Category Archives: Articles

Here is where you’ll find all the articles that Dr. Mary Ann has written.

THUMB SUCKING, HAIR CHEWING, NAIL BITING, AND OTHER DIVERSIONS OF CHILDHOOD

teddy_hugThe sucking of fingers is only one of a group of behaviors we observe in small children. These are called tensional outlets. They are thumb or finger sucking, chewing on clothing or hair, nose picking, and holding the genitals. These are very common behaviors during this period of childhood. They help a child reduce the internal tension, which results from anxiety and fear. Each child has his or her own personal tensional outlet, which may have become associated with stress reduction during infancy or toddlerhood.

All of these are difficult habits to change in a small child, although parents spend a great deal of time trying. They spend even more time listening to advice from well -meaning friends, relatives and even strangers, who warn of the dangers of these habits aren’t corrected. The simply truth is these tensional outlets are not harmful and are obviously very important to these small children who are experiencing some form of stress. They usually are outgrown by school time.

Here are some common questions from parents:

Does finger sucking cause orthodontic problems?

Most dentists today feel that serious malocclusion occurs because of genetic factors. There may be a moderate effect caused by finger sucking that extends into the fifth or sixth year, but these can be reversed by orthodontics.

Should I do something to help my child stop?

If a child is motivated or asks for help, you can provide encouragement. However, you should never force a child to give up their tensional outlet.

If your child is motivated, a positive reward system may be useful. In regards to finger sucking, the motivated child over age 7 can be fitted by an orthodontist with a special mouthpiece which has a bridge that hits the child’s fingers as it goes onto the mouth. This provides a gentle reminder. It is not recommended to put bad tasting substances on the fingers, to restrain them, or to use punishment to curb these behaviors.

Are there any health risks?
Most of these habits are completely harmless, but there can be some complications. Fingers and nail beds can sometimes become infected. Although it is rare, swallowing hair that is chewed on can accumulate in a child’s stomach. And picking of noses can cause nosebleeds.

When will they grow out of it?

Thumb or finger sucking, and nail biting will last the longest. It will vary based on the child, but most children give up finger sucking by age 8 or 9. Nail biting, however, can go on for a life time, but can be helped. Ask your pediatrician for suggestions when your child is older and motivated.

Sleeping

sleeping_on_shoulderHopefully your child is going to bed without any problems and staying asleep all night. However, even if they are, it will not be every night.

All children this age have some sleep disturbance at some time. In addition, some children will still be having difficulty on a regular basis. Here are some common problems with preschoolers and sleep. If you are having difficulties with sleep, consult your pediatrician for further advice and guidance.

Your bed or theirs?
By age three, even if you have chosen up to now to follow the philosophy of the “family bed”, it is a good time for your child to be taught how to sleep by himself in his own bed. As hard as it can be for many parents, your child will be happier and healthier if you can do this. Even if you wish to have your child sleep in the same room for a bit more, sleeping in the parental bed after age five may not be healthy for psychosexual development.

Bedtime routines
Bedtime routines will help your preschooler to go to sleep. Make sure you have a regular and calming routine before a child’s bedtime A routine can consist of the reading of a favorite story after the bath, kissing all the stuffed animals, or singing a special song. This will become the signal for your child that bedtime has arrived and will also provide a transitional period during which he or she can prepare for the separation that sleep brings. It also gives preschoolers some control of the situation since the ritual must be completed before they will go to bed.

Can’t go to sleep without you
Your preschooler may insist that you be present while he falls asleep. While some respect for his separation anxiety is needed, you can still gently tell him that you understand how hard it is, but you will help him to do this on his own. After the bedtime routine simply say, “It’s time for sleep now” Give a big hug and kiss and then leave him in his bed. If he gets up again, simply walk him back to his bed and repeat the same phrase. You may have to do this many times, but make it boring without a lot of extra hugs and kisses. After awhile he will know you mean business. This method works well with most children. Another technique is to challenge your child to stay in bed until you check on him or her. They will feel proud of themselves if they can do it. Check on them at 5-10 minute intervals gradually increasing the time between checks.

The Magical Age

magical_ageWhen your child turns three, he or she will suddenly announce, “Look out world, I am here!”

From the age of three until your child enters formal school usually at the age of five, he or she will experience the wonder of the world in a way that they will never experience again in their lifetime. This is the age of imagination, of magic, of play. And yet at the same time preschool children often appear as little “scientists” testing the limits of physics or little “sociologists” analyzing human behavior to understand how people live together and communicate with each other.

The challenging role of the parent is clear. You must continue the job of civilizing these young members of society, while preserving their need to explore, examine, and analyze the world. In other words, allow for these important developmental steps to occur within certain social boundaries and in a safe, protective environment.

To accomplish this you must first recognize your child’s temperament and understand the basics of child development at each age. Then you must allow your child to play as much as possible. Provide imaginative play materials and toys and then let the child do the rest. Re-live your own childhoods as you get down and play with your child and enter their rich imaginary worlds. Pay close attention to how they see things and marvel at the wonder of imagination and the richness of play. Have fun with them.

At the same time you must learn to set limits and to effectively discipline your child when necessary. This is the hard part for many parents. But your child is depending on you for this vital role. This is a magical age. It won’t last forever. Enjoy your preschool child.

The Magic of Loveys

“Loveys” “Blankies” “Teddies” Those worn and tattered pieces of comfort to babies and toddlers. These are truly magical items. They immediately help a toddler calm down when upset, frightened, or feeling the pangs of separation from a parent. These are officially called transitional objects and it is quite common for infants and toddlers to develop an attachment to a special blanket, a piece of material, or a special doll or stuffed animal. The object has usually been near the child while nursing or snuggling with the primary caretaker, usually the mother, and then the object “becomes mother” to the child. This is the “transition” and the object can take the place of the mother in her absence. This can help a child sleep alone or stay with a baby-sitter.

There is nothing wrong with children having “loveys” They are not harmful and as far as I know no child has ever become ill from one. Not every child will develop an attachment to something and it is very difficult for a parent to make this happen. It has to happen on it’s own. You can try by keeping a special soft piece of soft material between you and the baby when they are about 6-9 months of age while cuddling or nursing, however, just like with finger sucking, these are things that develop in their own way despite parents’ best efforts. In other words, the magic occurs without our help.

If the object is forgotten, lost or washed, the child might experience significant distress since they are very dependent on their object. I still remember a former patient of mine, a little girl who had lost her special “bunny” in the supermarket. Her parents contacted the local media and an article in the local paper helped a search get underway. Not surprisingly, there was a great deal of sympathy generated as many people remembered their own “special items” from their childhood.

The loss of an object should be treated with respect and a parent must acknowledge to the child that this was something very special. If a blanket has become so tattered and dirty, some parents have cut off small pieces of it over time until it becomes much smaller and more manageable. The need for transitional objects is more common in younger children and most children will give up carrying them everywhere by age 4-5. They will still be emotionally significant (maybe for life) and your child may want to keep them in a safe place in his or her room.

Bedtime and Toddlers: The final frontier

sleeping_toddlerA big concern of parents of toddlers is how to get them to sleep independently once they can scale the crib walls, or have graduated to a junior bed. The solution requires patience, stamina, and a true desire to make this happen. All toddlers are capable of independent sleeping. If you have made a decision, however, about co-sleeping with your toddler and have set up a family bed, then you should know that there is no “harm” in this choice. Living with a toddler requires lots of energy and all that matters is that everyone get a good night’s sleep.

Here are some tips to help alleviate the struggles associated with bedtime:

  • Keep the bedtime routine short (no longer than half an hour) and simple. For example, after the bath – read up to three stories, sing one song, say goodnight to the favorite stuffed animals, say goodnight to your child, then it’s lights out.
  • You should make it clear to your child (who is no longer in a restrictive crib and can open doors) that you mean business. If he keeps coming out of the bedroom, he should be returned as many times as necessary.
  • Use a reward system for staying in bed. You cannot force your child to go to sleep, but you can force her into a bedtime. What she does in bed after that time is up to her. This may take a lot of work in the beginning, but it will pay off later.
  • The alternative to this method is staying with your child until he falls asleep. If your child becomes used to this, or if the child has been sleeping with you, the transition to sleeping alone may be more difficult. Most children should be able to go to sleep on their own by age three, even if they have been raised in the family bed.

Temper Tantrums

temper_tantrumTemper tantrums represent the stormy release of toddler frustrations. These are actually necessary expressions of your child’s emotions before he can verbalize anger and frustration.

They may occur frequently and more often when your child is tired, hungry or restrained for a long period of time (for example, in a car seat during a long trip.) You must teach your child that this is not an acceptable way of expressing his emotions. The earlier you address this behavior, the sooner it will begin to disappear. In this article we will take a closer look at the following common questions related to temper tantrums:

What should I do during the tantrum?
The most important thing you can do when your child is having a tantrum is to remain unemotional and un-phased by this behavior — this is not easy! One suggestion is to pretend that you are an anthropologist on the Discovery Channel, watching a species of wild animal doing a ritual dance. Remove yourself emotionally from the scene. Remember — you are the parent in control, she is the child, not in control.

Next, remove the audience. If you are alone at home, simply turn away and walk a short distance from your child. If others are around, remove your child to another room and remain close by. It is very important not to abandon your child when she is having a tantrum. It is very frightening for your child to have a tantrum and she needs to know you will not let her totally lose control. If the tantrum goes on for longer than five minutes, place your arms around your child, to help slow her down.

Give your toddler words for his feelings. Say gently, “I know you are angry.” “I know you are upset.” Over time he will begin to understand what these words mean. He will not have to act out his feelings as intensely if he knows you get the message.

When the tantrum begins to slow down, you can offer some soothing moments alone together. This lets your child know that you still love him and understand that he is upset.

What shouldn’t I do?
Remember — if a tantrum is in progress – do not show your child that you are upset. Never hit your child during a tantrum. You do not want to reward your child, either positively or negatively, during a tantrum.

What if you are in a very public place such as a supermarket?
Experts are divided about how to handle this situation. One method is to leave the cart full of food behind and remove the child from the store to the car. He can have the tantrum alone. If it ends, you can finish your shopping. If not, remind yourself that this limit setting is more important at this moment than the groceries.

Another method is to allow the child to have the tantrum in the store. This can be very draining for you, the parent, however, for you may have to explain to the other customers and shop owners why you are blocking the aisle.

Feeding Your Toddler

toddler_feedYour responsibility as a parent is to offer healthy foods in a nurturing environment. Your child’s job is to decide what and how much of what is offered he will eat.

This is a very important concept and worth repeating to yourself from time to time. In simplest terms – provide a balanced diet for your toddler, limiting sweets and salt. Limit milk to 16 – 24 oz. per day and undiluted juice to a maximum of eight oz. per day.

The nutritional needs of babies and toddlers are different from those of adults. A typical toddler portion is one quarter of an adult portion. Do not restrict fat and cholesterol, which are necessary for adequate growth. Do not give babies and toddlers high fiber, low calorie foods, which may not have enough calories. Offer a variety of foods over time to your toddler.

Let’s take a closer look at the following two issues related to feeding your toddler:

Is my toddler eating enough?
If toddlers are not given more than 16 oz. of milk and 8 oz. of juice per day, and are not given excessive sugary snacks between meals, they will eat an adequate amount of calories if offered a variety of nutritional foods. This is known as relying on “natural hunger” to achieve a balanced diet. Moreover, it may occur over several days of eating, not in one 24-hour period. Regular check ups with your pediatrician who will check your baby’s weight and height are essential for monitoring your toddler’s nutrition.

Food Fights
Feeding is an area where parents and toddlers can get into major power struggles. You are frequently worried that your child is not eating enough, or not eating the right kinds of foods. This anxiety may cause you to pressure your child, who immediately picks up the cue that this is an area for struggle. In battles over food, you, the parent almost certainly will lose. The more you force your child to eat, the more she will resist. If this leaves you feeling out of control – remember, you are in control. You control the food you offer your child. Eventually, she will get hungry and eat.

Toddlers In Motion

baby_waterparkYour baby turned one a few months ago. You survived a very challenging year…

You marveled at the incredible changes in your baby from month to month. One day your baby decides it is time to walk. You grab the video camera. You clap and smile and your baby knows this is something special. Everyone asks them to repeat this great feat. They oblige and enjoy the attention.

A few months later they continue along in natural development and begin to climb on top of the kitchen table. You scream “No!” as they prepare to leap. You look horrified and your confused toddler does not understand why this next step in his development is not resulting in the same reaction as mere walking. “Where are the cameras?” “Where is the applause?”

You now have a toddler. From here on, your delight at your toddler’s advancement in physical and mental development will be balanced against your fear that they will be hurt. And your toddler will feel frustration and some confusion as they do “what comes naturally” and sometimes get a negative reaction.

Toddlers have no knowledge of danger. By the same token, they have no idea that they can be hurt. The normal bruises and bumps will begin to give them an idea of what to avoid, but a real sense of fear (like we have as parents) does not yet exist for them. All they know is that they must move forward along this developmental road. They must begin to become an independent individual –and it is your job as their parent to help them achieve this important goal in a safe, protected environment.

What a wonderful challenge this is! Here are a few points to keep in mind as you move ahead…

1. It is important to be aware that toddlers have very little — if any — self-control. They are driven to explore, to climb, to taste, to feel, everything in their world. So create an environment as free of danger and frustration as possible. The first step is to safe proof your entire house. Place gates between rooms and on stairs. Remove breakables, protect electronics and plug outlets and remove electric cords from reach. It is helpful to get down on your hands and knees and check the room from a toddler’s perspective. Remove anything that you find that could become a danger.

2. Now you are ready to make a space that fosters creative exploration for your toddler. Put cushions or small plastic climbing toys in the room. Provide a variety of toys, and change them every few days. If you are in the kitchen, put chairs on top of tables, and remember to lock all cabinets except for one filled with plastic containers, wooden spoons, and small metal pots that can become safe and entertaining toys.

3. Lastly, never forget the number one rule: Always keep an eye on your toddler. The reality is they are fast and can get into trouble quickly.

COLIC and YOUR INFANT

by Winnie Yu Sherer
Dr. Mary Ann LoFrumento (as medical advisor)

All new parents expect their babies to cry, some perhaps more than others. But when unrelenting wails of a newborn become a nightly occurrence, your baby may be suffering from colic.

Colic is a frustrating and distressing condition that describes a pattern of excessive crying for no apparent reason. The condition is quite common and affects up to 10 percent of all babies. Colic typically starts a few weeks after birth, peaks at about six weeks of age, then gradually improves somewhere between the third and fifth month.

Dealing with colic can be extremely difficult, especially for first-time parents who can’t calm their baby’s screams and are at a loss as to what to do. To make matter worse, most new parents are already exhausted and sleep deprived. The combination makes for a frustrating experience. The mom’s diet (if she’s nursing) and the way you feed a child might make a difference, but is no guarantee of relief from the nightly cries.

What it Looks Like

Many babies go through fussy spells in the late afternoon and early evening, which is why pediatricians are often reluctant to label these bouts of crying colic.

True colic starts between the second and fourth weeks after birth. Colicky babies may cry around the clock, but worsen in the early evening. The crying is inconsolable and often accompanied by the baby extending or pulling up his legs. During the crying jab, the baby may pass gas and their stomachs may be enlarged or distended by gas. Fortunately, the crying does dissipate eventually.

What to Eat

Consider giving your baby a teaspoon or two of chamomile tea, a remedy that may help calm you baby’s cries. If you do, make sure the tea you buy contains the purest form of chamomile possible. Moms who are nursing might also want to consider drinking chamomile tea, which can soothe their jangled nerves as well.

If your baby is using formula, consider switching to a different formula. A study in the journal Pediatrics found that babies who ate a hypoallergenic infant formula made with whey hydrolysate, a type of protein, decreased the amount of daily crying in colicky infants by 63 minutes.

What Not to Eat

If you’re nursing, consider cutting out foods that might promote gas, such as beans, broccoli, and cabbage. Consider also eliminating spicy foods, caffeine, and high-fiber foods, all which can irritate your baby.

Nursing moms might also want to consider giving up cow’s milk. One older study looked 66 moms of breastfed infants who were put on a diet free of cow’s milk. The study, which was published in the journal Pediatrics, found that the colic disappeared in 35 infants, but reappeared in 23 of the infants when cow’s milk was reintroduced.

Other food allergens may be involved, too. A separate study in the same journal looked at the effects of a maternal diet low in food allergens. Moms in that study eliminated highly allergenic foods such as cow’s milk, eggs, wheat, peanuts, tree nuts, soy, and fish. Babies whose moms ate the low-allergen diet experienced a reduction in the duration of their crying spells.

Supplements for Colic

There are no supplements recommended for the colicky infant or a nursing mom.

Stay-Healthy Strategies

  • Feed your baby whenever she’s hungry. Babies are generally less fussy on a full tummy.
  • Make sure to take care of yourself. Colic can be exasperating. Enlist help from family and friends who can provide you with a brief reprieve.
  • Soothe her in other ways. Try swaddling her tightly in a blanket. Sing to her. Walk her around the room to soft music. Consider massaging your baby.
  • Make some noise – white noise. The hum of a dryer or a vacuum cleaner can help settle some colicky infants. But be careful where you put the baby if you use a dryer. Never place the baby on top of a dryer, only beside it.

What Can A Newborn Do?

newborn babyAlthough a newborn baby does not appear very active, there is actually a great deal of brain activity going on. And many new parents wonder just what is going on inside that adorable little sleepy head. It might surprise you how much is happening as your baby’s brain takes in the world with all it’s sights and sounds.

Infants at this age can focus clearly on an object eight to ten inches from their eyes. This is exactly the distance between the baby and the mother’s (or father’s) face during feeding. You may notice your baby trying to make eye contact with you during this time. This is because babies react to the human face (or even a drawing of a face) during this time period more than any other shape. They are most drawn to the eyes. Smiling and making faces at your new arrival is the best stimulation you can do – and it’s fun too!

At this age, babies are good imitators and they will try to mimic your facial movements (open mouth, stick out tongue). In addition to the human face, babies also enjoy sharply contrasting colors, large squares, bright lights and round shapes. Moving objects are more attractive than still ones.

There are also reflexes that every new baby will have during the first weeks of life. One that you may have noticed is the startle reflex. This occurs whenever the baby hears a loud noise or moves suddenly downward. Both arms will move out and then in, and the baby may grimace or cry. This is a normal reaction. Another reflex is to grasp his tiny hand around your finger. It’s a great way to connect with your baby. If you place your finger on the bottom of his foot, the toes will try to do the same.

Babies usually smile by two months of age. This can occur earlier and I will never argue with the grandmother who claims the baby smiled at one week of age. But most babies are at least six weeks old before they can smile in response to something (such as another smiling face.)

Touching, cuddling and holding are all important stimuli to your baby. They are a form of communication, which will often calm a fussy baby. When a baby is crying and upset, he will have some capacity to quiet himself by hand-to-mouth activities. This may range from brief swipes of the hand to the mouth to actual thumb sucking.

You should be able to use some of this information as well as your own observations to console your baby and to interact with him in a positive, stimulating way. Be careful not to over stimulate! If you see your baby start to look away, it might be time to decrease the stimulation and allow the baby to rest. Remember to relax and enjoy your baby!