Parenting - Prenatal to preschool/Parenting_PrenatalToPreschool.bin/dp/0022/00222.txt

Text File | 1993-06-25 | 52KB | 878 lines

$Unique_ID{PAR00222}
$Font{NP}
$Pretitle{}
$Title{1 Year to 2 1/2 Years:  Safety and Health}
$Subtitle{}
$Author{
Editors of Consumer Guide
Mendelson, Robert A
Mendelson, Lottie M
Meyerhoff, Michael K
Ames, Louise Bates}
$Subject{1 Year to 2 1/2 Years Safety Health toddler trouble kitchen stove
knobs burners cooking refrigerator dishwasher oven shelves drawers childproof
caps pills bathroom doorknobs locks glass door garbage pails trash receptacles
wastepaper baskets dress-up clothes hazards animal pet pets outdoors swimming
pools flotation device devices life jacket swim car seat sibling siblings
confrontation confrontations conflict conflicts leash separated day-care group
contagious illnesses diseases fire drill crisis head bump bumps cuts scrape
scrapes bruise bruises stitches ipecac syrup poison poisoning cold flu stuffy
runny nose fever red watery eyes coughing sore throat appetite loss malaise
bronchitis pneumonia ear infections Strep throat antibiotic antibiotics
febrile convulsions fevers pinkeye conjunctivitis eye eustachian tube chicken
pox exposing exposure roseola DTP booster reaction reactions pertussis
whooping cough immunization schedule immunizations tuberculin test
tuberculosis MMR measles mumps rubella vaccines HiB Hemophilus influenza B
bacterial meningitis epiglottitis oral polio vaccination vaccinations allergy
allergies allergic allergen allergens drooling wet rash teething loose stool
stools Diarrhea constipated constipation ASSUME assumed emergency emergencies
FREEDOM SECURITY toddlers}
$Log{}

The New Parents' Question & Answer Book


1 Year to 2 1/2 Years:  Safety and Health


     I safety proofed my home as soon as my baby started crawling.  Will it be
necessary to make adjustments now that she's a toddler?

     It probably will.  Keep in mind that your toddler's physical abilities
will be increasing enormously during this period.  She will be capable of
moving faster, farther, and higher with each passing week.  Dangerous or
delicate objects that were placed "out of reach" in high cabinets or on high
shelves can no longer be considered inaccessible to your toddler.  Some of the
gates and latches that have been used to prevent her from entering various
areas eventually will lose their effectiveness.  Consequently, it would be a
good idea to periodically re-evaluate your toddler's environment and make any
necessary adjustments according to her recently emerging capabilities.  By the
way, it is important to do this not only from a safety standpoint, but to
ensure that your toddler has full opportunity to use her newly acquired skills
and continue to expand her horizons.


     What kind of trouble can my toddler get into in the kitchen that she
couldn't get into before?

     For one thing, your toddler eventually will become adept at turning
knobs, so there now is a greater danger that she will be able to turn on the
burners on the stove.  By the time she achieves this ability, it is possible
that she will respond to strong instructions that the stove is absolutely
off-limits, but it would be wise to keep a close eye on her anyway when she is
in the kitchen.  She should also continue to stay out of the area when cooking
is in progress.  As before, it may be a very good idea to remove the knobs
that turn on the stove or oven when you're not using them.  Your toddler also
will soon have the strength to open heavy doors that were previously too much
for her to handle.  As a result, the refrigerator, the dishwasher, and the
oven may become attractive--but extremely dangerous--places for her to hide.
Although admonitions may be effective, again, it would be a good idea to put
latches on these items (or move the latches higher if they're already there)
if you anticipate your toddler entering the area unsupervised for more than a
moment or two.  And, in general, since her climbing ability will continue to
increase during this period, any cleansers, knives, and other hazardous
objects that simply had been placed on high shelves or in high drawers now
must be more securely stored.


     Lately, my toddler has become very adept at unscrewing the tops of
bottles and jars.  Will those childproof caps keep her out?

     For the most part, childproof caps are very effective safety devices, but
they can't guarantee inaccessibility with absolute certainty.  In fact, some
parents swear their toddler can get these caps off more easily than they can.
Therefore, while you definitely should use childproof caps whenever possible
and appropriate, don't count on them completely to keep your toddler out of
things she shouldn't be getting into.  Continue to keep all pills, potions,
and other such items well secured in a locked or firmly latched medicine
cabinet, and get rid of anything that you no longer need.  Then, use
childproof caps as a good backup.  By the way, a childproof cap becomes
worthless if the container itself is made of glass or any other breakable
material, so be sure that anything hazardous to your toddler is kept in a
sturdy plastic bottle or jar.


     Now that my toddler is steadier on her feet and not quite so naive, is
the bathroom less hazardous for her?

     Not really.  Although she certainly will be fairly steady on her feet and
a fairly capable climber by the end of this period, she still may have a lot
of trouble with the bathroom surfaces.  Because they can get very slippery
when wet, and because they are hard enough to cause serious damage in a fall,
it just is not a good idea to let a toddler play on bathroom floors and
fixtures.  Furthermore, while your toddler is not as naive as she was
previously, she is every bit as curious and a lot more capable.  Turning on
the hot water taps, opening up and manipulating the mechanisms in the toilet
tank, and various other activities are no longer beyond her abilities.  Since
there is a strong potential for burns, drowning, and other major mishaps from
such activities, it still is inadvisable to let a toddler spend unsupervised
time in the bathroom.


     My toddler now is able to reach and turn many of the doorknobs in my
house.  Should I put locks on those that I don't want her to open?

     From a safety standpoint, that probably is a good idea.  In terms of
convenience, it may present a real problem.  Consequently, as is the case with
anything that becomes inconvenient, you may find yourself becoming lax about
it and forgetting or simply not bothering to lock up all the time.  Of course,
that negates the whole notion of using locks.  Fortunately, there is a more
practical alternative, and that is the use of high latches.  A simple
hook-and-ring latch placed high enough so your toddler can't possibly get to
it, yet still well within your reach, is inexpensive, easy to use, and solves
the safety problem quite nicely.  In addition, for certain doors, you may opt
to buy one of those electronic alarms that sounds when the door is opened by
an unauthorized person.  These cost a little more money, but you may find
their convenience worth it.


     I have a sliding glass door leading to my patio.  Is it a possible hazard
to my toddler?

     It certainly is.  Believe it or not, many toddlers are injured every year
by running through glass doors.  Keep in mind that your toddler, particularly
toward the end of this period, will be doing a lot of running around.  What's
more, she will be so caught up in her own excitement and enthusiasm that she
may not always be concentrating on what is directly in front of her.
Furthermore, although her vision skills are superb at this point, clear glass
is not easily detected by anyone.  Although adults have enough experience to
be careful going through any doorway, you can't expect your toddler to assume
or remember that there will be something blocking her path.  This does not
mean you have to get rid of your glass doors, however.  A few brightly
colored, easily visible decals placed on the glass at her eye level will
provide sufficient visual targets to make your toddler alert and aware and
help keep her out of serious trouble.


     Lately, my toddler has become fascinated with garbage pails and trash
receptacles.  Should I only use those with latched lids?

     Certainly, for any container that will hold organic matter or clearly
hazardous materials like broken glass, tin can lids, etc., a strong latch for
the cover is a necessity.  Keep in mind that by the end of this period, your
toddler will have impressive strength and dexterity, and she may be intensely
curious about something she's seen you throw away.  Therefore, you need to
double-check the construction of both the container itself and the latch to
make sure that it is inaccessible to her.  On the other hand, as long as you
are careful about what you put in them, it may not be necessary for you to
seal off some of the simple trash receptacles in your home.  Toddlers love to
explore wastepaper baskets and investigate the different kinds of crumpled
paper they find inside, so if you don't mind a little clutter, you may not
want to deprive your toddler of all such opportunities for fun and learning.


     My toddler loves to play dress-up with my clothes and accessories.  Are
there any special hazards associated with this kind of activity?

     There certainly are.  Providing your toddler with a collection of
appropriate items is a wonderful idea, but allowing her to roam freely through
your closets and drawers is not.  Buttons, jewelry, and other such items can
pose choking hazards; belts, suspenders, and any other elasticized material
can cause strangulation; and many toddlers have had nasty spills while trying
to walk around in a pair of high-heeled shoes.  In addition, if makeup,
deodorant, perfume, and other such things are kept in the area, they may very
well enter into your toddler's play, and on accidental poisoning could result.
Keep in mind that the bulk of the "raw material" that your toddler will be
using for these activities comes from within her own head, so it is not
necessary for her to have a huge amount of stuff available to her.  By going
through your things and selecting a few suitable hats, jackets, bracelets,
etc., you will be providing your toddler with a sufficient amount of
playthings and be keeping her safe as well.


     My neighbor's dog is very friendly.  Is it safe to let my toddler play
with him?

     Naturally, it is a good idea to steer your toddler clear of any animal
with which you are not familiar.  In cases where you know the animal and are
confident that he will be friendly and gentle with your toddler, it is okay to
let her play with the pet--but do not let her play unsupervised at this point.
The danger here is not necessarily from the animal, but rather from your
toddler.  Toddlers are very curious, and they do not always realize the
consequences of their exploratory and investigatory behavior on others--human
or nonhuman.  Consequently, it is very common for toddlers to pull tails,
stick fingers in ears, attempt to climb upon and ride, hug too hard, and in
other ways push even the mildest creature beyond his limits of endurance.
When this happens, the animal's instinctual self-protection mechanisms may
take over and put your toddler in serious jeopardy.  Therefore, make sure that
you are there to prevent the pet from harming your toddler by seeing to it
that she doesn't harm the pet.


     As long as she's prevented from running off, is it safe to let my toddler
play alone outdoors?

     Toward the end of this period, you may be able to feel more comfortable
about letting your toddler play unsupervised in the yard for short periods.
However, it is important that you not only prevent her from running off, but
that you make sure there are no major hazards to her well-being within the
confined area.  A wading pool--even if it only has a couple of inches of water
in it--can result in an accidental drowning; garden equipment left lying
around can cause serious mishaps; and anything from plants to peeling house
paint can result in a poisoning.  Be sure that all unsafe areas, such as
swimming pools, tool sheds, and garages are inaccessible to your toddler.
Check, too, to make sure that any buckets, drums, birdbaths, and ponds are
kept empty or inaccessible as well; your toddler can fall in headfirst and
drown in a few minutes in as little as a couple inches of water.  In general,
it is a good idea to stay nearby even older toddlers.


     Should I enroll my toddler in a special swimming class so she will be
safer in the water?

     As stated previously, the American Academy of Pediatrics does not
recommend organized swimming lessons for children less than three years of
age.  According to the Academy, children of this age who participate in
swimming programs are at increased risk of water intoxication--which can lead
to seizures and death--as a result of swallowing too much water (see Safety
and Health:  6 Months to 1 Year).  In addition, such instruction can lull
parents into thinking that their child can swim and is therefore "water safe."
A child of this age cannot truly learn how to swim, even with organized
instruction.  While she may develop the physical ability necessary, she does
not yet have the appropriate judgment needed for safety.  If she should fall
into or otherwise enter a pool when no one is around, she won't know why and
where to swim.  She won't know that if she swims in circles rather than toward
the side, she'll eventually tire.  She won't know that if she swims toward the
deep end rather than the shallow end where the steps are, she won't be able to
get out.  Therefore, a young child should never be considered "water safe."
She should never be allowed in the swimming pool (or other body of water)
unless you are holding her and watching her at all times, and she should never
be totally submerged.  In addition, all swimming pools should be completely
fenced in, and the gate should have a secure latch that is out of her reach.


     My toddler loves being in the water, but she can't swim.  Is it okay to
let her use flotation devices?

     Experts on the subject are split on the issue.  Everyone agrees that a
toddler should never be allowed to be alone in the water even when she's
wearing such a device; they are not one-hundred-percent reliable--the toddler
could slip out, or the air could leak out.  Some people feel that as long as
an adult is with the toddler, these devices are harmless and allow her to have
a lot of fun.  However, the majority of experts are uncomfortable with
flotation devices even under these circumstances, as they feel that using them
gives a toddler a false sense of her own abilities.  As a result, she may be
tempted to go beyond those abilities if she somehow manages to get near deep
water when no one is around.  By the way, if you ever take your toddler along
in a boat, she and every other child should wear a life jacket--whether or not
they are able to swim.


     Lately, it has become a real struggle to get my toddler into her car
seat.  When can I stop using it?

     Not until your child is over four years old and weighs more than 40
pounds.  Until then, in order to ensure her safety, you must make sure that
your toddler is secured in her car seat before you put the gearshift into
drive.  And, if your toddler should somehow manage to get out of her car seat
at any point during the trip, you must pull over, stop the car, and resecure
her.  Many parents routinely have trouble getting their toddlers into their
car seats and keeping them there, especially toward the end of this period.
However, it is important that you make this a non-negotiable issue and never
sacrifice your toddler's safety for the sake of convenience.


     Now that she's stronger and smarter, can I expect that my toddler will be
able to "hold her own" in her confrontations with her four-year-old brother?

     Although your toddler certainly will become stronger and smarter during
this period, you have to keep in mind that her brother will be getting
stronger and smarter too, so he'll still have the physical and mental
advantage over his sister.  Furthermore, while your toddler will be improving
her capacity to take care of herself, she also will be increasing her capacity
to get on her brother's nerves.  Consequently, you can expect that
confrontations during this period actually may become more frequent and more
violent, and it is important for you to remain vigilant.  By the way,
especially toward the end of this period, you may notice many instances where
your toddler and her brother start playing together quite nicely.  If you
remember to praise them both lavishly when they are getting along, you may be
able to help minimize the number and intensity of their conflicts.


     When I go out to the supermarket or mall, my toddler is no longer content
to stay in a seat or stroller.  Should I try using one of those "leash"
devices?

     It may be worth a try, but be careful.  While the leash has to be long
enough to give you and your toddler some potential for independent movement,
it can't be so long that your toddler can get herself seriously entangled or
that other people around you can get tripped, tangled, or otherwise
endangered.  If your toddler is going through her negativistic stage, you may
also find that she strongly resists being hooked up to this kind of device.
Therefore, it probably would be a good idea to avoid the need for a leash as
much as possible.  This can be done by planning your trips to the market or
mall at times when the other parent (or a friend or relative) can come along
so that while one does what needs to get done, the other can carefully
supervise your toddler.


     Is there anything I can do to help protect my toddler in case she somehow
becomes separated from me?

     There's not much.  Toward the end of this period, your toddler
undoubtedly will be able to tell someone her first name, but it is
unreasonable to expect that she will be able to produce her last name reliably
much less remember things like her address, phone number, etc.  Nor is she
likely to be able to retain and follow instructions concerning approaching a
policeman, staying away from strangers, etc.  Some parents send a little
identification tag on the inside of their toddler's jackets and coats, and
there currently are some movements directed toward having all young children
fingerprinted.  In general, however, the most effective protection you can
provide for your toddler at this point is your careful supervision, which can
largely prevent such events from occurring.


     I am thinking about putting my toddler in the local day-care center.  The
classrooms and materials appear to be safe, but will she be in danger from the
other children?

     There are prices to be paid when you put your toddler in a group
situation.  First of all, it is well documented that children in day care are
far more likely than stay-at-home children to develop a wide variety of
contagious illnesses.  High-quality centers take careful measures to prevent
the spread of diseases, but you can expect your toddler to pick up anything
that's "going around the neighborhood" from common colds, ear infections, and
the flu to chicken pox.  Until the end of this period, you can also expect
that your toddler may come home with some minor bumps and bruises inflicted
upon her by her classmates.  Again, the personnel at high-quality centers
provide adequate supervision so that a serious injury is very unlikely.
However, keeping children at this age from occasionally engaging in small
scuffles and tussles is nearly impossible.  If you have a compelling reason to
place your toddler in day care at this point, none of these noncritical
hazards should really deter you, but you should at least be aware of them.


     In case of fire, is my toddler still too young to understand and carry
out simple emergency routines?

     Toward the end of this period, it may be possible to get your toddler to
participate in a family fire drill.  Especially if she views it as a game of
some sort, your toddler is likely to follow an escape-and-gather procedure
fairly reliably.  However, you simply cannot count on your toddler to respond
appropriately in a real emergency.  When frightened, toddlers quickly forget a
lot of what they've learned.  They are more likely to react in ways that have
nothing to do with what they've been taught.  In fact, if a fire should break
out in your home, chances are that your toddler will try to hide under a bed
rather than run out of the house.  Therefore, while it might be a good idea to
start including your toddler in family fire drills, you certainly cannot count
on her carrying out the procedures in a crisis.  Her best protection will be
your continued vigilance in checking smoke alarms and taking other preventive
measures.  Also, be sure to post a safety sticker on the window of her room so
that, should a fire occur, emergency personnel will know where to look for
her.


     How can I tell if a bump on the head requires medical attention?

     Almost all children suffer an accidental bump on the head sometime during
their early years.  Most of these bumps are not serious, but they frequently
cause parents a lot of anxiety.  Often, there is an almost immediate swelling
at the point of impact, but this alone shouldn't worry you as long as there
are no other signs of injury.  The immediately formed lump usually means that
a blood vessel has been broken just under the skin and there has been some
local bleeding.  Such bleeding would be under the skin but outside the skull
so it is of less concern than bleeding that occurs within the skull.  Signs of
concussion or brain swelling in children usually include vomiting and/or
unusual drowsiness.  It is therefore recommended that a child who has
sustained a blow to the head be observed closely for the next 24 hours.  If
the child begins to vomit or becomes difficult to rouse, call your
pediatrician at once and follow his instructions.  Don't try to keep your
child awake after a head injury.  If she falls asleep, observe her carefully
and be sure that her level of consciousness is that of normal sleep.  Check
this every hour or two by giving her a gentle nudge or by rolling her over;
make sure that her response is what you would expect during normal sleep.  If
it is not, or if your child begins to act abnormal in any way, call your
pediatrician.  This is another instance when you are better to be safe than
sorry.


     What's the best treatment for cuts, scrapes, and bruises?  How can I tell
if a cut requires stitches?

     A cut or scrape should be cleaned as soon as possible after it occurs.
Often, the injury will look worse than it is until it is cleansed.  Soak the
area in warm, soapy water or wash it with a clean cloth that you've wet with
warm, soapy water.  Then rinse the area well with clear water.  Try to stay
calm throughout the procedure while calming and comforting your toddler.  If
the bleeding continues, apply pressure and a cold pack (ice cubes in a plastic
bag wrapped in a towel) and elevate the area until the bleeding stops.  If the
amount of bleeding seems excessive or is difficult to stop, or if the wound is
deep or uneven, call your pediatrician or seek medical attention.  If the cut
is not very deep and is not uneven, you can probably apply a butterfly bandage
after cleaning; it will keep the edges of skin together and allow the injury
to heal.  In important cosmetic areas like the face and hands and across
joints or bony areas, stitches may be more appropriate.  If you have questions
or concerns or are in doubt about proper treatment, seek medical advice.


     My pediatrician told me to keep syrup of ipecac on hand in case of an
emergency.  Are there other medications I should have?

     You are wise to follow your doctor's suggestion.  Syrup of ipecac should
be kept on hand to induce vomiting if an accidental poisoning should occur.
(You will still have to call your pediatrician or the local poison control
center before you use it, however, since vomiting should not be induced for
certain ingested substances, such as hydrocarbons.)  It is also advisable to
have acetaminophen available at home to treat fever and/or pain.  Some
pediatricians advise parents to have a liquid form of antihistamine for
allergic reactions, and some will recommend having a cough/cold preparation
for treatment of respiratory infections.  If your child has many painful ear
infections, it is a good idea to have an analgesic ear drop available; this is
a prescription item, however, so you will need to ask your pediatrician about
it.  This short list is as much medication as you will probably need, but
consult with your pediatrician to be sure.


     My toddler was ill several months ago, and the pediatrician prescribed an
antibiotic.  Now I think my child has come down with the same illness.  Since
I still have some of the antibiotic left, can I just go ahead and give it to
her instead of bothering the pediatrician again?

     It is not wise to give any medication, but especially prescription
medication, for any illness other than the one for which it was prescribed.
For most illnesses that require an antibiotic, the amount prescribed is just
enough to treat that illness so that there should be none left over.  Many
antibiotics outdate in a few weeks and should be discarded after that date.
Most important, it may be very difficult for a parent to determine if an
illness in a toddler is really the same as the last one.  A medication used
for one illness may be contraindicated for another.  Don't give your child any
medication without consulting your pediatrician first, unless your
pediatrician has told you that you may.


     How can I tell the difference between a cold and the flu?  How do I treat
them?

     Sometimes you won't be able to tell whether your child has contracted a
cold or the flu.  If you can't, it won't matter; and sometimes, if you can, it
won't change the way you treat it.  Colds and flu are both caused by viruses,
and the flu that infects the nose and throat produces symptoms similar to
colds.  The type of flu that causes gastrointestinal symptoms is generally
easy to identify.  Either way, you'll want to treat the symptoms, since there
is no medicine that will cure either condition.  The symptoms are likely to
include a stuffy or runny nose, fever, red and watery eyes, coughing, sore
throat, loss of appetite, and malaise (generally feeling miserable).  To
relieve stuffiness, you can use saltwater nose drops, a cool-mist humidifier
in the toddler's bedroom, and perhaps a decongestant and/or cough medicine if
your pediatrician suggests it.  You'll want to pamper your toddler, give her
plenty to drink, and offer her small, light meals.  Encourage her to rest and
engage in only quiet activities.  Comfort her as well as you can, since crying
will increase her stuffiness and discomfort.  If your pediatrician approves,
you can give her acetaminophen to help relieve fever and make her more
comfortable; do not give her aspirin or ibuprofen.  A cough that becomes
severe or lasts more than a few days should be investigated.  Any sudden
worsening of her symptoms should also be reported to your pediatrician, since
a secondary infection, such as bronchitis, pneumonia, or ear infections, can
sometimes accompany a cold or the flu.  Most of the time, however, the cold or
flu will run its course, and your toddler will begin to feel better within
three to five days and be well in a week or two.


     How will I know when a cold is developing into something more serious?

     If your toddler's symptoms worsen later in the course of a cold, a
secondary infection or complication may be occurring.  Coughing that deepens
and becomes constant; fever that returns or shoots up; refusal of liquids;
increased irritability; increasing fatigue or lethargy; crying or shrieking;
or a red-streaked throat can all be symptoms of secondary infections or
complications.  Strep throat is one possible complication that should be
screened for.  An ear infection is also a possibility, since ear infections
often follow a cold or upper respiratory infection.  Remember, anytime your
toddler's symptoms concern you, contact your pediatrician; this is especially
true if her symptoms worsen after the first few days of a cold.


     Will my doctor automatically put my toddler on an antibiotic if she has a
severe cold or cough?

     Children of any age are not put on antibiotics automatically for colds or
for a cough.  Colds are caused by viruses, and antibiotics are ineffective as
a treatment for viruses.  Antibiotics, however, may be prescribed to treat a
bacterial infection that occurs or develops while the child is fighting a
cold.  Anytime you are concerned about your child's illness or the course it's
taking, you should consult your pediatrician.


     How high of a fever causes convulsions?

     The height of a fever seems to be less important than how fast it rises
in determining whether it will cause febrile (fever-related) convulsions.  A
rapid rise of two or three degrees is more likely to stimulate a seizure than
a gradual elevation of four or five degrees.  Another determining factor is
the family history.  Convulsions with fever tend to occur in certain families
(up to five to ten percent of the population) and are very uncommon in others.
For the comfort of your toddler, it is recommended that a fever over 102
degrees Fahrenheit be treated, usually with an appropriate dose of
acetaminophen.  In families with a history of febrile convulsions, the fever
can be treated a bit more aggressively.  If there is a history of febrile
convulsions in your family, make certain your pediatrician is aware of it so
that you can receive any necessary recommendations about treatment.


     My 20 month old was excluded from day care because she had "pinkeye."
How long will she need to stay at home?

     Pinkeye (conjunctivitis) is a redness or pinkness of the white portion of
the eye(s); it often accompanies a cold.  It is usually caused by the same
virus that causes the cold, although a secondary bacterial infection may also
be present.  A child with a cold and conjunctivitis is no more contagious than
a child with a cold alone.  There is really no more reason to exclude a child
with conjunctivitis than a child with just a cold.  This has been difficult
for many caregivers to accept because of the long-standing feeling that
conjunctivitis is more contagious than the cold itself.  It just isn't.
Treating the pinkeye with warm, wet packs placed on the closed eye(s) for five
or ten minutes four times daily will often take care of it within a few days.
If it does not, consult your pediatrician.


     When should I take my child to the eye doctor?

     This question is usually best answered by your pediatrician.  As part of
every well-child exam, the eyes will be examined.  If any significant
abnormality is found, further evaluation will be suggested.  If you and your
pediatrician both feel that the eyes are normal, an examination by an eye
doctor is probably not necessary at this age.  Some of the more common reasons
to see an eye doctor include a tear duct that does not open by six to 12
months of age, persistent deviation of the eyes in or out, suspected
cataracts, suspected vision problems, or ally significant injury to the eye.


     Do children outgrow ear infections?

     The reasons that older children seem to get fewer ear infections than
younger children are many.  Most ear infections are preceded by an upper
respiratory infection (a cold).  Young children begin to get upper respiratory
infections as soon as they are exposed to other people (especially other
children) with colds.  In our society, children are entering day-care and
child-care situations at an earlier age, and such situations encourage the
spread of cold viruses.  As the child grows, however, she is exposed to more
and more cold viruses, and her body begins to build up its defenses against
them.  So in the later childhood and adult years, she tends to get fewer
colds.  In addition, during a cold, the eustachian tube (which equalizes
pressure between the middle ear and the outside) becomes blocked and
malfunctions, resulting in an infection in the middle ear.  In younger
children, the eustachian tube is shorter and more crooked and is therefore
easier to block.  In older children, the tube enlarges and straightens and is
less likely to be obstructed when the child gets congested.  Although ear
infections can occur at any age, for these and other reasons, they are much
less common after the age of five to seven.


     My two year old has had three ear infections.  Should I have "tubes" put
in her ears?

     Three ear infections in a two year old is not unusual and is probably not
a reason to consider ear tubes.  These tubes are small, hollow, plastic
devices which are inserted through the eardrum to serve as a temporary back-up
to the eustachian tube (the eustachian tube equalizes pressure between the
middle ear and the outside).  These tubes are usually inserted when there is
evidence that the fluid in the middle ear space from an ear infection has not
cleared after several months (or after several car infections) and the child's
hearing is impaired and/or his general health is affected.  The decision to
consider placement of ear tubes is one that should be made in consultation
with your pediatrician and an ear specialist.  The tubes are only temporary
and can have some of their own side effects, including permanent scarring of
the eardrum.  For more specific information, you'll want to discuss this
matter with your pediatrician.


     How serious is chicken pox?  Should I expose my toddler to it on purpose
just to get it over with?

     Chicken pox is usually a relatively mild disease in childhood, although a
very small number of children who have a compromised immune system may
experience serious complications.  Chicken pox is marked by a rash that first
appears on the torso and then spreads, over the course of a few days, to the
rest of the body.  It can involve the mouth and throat; in girls, it can even
involve the vagina.  Some of the lesions look like small drops of water on a
red background.  Overnight, the "drops of water" are usually replaced by
scabs.  Some children only get a few lesions while others may get hundreds.
Chicken pox can be accompanied by runny nose, fever, and itching.  The time
from exposure to onset of symptoms is 14 to 21 days.  The child is contagious
until the scabs are dry and have begun to fall off, this can take a week to
ten days.  If the itching is severe, the pediatrician may prescribe an
antihistamine to make the child more comfortable and help prevent excessive
scratching, which may lead to scarring.  There are different opinions
regarding whether to expose your child deliberately or not.  Since this is
such a contagious disease, your child will usually be exposed at some point
anyway.  You probably should avoid exposing your toddler on purpose, at least
until he's a little older and bigger.  What's more, a chicken pox vaccine is
currently being tested, so you may not want to purposely expose her to someone
with chicken pox at all.


     What is roseola?  Do all children get it?

     Roseola is a viral illness that most children will get sometime between
six months and six years of age.  It can be frightening to parents because it
begins with a fever that is often very high (103 to 105 degrees Fahrenheit)
but that is not accompanied by any other symptoms.  Most of these children
feel much better than you would expect them to with such a high fever.  The
fever lasts three to five days and then goes away.  Within 12 to 24 hours, a
rash develops all over the body.  It is pink or red and rarely itches.  The
rash lasts less than two days, and the illness is over.  Roseola is unique in
that the fever and rash do not occur at the same time, and by the time the
rash does appear, the child feels much better.  Treatment with acetaminophen
does not control the fever as readily as with other illnesses, but may bring
it down enough to make the child more comfortable.  Children recover very
quickly from this illness despite the unusually high fever.


     Is there any way to prevent my toddler from developing a reaction to the
DTP booster?

     The part of the DTP to which there are rare reactions is the pertussis
(whooping cough) portion.  If your child hasn't had a reaction previously, it
would be very unlikely for her to have one this time.  Serious reactions from
the DTP occur about once in every 310,000 to 500,000 doses.  However, the risk
of serious complications from whooping cough in an unimmunized child is one in
10,000.  In other words, the risk from the disease is many times greater than
the risk of reaction from the immunization.  Most children will have only a
mild or minor reaction to the immunization; it may include temporary soreness
at the injection site, a low-grade fever that lasts only a short time, and
crankiness for several hours after the injection.  If you would like to take a
further step to modify even these minor reactions, administer acetaminophen at
the time of the immunization.  If you're still concerned, talk to your
pediatrician.  Protecting your child from preventable disease is vitally
important to her health and well-being.


     I understand that between 12 and 18 months of age my toddler will receive
several immunizations--some that she has never had before.  Must she have
them?  Are any of them dangerous?

     At 12 months of age, your daughter will receive a tuberculin test.  This
simple skin test is very important because it is necessary to diagnose and
treat tuberculosis early in order to get the best results.  The test is
repeated yearly in many pediatric clinics, but the risk in your community may
affect the recommendation for how often your toddler should be screened.  At
about 15 months of age, your toddler should receive the MMR, which provides
immunity to measles, mumps, and rubella.  The measles part of the vaccination
may cause a fever or a slight rash seven to ten days after the injection.
There's usually no reaction to the mumps or rubella portions.  If your toddler
has a severe allergy to eggs, be sure to tell your pediatrician before your
toddler is vaccinated.  Several vaccines are grown on eggs and therefore may
pose a greater risk to your toddler.  If your toddler does have such an
allergy, she will be given a skin test before getting the vaccine to determine
whether or not it is safe for her.  There has been a recent increase in the
incidence of measles in this country, so it's important to make sure that all
family members, including yourself and your spouse, have been properly
immunized against this disease.  Check with your doctor to see if you need a
booster as well.  In addition to the MMR, your daughter will also receive the
HiB vaccine to protect her from Hemophilus influenza type B.  This is not a
flu but a bacterium that has caused serious disease in many children five
years of age and younger.  It is the most frequent cause of bacterial
meningitis, epiglottitis, and other serious diseases and complications.  There
are no expected reactions to this vaccine.  The DTP and oral polio
vaccinations will be repeated at 18 months of age and then again at age five.
If you have any concerns about the vaccines, discuss them with your doctor.
Keep in mind that you, as a parent, are responsible for the health and
well-being of your child.  An important part of that responsibility is to
protect her from getting diseases that can be prevented.  Parents who do not
immunize their children out of fear or ignorance are putting their children at
great and unjustified risk.  It's similar to expecting a toddler to cross a
major highway by herself and not get hit by a car.  It would be a high risk
gamble, and a senseless one for your child.


     My daughter has allergies.  How can I make my home as nonallergenic as
possible?

     You'll want to try to identify the allergens (substances that produce an
allergic response) in your child's environment.  Sometimes they're easy to
identify and remove.  Other times, you'll want to consult with your
pediatrician for help.  If indicated, your child may need to have skin tests
to help identify allergies and indicate specific treatment.  Some allergic
children will have allergies to house dust, mold, tobacco smoke, and bacteria;
often, feathers, fur, and wool will cause reactions as well.  You can try to
remove or diminish these common allergens in her sleeping area by only having
washable surfaces, curtains, and floors.  Washing all the surfaces frequently
and keeping dust to a minimum can be helpful in diminishing symptoms of some
allergies.  Remove stuffed animals from her crib or bed, and allow one or two
toys that can be washed frequently.  Make sure that the mattress is made of an
allergen-free material or is completely enclosed in a safe and allergen-proof
cover.  Don't allow pets in the house, and keep her away from other people's
pets.  If she pets an animal to which you know she is allergic, bathe her,
shampoo her hair, and launder her clothes as soon as possible.  Air cleaners
or electrostatic equipment for furnaces are said to be extremely helpful to
allergic families.  There are many of these on the market so you'll want to do
some careful research before choosing one.  If these steps do not make your
daughter more comfortable, talk to your pediatrician.


     My 15 month old always has a wet rash around her mouth.  Is there an
effective way to treat this?

     What you are describing is probably a contact rash from the child's
drooling.  At this age, toddlers do a lot of salivating because they are
teething.  Measures to keep the area dry are the most effective in treating
and preventing the rash.  An absorbent, nontoxic powder dusted lightly on the
chin is often helpful.  Lubricating creams and lotions may also help since the
skin frequently gets irritated and then becomes dry; as a result, the wet rash
may become a dry, rough rash.  Gently patting and blotting the area
occasionally with a soft cloth may also help, but wiping too frequently can
increase the irritation.  Do the best you can for now.  You will notice that
the rash will gradually disappear as the drooling decreases.


     Does a loose stool mean that something's wrong?

     An occasional loose stool is nothing to worry about.  Children have
various patterns for bowel movements, and there's a wide range of what may be
normal for your child.  Loose and watery stool would usually be a sign that a
food or beverage (or one of its ingredients) didn't agree with her or that
she's getting an illness.  Sometimes toddlers will have loose stools
associated with colds or teething.  Diarrhea is considered to be more than
one loose stool per feeding; usually, it's accompanied by other symptoms of
illness, such as a fever or abdominal cramping.  If your toddler frequently
has loose stools, but has no other symptoms of illness, you may want to
decrease her intake of fruit and fruit juices to see if this helps.  You might
also want to investigate other aspects of her diet.  Sometimes, identifying a
certain food that doesn't agree with her and removing it from her diet will
negate the problem.  Anytime you are concerned about loose stools or diarrhea,
contact your pediatrician.


     Is my toddler constipated if she doesn't have a bowel movement for two to
three days?

     It can be entirely normal for a child to have a bowel movement every two
to three days.  If she isn't exhibiting signs of constipation (such as crying,
severe grunting, or misery while having the bowel movement) and if she isn't
excreting large, hard stools or many hard pellets, she isn't constipated.
Some toddlers will grunt and fuss at the time they have a bowel movement
because it's bothersome, and they have to stop and concentrate on something
when they'd rather not.  If the consistency of the stools seems normal and the
pattern of bowel movements is fairly reasonable (every two to five days),
don't worry.  Of course, if you become concerned, discuss it with your
pediatrician.  Some toddlers can develop a habit of holding stools, and that
can cause problems.


NEVER ASSUME

     The people who staff hospital emergency rooms report that the most common
phrases they hear from the parents of toddler accident victims are "I assumed
she couldn't..." and "I never thought she could..."  As they go about safety
proofing their homes at the start, as well as when they go about making
periodic improvements, many parents make the mistake of thinking in terms of
their toddler's abilities of the moment.  If she is climbing in six-inch
increments, they assume that she can't climb 12-inch increments, and therefore
consider something placed on a 48-inch high shelf to be far beyond her reach.
If she is barely able to operate a simple lever mechanism, they assume that
she can't cope with a twist-and-turn latch, and therefore consider something
locked away in a cabinet with this kind of device to be safely secured.
Unfortunately, such assumptions often lead to big trouble.  Toddlers develop
at rapid rates and in irregular patterns, and it is virtually impossible to
predict exactly what your toddler will be capable of from day to day.
Furthermore, many major abilities arrive with very little or no advanced
warning and your toddler's skill profile could change dramatically overnight.
Therefore, as you go about designing a safe environment for your toddler's
explorations and investigations, avoid making such simple assumptions; try to
anticipate as much as possible.  Giving your toddler current credit for any
and all abilities that could possibly make an appearance during the next six
months will give you a wide margin for error and go a long way toward ensuring
the well-being of your toddler.


FREEDOM VERSUS SECURITY

     During this period, toddlers are incredibly daring and adventuresome,
which in turn often causes their parents to become extremely anxious and
fearful.  Armed with physical skills that are becoming more impressive every
day, and motivated by ever-expanding curiosity, toddlers routinely take on new
challenges to run faster and climb higher.  Unfortunately, they occasionally
bite off more than they can chew.  Consequently, it is a rare toddler who
doesn't crash or fall from time to time, and minor bumps and bruises are a
regular part of a typical toddler's appearance.  Some parents react to this by
keeping their toddler severely restricted unless they can provide constant
supervision for her activities.  While this is understandable, it is also
detrimental to the toddler's optimal development.  Trading your toddler's
freedom for your own psychological comfort is a bad bargain.  As long as you
have done a thorough job of safety proofing, it is also largely unnecessary.
Simply learning to accept the fact that minor mishaps are an inevitable part
of early childhood will be a considerably more productive strategy for
everyone involved.  This also applies to situations outside the home.  Now
that toddlers are capable of disappearing from sight or dashing toward heavy
traffic in the blink of an eye, some parents react by confining their toddler
almost exclusively to the home environment.  While the peace of mind of the
parents will be largely guaranteed by this strategy, there also is a good
chance that the toddler's progress will be stifled.  Again, although it is
understandable, trading your toddler's opportunities to learn about her world
for your own psychological comfort is a poor deal.  In the long run, everyone
will be better off if you merely recognize that having a toddler means that
your nerves inevitably will be on edge from time to time.


THINGS TO DO AND NOT TO DO FOR A COLD

DO:

  -  Offer fluids frequently and provide small nourishing meals
  -  Pamper and offer sympathy
  -  Encourage adequate rest and sleep
  -  Treat fever (higher than 102 degrees Fahrenheit) and discomfort with
     acetaminophen
  -  Use disposable cups whenever possible to prevent spread of viruses
  -  Teach your child to wash her hands before and after meals and after
     using the bathroom
  -  Use a cool-mist humidifier in your child's room
  -  Watch for complications such as ear pain, severe cough, or a worsening
     of symptoms
  -  Call your pediatrician for advice if you think the illness is not
     following the expected course

DO NOT:

  -  Offer large, heavy meals
  -  Criticize or show impatience
  -  Allow a noisy or unpleasant environment in the child's room
  -  Give aspirin, aspirin products, or ibuprofen
  -  Share eating or drinking utensils
  -  Allow unwashed hands to handle food
  -  Use hot-water vaporizers
  -  Delay consulting with your pediatrician about significant changes in
     your child's condition


RECOMMENDED IMMUNIZATION SCHEDULE FOR CHILDREN

Age                           Immunization

Birth                         HB
Two months                    DTP, oral polio, HbCV, and Hb
Four months                   DTP, oral polio, and HbCV
Six months                    DTP and HbCV
Nine to 12 months             Tuberculin test (may be repeated at one to two
                              year intervals; consult pediatrician)
12 months                     HbCV and HB
15 months                     DPT, oral polio, MMR, and HbCV
18 months                     DTP and oral polio
Four to six years             DTP and oral polio
12 years                      MMR
Every 10 years                Td

DTP = Diphtheria, tetanus, and pertussis (whooping cough) vaccines given as
      single injection
HB  = Hepatitis B
HbCV= Haemophilus b conjugate vaccine
MMR = Measles, mumps, and rubella vaccines given as single injection
Td  = Tetanus-diphtheria booster


IMPORTANT REASONS FOR CONTACTING YOUR PEDIATRICIAN

  -  Routine well-child examinations and immunizations
  -  Drastic changes in your child's behavior
  -  Severe pain
  -  Severe or worrisome injury
  -  Prolonged high fever
  -  Persistent cough
  -  Foul-smelling drainage from the nose, eyes, ears, or anywhere else
  -  Persistent vomiting
  -  Unexplained, persistent rash
  -  Prolonged diarrhea
  -  Blood in urine or stool
  -  Anytime you are worried about your child's health or physical or
     emotional well-being