Developmental "Red Flags"

By Dr. Kurt Klinepeter, Brenner Children’s Hospital
Developmental and Behavioral Pediatrician

Many parents worry at some point whether their child is developing normally and when they should be concerned about sitting up, walking, talking and interacting with others. It is commonly stated that children, and particularly siblings, should not be compared to each other. However, because children’s developmental skills develop in an orderly and predictable manner, it is quite possible and appropriate to compare children to the skill set they should have at any age and to be aware of developmental “red flags”.

Gross or large motor skills are the primary developmental skills in the first 12-18 months of life. Even newborn infants should demonstrate some head control. The 5-6 month old is holding his or her head up, popping up on his or her arms in prone position, and starting to sit with support. By 8-10 months of age, infants should be sitting independently and developing mobility (scooting, crawling). They are usually pulling up by at least 12 months of age and walking with, and then without, support a few months afterwards. Muscle tightness, weakness, or any unusual movements are a developmental red flag. The rate of motor progress can vary, but the key is steady progress over time.

Infants develop reaching, grasping, and transferring skills by 8-10 months of age. Most are able to self feed by 12 months of age with further refinement of self-help skills thereafter. Most 2 years-olds help with dressing and bathing. The range of toilet training is 2 to 4 years of age. Toddlers know what to do with a crayon -- making a stroke by 2.5 years-old and a circle by 3 years-old. True handedness is not usually apparent until 3 years of age. Early handedness (right or left), particularly in the first year of life is a developmental red flag.

Babies are social and demonstrate responsiveness to others by 6-8 weeks of age. Their eyes track together by 3 months of age and they are able to localize to voice or environmental sounds by 8-10 months of age. Any failure to respond to visual stimuli by 3-6 months of age or auditory stimuli by 8-12 months of age is a developmental red flag.

Young babies produce vowel sounds and then babble (consonant-vowel sounds) beginning at 6-8 months of age. Failure to babble by 12 months of age is a concern. Single words occur at least by 12-18 months of age. Thereafter, speech/language development literally explodes. Typical two year-olds have a multiword vocabulary and are putting words together. No expressive language by 2 years of age is a developmental red flag. Even limited language should be noted by 2 years of age and closely tracked since speech/language delays are the most common developmental disorder in young children. Children should be talking in complete and lengthy sentences by 3 years of age and in paragraphs with the ability to relate a story by 4 years of age. Speech sound development is not complete until 6-7 years of age. This means that young children predictably mispronounce certain speech sounds. By 3 years of age, approximately 75% of speech production should be understood in a typically developing child. If you find that you are still “interpreting” for your child after that point, a speech/language evaluation may be needed.

Children will look at something that is pointed out to them by 15-18 months of age. Failure to seek, share, and be motivated by social interaction (wanting mom and dad’s attention) after 18 months of age is a developmental red flag.

The bottom line is that children grow and progress in a steady fashion within age appropriate ranges. Any loss of developmental skills at any age is a developmental red flag. Trust your instincts. As a parent you can best serve your child by fostering a good relationship with your child’s pediatrician or health care professional and discuss any questions or concerns that you have at your child’s well-check visits. Development is easily screened in the primary care office and, if necessary, you and the provider can discuss whether a referral for assessment is indicated. Developmental disorders occur frequently and it is well known that the key to the best possible outcome is to identify and treat as early as possible.

Brenner Children’s Hospital houses the only medical and developmental evaluation clinic in the region for developmental delays and disabilities. For more information, call 336-716-2255.

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When do you give the boot to thumb-sucking & paci-addictions?

By Guest Blogger, Dr. Grant Coleman, DMD, MS

My 3-year old son loves his pacifier. It's pretty much a requirement for him to have a successful nap or bedtime, and given that my wife and I like sleep, we gladly give it to him. The paci has also given him what we in orthodontics call an "anterior open bite," which in means that even when he's biting down on his back teeth, his top and bottom front teeth don't overlap at all. In fact there's now a hole in the front that you could probably fit a McNugget in without him even opening his mouth if you tried....

Some of the most common questions that we get in our orthodontic practice from parents of younger children relate to oral habits. Parents are often scared that their child is doomed to a decade in braces because of a thumb-sucking habit, but a little bit of information may put those fears to rest.

First of all, sucking habits in young children are completely normal. It's a comfort thing, and if it helps your kids sleep better or calm down, then you usually let it continue. When a child has a persistent habit with a thumb or pacifier, you'll likely see some effects on their teeth from the habit. Orthodontics is nothing more than the process of putting pressure on the teeth to move them-it doesn't matter where that pressure comes from. So, a persistent habit tends to push the upper teeth up and the lower teeth down, which leaves a hole or "open bite" in the front where the thumb or pacifier fits.

So when should you try to get your child to stop the sucking habit? Ideally before the first adult teeth erupt, which is typically around age 5 or 6. The side effects of sucking habits that are seen in the baby teeth are typically temporary, but once the adult teeth begin to erupt the orthodontic effects of habits can create more involved problems. Difficulty eating or biting through certain foods and speech problems are a couple of things you might encounter if the habit continues.

Getting your child to stop this kind of habit isn't necessarily hard to do, and I usually recommend starting with the most conservative/least expensive method possible:
1) Begin with a simple, positive reward system at home. Create a "reward jar" that gets $1 put in it for each day your child doesn't suck his thumb or pacifier; each time he falters and does the habit, you take out 50 cents. At the end of the week, he gets a fun trip to Target where he gets to spend the money he earned in the jar from stopping his habit. This is usually really effective but takes some time to work. It's also relatively cheap!
2) Use a removable orthodontic thumbguard. You can get this from your dentist or orthodontist, and it is really designed for finger/thumb habits. It is a plastic sleeve that fits over the thumb or finger, held by a wrist strap that the parent snaps on. This can be quite effective because the child can't take it off by himself-the parent has to actually cut the disposable strap to get it off.
3) Have your orthodontist make a custom "thumb guard" or "thumb crib." This is a lab-fabricated, metal appliance that is cemented to the upper teeth, and it has a metal mesh just behind the front teeth. It doesn't hurt, and basically all it does is block the finger/thumb/pacifier from fitting in the mouth like it normally does, taking away the pleasure from the habit. Although more expensive, these appliances almost always work because they are cemented in the mouth and aren't removable.

Above all, the most important thing is to keep the experience of stopping the habit a positive one! It doesn't help to call your child a baby or to embarrass him for what he's doing. You have to create in your child the desire to stop, and positive reinforcement is the best way to do that. Even trips to the dentist or orthodontist can be framed in a positive light to help your child see how he's growing up.

So, here are the take-home points: if you have a younger child (below age 6) with an oral sucking habit, don't worry! It's normal and can provide a lot of comfort, and the dental side effects are typically temporary in the baby teeth. Once the adult teeth start to come in, try the above methods to help your child stop. Stay positive and make it a rewarding experience, not a punishment. And if you're not having any luck with your at-home methods, talk with an orthodontist about taking the next steps to help your child quit. You and your child will be glad you did.

Our June Giveaway started this week! Register to win a free birthday party for your child at Funigan's! Please be sure you are first a newsletter subscriber (enter email address in the box in the upper right corner). Then you can click here to read about the giveaway and register!

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I'd Rather Stick Pins in my Eyeballs

By Rachel H
One day when I asked my daughter to do something that she wasn’t too crazy about doing, she looked at me and replied with a bit of sass, “I’d Rather Stick Pins in My Eyeballs.” You might be thinking. “Oh, she is going through the teenager attitude phase right?” No, the girl is FOUR! I couldn’t believe when that came out of her mouth! Initially, it struck me as funny and I could not help but laugh. Then I asked her where she had heard that and she replied, “High School Musical.” I know what you are thinking – “It is HIGH SCHOOL musical, Rachel, not PRESCHOOL musical, of course she is going to hear things like that and mimic what they do.”

I guess I have just always tried to be laid back and consider that I ran around the house singing, “Push It” and “Like a Virgin” when I was a kid having no idea what they meant and I think I turned out OK! (Enter zinger comments from my friends here!) I watched Three’s Company, Grease, and other things that had “suggestive” plots , but never really caught on.

But then other times I wonder if I am totally warping their minds when I let my kids watch shows or movies like this. My son’s new response when I ask him to clean his room or pick up his things is, “Got it, girl!” Far cry from the “Yes, ma’am” that many parents would expect, huh?

Personally, I think most of these sayings and actions are harmless and more than likely they are catching on to my own personality and common sayings more than anything from TV! As long as my children are respectful to others and to themselves, I think that is the number one priority, but it still brings me to the topic that I wanted to discuss today – which TV shows and movies do you think are inappropriate for your kids?

I personally love Noggin – good, clean, fun, but needless to say, my son who is almost seven is absolutely over that channel, which means my daughter only watches it when he is not around. I also like Boomerang because it brings back memories of my childhood when we watched the Flintstones and the Jetsons. I am not crazy about Cartoon Network, and even Disney sometimes has shows that I am not too happy about letting my kids watch. Don’t even get me started on Nickelodeon.

I may need to throw in here that we do not have DVR, so there is no advance planning for shows. If we are home on a weekday, my children get about an hour of TV, so it totally depends on what time homework is done, if we have any other activities, etc. What they watch just depends on what happens to be on television at the time that we have a free hour.

And what is up with the dark and dreary movies for kids lately? Have you seen Corraline? What about the remakes of Alice in Wonderland, A Christmas Carol, and Where the Wild Things Are? Why do they have to be so creepy, dark, and dismal?

Realistically, most parents do not have the time to sit with their children and monitor every TV show, or prescreen every movie before we allow them to watch it, so let’s help each other out here – what shows and movies are appropriate for what ages?

Again, my top recommendations for children ages 4-7 are the Noggin shows and Boomerang Channel. I also think the PBS shows are great for younger kids. For movies, we recently saw How to Train Your Dragon. It was so cute. A great DVD ... I thought Kung Fu Panda was so cute for adults and kids without being too scary or sad. And the classics ... I love The Parent Trap (old and new versions).

You can also check out our past blog on TV ratings for kids here. Tell us what you think!

Got a kid who loves soccer? Register here to win a $100 gift certificate to Triad Elite Soccer Club or Camp! Giveaway ends on Friday, May 21st.

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A Tale of a Tantrum

By Guest Blogger Kelly Gunzenhauser


So I thought I was getting off easy when my younger son came along and we were blessed with a child who had the sunniest disposition I have ever seen. He was a content, easy baby. Now, as a two-year-old, he kisses his preschool teachers after they change his diapers and tells everyone who will listen that he loves them. He can get a little feisty with his friends, but he’s usually a piece of cake at home.

By now you are all laughing at me and waiting for the other shoe to drop, and of course it has. My son has hit the tantrum stage. He is not a small kid and he’s strong as an ox, so tantrums are not minor events. Here is a list of some of the things that have set him off: socks too “waggy,” socks at all, shoes at all, getting dressed, wearing a coat, not getting his fingers in the right glove holes, wearing mittens instead, changing his diaper, going to the grocery store, going home from anywhere, getting strapped into his car seat, going to preschool, going to bed, reading only one book at bedtime, getting a bath, getting lotion on his eczema, brushing his teeth, having his fingernails cut, leaving a friend’s house, waking up from a nap, getting too many kisses, being asked what he wants for breakfast, getting the wrong color of cup, and when his brother looks at him.

The “best” tantrum by far was at the grocery store. He wasn’t in the mood for the store. I was of two minds. His tantrum was more whining than anything else—should I risk it? Maybe a cookie once we got inside would help. And, I don’t really like giving in to tantrums. And, I REALLY needed to go to the store! So off we went.

While we were there, he screamed at the absolute top of his lungs the whole time, “Put your stuff back!” He ran from one side of the store to the other and hid. He kicked and screamed every time I picked him up to move him to a new part of the store. He ran away from me and tried to escape out of the door into the parking lot; I only stopped him by grabbing the hood of his jacket. So many people offered help: “Can I get him a balloon? Can I get him a cookie? Can I hold him while you tie him to the cart?” (OK, just kidding about that last one.)

And just as many people came up to me and said, “I have 2 (3, 5, 10) kids and I have been there. It gets better.” (Yes, I know it does. The five-year-old evidence of that is calmly riding in the spaceship grocery cart.) And a few people looked at me like I was the world’s worst mother, you know, shaking their heads in that, “Wow, why can’t you control your child?” sort of way.

As I look back over the list of things that have set him off, I see that many of them are transitions and “have-to-dos.” Kids don’t like to change course until they are ready. The reality is, though, that sometimes we have to do what needs to be done, and I can’t accommodate his timetable. Like right now, while I am trying to finish this up quickly, and he is hanging on me and whining and lying in the floor and kicking. Now he’s telling me, “I don’t like you Mama,” even though the reason he’s mad is because he wants to play a game - with me. He must like me a little bit. Sometimes. But I know that soon, this stage will be over. And with it will go some of the “I love you’s!” and the constant smooching and the crawling in bed with me in the morning when he wakes up at 5:00am. He’ll be more reasonable, but a little more grown up, too.

So what are your favorite tantrum stories? And what are your tips for dealing with them?

* We thought you would enjoy a "post-tantrum" picture of the star of this post, shown at the top of the blog!

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Travel Safely With Toddlers This Holiday Season

By Marjorie Wrenn, a Child Safety Expert

When children first begin to crawl, their curiosity about the world around them triples as they explore any and everything. Pre-schoolers develop motor skills but they have poor impulse control and judgment. Children don’t have the strength, coordination nor maturity to avoid injury and their curiosity is a powerful force. As a result, they enter one of the most dangerous times of their lives when they are at the highest risk for injury. Preventable injuries in the home are the number one cause of death of children. These injuries also transfer to any environment where you are with your infant or toddler. That can be a hotel room while on vacation, grandma’s house, a rental property, etc.

The same precautions that you take at home should be taken at any of these temporary locations as they all have dangerous sliding doors, toilets that can cause drowning, doors that should not be opened by a toddler and sometimes access to toxic products that can cause a poisoning.

Child proofing needs to travel with you. I suggest you have a travel kit filled with door knob covers, electrical outlet covers, sliding door blocks, toilet seat locks, a first aid kit, a poison antidote, etc. to ensure the protection of your small children.

Also, should there be an accident while your child is with a caregiver, be sure you have a Medical Authorization form completed and notarized so that caregiver can authorize medical care should you not be available. If, for instance, there is a poisoning and your child is rushed to the hospital while you are finally out for that long awaited romantic dinner, the grandmother cannot authorize care without a Medical Authorization form. You don’t want the physicians just standing by waiting for you to arrive when they could be saving your child’s life. An emergency telephone list with details of your child’s blood type, allergies, etc. should also be with each caregiver.

There is absolutely no greater devastation than losing a child and certainly that devastation is compounded when the loss is due to a preventable accident. Your question is not will your child find hazards, but when. Take the extra precautions today to prevent a trip to the emergency room tomorrow.

For a Travel Safety Kit perfect for protecting mischievous toddlers, contact Marjoie at spinaker12@msn.com.

Did you travel with your toddlers this holiday season? If so, share your stories, advice and lessons learned!

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Basics of Potty Training

By Steve J. Hodges, MD
Pediatric Urologist at Brenner Childrens Hospital


There are two main questions most parents have about toilet training: 1) When should I toilet train my child? and 2) How should I toilet train my child? Unfortunately, there aren’t any straight answers to either question. Not that you won’t find a lot of opinions, but very few of them are based on scientific fact, just anecdotal views.

When to Train?

With regards to the timing of toilet training, there are two distinct camps here: the parent-centered and the child-centered approaches. The parent–centered approach typically occurs earlier, at around 18 months or so, and involves introducing the child to toilet training rather quickly by using a variety of methods, often by just removing the diapers. The child learns to go in the toilet or get wet/soiled, and it is actually quite surprising how quickly some toddlers can catch on. Proponents say that this method is more environmentally sound (less diaper waste), saves families money that they would otherwise spend on diapers, and forms the proper habits before children get too strong-willed or set in their ways. Some preschools or other children’s programs require that participants be toilet trained prior to entry, so this method may be forced on families due to these circumstances. Opponents to this technique believe that children much younger than three years old don’t possess the physical and mental capacities necessary to become properly trained, so there’s no use in trying.

The other approach, the child-centered method, usually occurs later (often after 30 months) and waits until the child is interested in training and generally takes things at a slower pace. Children must reach certain milestones, such as the ability to communicate, dress/undress, show interest in toileting, etc before training begins. Supporters of this technique point to fewer complications of potty training (bed wetting, accidents) in children trained at a later date. Detractors point to conflicting data (more accidents in children trained later), and the difficulties of training a child that is so used to being in diapers, and in the middle of the terrible twos or threes (their favorite word being “No!”).

There are no strong data suggesting that either approach is wrong. As Americans, we tend to train later than most (Europeans think we’re nuts), but the question remains - what is best for the child? Not the environment, not the preschool, . . . the child.

Well, for whatever it’s worth, this is the way I look at it. To be properly toilet trained, a child must go from the infant voiding/defecating pattern to an adult pattern, with the smoothest possible transition. How do we do that?

When we are babies and in diapers, we poop/pee totally by reflex. There is no thinking about it, we just go. As the bladder fills, it spontaneously empties, and the same with our bowels. These are probably the healthiest toileting habits we will ever have.

Adults go slightly differently. We sense the need to go, and as soon as possible, we find the closest bathroom and we go. The only difference compared to babies is that we use our sphincters to delay or put off emptying until it is socially acceptable.

So when children are toilet trained, two main things happen. First, they become aware of the urge and need to empty their bowels and bladder. Secondly, they learn to control when to go to the bathroom by squeezing and relaxing their sphincter. The child has to sense that the bladder/rectum is full, decide that he wants to go, and find a comfortable and safe place to go. Then he actually needs to go there, relax his sphincter, and take the time to actively and completely empty his bladder/rectum. That’s quite a lot to ask of a 2 year old.

What happens in reality is that once kids learn to put off going to the bathroom, they almost always put it off too long. They would rather play, watch TV, anything other than go to the bathroom. And when they do go, they go for the shortest amount of time possible, usually not emptying completely. When you put off pooping, you get constipated. When you put off peeing, you risk urinary tract infections, and often develop an overactive bladder that can result in wetting.

These bad habits can develop in a child toilet trained at any age, but in my opinion, if a three year old tends to put off emptying, a one year old will too, they will just do it for a longer time (potentially causing more problems). So it’s probably best to let the healthy infant emptying habits (just going in diapers) last as long as they can, and train at a slow, steady pace once the child shows interest. Sure you may have a 4 year old in diapers, but I promise they won’t go to college in diapers, and they will likely have fewer problems in the long run.

How to Train?

Now that we think we know when to train a child, how should we train the child? Well, whenever there are a million different ways to do something, you can be sure none of them is perfect. And this is the case with toilet training. In general, I believe the slow and steady approach is best here as well. The Brazelton method(named for the famous Pediatrician) makes the most sense to me. First you make sure the child is ready (can dress and undress, can communicate the need to go, has a desire to go, etc.). The you have them start by sitting on the potty fully clothed, usually when you go, so they can watch and learn. Then you start emptying the diaper contents in the potty so they learn what goes in there. Once the child has these concepts down, you pick a few days and have them go around without diapers in a room with a potty. After a few accidents, they catch on and begin going in the potty on their own.

Another method that is appealing in its methodology is the timing method. You simply have the child in pull-ups go to the potty at certain time intervals during the day (every couple hours of so) and reward them when they poop or pee in the potty instead of their diapers. Again, eventually they get it, and you have less cleaning up to do.

To be honest, the method of training really doesn’t matter. Even if you drop diapers cold turkey, the child will learn to go to the potty to avoid being wet. The key, and I cannot stress this enough, . . . the key is to not lose track of when your child is going to the bathroom after they are trained! Once children are trained, parents assume they will go when they need to. Believe me, they won’t. So what you need to do is keep track of when they go, and keep a look out for signs that they need to go. If you see your child doing the “potty dance”, don’t ask them if they need to go (they will say no), just take them to the bathroom. Once there, you need to make sure they take their time to empty completely, so its best to say that they need to sit on the potty for at least 2-3 minutes before they can say they are done. Also, instead of looking for signs of holding (like curtseying or squatting in girls, grabbing their privates in boys), you can always just impose a peeing schedule, that way you know they are at least trying to go every few hours.

You also need to keep a close eye on how they are pooping. Between 30-50% of kids are constipated and parents often have no idea. Make sure your child poops every day or every other day, and make sure the poop is gooey soft (like a thick milkshake). If they are going less frequently than every other day, or if their poop is painful or hard, consult with your pediatrician for treatment options. Constipation is probably the most common preventable cause of belly pain, bedwetting and daytime poop and/or pee accidents in children, so the importance of treating it cannot be overstated.

For whatever reason, people have very strong opinions on toilet training, so I try to not be too dogmatic in my recommendations. Everyone’s circumstances are different, and there are data to support almost any point of view. The key is to help your child develop the habits of regular and complete emptying of the bowels and bladder, and there are many ways to do that. Keeping in mind the points mentioned above should keep you out of most trouble, and hopefully lead to a happy, healthy and dry child.

For more information, you can check out these websites: www.homepottytraining.com is my website and has some useful ideas. The International Children’s Continence Society has an excellent site (www.i-c-c-s.org), check out the “general public” link.

Don't forget to register for this month's giveaway! You may be the lucky winner of a $50 gift card to Emma Jane's Children's Specialty Shoppe! Their clothing, furniture, toys and accessories are high quality and unique! Good luck!

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Surviving the Terrible Twos

By Katie M

In less than 24 hours, my two-year-old son managed to take a ball point pen to our leather couch, color with crayons all over our plasma TV and coffee table, and shove every penny, nickel and dime he could find into my car’s CD player! A few weeks earlier he also drew crayon designs on our painted living room walls. All this while our house was on the market, no less. Yes, we did manage to sell the house…and get all the crayon off (thanks to WD 40 on the walls, fyi), but there are still traces of ink on our leather couch.

As if that’s not bad enough, a friend of mine recently told me her two-year-old daughter combined Comet and cooking oil and poured that fancy concoction all over the back fabric cushions of their couch. Those cushions are now in the trash, and she and her family have resorted to sitting on cushion-less couches for the next five years or so.

So, what is it with these cute little demons? How do you manage this behavior?

The “terrible twos” (a misleading term because this phase can start as early as 18 months and last past age three), is pretty much a given no matter your parenting style. It’s not that we’re giving our child too much or too little attention, or too much or not enough discipline. You can try your darndest to not spoil your child, and chances are they will act spoiled anyway. And let’s fact the facts: play dates for children of this age are more for moms since toddlers rarely “play” with other children. It’s hard enough to get them to share a toy or even interact.

Well all this is normal – and for those of you who have gone through this phase once or several times – you know what I’m talking about. This is part of normal child development – and it’s actually good, so I've been told. It’s their way of creating independence – a character quality we should all help them achieve.

Since I am in the thick of it here in our home, I did a little research to find some tips for surviving the “Terrible Twos” and thought I’d share some advice I found from www.Baby-Medical-Questions-and-Answers.com. I also found a nifty Terrible Twos Countdown Calculator to let you know how much longer you will have to deal with this stage. According to the calculator, I have 98 days, 4 hours, 14 minutes and 10 seconds until my son is out of this crazy stage! You can bet I’m counting!

It's all about the "Here and Now"
Children live in a short time frame. The upside of this is that toddlers don't bear grudges. So any management of toddler behavior needs to be immediate. Your child won't get it if you wait to discipline him until later. Positive reinforcement needs to be immediate as well.

Be clear and consistent
Your child needs to get clear messages from you and you need to be consistent. It's no use laughing about a particular toddler behavior one day and then the next day being cross about it. Both parents need to be giving the same message, as well. Your child doesn't understand subtleties or mixed messages. Make sure your body language doesn't give a different message from what you're saying.

Don't sweat the small things
Give your child a break. He's not going to behave perfectly all the time. Don't get upset at every little thing. Concentrate on the big stuff (the toddler behavior you find unacceptable) and get that right.

Consider the behavior not the child
Your child will exhibit unacceptable behavior and be "out-of-control" from time to time. That doesn't make him a "bad" child. When you are unhappy with your toddler's behavior, make it clear that it is the behavior, not the child, that you don't like.

It's not a democracy
Not everything that happens in your family is by consensus. You have right of veto. You are the parent. There are times when discussion is not appropriate.

Don't fight with your toddler
It is pointless to get into an argument or fight with your toddler. You are the adult and you have to resist.

Positive Reinforcement Works
Positive reinforcement is the best form of child and toddler behavior management. Give lots of positive attention for behaviors you want to see. Your child needs the positive feedback. So, when he is being "good," tell him, make a fuss about how good he is and how much it pleases you.

You might even want to consider using a toddler-basic version of the reward chart. We featured an example of this on Triad Smarty Pants last year.

Ignore Unacceptable Behavior
Ignoring, or more correctly failing to give reinforcement, works. Your child's motivation is to get attention (and sometimes he doesn't care how) - if he doesn't get attention, he will try something else.

Use Time-Out for "Out of Control Behavior"
They way you choose to discipline your child is up to you, but time-out can be effective for changing toddler behavior. It is actually "time out" from positive reinforcement.

Model "good" behavior
Show your child how you want him to behave - it's very powerful. If you don't want your child to swear and curse, don't do it yourself.

What are your smarty tips for surviving the Terrible Twos?

Don't forget to register for this month's giveaway! You may be the lucky winner of a $50 gift card to Emma Jane's Children's Specialty Shoppe! Their clothing, furniture, toys and accessories are high quality and unique! Good luck!

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What I Didn't Do the Second Time Around

By Jenny D., Charlotte Smarty Pants



I just had a beautiful baby girl, Annie, in September. Three years and one week after my first girl, Zoe. And the second go around, I noticed that I did things a little differently, actually there were some things that I didn’t do at all.

With Annie, I didn’t worry about all of the gear. I used a diaper bag for about 4 weeks, but it was half the size of my first one, and all I included was a couple of diapers, wipes, and changing pad. With Zoe, I had enough stuff to last us through the weekend if I ever got stranded at the mall for that long.


I don’t worry about schedules. Annie slept through the night early on, but now she has decided to wake up at 3:00 in the morning. With Zoe, I would have been worried that I was doing something wrong, but this time, although I am exhausted, I love seeing her smile at me when I give her a bottle in the middle of the night.

I don’t worry about keeping the house so quiet during naptime. When Zoe was a baby, you could hear a pin drop anytime she was asleep. You quickly realize that it is virtually impossible to get your older child to be quiet when the baby is sleeping, so your newborn learns to sleep through anything.

I guess I just don’t worry as much overall. And it shows. Annie is a laid back baby, and I am sure that it has something to do with the fact that I am more relaxed. And because of it, I have enjoyed every minute of the newborn stage. Having gone through it once before, I am aware of how quickly they change, so instead of wondering when I am going to get my life back, I just sit and stare at her happy little face as much as I can.

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How Old Is Too Old?

By Rachel H

My first child was a boy, so since he was born, I have always taken him into the Ladies’ Restroom with me when we are out in public. He just turned six, and I guess I got so used to doing this that it never really crossed my mind that there will come a point when he needs to go into the Men’s Room alone. My family went out for dinner a few months ago, and when I got up to use the restroom my son said he had to go as well, so we trotted off together to the ladies room. When we got back my husband immediately said, “You can’t do that anymore! He is way too old to be in there with you!” For the first time I had to stop and think, “How old is too old?”

When I told Katie I wanted to write about this, her first response was, “I have to tell you the truth … it creeps me out to see six-year-old boys in the women’s bathroom.” But then I told her my side and explained that my fear is sending him in to the Men’s bathroom alone and running into the psychopath who is just sitting there waiting for an innocent little boy to waltz in! She said she’d never thought about that since her son is still small enough to accompany her and no one really notices. Do I think Mr. Creepy Man is waiting in the restroom at a fine dining restaurant? Probably not … but, when we are at the park or the mall, I truly do have that fear. I have heard stories of men exposing themselves to young boys in the bathrooms and it scares me to death.

I am pretty far from being an over-protective mom, and sometimes I think I have raised my kids to almost be TOO independent, but this is one situation where I really need help. I am guessing I just need to start standing next to the bathroom door and sending my son in to use the restroom as quickly as possible. I don’t know what other option I have. So please share! When did you start letting your son use the Men’s Restroom without an adult?

Now this leads me to many other questions where I wonder “How old is too old?” I am going to preface this now by saying that some of these questions can get very touchy and I know some readers will get very opinionated about them. So please keep your comments nice and respect the views of others. After all, some of us really do have justifiable reasons behind why we do things! This also goes for children who have special needs. There are often times where they may need extra help and should not be judged.

How old is too old to …

Bathe with a sibling of the opposite sex?
See their parents nude?
Need help getting dressed?
Watch Barney?
Breastfeed?
Be rocked to sleep?
Wear longalls and shortalls?
Wear smocked clothes?
Use a pacifier?
Be walked into their classroom by mom or dad?
Ride in a stroller?
Have their parents cut up their food?
Trick or treat?
Still take a bath instead of a shower?
Still be wearing diapers?

Lots of thought provoking questions here, folks! So, weigh in with your answers and let us know !

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Shopping for a Stroller? Read This!

By Katie M

Let me start out by saying, “Don’t do what I did!” When I had my first child almost six years ago, I did not put any emphasis on buying a good stroller. I don’t think I even registered for one, and despite the fact that we received enough gift cards from Babies R’ Us to more than pay for a great stroller, we opted to use that money towards other things we thought were more important (probably diapers!).

Buying a stroller is an overwhelming process, to say the least. There are so many considerations, styles, prices, brands, and features that your head will spin! If you are trying to keep your research simple, I would suggest starting your search with the Baby Bargains book, www.consumerreports.org, and by simply talking to professionals at stores like Babies R’ Us. If money is not a concern, you can always check out the latest models at trendy baby boutiques too.

The following is my story which offers some suggested brands and styles, and some to steer clear of. Regardless, hopefully my decisions – and lack of – will better help you in your stroller search.

Like I mentioned above, I did little research on strollers before Emily was born. I did look at some “travel systems” because it seemed like everyone I knew had one. But I never thought they looked user-friendly and I am not the kind of person who deals well with lots of buttons, snaps and instructions when I need something to work quickly and often. As luck would have it, Jen P (of Charlotte Smarty Pants) let me borrow her Baby Trend Snap N’ Go stroller the whole time Emily was in her infant car seat. The Snap N’ Go (or similar model like the Graco SnugRider), in my humble opinion, should be on the top of every new mom’s must-have lists. Not only are these “frames” super inexpensive (between $50 and $60), but they’re incredibly light, and a cinch to pop open, fold up and put in the back of your car. They also have plenty of room below for storage, and some even come with cup holders for mom!

Then when Emily grew out of the Snap ‘N Go, my husband’s sister passed down her Maclaren stroller which, to me, was just a glorified umbrella stroller. Again it didn’t matter to me at the time because as new parents adjusting to living on one salary, we were both immensely grateful not to have to invest in a new stroller. So we stuck with the Maclaren.

However, not getting a more functional stroller was a huge mistake on my part. Don’t get me wrong, Maclaren is a great brand. As far as convenience, it was the ticket. Super light. Easy to fold and unfold. Not bulky at all in the back of a car. But the stroller we had wasn’t suited for what we needed it for. It was better for quick trips with the baby or as a back-up stroller when traveling (it works great in aiports!). On top of that, it had no tray for sippee cups or finger foods. And for some reason, our stroller had no storage. None, zip. Not sure if the lack of the tray and storage bin was because it was an old model, or a result of it being a hand-me-down. (The models on its web site look much more functional than what I had).

But the worst part of our stroller: Emily was constantly in the reclined position and I couldn’t adjust it otherwise. So as a result, she never became a “stroller baby” – something that drove me – and my mom – crazy because it was impossible to take her shopping – or anywhere in a stroller – for more than 15 minutes.

Then my son came along. He too used a Snap ‘N Go, and then we moved both kids into a Joovy Caboose stroller - our mode of transport for nearly two years. I think the tandem model is a novel idea, however, I’m not sure I’m sold on Joovy. Maybe it’s just my stroller, but more often than not its wheels are IMPOSSIBLE to maneuver.

So what should you consider when buying a stroller? Obviously don’t follow my steps! According to Consumer Reports.org, you should consider the following:

1. Select the stroller yourself. Only you know what will work for you, and what you feel comfortable with.

2. Know your lifestyle, and use that as a guide. Obviously if you live in a busy city, you'll need a stroller that folds quickly and is compact. Here in the Triad, you could probably go for a bigger stroller. Or if you’re athletic, you might want to consider a jogging or all-terrain stroller.

3. Don’t go by price alone. Lots of variables go into the price and you need to determine what’s important to you first, then consider the price. Bigger-ticket strollers might have more amenities than lower priced models, but those less expensive strollers may serve you just as well. The average price of a good-quality stroller starts at about $250.

4. Take it for a test drive. Even if you plan to buy online, find the model in a local store and take it for a spin. Compare maneuverability and ease of use. Make sure the height is suitable for you – and your spouse. Give it a jiggle and make sure the frame feels solid.

5. Take your baby’s age into consideration. Remember newborns can't sit up until about six months old, so be sure the stroller reclines for babies of this age.

6. Check certification. Make sure the certification sticker shows that the stroller meets the minimum requirements of the American Society for Testing and Materials (ASTM) voluntary standard, and that its manufacturer takes part in the certification program administered by the Juvenile Products Manufacturers Association (JPMA). Companies that are certified are: Baby Trend, Britax, Bugaboo, Delta Enterprise, Dorel Juvenile Group, Evenflo, Go-Go Babyz, Graco, Hauck Fun for Kids, J. Mason, Joovy, Kolcraft, Maclaren, Mia Moda, and Peg-Pérego.

7. Evaluate the warranties and return policies. Your best bet is to purchase the stroller from a store, catalog, or web site that offers a 100 percent satisfaction guarantee.

And what are the hot sellers? According to the latest Baby Bargain book, the following are their favorite picks:

Mall Crawlers
Baby Trend Snap N’ Go ($60) or
Graco SnugRider ($60)

Travel Systems
The authors actually advise against these models, but if pushed they recommend Chicco Cortina ($300)

Second Strollers
Evenflo X-Sport Plus ($50) or
Chicco C6 - also known as Capri ($65)or
the Maclaren Volo ($100 - $130)

High-end picks
Baby Jogger City Mini ($230)
or Maclaren Techno XLR ($350)

*Baby Bargain also gives picks for other types of strollers, including urban jungle, green acre, exercise, and double strollers.

I hope this information helps. Let us know what your favorite stroller is, and why!

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BPA-Free Pacis By Request!

By Jenny D, Charlotte Smarty Pants


Many of you asked us to do some Smarty research on BPA-free pacifiers and teethers. Well, here you go! Here's a list by brand:

BPA & Phthalate Free Pacifiers:
- Playtex: Playtex “Binky” (one piece silicone pacifier), Binky Most Like Mother Latex Pacifier, Binky Most Like Mother Silicone Pacifier, Binky Angled Pacifier, Ortho-Pro Pacifier
- Gerber: NUK Original, NUK Classic, NUK Nautical
- The First Years: Soothies Silicone Paci’s, Safe Comfort, Ultra Kip
- Vice Versa Binky w/ Case
- Natursutten Natural Rubber Paci
- Evenflo: Mimi Soft Touch, Mimi Premium, Mimi Neo One-Piece, Vizion, Fuzion and Illuzion
- Gumdrop Silicon Pacifiers

Quick note: if the nipple of the pacifier is made of latex or silicone, the nipple is BPA-free. Some pacifiers, like Avent have silicone nipples, but the handle and front plastic contain BPA. I have also read to choose silicone over latex because of possible carcinogens found in latex (except in Natursutten).

Here’s a general list of pacifiers to avoid:
-Avent
-Gerber: Natural Flex, NUK Button pacifier, Gerber Round Soft Center pacifier, Gerber NUK Fashion Silicone
-Evenflo: Vizion, Fuzion, Illuzion (only those not labeled as BPA free)
-Munchkin
-Sassy/MAM
-Nuby
-Razbaby Keep-it-Clean

BPA & Phthalate Free Teethers:
- Sassy: Sassy Jelly Fish Teethers, Sassy Coolin’ Teether, Sassy Chilly Dilly Daisy, Sassy Teething Feeder, Sassy Teach Me Toothbrush Set, Sassy Teething Tunes, Sassy Gummy Guppy, Sassy Earth Brites Natural Wooden Toys, Sassy Buzz n’ Bites teether
- Luv n’ Care Icy Bite Teether
- Nuby: Nuby Jiggle Giggle Teethers, Nuby Nibbler, Nuby Ice Gel Teether Keys on a Ring,
- Bug-A-Loop Teether, Nuby Icy Bite Teether Rings, Nibbler, Nuby Kool Soothers, Nuby Pur Icy Bite Teethers, Nuby Fun Teethers, Nuby Fun Links and Fun Links on a Ring
- Je Je Vibrating Teether (rubber)
- Vulli Sophie the Giraffe Teether, Vullie Chan Pie Gnon Teethers, Vulli Vanilla Flavored Chan Pie Gnon, Vulli Cool It Soother Chan Pie Gnon, Vulli Vulli Musical Fruit Keys, Vulli Rattle Key Chain, Comfor & Joy Teether (not yet available)
- Gentle Vibes teether
- Fisher Price: Laugh & Learn Learning Keys, Rainforest Monkey Teether,Rainforest Giraffe Rainstick Rattle, Miracles & Milestones Musical Zebra, Miracles & Milestones Sunshine Activity Ring, Miracles & Milestones Penguin Water Teether, Lil’ Laugh & Learn 1-2-3 Puppy Rattle
- Combi Teethers
- Bright Stars: Chill and Teeth Tubes, Licensed to Drool, Rattle and Spin teethers, fun links
- Gerber: Cooling Gum Soother, Cool Fish Soother, Cool Ring Soother, OrbiTeether
- Learning Curve: Cool Triangle Teether, Floating Friends, Soft teething beads, First Keys
- Camden Rose: Maple Teether and Waldorf Cheery Rattle/Teether

We hope you find this information helpful. I pulled this information from several websites and blogs, but I think the Soft Landing Blog has a pretty extensive list of non-toxic products. Let us know if you have any other tips to share!

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