Texas Health Science Center at Tyler

Q: When can my toddler switch from whole to low-fat milk?

A: There are no hard and fast rules about this, but typically a child can transition from whole milk to low-fat at 18 months. But this is something you should definitely discuss with your child's pediatrician before making the switch. Young children do need calories from fat for growth and brain development. Generally, though, as long as they are drinking milk that is fortified with iron and vitamin D, there shouldn't be a problem going with a low-fat option.

-- Dr. Christy Valentine, pediatrician in New Orleans, LA.

Q: My toddler now wakes up in the middle of the night screaming. Should I be concerned?

A: If it is happening at the same time every night, it is considered a night terror. It's nothing to be concerned about -- it is quite common in kids over 18 months old. A solution is to set your alarm clock for 30 minutes before your child usually wakes up screaming, and go in and gently wake him up. You don't need to get him out of bed; just wake him to abort the sleep stage that leads to the night terrors. If you do this for two or three nights, the night terrors should go away completely.

-- Dr. Amanda Jackson, pediatrician at Ochsner Medical Center for Children in New Orleans

Q: When is the right time to potty-train? And what is the best method?

A: You'll know your child is physically ready when he can walk to the potty, sit on the potty without falling off, remain dry/clean for several hours, follow simple commands, and communicate enough to tell you his needs. Emotional readiness occurs when your toddler seems eager to please you and when he seems to want to be independent about going potty. Your child should have a potty of his own. It should be a comfortable place to sit, allowing his feet to touch the floor. To begin, the child can sit on the toilet fully clothed, reading or playing. Once your child is comfortable with that, you can try taking off his wet or soiled diaper and letting him sit there. If he's up for it, he should sit on the potty several times a day without a diaper. Sessions need to be only a few minutes long, and the child should receive praise regardless of whether anything comes out. You can work toward a routine where he sits on the potty first thing in the morning, after every meal or snack, and before naps and bedtime. In most cases the whole process takes a few weeks.

-- Dr. David Hill, FAAP and Pediatrics Expert on JustAnswer.com

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