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Whooping Cough Vaccine Not As Effective As Thought

5/5/2015

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Just when the fears over California's outbreak of measles have started to fade, another rising concern now comes to the fore. From a recent article on NPR, it appears that the Tdap vaccine, used to fight Whooping Cough, also known as pertussis, is not nearly as effective as once thought. And, it is much less effective than the prior vaccine that it replaced back in 1997.

From NPR,
   Lately, Californians have been focused on a measles outbreak that got its start at Disneyland. But in the last five years, state health officials have declared epidemics of whooping cough twice — in 2010 and in 2014, when 11,000 people were sickened and three infants died.
    Now an analysis of a recent whooping cough epidemic in Washington state shows that the effectiveness of the Tdap vaccine used to fight the illness (also known as pertussis) waned significantly. For adolescents who received all their shots, effectiveness within one year of the final booster was 73 percent. The effectiveness rate plummeted to 34 percent within two to four years.
   "(T)his waning is likely contributing to the increase in pertussis among adolescents," the authors wrote.
   Tdap protects against three diseases: tetanus, diphtheria and pertussis. The pertussis protection is from the acellular pertussis vaccine. It was introduced in 1997 to replace the whole-cell vaccine, which caused more side effects. Monday's report confirms earlier analysis that the acellular pertussis vaccine may be safer, but less effective, than the old one.
   The study was published Monday in the journal Pediatrics.
   Shots - Health News Schools Not Keeping Track When Kids Are Behind On Their Shots "The take-home message is that the waning is there," said Dr. Art Reingold, a University of California, Berkeley professor of public health. "You're protected initially but it wanes over time."
   It doesn't mean people should skip the vaccine. Someone who is vaccinated, but becomes sick with whooping cough, should have a less severe course of illness.
   The authors said that new vaccines are "likely needed to reduce the burden of pertussis disease." But Reingold, who leads the CDC's Advisory Committee on Immunization Practices group on pertussis, said he doesn't know of any pertussis vaccine development in the pipeline.
   He also said that adding another dose of the vaccine at a later age wouldn't help much, based on research that was presented to the ACIP group. "(An additional dose) would have very little impact on pertussis," he said, "in terms of cases prevented."
   Shots - Health News How Vaccine Fears Fueled The Resurgence Of Preventable Diseases The most severe cases are in very young infants, Reingold said. Babies can't be vaccinated until they are 2 months old. To protect newborns before they can be vaccinated, the CDC recommends that women be vaccinated during the last trimester of every pregnancy — even if they received a vaccine before they became pregnant.
   "Babies will be born with circulating antibodies," Reingold said, "and there's pretty good evidence that that will reduce the risk of hospitalization and death in babies."
   In an accompanying commentary, Dr. James Cherry at UCLA said the findings about Tdap effectiveness were "disappointing," but he also pointed to other drivers of recent pertussis outbreaks, including increased awareness and better, more sensitive testing.
   Previous reports have shown that vaccine refusal played a role in the 2010 whooping cough epidemic in California.
   Reingold also drew an interesting distinction between measles and pertussis having to do with herd immunity. If a large enough percentage of the population is immunized against measles, both individuals and the broader community are protected against outbreak. That's because the measles vaccine protects you against the virus that actually causes the measles illness.
   But in pertussis, the disease is caused by toxins that are released by bacteria. The pertussis vaccine protects you against those toxins, but may not prevent you from spreading the bacteria to others — and causing illness in them.
   The outbreak of measles earlier this year was likely caused by someone who brought the disease back from abroad. Measles was eliminated in the United States in 2000.
   "Pertussis is not going to go away with the current vaccine," Reingold said.

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New Sugar Bites TV Ads Target Children’s Juice Drinks in Contra Costa County

5/4/2015

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Concord, CA – Days after a bill to place warning labels on sugary drinks died in Sacramento, Contra Costa County’s Sugar Bites campaign is launching provocative new television commercials challenging the deceptive marketing tactics used to trick parents into thinking sugary juice drinks are healthy beverages for young children.

The commercials, available in English and Spanish, feature a young child pleading with her mother to purchase a juice drink in the grocery store. The mother is horrified when the container morphs into a toothy monster and she learns that consumption of sugary beverages can lead to tooth decay, obesity, and type II diabetes. First 5 Contra Costa and the Healthy and Active Before 5 collaborative created the ads.  

“Most children’s juice drinks contain as much sugar as soda and miniscule amounts of fruit, yet they’re marketed as healthy options for young children,” said Contra Costa Health Services pediatrician and Healthy and Active Before 5 member Dr. Diane Dooley.  “The new Sugar Bites ads provide a much-needed counter message for parents barraged by misleading claims from the beverage industry.”

A recent study by the Rudd Center for Food Policy and Obesity found that most parents believe some sugary drinks are healthy choices for kids, primarily because the labeling and marketing of these products imply they are nutritious. Among parents surveyed with children ages 2 to 5, 80 percent served them juice drinks such as Capri Sun or Sunny D. That’s why researchers recommend that, in addition to product labeling changes, sugary drink health campaigns should focus on juice drinks as well as soda.

“We may not have beverage industry advertising budgets, but we have the science and the truth. And parents have a right to know that sugary drinks are tied to serious, lasting health risks,” said Cally Martin, Deputy Director of First 5 Contra Costa.

According to researchers, sugary drinks are the largest source of added sugar in the diets of children and contribute to childhood obesity. Unless trends change, health advocates say one in three U.S. children born after the year 2000 – and nearly half of Latino and African American children – will develop type II diabetes in their lifetimes. Already half of California children experience tooth decay before kindergarten.   

The Sugar Bites commercials will run through July on Contra Costa cable stations and online. The campaign also includes a two-minute video with tips for parents to cut back on sugary drinks and serve their children water instead.

Watch the commercial/video:

·       Sugar Bites 30-Second TV Ad: https://youtu.be/TzPS6ELoZ1I

·       Sugar Bites 2-Minutes Informational Video: https://youtu.be/8U91Rby-O3Q

To learn more, visit the campaign website: www.cutsugarydrinks.org.

About First 5 Contra Costa

First 5 Contra Costa helps young children start school healthy, nurtured and ready to learn by investing in programs and activities focused on children during their first five years, the most important time in children's development. Since 2000, First 5 Contra Costa has invested more than $120 million in Proposition 10 tobacco tax funds to help Contra Costa’s children get the best possible start in life. Learn more: www.firstfivecc.org. 

About Healthy and Active Before 5

Healthy and Active Before 5 is a collaborative committed to reducing childhood obesity in Contra Costa County. The collaborative includes 50 Contra Costa community organizations who serve families with children up to age five. Learn more: www.healthyandactivebefore5.org.
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How Well-Vaccinated Is Your Child's Child Care Facility or PRESchool?

4/23/2015

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Child care facilities with low vaccination rates are at increased risk for outbreaks of vaccine-preventable diseases. Some children are allowed by California law to skip immunizations if a parent submits a personal beliefs exemption (PBE) or a medical exemption (PME) at enrollment. Other children may be admitted to child care on the 'condition' they complete remaining vaccinations when due. Until follow-up is complete,  'conditionally admitted' children remain under-vaccinated. Note: Child care /preschool facilities with fewer than 10 students are not listed and will not appear on the map. Also, data for children under the age of 2 years are not included.

Child Care Facility and Preschool Vaccination Rates
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Measles December 2014 Outbreak Declared Over

4/23/2015

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In December 2014, a large outbreak of measles started in California when at least 40 people who visited or worked at Disneyland theme park in Orange County contracted measles; the outbreak also spread to at least half a dozen other states.

On April 17, 2015, the outbreak was declared over, since at least two 21-day incubation periods (42 days) have elapsed from the end of the infectious period of the last known outbreak-related measles case.


Measles is a highly contagious viral disease. It is widespread in many parts of the world, including Europe, Africa, and Asia. Measles begins with a fever that lasts for a couple of days, followed by a cough, runny nose, conjunctivitis (pink eye), and a rash. The rash typically appears first on the face, along the hairline, and behind the ears and then affects the rest of the body. Infected people are usually contagious from about 4 days before their rash starts to 4 days afterwards. Children routinely get their first dose of the MMR (measles, mumps, rubella) vaccine at 12 months old or later. The second dose of MMR is usually administered before the child begins kindergarten but may be given one month or more after the first dose. For anyone planning to travel internationally, the California Department of Public Health (CDPH) strongly encourages all Californians to make sure they are protected against measles and other dangerous diseases before they go abroad.

For additional information on California measles cases, please see the Measles Surveillance Updates.
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Measles, Strangers, Bullies & Summer Camp - A Family Discussion 

4/10/2015

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Believe it or not, it’s already time to start planning our children’s summer camp schedules. Each year in our household this stimulates furious, anxious planning and discussion. I mean, how many activities do these youngsters really need? Back in our day we were sent out to play for the summer and told to come back in August! Okay, not really but you probably feel the same way.

With new times come new challenges. This year our family discussion fell directly on the latest ‘hot button’ topic and our first important topic to consider when choosing summer camps: Communicable diseases - or more specifically, the measles. Much has been said in the media about pockets of un-immunized in Northern California and not surprisingly there has been an incredible social media frenzy surrounding the topic. People seem to be turning on their neighbors with pitchforks over this so I’m definitely not going to get into that discussion here. My only thought is this: each side is absolutely sure that they are right. Unless we can all step back and remove the emotional charge from the topic, we’ll never discuss the actual facts behind the science. No matter what your stance is, remember to be respectful - I’ve read about and personally witnessed grown adults acting like children, resorting to name calling and flat out obstinate behavior. Remember - our little ones are watching and mimicking. Measles is normally a mild, self- limiting disease that runs its course without long- standing effect. Two facts to put your mind at ease: we still have an 85-90% vaccination rate. Secondly, the risk of death amongst infected persons is 0.2% and these are mostly immunocompromised and/or malnourished individuals. (Atkinson, William - 2011. Epidemiology and Prevention of Vaccine-Preventable Diseases.)

So what do we do to protect our little ones from diseases like measles? Make sure that they have optimally functioning immune systems - easy right? Start with getting proper sleep. Consistent bed time is often the largest barrier to successful sleep pattens, especially trying to get into that all-important REM cycle. After all, this is when the body most efficiently heals and replenishes. Next on the list, not surprisingly, is great - not good - great nutrition. Yes, the kids need to eat something green! If you’re having a hard time, consider a delicious green smoothy. Our kids actually ask us for this on a regular basis. Next, please teach your kids to use their ‘cough pocket’ - coughing into the crux of the elbow instead of into hands or worse into the air for all to share - is one of the best and most effective methods for stopping spread of viral particulate. And lastly, washing hands is still the most effective method to stop spread of airborne communicable disease. The CDC recommends washing hands, with soap and water for at least 30 seconds many times per day. Also be aware that hand sanitizers are generally less effective than proper hand washing techniques.

The second concern our family discussed this year was personal safety. Yes, ‘stranger danger’ could not be more serious these days. Let’s face it, sending our kids off to a new, unfamiliar place with new unfamiliar routines, instructors and friends can be quite disorientating - to parents and kids alike. Have your routine down. Be sure your child knows when and where things are happening. Go over it each morning and drill it until they can repeat it back to you. Develop a unique family password or safe word in case you have to send someone else to pick them up or in worse-case scenario, some unauthorized person tries to. Make sure your kids know to ask them for the password and to run to safety if the person hesitates. This may seem extreme, but it could make all the difference in the world. Secondly, be sure that the camp utilizes the buddy system for an additional layer of safety. This is especially useful for youngsters using the bathroom - this is simply a matter of safety in numbers. By all means begin having the talk about human anatomy and personal and private areas of the body. Starting this dialogue doesn’t need to be daunting - as they are learning about the body in school, just point out private areas and be sure they know to tell you about any unauthorized actions. As always, having open lines of communication with your children is of utmost importance and remember communication is 60% body language.

The third topic of concern for us this year was that of bullying. Here again communication is extremely important and having a good working relationship with camp
counselors and staff can really help. Have them bring up to you any issues quickly as being on the look-out for signs of trouble early is of utmost importance. Early detection is key. Again, have conversations with your child about this and be acutely aware of their body language. Bullying situations can accelerate quickly, and end in dire circumstances for some, so please have a plan of attack and don’t hesitate to remove your child from the camp or class if you’re not seeing the behavior change.

Lastly, let’s remember that camps can be a fantastic source of fun and education for our children, but let’s try to not let this be a stressful endeavor for them. You’ll be able to tell if they are not enjoying themselves and if so, change it up. After all, we survived those summers alone in the wilderness - it only made us stronger!

From my family to yours - be well.

Dr. Chris Pieda DC

Dr. Pieda is owner/operator of Back To Health Chiropractic, a family-focused practice serving the East Bay since 2004. For more information, questions or concerns please visit: BackToHealthAlameda.com or call 510-523-5000.
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Co-Sleeping, Sids and You

2/16/2015

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What are your thoughts on co-sleeping?” asked a patient who had recently given birth to a wonderful, healthy new baby. It’s one of those loaded questions that you know will lead to more. Sure enough, she fired off in rapid succession: “Is there really a higher chance of Sudden Infant Death Syndrome (SIDS)? “How could I possibly roll over on my own child?” And then the final clincher: “What did you do with your kids?” The last one made me smile because it’s probably the most important question you could ever ask any doctor. 

My cautious answer was: “Yes, we chose to co-sleep with our children, but that may not be right for everyone.” The fact is, my wife and I deliberated on this topic for a long time and finally came to the decision based on what we felt best for our family. Thankfully we are not alone and most often the answers are out there.  

With decisions of this magnitude, it’s a good idea to take a world-view of the problem. Currently, Japan leads the way with the lowest overall infant mortality rates. They also have the lowest rate of SIDS. Coincidentally, they also have a cultural belief in cosleeping and shared living arrangements. This doesn’t mean it’s a direct causation, but it’s a very important connection.

Next we took a basic Pro and Con approach:
Cons - range from serious dangers such as asphyxiation, over-lay, and thermoregulation issues to simple inconveniences like lack of sleep.
Pros - family bonding benefits, health benefits including improved immune status and digestive function (from regular nursing patterns), improved neurologically based infant responses (reaction to smells of mother, movement and touch reactions), decreased stress response (decreased cortisol levels), increased oxygenation, and reduced chances of SIDS (by up to half according to recent research).

As you can see, our ‘pros’ list quickly out-weighed our ‘cons’ especially when we factored in some of the causes for serious dangers that have links to drug and alcohol use. With that being said, if you are leaning towards co-sleeping, remember to do your own due diligence. Assess parents depth of sleep - delta versus deep REM sleepers - and determine how quick to wake you are. Reduce excess bedding, place the mattress on the floor and be sure there are no crevices for your child to fall into. Also, no soft mattresses and definitely no old-style waterbeds.  

Above all else - be smart, use your own intuition and use your best judgement.  
From my family to yours - be well.  
Dr. Chris Pieda DC 
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Dr. Pieda is owner/operator of Back To Health Chiropractic, a family-focused practice serving the East Bay since 2004. For more information, questions or concerns please visit:
BackToHealthAlameda.com or call 510-523-5000.

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3 Years Old and Not Potty Trained, What To Do

1/19/2015

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Question:
     Our son Max is 3. He has been toilet trained for months. He uses the potty or the toilet at home and at preschool with hardly any help. But anywhere else he almost always wets his pants. We try to remind him, but we can’t go on every play date or watch him every minute. Should we tell him he can’t wear underwear if he’s going to be wet all the time?

Answer:
     “Is your child toilet trained yet?” may seem like a question that can be answered “yes” or “no.” However, the answer depends in part on how you define the phrase “toilet trained.” To some parents, a child is toilet trained when he can wear underpants and stay dry and accident free throughout the day with help and supervision from an adult. He is cooperative, but still needs reminders and encouragement from his parents and some assistance with clothing or cleaning up. To other parents, a child is toilet trained when he is able to independently remember to use the toilet, rarely needs prompting and can take care of himself in the bathroom without assistance. One way to describe the child who still needs help is to call him “half trained.”
     There are some things that parents can do to help their child move from being half trained to using the toilet independently. During the first stage of toilet training, it helps parents if you dress your child in elastic waist pants or other types of easy to remove clothing. If a child needs to struggle with buttons, zippers, tights or overalls before or after going to the bathroom, the effort may discourage him from taking a break from play. If he waits until he has no choice, he may wind up having an accident.
     When parents notice wet pants in a child who is often able to stay dry, the degree of wetness will offer a clue to what may be the problem. If your child is soaked or if he has a complete bowel movement in his pants, it is likely that he was not motivated enough to stop his activity to go to the bathroom. However, if his pants are simply damp or the bowel movement is very small, it is likely that he did notice the feeling but was trying to hold on. The smaller accident is from letting go slightly to relieve pressure.
Another common pattern among half-trained children is that they are able to get to the bathroom easily at home or in familiar places, but frequently soak or soil their underpants when they are away from home. This may be what you are noticing with Max. He is mature enough to master the physical control necessary to use the toilet and stay dry, but he’s not old enough to be psychologically in control as well. When he is in a familiar place, he can take himself to the bathroom, perhaps with a reminder or perhaps without any help at all. Away from home, he has accidents because he has many new experiences to distract him, and he is not paying attention to the signals from his body that say, “Time to go.” It’s not necessarily a lack of motivation, and it’s certainly not “laziness” as some parents think. It is simply that when you are very young, it is difficult to pay attention to many things at the same time!
Since you notice that Max has accidents when he is out but not at home, you may want to think about limiting the number of away-from-home events and excursions for now. A common reason for delayed toilet training is that children need more time to be at home. When you are out and about, you are probably providing stimulating and interesting activities for Max. Those activities are a distraction from the quieter, familiar environment of home. Guess which environment makes it easier for a child to practice using the toilet? I have sometimes advised families to take a month off from extracurricular activity so that their not-yet-trained child can practice at home. Consistency without pressure is often the best plan.
     If you don’t want to cut out all of your extra activities you can tell Max until he is older, you want him to wear diapers or pull-ups when you are out. Tell him that even if he is in diapers, he can still use the bathroom if he wants to. When you go to unfamiliar places, find the bathroom when you arrive. Offer him a chance to use it then and after an hour or two. If he has not used the bathroom before it is time to leave, you can suggest that he try then. Learning a new routine of trying to go before you “have” to go can be helpful. If Max is visiting somewhere without you, make sure that before you leave, someone has shown him where the bathroom is and that he feels comfortable using it. Don’t assume that grandparents or parents of other children will remind him or help him unless you ask them to do so. Most people simply do not think about a young child’s bathroom needs unless the child is their own.
    When Max forgets to go to the bathroom, whether he is at home or away from home, it is unlikely to be because of carelessness. Although he may want to use the potty, he is also busy learning and doing many other things that are
very important to him. He will need time to get from being half trained to being fully trained, but with patience — mostly yours — he will get there.



Meg Zweiback, RN, MPH, is a certified pediatric nurse practitioner and family consultant in Oakland. She is an associate clinical professor of nursing at University of California, San Francisco and posts articles and other resources on her Web site, bringingupkids.com.  To possibly have your question included, please send your questions to editor@parentspress.com - See more at: http://www.bayareahealthykids.com/bay-area-healthy-kids/category/meg-zweiback#sthash.CtWEuQyF.dpuf
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What To Do If Your Child LOses A Permanent Tooth

1/7/2015

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If Your Child has lost or knocked out one of their permanent or adult teeth, here is some advice from UCSF Benioff Children’s Hospital Oakland

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Top Strategies For Dealing With Defiant Toddler

1/3/2015

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Question:
I don’t know what has happened to my beautiful baby!  We were so excited when Evelyn started walking right after her birthday. We thought that it would make life so much more fun for her and us when we could go places and do things with her without having to hold her or strap her in a stroller. It’s been a few months and now I dread leaving the house—she is so difficult to take anywhere. She runs away, won’t listen, and then laughs when I try to stop her. She does the same sort of thing at home, but not as extreme, and it’s not as embarrassing. I feel like she’s saying “No” even when she’s not talking! What can we do?


Answer:Sounds like you have a toddler now, not a baby! 

A toddler’s saying “No” is a symbol of her increasing ability to tell you she has a will of her own. Most toddlers, just like Evelyn, begin saying “No” in non-verbal ways for months before they say the word. Do you remember the first time she pulled back from a spoonful of food you offered her and shook her head from side to side? The shaking movement of an infant to avoid her parent’s spoon is one of the earliest ways she says “No”! 

Once a 1-year old begins to express “No” you will probably see an increase in the number and variety of ways she resists you. The term “oppositional behavior” has been used to describe this resistance, because at times parents feel that whatever they suggest, the child wants to do the opposite. At times you may feel as though whatever you say or do it’s wrong. As one parent said, “I asked my toddler if she wanted a cookie or ice cream. She threw herself on the floor saying ‘No!  No!’  I finally found out she wanted a cupcake like she had a week ago, but we didn’t have any. I can’t figure out how to make her happy.”

If you try to please a defiant 1-year-old, you probably won’t be successful. The more absurd and trivial her demands are, the less likely they are to be ones that you can fulfill. In fact, if you keep attempting to please her, you may find that she simply increases her demands until you are exhausted, angry, and finally willing to say “No” to her as well.

If parents can treat their toddler’s negativity as a part of normal daily life, they find it easier to stay casual and matter-of-fact when they are faced with an outburst. When your one year old says “No!” check to see if she is resisting something that she is reasonably within her rights to resist. If she refuses to eat her cereal, or to wear her pink socks, or to kiss Aunt Mildred, it’s okay. to respect her “No!”  But if she refuses to sit in her car seat, or to let you change her diaper, or to put down the scissors she found in the desk drawer, you’ll have to be firm.

No matter what the issue, it helps to stay calm. Most parents try either to give their child a brief explanation of why she can’t have or do what she wants, or ignore her protests and get on with their activities. As you watch your toddler’s reactions to these different responses, you’ll figure out which ones work best for both of you.

Occasionally parents are told that a toddler learns to say “No!” because she hears it from others, and that if parents can  avoid confronting their children with the “N” word they won’t hear it directed back at them later. This advice sends parents the message that their toddler’s defiant “No!” is something bad to be avoided. In fact, your toddler’s saying “No!” is an important sign that she is becoming her own person, willing to take the risk of defying the parents she loves and needs. It may be too much to ask parents to enjoy this stage of development, but it is a stage that should give you the satisfaction that your child is ready to begin becoming independent.

You don’t need to be so strict with your toddler that you wind up challenging her into a battle of wills about issues that don’t matter. That battle has no winner. If you force your child to give in she will feel angry and resentful. If you then decide to give in because it’s not worth a fight you will feel silly for taking on the issue in the first place.

StrategiesOne strategy that often works to avoid head on collisions is to offer your one year old a choice between two realistic options. Instead of asking “Do you want milk?” ask,  “Do you want milk in the red cup or the blue cup?”  Instead of, “Do you want to go shopping?” ask, “Do you want to go to the store now or after a story?”  Don’t ask her to make a choice that isn’t reasonable: “Do you want to take your nap now or later?” isn’t a fair question to ask an overtired and cranky toddler. Offering choices is one way to avoid some negative responses, but it won’t always be practical and will not help you to avoid ever having to deal with your child refusing to cooperate.

Some toddlers can be more challenging than others because of inborn temperamental characteristics. For example:

An active toddler will have more trouble being cooperative in situations where she has to be still. She’s resist sitting in a stroller or car seat or in a group because she needs to move, not just because she’s being oppositional.

A persistent and non distractible toddler can be stubborn and refuse to follow even the most clear limits. The best that you can do will be to be very firm and act rather than argue (as in take away a toy immediately if he throws it, remove him from the table if he spits his food)

An intense toddler may shriek or scream when you tell her no or try to keep her from doing something she wants to do. Her protests may tempt you to back down or to walk on eggshells to avoid frustrating her.

A highly sensitive toddler may seem oppositional when she is actually trying to avoid a situation that is physiologically uncomfortable, such as being in a noisy environment or wearing clothing that scratches her.

Figuring out how to manage Evelyn’s behavior, whether it stems from her age and stage of development, her temperament, or from causes that once understood can be resolved will be a challenge, but over time the patterns that are unique to her will emerge.

The bottom line is this: all toddlers, sometime between 1-1/2 and 3, will begin to be unreasonably and mystifyingly resistant. It’s not a sign that you have a difficult child or that you are a failure as a parent. It’s simply a stage and it will pass (and recur, and pass, and recur again . . . sorry to say!)



Meg Zweiback, RN, MPH, is a certified pediatric nurse practitioner and family consultant in Oakland. She is an associate clinical professor of nursing at University of California, San Francisco and posts articles and other resources on her Web site, bringingupkids.com.  To possibly have your question included, please send your questions to editor@parentspress.com
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Should I Be Concerned With My Child Sucking His-Her Thumb?

12/27/2014

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It’s Usually Fine, Depending on the Intensity

Question:
     Our 3-year-old Jamie is sweet and bright and pretty. Her only “flaw” is that in between playing or talking or running around, she’s likely to be sitting somewhere sucking her thumb. It’s not constant, by any means. In fact, when we are at a park or out with friends, she hardly ever has her thumb in her mouth. But once she’s home, she grabs her “lovey” (a striped blanket she’s had since she was a baby) and heads for the sofa where she hunkers down for some sucking time. If we distract her or she hears her sister playing, she’s usually done in a few minutes. She puts her blanket on the hook in her room (which we installed when the dog seemed as fond of it as she was), and then she’s her usual busy self. At pre-school no one seems to care — in fact, at circle time, she’s one of several who suck their thumbs or twist their hair. But we get a lot of negative comments from grandparents and other family members. What should we do
about this?

Answer:
     Don’t worry! Jamie is doing just fine.
     Sucking is the first way that babies learn to soothe themselves, and almost all babies and toddlers take pleasure in sucking their thumbs or fingers or a pacifier. It’s a myth that babies who don’t breast feed are more likely to suck their thumbs or a pacifier. In fact, some babies actually prefer to get their soothing without the added calories! As most children get older, they gradually suck less and less during the day, but they may continue to suck when they are falling asleep or feeling distress.
Some children, like Jamie, develop habitual patterns of comforting themselves throughout the day. Sometimes it’s only when they are tired or in the midst of transitions. Sometimes the habit evolves, as you’ve observed with Jamie, into sucking while holding a lovey, sitting in a special place and going through a familiar routine. When the habit is pacifier sucking, parents can control access to a pacifier or remove it entirely. You don’t have that choice with a child’s thumb!
     Fortunately, there is no evidence that a 3-year-old’s thumb sucking is harmful to her. In fact it’s probably helpful.
     Here’s why: Children who suck their thumbs have the ability to calm themselves readily, often before they
get so unhappy that a parent notices that they are upset. If you expect your child to give up such a useful way of coping, what will be her substitute? Will she still be able to quiet herself when she is feeling stressed, or to fall asleep independently? Future teasing isn’t a cause for concern. A pre-school age child doesn’t worry about what others think of her now, and she can’t imagine or care what the future might be like.
     The only reason to discourage thumb sucking in a 3- to 5-year-old, or in any child, is if the degree of sucking is so frequent and of such intensity that it is likely to interfere with permanent tooth development. This would be highly unusual at this age. If a 5- to 6-year-old child sucks her thumb with strong suction throughout the day and night, many dentists would advise parents to intervene. However, you have noticed already that Jamie has long periods when she does not suck and that she is gradually becoming less dependent on her thumb; her teeth may not be affected at all as she gets older. (If her parents have overbites or needed braces, Jamie might still need an orthodontist no matter what you do!)
      There are a few things you can do now to help Jamie continue to gradually reduce her dependency on her thumb. The first is to make sure that she is also developing other ways to soothe herself and to accept comfort from others. Make sure that Jamie gets lots of hugs and cuddle time. Encourage her to practice relaxation in ways that don’t involve her thumb:  stretching and splashing in a bathtub, blowing bubbles, playing with sand or clay and doing slow deep breathing while you play music. These aren’t strategies to “fix” the thumb sucking. This is long-term skill building that will be helpful to any of your children.
      Many young children suck when they are bored or when they are in a situation where they have learned to automatically suck their thumbs. At those times, a child doesn’t need comfort. She’s just unconsciously doing what she’s used to doing. You can interrupt that type of sucking (or any other unconscious habit) by introducing an activity that is incompatible with the habit. For example, you may notice that providing Jamie with something else to do with her hands — holding a doll, drinking a glass of milk, doing a puzzle — gives her enough distraction for her to forget about sucking. If she tends to suck her thumb when you are driving in the car, you can give her an interesting toy to play with. Having a conversation or singing a song together may also keep her mouth busy without her thumb. You aren’t trying to stop the thumb sucking all the time; you are just substituting ways for her to keep her hands busy.
     Sometimes a child’s sucking pattern is connected to a comfort object, as you’ve noticed with Jamie and her blanket. By having her keep the blanket at home, in a special place, you have helped her to think first before she decides when and where she wants to suck. That’s a good way to interrupt an automatic habit. However, I would not advise you to set any further limits on blanket use now — when Jamie needs comfort, her blanket and thumb are valuable, not harmful.
     You may hear that children should have their thumbs painted with nasty tasting substances to discourage thumb sucking. Some parents who have taken this path regret it later. They discover that their child develops another habit that may be less pleasant than the thumb sucking — lip licking and nose picking are common — or that their child becomes whinier and more easily distressed without a way to comfort herself.
     If a parent reacts with disapproval when a child sucks her thumb, or even worse, nags her to stop, the thumb sucking is likely to increase. Some children will become defiant and suck more in reaction to comments. Others will simply hide the thumb sucking from the critical parent and may wind up seeking ways to sneak in extra sucking time.
     Comments from adults other than parents or regular caregivers aren’t as likely to cause this kind of rebound effect. However, children naturally avoid being with people who disapprove of them, so you may want to advise critical family members to keep quiet.
     You can also explain to them that pediatric and pediatric dental organizations have all issued statements that thumb sucking does not need to be interrupted at this age, if ever. If that doesn’t work, you’ll be setting a good example to your child about resisting peer pressure if she hears you say, “We think it’s fine for Jamie to suck her thumb, and we don’t see it as a problem.”


Meg Zweiback is a certified pediatric nurse practitioner and family consultant in Oakland. She is an associate clinical professor of nursing at University of California, San Francisco and posts articles and other resources on her Web site, bringingupkids.com.  To possibly have your question included, please send your questions to editor@parentspress.com
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