Being the “show me the data” mom-pediatrician that I am, I researched the literature on nose-picking and made my best effort reform my booger-eating toddler.  Here’s what I found out—the answers will surprise you!

(By the way, if you have an infant with a nose full of boogers, check out this post on clearing a baby’s nose by my colleague Dr. Katie Bucklen. )

1)      Picking your nose and eating it might even be good for you. Various scientists have long hypothesized that eating mucus from your own nose is an effective method of strengthening the immune system.   Nasal secretions trap germs and other toxins that are in the air so that they don’t enter our lungs.  Instead, we swallow most of our nose mucus, even if we don’t actually pick our nose and eat it.  In the GI track, these germs can act like a vaccine, teaching our immune system what pathogens are in our environment.  Our immune system can then be primed and ready to fight the specific germs we encounter regularly.  Too much cleanliness may also be associated with allergies.

A Canadian professor of biochemistry is currently conducting a study to test this hypothesis… but apparently he’s having trouble finding volunteers.

Even if eating your snot isn’t so bad, dirty toddler boogy-fingers are a big problem.  Germ-covered nose-picking fingers spread infectious diseases, especially viruses such as the flu and the common cold.  And kids need to learn that nose-picking is not socially acceptable behavior.  So what can parents do to get their kids to break the pick-your-nose habit?  Keep reading.

2)      Figure out why your child is nose-picking.  Is it a nervous habit or is there something in their nose that just doesn’t feel right?  Do they have a cold or allergies?

If it’s a nervous habit, try replacing it with another nervous habit that is more acceptable.  A teacher gave our child a squishy ball to play with during story time.  Keeping his hands busy kept them out of his nose.

3)      Don’t count on the tissues.  Most of the time kids pick their nose because something in there feels funny.  Tissues are rather poor at fixing this problem.  It’s important to teach kids to blow and use tissues, especially if they have a cold or allergies, but tissues usually don’t do much to fix chronic nose picking.  And, your child still needs to wash their hands or use hand sanitizer after using tissues, anyway.

Instead of tissues, teach your child to nose pick in a private space, such as the bathroom, and then wash hands.  Like my medical school professor said, nose picking really is the best way to clean out your nose, and it’s OK as long as no one else sees you and you wash your hands afterwards. 

If you catch your child in public a finger in the nose, send them right to the sink or hand sanitizer.  We worked with nursery school teachers to enforce this.

4)      Hand sanitizer is your best friend.  Realistically, proper hand washing doesn’t usually happen each and every time a toddler picks his nose.  Hand sanitizer is effective in killing the vast majority of common cold and flu viruses.  We keep a bottle on our kitchen countertop.  I like the kind that smells so good that our kids actually like to use it.  Regular hand sanitizer use in school classrooms has been shown to decrease absenteeism.

5)      Treat allergies.  What do kids do when they have an itch deep inside their nose?  You got it—they pick.  Allergies are a major contributor to chronic nose itching, but they are very treatable.

For seasonal allergies that cause nose-itching/running/congestion, I start with over-the-counter Zyrtec or Claritin, both of which are available in generic form.  (Ask someone at your pharmacy for help finding the generic forms so that you don’t pay too much.)  If this doesn’t help enough, talk to your pediatrician about the many other treatment options available.

6)      Address dehydration.  Dried out boogers almost necessitate nose-picking.   They just don’t come out with tissues.  The best way to prevent dry nasal passages is good hydration.  Saline nose drops and cool air humidifiers can also help.

7)      Don’t be punitive.  Punishment for nose picking is usually ineffective and only results in frustration and shame.  Sometimes parents (especially me!) feel tempted to punish our kids because we are so frustrated with this disgusting habit.  Instead, try to figure out the root of the problem and address it.

There are a few products out there intended to help kids stop thumb-sucking that are sometimes used by parents to stop nose picking.  These are yucky-tasting non-toxic substances you can put on your kids’ fingers so that when they try to pick their nose and eat it, it tastes terrible.  I’ve found them to be ineffective.  They usually wash right off as soon as you send your nose-picking child to the sink.  Also, some contain hot-pepper extract, which can cause a very severe burning sensation in your child’s nose.

8)      Keep fingernails short.  Untrimmed nails are a breeding ground for germs and hard to keep clean.  They also promote nose bleeds.

9)      Know how to manage nose bleeds.  Nose picking is the most common cause of nosebleeds.  Dry air and dry nasal passages can also tempt kids to pick and cause frequent nose bleeds.  Try putting a dab of Vaseline in the nose each day to keep the nose moist, and address dehydration as above.  If your child’s nose starts to bleed, check out these tips to make it stop from St. Louis Chlidren’s Hospital.

Be patient!  Eventually kids do learn that nose picking is a socially unacceptable activity.  Hopefully by the time my toddler is a teen, he’ll at least pick his nose in the bathroom and wash his hands.

I shouldn’t have felt embarrassed at all. Mothers often put undo pressure on themselves and their children based on peers and other societal “norms.” I am vulnerable to this as well. I just hate to admit it to myself.

So here is my quick and not-too-dirty guide to potty training at three.

1)      Be sure your child is developmentally ready. Most 3-year-olds are. Signs of readiness include the ability to keep a diaper dry for a few hours or through a nap, take off their pants, and communicate simple needs effectively.

2)      Start a dialog with consistent language that you aren’t afraid to say in public. We use penis and bum, pee-pee and poop, both of which go into a potty.

3)      Introduce the potty seat or chair to your child in a fun non-threatening way. Consider allowing them to decorate it, sit on it with clothes on, or put toys near it.

4)      Decide if and what kind of reward system you might offer your child. We use jelly beans, M&Ms, chocolate covered sunflower seeds. Friends have used stickers, tiny cars, etc. The main point is that it has to be something small that you can afford to give your child with every real attempt. Notice I say attempt and not just success. Not all kids need rewards, but you aren’t going to ruin them for their adult life by training them in this way.

5)      When you and all caregivers are in agreement, the daytime diapers must go. I embarrassingly spent months switching him back and forth between potty and diapers because I wasn’t ready to deal with the risk of mess in the car or in public. Part of me just thought it would “happen.” With some children it just does. They almost do it themselves. My wonderfully busy and laid back 3-year-old was fine going in his diaper. It wasn’t just going to “happen” for us.

6)      Try it naked. This is a tactic used by many parents. My son easily noticed the difference between diaper and no diaper and if naked would seek out the potty. It also saves them time at the last minute when little hands get tangled in little pants and the “pee-pee is coming.”

7)      Invest in a few pairs of thick training underwear that have plastic liner or add plastic pants over them. When my son was first put in underwear he could not remember that they were not diapers and went in them repeatedly, which is how I always ended up putting him back in diapers . Don’t do what I did. Stick to the training pants. They will help contain some of the mess but your child will eventually realize they aren’t diapers.

8)      Create a bag with extra undies, clothes, wipes, empty Ziplock bags, paper towels and anything else you might use to clean up and accident in the car, playground etc.

9)      Take the potty seat with you… if your child is fond of their special seat, take their seat with you. Yes, it is a pain, but you are only likely to need it until potty training is established. The easier you make it for them, the more successful they will be and trust me you will be thrilled. My son now loves to “make a fountain in the big potty,” but it took several days.

10)   Accept that accidents will happen. It’s part of the process. You will hear “Mama, I need you! There is pee-pee all over the couch.” If you are mentally prepared for this you are less likely to get frustrated and quit, or get mad and yell or scold. Overly negative reinforcement when potty training tends to result in children who withhold urine and stool and create lots of problems down the road such as chronic constipation and urinary tract infection.

11)   Remind your child to use the potty on a regular basis, but resist the urge to have them pee every 15 minutes or sit for long periods. Reinforce normal toileting patterns. This may include going to the potty when you get up from bed, before and after meals, before getting in the car, before bed. Eventually you will need to let them have some control over this. Poop often happens 10-20 minutes after eating. Food in = food out. You’ve been warned.

12)   Be a cheerleader. If you are proud they will be, too, and that is a powerful motivator. If they forget or make a mistake, remind them calmly of what they need to do and tell them that you know they can do it next time.

13)   Sleeping is the exception. Naps and nighttime dryness may not happen for months or years. There is a different mental/physical control for this and bedwetting into double digit ages is normal and common especially in boys. This is the one time of day you might go back to pull ups or diapers.

It took about 3 days of reminders and mess for my son to really get it. Now, a week in, he has been accident-free for about two days. We chose to keep him out of daycare during this period, so that training would be consistent with less distraction. I am crossing my fingers for when he starts back. I could have/would have done this much sooner, but I just wasn’t ready.

Having crossed that figurative bridge, I felt her angst. When I first contemplated transitioning to regular cups, I had visions of 3 newly-walking babes toddling around sloshing milk and my home taking on the aroma of a dairy farm on a 100 degree day. “Nope,” I remember thinking, “we will keep the sippy cups.”

Second grade seemed like a good time to switch.

But, let me just disclose this little-known secret of MomDocs. For many of us- myself included – the basis of what we teach parents about children is based in scientific research about what is best for them. We push ourselves beyond the comfort zone to meet those guidelines and teach them to you. But the reality of how to do those recommendations, that comes from ”real world” experts, AKA other moms and our kids’ teachers.

As a pediatrician, I never will forget walking around the Montessori classroom in complete awe of how Maria Montessori taught children the foundations of education through exploration and play. I thought the founder of the Montessori method was brilliant. That is until I saw the tables with little, open, non-sippy, no-lid cups.

After allowing the idea that they had lost their ever-loving  minds  (giving 15 four-year-old kids open cups!) to pass through my consciousness, I came to the realization that they had been doing this for many, many years and it worked or else they wouldn’t continue to do it. Then, for the first of many times to come, I stepped back, watched and learned.

Before we get to the “how” of sippy cup abandonment, let’s briefly explore the scientifically-based ”why” and “when.” Because pain based in education is much more tolerable than pain based in cluelessness.

When do we want to transition our children from a sippy to an open cup? Turns out my gut reaction of 2nd grade is a bit late. The goal? By one year of age. Don’t throw up your hands and close this page. I’m going to teach you some practical, no smelly dairy farm, tricks. I promise.

Yes, I really said one-year-olds should be using open cups. But why?! We know that once those pearly whites show up in a child’s mouth, keeping them bathed all day in the sugars of milk or juice allows bacteria to cause tooth decay. We know that kids need to eat their fruits, not drink them and should get a maximum of 6oz of juice per day.  We also know that toddling around drinking and driving one’s push car or just plain drinking and walking leads to accidents. Children under age 3 falling while drinking from a sippy cup or bottle make up approximately 4500 visits to the ER every year. Can your toddler fall while walking and drinking from an open cup? Of course. But, are you likely to let your toddler wander around all day drinking from an open cup?  So it’s safer to drink from an open cup because that usually means the child is sitting and drinking, not moving around while drinking.

While facial trauma, rotten teeth and calorie reduction “why.” The “when” is as soon as possible. When teeth erupt, they are at risk for decay. When kids begin to move around, they are at risk for oral trauma. And when a child is around one-year-old, he has the coordination to begin getting a cup to his mouth with some success.

For the beautiful, non stressful “how” of getting rid of sippy cups, let’s return to my Montessori experience. When you begin to offer drinks from an open cup, it means a mental transition in thinking about drinking and eating. Your one-year-old is getting old enough to space out calories. Your one-year-old is getting old enough to begin to learn patterns and routines. She is watching you eat and drink. So, at the same time, you make 2 changes in her drinking. First, you give her a cup with a wide base that doesn’t tip easily and either is small enough for her to grip in her tiny hands or has handles. This cool, new cup comes with meals while seated and with lots of positive affirmation. It is also accompanied by you mirroring the behavior of a plate with food and a cup with drink. You initially fill her cool new cup only one fourth full and it contains either milk or juice. At the same time, her favorite sippy cup continues in her life but filled only with water. Your goal is to allow her to stay hydrated, but begin the transition to drinking from a regular cup by filling the regular cup with the good stuff and the sippy cup with water, which she will drink but only when she is thirsty, not to take in liquid calories that harm her teeth. With time, the sippy cup with water will naturally transition to a straw cup with water and eventually to a water bottle that she takes to school and drinks from all day. The message you begin at one year of age: drink water all day and liberally because your body needs hydration. Drink milk and juice sparingly and while seated with meals.

One last caveat. Some children have been playing the fill-and-dump water game in the bathtub for a while before you first provide an open cup at meals. If you find that the open cup gets repeatedly inverted and the high chair tray turned into a pond, keep the cup out of reach. Show him how you drink from the cup. Show him how to lift the cup to his mouth. Hand it to him for a drink, then put it out of reach for a few bites of food, then offer it again. With time, patience and contents that he enjoys, he will figure it out.

Questions about this transition or others? Hints that worked at your house? Write to me. I would love to hear your thoughts and challenges.

This can be particularly true for some children, who need consistent routines and seem to “fall apart” when school gets out. If they are not already signed up for camp every day, it may be helpful for these children and ‘tweens to collaborate in creating a general summer weekday schedule. This may include expected wake and sleep times, household chores, reading or math review, and planned (but limited) screen time.  Negotiating this up front before summer break begins can help ease the transition for these children as well as curtailing arguments between parents and children about expectations.  It is always a good idea to plan to complete daily responsibilities before engaging in fun activities.  Write down the plan as a visual reminder for everyone.  This also helps teach time management, self-discipline and collaborative problem-solving—skills all kids need to practice.

Also, consider asking family members to brainstorm about fun activities they’d like to do or new things they’d like to learn this summer. You will likely need to explain that this is a “wish list” and then pick a few realistic things to do. You also may need to nudge your child out of his/her comfort zone a bit.  Perhaps your child would like to learn to ride a two-wheeler, try the big water slide, or earn some money helping to water plants or walk dogs. This can boast children’s self-confidence and can even become a lasting memory (e.g., “The Summer I Went Off the High Dive”).  You may also want to use summer as an opportunity to start (or resume) fun activities as a family, such as walks, bike rides, game nights or outdoor concerts. Hopefully, this won’t just be a good opportunity to teach your children goal-setting and planning, but a path to having a fun, enriching summer for the whole family.

As a physician I’ve been indoctrinated with HIPPA and patient privacy rules.  We go to great extremes in health care to protect patient privacy, and spend a lot of tax payer dollars to do it.  But when it comes to Facebook and the internet… not much seems private anymore.

Privacy is changing.  What does that mean for kids? 

The researchers at PEW have put together a great infographic that summarizes their report on teens, social media, and privacy.

The easiest way to protect kids is to monitor their online activity, right?  Be their Facebook friend.  Follow them on Twitter.  Know who they are interacting with online.  Be sure your kids are not Facebook friends with people they have never met in person.  Yet according to this new data from PEW, only  70% of teens on Facebook are Facebook friends with their parents, and 33% are Facebook friends with people they have not met in person. 

More teens are also getting access to uncensored internet.  Our schools, libraries, and most workplaces limit internet access.  My own hospital has filters for certain types of images and marketing.  But with the boom in mobile technology, teens are getting access to uncensored internet in increasing numbers.  Check out this data on Teens and Technology from the Berkman Center for Internet and Society at Harvard University:

• 78% of teens now have a cell phone, and almost half (47%) of them own smartphones. That translates into 37% of all teens who have smartphones, up from just 23% in 2011.
• 23% of teens have a tablet computer, a level comparable to the general adult population.
• 95% of teens use the internet.
• 93% of teens have a computer or have access to one at home. Seven in ten (71%) teens with home computer access say the laptop or desktop they use most often is one they share with other family members.

Looking at this data another way, about a quarter of teens don’t share their computer with family members and/or have a smart phone or tablet.  Are teens really old enough to have uncensored internet whenever and wherever they want?  Especially if they don’t seem very concerned about privacy? 

What’s really the risk to our children of being totally open, out there? 

• You can’t take it back: Once it’s out there, your personal data, pictures, and stories can be very hard to get off the internet.  Do you want the whole world to know what you were like as a teen forever?
• Directed marketing, lots of it: Teens are especially susceptible to marking.  The teen brain is not fully matured, causing teens to be famous for risk-taking behavior.  As online targeted marketing grows, it will be harder for them to resist the temptations.
• Wasted time:  Online reputations take time to manage.  I tell my kids: time is your greatest gift—use it wisely. 
• Cyperbullying : Nearly 43% of kids have been bullied online. 1 in 4 has had it happen more than once.  Bullying victims are more likely to commit suicide. 
• Online sexual preditors: They are real, and they can be hard for law-enforcement to catch.  Be sure your kids never meet up in person with anyone they met online. 
• Identity theft: According to PEW, 53% post their email addresses and 20% post their cell phone numbers online.   All an identity thief has to do is scrape your child’s birthday and photo from their Facebook account and the sky’s the limit…

What have you done to keep your kids safe online?  How old is old-enough for a smart phone with a data plan?  How do you monitor their online activities?   What’s your take-away from these new statistics?    Is online privacy a lost cause?  

I am always amazed when I see parents drop off their kids (often under age 12) to swim unsupervised. The lifeguards may be vigilant, but they are not a substitute babysitter. I can’t tell you the number of times I have witnessed kids diving into the shallow end of a pool or trying to prove themselves to their friends by attempting to swim across the lake or reach the dock on a dare.  Every year I see kids with second-degree burns and huge blisters because parents thought they didn’t need sunscreen because it was cloudy or their child “had a base tan”.

Drowning is the second leading cause of accidental death in children.  Near-drowning and other water related injuries prompt countless emergency room visits every year.   All it takes is one second for a child to drown or be seriously harmed at the pool or beach.  It is our job as parents to make sure our kids are being closely supervised and are safe while playing in or around the water.

When should my child start swimming lessons?

Swim lessons are essential for school-aged kids and a wonderful way to increase water readiness in younger children. It can be appropriate for children as young as one-year-old  to join a swim class.  Lessons for babies and toddlers should focus on water comfort and fun.  Programs for young children are not designed to teach children to swim and parents should be wary of any programs that claim to make children drown-proof.  There are a variety of programs for pre-school aged children.  Some are independent classes and others are parent/child classes. These classes begin to teach early water safety skills and beginning swimming skills.  It is a good idea to enroll your child in their first independent swim class between 3-5 years of age.  Children who are minimally exposed to water and start swimming lessons after the age of 5 tend to more fearful and often take longer than their peers to develop water comfort and basic swimming skills. However, even children who are experienced swimmers need to be properly supervised when playing in the pool or at the beach.  No child is completely safe from drowning.

Can I use flotation devices or life jackets to help keep my child safe?  

Coast Guard approved life jackets can be used to help keep kids safe.  They are designed to float children in an upright position with the face out of the water when worn properly. All children on boats need to be wearing life jackets regardless of swimming level. Other types of flotation devices, water wings, and non coast guard approved life vests should be treated as toys.  You should never rely on these items to keep your child safe.  In fact, these types of flotation devices can give both kids and parents a false sense of security.

What is the best kind of sunscreen for kids?

There are lots of different brands and types of sunscreen.  Look for sunscreen that protects against both UVA and UVB rays and is at least SPF 30. In general, lotions are better than spray sunscreens. They can be applied more evenly and you are less likely to miss a spot.  Lotions containing zinc oxide and titanium dioxide are safe and well tolerated by kids.  Make sure you reapply every two hours and again after your child gets out the water.  Remember ANY sunscreen is better than no sunscreen!

Can I read a book on the side of the pool if a lifeguard is present?

No!  While lifeguards add an additional level of security, they do not take the place of close supervision by a parent or other adult.  Lifeguards are trained to rescue children and to monitor the water; however, training levels vary and lifeguards are responsible for watching a large number of people.  I’ve seen lifeguards reading books, listening to music, and talking on the phone all while supposedly watching the water.  You should never rely on someone else to watch your child.  Children drown in lifeguard protected pools and beaches every year.  It only takes a second for a child to slip under the water unnoticed.  This is especially true at beaches or other areas where the water is cloudy and bystanders are unable to easily see the bottom of the lake. Enjoy your time in the water, but make sure you are an arms length away from any young children or early swimmers and closely monitoring older swimmers from nearby.

My teenagers are very confident and strong swimmers – Can I let them go to lake/pool with their friends?

Most older teens can safely swim at public lifeguarded pools or beaches.  If the beach or pool is unguarded, a supervising adult should accompany teens.  Be sure you talk to your child in advance about water safety and expected rules and behavior.  Make sure they know not to swim in unguarded or closed beaches or pools.

Hookah is a centuries-old practice of smoking flavored tobacco through a water pipe known as a hookah.  The tobacco is packed in the bowl at the top, covered with aluminum foil, and heated by putting charcoal or another heat source on the foil.  The smoke is filtered through the water and inhaled through the mouthpiece.  Many people also smoke marijuana through a hookah, or mix marijuana with the tobacco.  Hookah bars generally only offer legal tobacco-based products on their menu.  Hookah is a social thing to do, usually shared among several friends.

A recent study published by researchers at UC San Francisco calculated daily nicotine and carcinogen exposure with water pipe [hookah] and cigarette smoking in 13 people who were experienced in using both products.

UCSF research chemist Peyton Jacob III, PhD, and UCSF tobacco researcher Neal Benowitz, MD, found that hookah smokers are exposed to a different pattern of toxins and nicotine compared to cigarette users, although hookah smoking is still dangerous.  Of particular concern is the risk of leukemia related to high levels of benzene exposure with hookah use.  The researchers conclude that hookah smoking is not a safe alternative to cigarette smoking.

While it is true that hookah smoke generally contains less nicotine than cigarette smoke, hookah smokers tend to smoke for longer periods of time than cigarette smokers, making up for the difference in nicotine exposure.   A 2005 World Health Association report concluded that “a typical 1-hour long water pipe smoking session involves inhaling 100-200 times the volume of smoke inhaled with a single cigarette.”  The nicotine in hookah smoke is still addictive.  Hookah smokers are also exposed to the chemicals from the heat source, usually charcoal or a “quick light,” as well as the toxins in the tobacco, further increasing exposure to cancer-causing toxins.  Additionally, if you are sharing the mouth piece among several people while smoking hookah socially, you are exposing yourself to all the infectious diseases their saliva may carry, from the common cold to herpes simplex virus. 

Many people mix marijuana with hookah tobacco, or smoke marijuana straight with the hookah.  Smoking marijuana though a hookah is associated with similar risks of smoking marijuana through a bong or other form of water pipe.  Smoking marijuana through a hookah causes exposure to the charcoal toxins as well as those found in the marijuana.

If you’re a parent smoking marijuana, however, consider this: a study in Jamaica found that babies of moms who smoked marijuana had altered neurophysiological integrity.  Their babies didn’t cry to express their needs the way babies who are not marijuana-exposed do.

Now that hookah bars have hit suburban St. Louis, it seems hookah is here to stay.  Whenever parents smoke anything, they need to consider that their children will be exposed to the toxins and drugs in that smoke.  Parents tell me, “I don’t smoke around my kids.”  But unfortunately, your kids are still exposed to whatever you smoke.  The smoke toxins remain in your hair and clothing.  Even this exposure is enough to make your kids sick.

“Learned helplessness” occurs when a person or animal receives a negative stimulus that they cannot escape.  Eventually, the person or animal will stop trying to avoid the stimulus and behave as though they cannot change the situation.  Learned helplessness impairs the human brain’s ability to process stress and is strongly associated with depression and anxiety disorders in later childhood and adulthood.

Is this what sleep training does to babies?  Do infant sleep training techniques such as the Ferber method, the “camping out method,” or the “cry it out method” (explained in detail below) teach infants learned helplessness?  If we teach babies to go to sleep, are we really turning them into helpless people who don’t avoid pain? Are we putting our infants at risk for a life a depression, anxiety and mental illness?

This is enough to make any sleep-deprived parent cry.  Keep reading.  I have good news. 

A study by Dr. Wendy Middlemiss of the University of North Texas, looked at babies from age 4-10 months who “cried it out” until they fell asleep without any soothing from a parent or caretaker.  By the third night of the study, infants were found to have cried for a shorter period of time before falling asleep. But the babies’ coritsol levels remained high, while the mothers’ levels fell in accordance with the time spent crying.

Some have called this learned helplessness.  I disagree.

The term “learned helplessness” was coined by psychologists Seligman and Maier in 1967. They observed helpless behavior in dogs that were conditioned to expect an electrical shock after hearing a tone. Later, when given an opportunity to avoid the electrical shock by simply jumping over a low barrier, these dogs didn’t even try to escape.

But babies who are sleep-trained by loving parents are not the same as the dogs in cages that are given electrical shocks they cannot escape.  Babies go through soothing bedtime rituals and have parents who come back in the morning.  Their daily needs of nutrition, love, and attention are met.  Sleep-trained babies are learning appropriate inhibition, or self-control.  Their brains are developing critical inhibitory connections.  Sometimes learning self-control is stressful.  In fact, it usually is.  Babies over six months need to develop inhibitory connections in their brains, sometimes called “self-regulation.”  If your baby cries when you change her diaper, are you going to leave her in a dirty diaper?  No, you do your best to sooth her but still meet her needs and yours.  Sleep training isn’t very different.  It’s just about sleep rather than poop.

Our best pediatric research supports this hypothesis—that sleep trained babies grow into healthy children without psychiatric or behavioral disorders.  As for those who believe that sleep-training teaches infants learned-helplessness, we have no research evidence that babies who are sleep-trained are at higher risk of behavioral and psychiatric disorders later in life.

A September, 2012 study from the journal Pediatrics  strongly supports sleep training as a healthy part of development.  This study showed that babies who were sleep trained using either the Ferber method or the camping-out method did not have increased risk of emotional, psychological, or behavioral disorders at age 6.  In fact, babies who were in the control group (not sleep trained) actually had a higher risk of behavior disorders.  Furthermore, mothers of infants who were not sleep trained had a higher rate of depression.

I can’t believe we need research to tell parents it’s okay to get a good night’s sleep.  By the time baby is about six months old, parents need to get at least 6 hours of uninterrupted sleep each night.  How do you accomplish this?  Sleep training.  Sleep deprivation makes for very poor parenting. Adult sleep deprivation is also associated with a host of diagnoses parents don’t need—everything from depression and anxiety to obesity, diabetes and cancer.

I am not an advocate of just letting babies cry in their cribs until they fall asleep.  This isn’t fair to the baby, who may not understand that parents will come back and are not gone forever.  In psychological terms, infants may not yet have developed “object permanence.”  This is why modern pediatricians and psychologists have developed sleep training methods, sometimes called “graduated extinction,” or “controlled comforting.”

The Ferber method of sleep training, also known as “Ferberizing,” is an infant sleep-training technique developed by Dr. Richard Ferber.  Dr. Ferber is currently the director of The Center for Pediatric Sleep Disorders at Children’s Hospital Boston and Harvard Medical School.  He has been researching sleep and sleep disorders in children for more than 20 years.  The Ferber method is meant to be used for infants who are at least 4 months old, but Dr. Ferber recognizes that many babies have nutritional needs at night and cannot go six hours without feeding until about six months of age.  For this reason, I usually don’t recommend sleep training before babies are six months old.

Here are the key points to the Ferber method:

• Prepare your baby for sleep using night-time routines such as rocking, reading, and singing.
• Put your baby in the crib when they are drowsy but not yet asleep.
• At bedtime, leave the infant in crib and leave the room.
• Return at progressively increasing time intervals to comfort the infant with soft words, but without picking him or her up or turning on the light. For example, on the first night, soothe the baby after three minutes of crying, then after five minutes, and then each ten minutes, until the baby is asleep.
• Each subsequent night, return at intervals longer than the night before. For example, the second night you might soothe your baby first after five minutes, then after ten minutes, and then each twelve minutes, until the baby is asleep.

The “camping out method” also called the “camp-it-out method,” or “adult fading” is another commonly accepted form of sleep training.  In this method, parents sit or lie in their infants’ room and may touch them while they are in their crib, but do not feed, rock, or cuddle them to sleep. Gradually, caretakers move back from the crib and eventually out of the room.  Usually, parents use a chair or mattress on the floor and slowly move the chair or mattress away from the crib until they are out the door.

An essential element of any sleep training method is that babies are put in their cribs when they are drowsy but not yet asleep.  Only then can babies learn to fall asleep.

Never try to sleep-train an infant under four months of age.  As I mentioned above, it’s probably best to wait until at least six months.  If you are struggling with sleep in an infant under six months of age, my college and fellow mompediatrician Dr. Katie Bucklen has some great suggestions for solving baby’s sleep problems.  Please use safe-sleep techniques such as a bedside infant bassinet or “co-sleeper,” rather than sleeping with your infant in bed with you.  Although co-sleeping allows for easy breastfeeding for moms of newborns, co-sleeping has been associated with SIDS and infant suffocation.  We see these babies dead on arrival when they come to the hospital.  I use a “co-sleeper,” or three-sided crib that abuts the edge of my bed.  My babies sleep just about six inches away from me, but are safe from soft adult bedding.  We no longer recommend sleep positioners.

If your baby is sick, teething, out of his or her routine, or in a new environment, it’s not a good time for sleep training.  Always respond to the physical needs of your baby, such as clearing their nose of mucus when they awake with a cold.  If your baby is teething, try these techniques to sooth their painful gums and don’t expect them to sleep well.  If they are coughing a lot at night, be sure to see your pediatrician as this can be a sign of wheezing, asthma, or reactive airway disease.  If you’ve already sleep-trained your baby, you may need to re-train them if they get out of their routine due to sickness or other stressors. 

Sleep training works for naps, too, but most people start with night-time.  If you are struggling with nap schedules or a little one who doesn’t want to take naps, read this very practical article by my colleague Dr. Sarah Lenhardt.

Many have argued that infants who are permitted to cry in their cribs, even during sleep training methods, are not capable of “self-soothing.”  Critics say that infants don’t really settle down, relax, and go to sleep.  They just give up.  But we know from other research that infants do have effective methods of self-soothing.  Sucking a pacifier, for example, releases calming hormones in the brain.  Attachment objects, such as a blanket, doll, or plush toy can have similar calming effects, especially in older infants and toddlers.  Ask any parent who’s tried to take a pacifier or favorite blanket away—removing attachment objects causes stress!  And giving them to children helps them self-sooth.  Consistent bedtime routines, rocking before bed, and singing or playing music for your infant can also reduce stress.

What about the study I cited above that found elevated levels of stress hormones in babies who were left to cry in their cribs?  Why didn’t these babies seem to self-sooth?  First off, these babies were not put to sleep using a modern sleep training technique such as the Ferber method or the camp-out method—they were left in their cribs to cry it out without any comforting.  Furthermore, these babies were not in their own homes but rather in a research center.  So they were left in strange cribs in a strange room to cry-it-out without any comforting.  Of course they were stressed!  The 2012 pediatrics study that supports sleep training DID use either the Ferber method or the camp out method, and babies were permitted to sleep in their own cribs in their own homes.  I’d love to know what these babies’ coritsol levels were like—I’ll bet they weren’t as elevated as those of Dr. Middlemiss’ study.  In defense of Dr. Middlemiss, even she admits that it is not the elevated infant levels of cortisol that were of interest, but rather the fact that infant levels remained high on the third night while parental levels declined.

So relax, teach your baby to sleep, and get some sleep for yourself.  Sleep training is good for babies and parents.

This is why I say, “Yes!” to my toddler and his tablet.

“Mama, can I have the ‘myPad’? Please!”

This is one of the most common phrases I will hear most any given day. My iPad was fondly renamed by my now 3-year-old, when he turned two. Like most kids, he was drawn to the colorful glowing screen that usually features a picture of his face on the home screen. Of course he would think it was his!

As a mother and pediatrician, I have spent many – too many –  minutes worrying about whether the iPad was a good idea at all. How much time is too much? What was appropriate “educational” content? Were other parents providing better apps then I was? Was I “cheating” as a parent to have a kid sit calmly through dinner at a restaurant because of an electronic device? Was there some benefit to having a child scream and kick through a long car trip?

The further I get into parenting, the more realize the iPad, or any similar device is just a tool like any other, and a toy like no other.  Here are my top reasons for continuing to allow my young child to have the “myPad”.

1)      I want my child’s brain to be more comfortable then mine switching from paper to electronic formats and back. I have been using a computer since I was less then 10. Yet, it has still taken years to “let go of the paper.” From calendars to books, my brain still fights me on this one. I love my e-readers, but sometimes I just want a heavy stack of papers and a fat highlighter. The world is not headed back to paper, so why would I try to raise my child as if it was?

2)      I don’t believe in “just because.”  As in, just because I was raised without a tablet and turned out well (by my parents’ standards) does not mean that all future generations should be raised in the exact same manner. That is backwards thinking. They are growing into a world different from the one we currently live in and so they should be raised accordingly.

3)      He learns things from it. He does and so do I. Many of the apps challenge him and he quickly will become bored with material and skills he has mastered and move himself to something else. It grows with him.

4)      It builds fine motor skills.

5)      He likes it.

6)      It has built-in safety features. Bear with me. Many times I have provided the “myPad” at the kitchen island while working with knives, hot burners, ovens, etc. Often alone in the house with my child, I would rather have him engrossed in a positive “sit still” activity then constantly underfoot and at risk of harm. It is also useful when I need a shower, or to return a page, etc.

7)      It reduces stress. Whether in a waiting room, the car, waiting for the check at dinner, or visiting friends without children, a tablet device can hold enough entertainment to keep him from boredom, mischief, and melt down. This reduces both his stress and mine.

But… there are some things to keep in mind:

1)      It is a tool: Multipurpose it may be, but it requires observation and responsibility on the part of the parent to provide age-appropriate material and time limits if needed.

2)      It does not replace human interaction which is so very important: Both parent/child and peer group or sibling interactions are extremely important. “Mommy and Me” time is always a priority. My son attends a child development center where there is no screen time and lots of social time. He has an extroverted personality so the isolation of the myPad at home is not a concern right now. Know your child. If they need to work on social interactions then time limits should be enforced or the device could be used in specific ways to encourage and aid social interactions.

3)      It does not provide exercise or gross motor development: It may be great for the mind but less so for the body. There are exercise apps. I am not sure if there are kid-specific apps along this line, but there probably are. Weight issues are a concern for our young sedentary population. Keep this in mind. Balance in life is important. A tablet can teach you the rules and strategies of soccer, but it can’t teach you how to kick a ball or be on a team.

4)      They can break it: If you can’t live without it, insure it, or replace it, be very careful how, where and when you let your child use it. Back-up data and photos that can’t be replaced.

So, those are my thoughts and my decision. Every family, every child is different. This is not an ad for iPads, but the future of child rearing is upon us and the newest generation of tech savvy toddlers is here to stay.

Sleep deprivation steals your patience towards your children.  Without patience, apathy and anger easily replace love and gentleness. 

The Sydney Symphony Orchestra and Choirs express this sleep-deprived parental irritability in their Ode to Sleep Deprived Parents and Terrorizing Toddlers:

Nothing will steal your sleep like children do.  It’s not just the total number of hours slept that suffers, but the quality of sleep.  Infants can awaken parents every few hours.  Parents of toddlers and older children seldom get a night of uninterrupted sleep.  One groggy day I asked a table full of pediatricians  when their kids stop getting in bed with them at night.  A senior colleague of mine laughed and said his sixteen-year-old came into their room the other night.

There is tons of medical research about how terrible sleep-deprivation is for kids and adults.  My colleague, Dr. Kelly Ross, has described how helping your kids get enough sleep can decrease obesity, improve school performance, and help your kids succeed socially.  It’s a great column that quantifies how much sleep your kids need by age, etc.  But what does sleep deprivation do to parents?

There’s also lots of research about adult sleep-deprivation, and its association with everything from obesity and cancer to memory loss and early death.  Some research even claims that driving sleep- deprived is worse than driving drunk.  I have not, however, found any medical research that associates sleep deprivation with poor parenting or increased incidence of child abuse.  I think this research doesn’t exist because the studies would be very hard to do.  I could design a study of night-shift workers and incidence of child abuse, but who would agree to participate in this study?

Courtesy: www.weightymatters.ca

I remain convinced that sleep-deprived parenting is very dangerous.  Without sleep it’s very hard to be attuned to kids, to provide them with the attention and positive parenting they need, especially in stressful situations.  If my kids are watching TV when they’re not supposed to, I don’t feel like making them turn it off and dealing with the complaining that follows.  If my toddler starts throwing a fit, it is easier to give her my phone or a food treat than to give her the attention she needs.  I try to read my four-year-old a story, but fall asleep while he’s asking me questions.  He gets mad and starts hitting me.  It’s hard to come up with creative ideas for redirection and use humor.  It’s hard to enjoy parenting.

When I’m sleep-deprived, it is very tempting to turn to spanking, corporal punishment, scolding or anger.  These methods of parenting provide immediate solutions yet cause long term harm.  We stopped spanking our kids several years ago. Dr. Rachel Metheny, a psychiatrist at Washington University in St. Louis, writes about the history of spanking throughout the world and its negative effects on child development.

Rather than corporal punishment, children need attuned parenting for healthy brain development.  Dr. Joan Luby is a professor of child psychiatry and director of the Early Emotional Development Program at Washington University School of Medicine in St. Louis.  Her research shows that positive parenting of toddlers in stressful situations, rather than scolding or corporal punishment, is actually associated with an increase in the size of certain areas of the brain.

Attuned parenting is hard.  It’s even harder for sleep-deprived parents.  As for me, my husband and I have made hard life choices to allow both of us to sleep more, so that we can be the present, attuned, and positive parents we want to be.  I still work night shifts because ultimately it allows me to spend more time with my family, but I sleep when I get home.  My husband quit his job to be a more dedicated father.  We re-arranged our family schedule to fit around my work schedule by switching to homeschooling.   Ultimately, we’ve become a happier family together.  We couldn’t have done it without sleep.