How to Handle a Temper Tantrum

You’re standing in the snack aisle of the supermarket. Lying at your feet is your toddler, who has just been informed (by you) that, no, they cannot have the Cinderella fruit snacks. Their face has turned a shade somewhere between red and purple. Their fists are pounding the floor in fury as they emit a shriek that can be heard in the farthest reaches of the parking lot. The other shoppers are gaping at this spectacle as you wish desperately for a hole to open in the floor and swallow you up.

Many a parent has been through a scenario like this, although the tantrum might have taken a slightly different form; crying, hitting, kicking, stomping, throwing things, and breath holding are all popular tantrum techniques.

Temper tantrums are exceedingly common in children, especially between ages 1 and 4 — the early part of which is sometimes called the “terrible 2s” — when kids are still learning how to communicate effectively. More than half of young children will have one or more tantrums a week as they vent their frustrations and protest their lack of control.

Although they are a normal part of the toddler repertoire, temper tantrums can be distressing to parents. When they occur infrequently, tantrums aren’t a big deal and are best ignored. It’s when they become regular or intense that parents need to look into what’s causing them and find ways to stop them.

Tantrum Triggers
Some children are more prone to tantrums, particularly kids who are intense, hyperactive, or moody, or kids who don’t adapt well to new environments. For most toddlers, tantrums are simply a way of getting out their frustration and testing limits (Will mommy buy me that toy if I scream really loud?).

The smallest things, from asking them to take a bath while they’re in the middle of watching Sesame Street to requesting that they share a favorite stuffed animal with a younger sibling, can set off young children. Any situation that involves change may spawn a tantrum. Add fatigue or hunger to the equation and children, their threshold for tolerance even lower, are even more likely to throw a tantrum.

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The Power of Play: How Time Outside Helps Kids

For millennia, parents have told their rowdy kids to “Go out and play!” In doing so, most hadn’t a clue they were nurturing the emotional, cognitive, language, and self-regulation skills that build executive function and social aptitude in children, all while enhancing critical brain structures that support pursuing goals and ignoring distractions.

In other words, play is needed for healthy development. So says a recent report published in the journal Pediatrics, which outlines how play advances such skills even as it manages toxic stress. What’s more, playing is shown to support the formation of stable and nurturing relationships with caregivers that kids need to thrive.

While the definition of play is not clear-cut, the researchers agree that play is naturally motivated, uses active engagement, and results in joyful discovery. It’s also voluntary, fun, and spontaneous, with no extrinsic goals.

There are different types of play, says Eileen Kennedy-Moore, PhD, a child psychologist and the author of Growing Friendships: A Kids’ Guide to Making and Keeping Friends. “Some play is child-directed; it’s about exploring,” she says. “A toddler puts everything in her mouth — she’s curious about the world. Physical play is rough-and-tumble, with kids running and moving their bodies. Social play may involve a child watching another kid, playing alongside him, which becomes cooperative play with shared goals as they interact. Pretend play is when children take on adult roles. Interestingly, this happens cross-culturally at specific developmental times, primarily during the preschool years.”

Free play enables children to understand their own preferences and interests, the report states. But play guided by an adult, where the child does her own actions, better promotes learning with a specific goal in mind.
Kennedy-Moore agrees: “Adult-guided play is not about an adult lecturing, but rather modeling for children by asking questions. For example, if a parent and a child are doing a puzzle, the adult might say, ‘I notice the color yellow is running through here. Do you see a yellow piece?’ Asking questions instead of giving the answers.” This allows a child to figure it out — and succeed — independently.

Play and stress are closely linked, with high levels of play associated with low levels of cortisol. Play may be especially important for children in high-stress family situations, the report says.

4 Game Changers
Use these play tips from Kennedy-Moore in your kids’ downtime to boost social, emotional, and mental development.

Ditch the device. There’s no “right” number of hours for kids to play — but do monitor screen time, Kennedy-Moore says: “Playing a video game virtually with a friend is not the same as a game of tag, where kids negotiate the rules, cooperate, and compete to catch each other.”

Solo play is good — to a point. “Alone play can be wonderful, and it builds imagination,” Kennedy-Moore says. “For instance, kids love playing alone with Legos.” But if your child always plays solo, it can be a red flag for social isolation.

Embrace unstructured play time. “Kids say, ‘I’m bored!’ and parents leap to the rescue,” Kennedy-Moore says. “If they can resist, the child moans and groans — and, then, something wonderful happens: Kids think of something to do. It’s a life skill to follow their own curiosity, entertain themselves, and manage their emotions.”

The play’s the thing. “Play is important and valuable, in and of itself,” Kennedy-Moore says, “even if it doesn’t always encourage development every time. Play is like art — to be appreciated.”

Can Gluten-Free Foods Fuel Your Kids?

When it comes to food trends, “gluten-free” (GF) is at the top of the heap. Some people claim that the meal plan has helped them lose weight, have more energy, and just feel better. But is it better fuel for your kids?

Unless your child has a specific medical reason to avoid gluten, there’s little proof that a GF meal plan is better than the healthy, balanced foods that all kids need. Before you start planning GF meals, it’s important to understand the basics of this approach to eating.

What It Means to Go Gluten-Free
Gluten is a protein found in some grains. If your child goes on a GF diet, they’ll avoid all food and drinks that have:

Wheat
Rye
Barley
Triticale (a cross between wheat and barley)
Instead, they’ll focus on foods that are naturally gluten-free. These include fruits, vegetables, meat, poultry, fish, beans, legumes, and most dairy products.

Some grains and starches are OK on a gluten-free diet, like:
Buckwheat
Corn and cornmeal
Rice
Soy
Quinoa
Tapioca
Special GF flours are also made from many of these grains.

Is a Gluten-Free Diet a Healthy Choice for Kids?
The only people who need to stick to a gluten-free diet are those with celiac disease, a condition in which gluten can damage the small intestine. Kids who are allergic to gluten, like those who have a wheat allergy, should avoid it, too.

For everyone else, gluten is not unhealthy. Avoiding it won’t make your kids “feel better” or have more energy. In fact, trying to cut it out of your child’s diet may make it harder for him to get enough key nutrients, like iron, zinc, calcium, vitamin B, and folate. Plus, since so many grains are off-limits, a GF diet can mean he’ll have a tough time getting enough fiber.

It’s still the overall quality of the foods your child eats that makes the biggest difference in how he feels. Focus on helping him choose a variety of whole, healthy foods and cutting out processed ones. (Packages of gluten-free cookies or potato chips aren’t any healthier than the regular kinds.)

Artificial pancreas effectively controls type 1 diabetes in children age 6 and up

A clinical trial at four pediatric diabetes centers in the United States has found that a new artificial pancreas system — which automatically monitors and regulates blood glucose levels — is safe and effective at managing blood glucose levels in children as young as age six with type 1 diabetes. The trial was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), part of the National Institutes of Health. Results from the trial were published August 26 in the New England Journal of Medicine.

“Fewer than 1 in 5 children with type 1 diabetes are able to successfully keep their blood glucose in a healthy range with current treatment, which may have serious consequences on their long-term health and quality of life,” said Guillermo Arreaza-Rubín, M.D., director of NIDDK’s Diabetes Technology Program and project scientist for the study. “Earlier research showed that the system tested in this study was safe and effective for people ages 14 and older. This trial now shows us this system works in a real-world setting with younger children.”

The artificial pancreas, also known as closed-loop control, is an “all-in-one” diabetes management system that tracks blood glucose levels using a continuous glucose monitor (CGM) and automatically delivers the insulin when needed using an insulin pump. The system replaces reliance on testing by fingerstick or CGM with delivery of insulin by multiple daily injections or a pump controlled by the patient or caregiver.

The study enrolled 101 children between ages 6 and 13 and assigned them to either the experimental group, which used the new artificial pancreas system or to the control group which used a standard CGM and separate insulin pump. Check-ins and data collection were conducted every other week for four months.

Study participants were instructed to continue about their daily lives so that the researchers could best understand how the system works in the typical routines of the children.

The study found that youth using the artificial pancreas system had 7% improvement in keeping blood glucose in range during the daytime, and a 26% improvement in nighttime control compared to the control group. Nighttime control is of particular importance for people with type 1 diabetes, as severe, unchecked hypoglycemia can lead to seizure, coma or even death. The overall time-in-range goal for the artificial pancreas reflected a nearly 11% improvement, which translated to 2.6 more hours per day in range.

“The improvement in blood glucose control in this study was impressive, especially during the overnight hours, letting parents and caregivers sleep better at night knowing their kids are safer,” said protocol chair R. Paul Wadwa, M.D., professor of pediatrics at the Barbara Davis Center for Childhood Diabetes at the University of Colorado, Aurora (CU). “Artificial pancreas technology can mean fewer times children and their families have to stop everything to take care of their diabetes. Instead, kids can focus on being kids.”

Sixteen adverse events, all classified as minor, occurred in the artificial pancreas group during the study, with most due to problems with the insulin pump equipment. Three events occurred in the control group. No cases of severe hypoglycemia or diabetic ketoacidosis occurred during the study.

“For decades, NIDDK has funded research and technology development to create a user-friendly automated device that could ease the constant burden of type 1 diabetes, from the finger sticks and insulin injections, to the insulin dose calculations and constant monitoring while improving diabetes control outcomes and preventing both short- and long-term complications of the disease,” said Arreaza-Rubín.

“The artificial pancreas is a culmination of these years of effort, and it’s exciting to see how this technology may benefit children with type 1 diabetes and their families, and hopefully benefit everyone with diabetes in the future.”

The artificial pancreas technology used in this study, the Control-IQ system, has an insulin pump that is programmed with advanced control algorithms based on a mathematical model using the person’s glucose monitoring information to automatically adjust the insulin dose. This technology was derived from a system originally developed at the University of Virginia (UVA), Charlottesville, with funding support from NIDDK.

This four-month study was part of a series of trials conducted in the International Diabetes Closed-Loop (iDCL) Study. In addition to CU and UVA, study sites included Stanford University School of Medicine, Palo Alto, California; and Yale University School of Medicine, New Haven, Connecticut. Jaeb Center for Health Research served as the data coordinating center.

Based on data from the iDCL trials, Tandem Diabetes Care has received clearance from the U.S. Food and Drug Administration for use of the Control-IQ system in children as young as age six years.

“As we continue to search for a cure for type 1 diabetes, making artificial pancreas technology that is safe and effective, such as the technology used in this study, available to children with type 1 diabetes is a major step in improving the quality of life and disease management in these youth,” said NIDDK Director Dr. Griffin P. Rodgers.

The iDCL Study is one of four major research efforts funded by NIDDK through the Special Statutory Funding Program for Type 1 Diabetes to test and refine advanced artificial pancreas systems. The studies, with additional results forthcoming, are looking at factors including safety, efficacy, user-friendliness, physical and emotional health of participants, and cost.

This study was funded by NIDDK and Tandem Diabetes, Inc. Tandem provided the experimental closed-loop systems used in the trial, system-related supplies including the Dexcom CGM and Roche glucometer, and technical expertise.

Remedies for Nausea and Vomiting

Nausea and Vomiting: What’s Wrong?

Your child’s nausea has turned to vomiting, and you want to help him fast. Luckily, bouts of vomiting in kids aren’t usually harmful, and they pass quickly. Common causes are stomach viruses and sometimes food poisoning. Check in with your doctor if your child is less than 12 weeks old, acts sick, or if you are worried.

Signs of Dehydration

One of the best things you can do is watch for dehydration. Kids get dehydrated more quickly than adults. Watch your child for: acting tired or cranky, dry mouth, fewer tears when crying, cool skin, sunken-looking eyes, not urinating as often as normal, and when he does go, not peeing very much or urine that is darker yellow.

Treating Dehydration

To prevent and relieve dehydration, try to get your child to drink in very small amounts. Even if vomiting continues, she’s still absorbing some of what you give her. Try ice chips, sips of water, sports drinks, or oral rehydration solutions like CeraLyte, Enfalyte, or Pedialyte. After she vomits, start with a small amount: a few tablespoons every few minutes. Over time, give her more as she is able to hold it down. Make sure she urinates regularly.

What About Flat Soda?

For many years, parents used flat lemon/lime soda and ginger ale to help kids replace fluids, and many doctors still recommend those. But research has begun to show that oral rehydration solutions are better for kids. These drinks offer the right amounts of sugar and salt. An alternative can be a sports drink mixed with an equal amount of water.

Liquid Diet

When it’s been several hours since your child last vomited, you can begin a clear liquid diet beyond just water, electrolyte drinks, or oral rehydration solutions. Stick with liquids you can see through. They are easier to digest, yet they offer nutrients to give your child energy. Think clear broth, cranberry juice, apple juice. Popsicles and Jell-O can work well, too.

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Talking to Your Child About Bedwetting: Dos and Don’ts

As many as one out of five children wets the bed at night. Also called nocturnal enuresis, bedwetting is as common as it is misunderstood.

How you, as a parent, handle your child’s bedwetting can have a big effect on how successful your child is at staying dry. When you’re ready to talk with your child about bedwetting, here are a few simple tips that can help.

Bedwetting: Talking to Your Child
Educate. In a class of 30 children, as many as six kids may wet the bed. Letting your child know that other kids have the same problem can take the weight off his shoulders and help him feel he’s not alone.
Tell your child if you used to wet the bed. Was bedwetting a problem for you as a kid? If you or a close family member used to wet the bed at night, let your child know. This helps them understand that bedwetting may be hereditary and is not completely their fault.
Tell them they’re not to blame. Even if there’s no family history of bedwetting, make sure your child knows they’re not to blame for wetting the bed. Explain what can cause bedwetting, including how some children have small bladders or are such deep sleepers they don’t feel bladder contractions in the night.
Tell your child a doctor can help. Talk to your child about seeing a pediatrician or other health care professional to discuss bedwetting treatments. An examination by a doctor can also help rule out medical causes for wetting the bed, such as urological problems or a reaction to certain medications.
Talk to your child about treatment options. Make sure your child understands what’s available to help him overcome wetting the bed, including enuresis alarms, medication, and lifestyle changes. Generally, treatments such as medication are used for children older than 6. Explain, too, how each option works and what to expect from each treatment.
Talk about changing habits. Going to the bathroom before bed, avoiding caffeinated and salty foods, drinking a little less fluid close to bedtime — these and similar changes can help your child achieve dry nights, so talk to him about how he can help himself.
Be encouraging. When your child successfully follows the bedwetting treatment you’ve chosen — whether he’s had a dry night or not — give him praise and encouragement.
Stay low-key. After a child wets the bed, be sure to remain calm and positive.
Encourage your child to go on sleepovers. Your child doesn’t need to miss out. With the use of absorbent pants, medication, and the help of other parents, let your child know they can go on sleepovers or away to camp.
Ask if it’s OK to share. Many kids don’t mind it if other adults know about their bedwetting — especially if that adult can help, such as a parent at a sleepover, or a counselor at camp. But do check with your child first.
Talk to your child about taking part in cleaning up. Sharing the responsibility of changing and washing the wet sheets helps a child actively tackle the problem of bedwetting. Help them with the activity, and praise them for taking part.

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Baby Talk: Communicating With Your Baby

Your baby’s first year will be a flurry of changes — and not just diapers. From the first smiles, gurgles, and coos to learning to say “mama” or “dada,” babies love to communicate with their own form of baby talk. And they hope you’ll “baby talk” right back.

All through this first year, you can do a lot to encourage your baby’s communication skills. And it’s easy. All you need do is smile, talk, sing, and read to your baby.

Why focus on communicating with your baby? Because early speech and language skills are associated with success in developing reading, writing, and interpersonal skills, both later in childhood and later in life.

Baby Talk: Smile and Pay Attention

Long before they can speak clearly, babies understand the general meaning of what you’re saying. They also absorb emotional tone. Encourage baby’s early attempts to communicate with you with loving attention:

  • Smile often at your baby, especially when he is cooing, gurgling, or otherwise vocalizing with baby talk.
  • Look at your baby as he or she babbles and laughs, rather than looking away, interrupting, or talking with someone else.
  • Be patient as you try to decode your infant’s baby talk and nonverbal communication, like facial expressions, gurgling, or babbling sounds that could signal either frustration or joy.
  • Make time to give your baby lots of loving attention, so he can “speak” to you with his or her baby talk, even when you’re busy with other tasks.

Baby Talk: Imitate Your Baby

Right from the start, baby talk should be a two-way street. By imitating your baby, you’ll send an important message: what he is feeling and trying to communicate matters to you.

  • Have back-and-forth conversations in baby talk to teach your baby the give-and-take of adult conversation.
  • Imitate baby’s vocalizations — “ba-ba” or “goo-goo” — then wait for him to make another sound, and repeat that back.
  • Do your best to respond, even when you don’t understand what your baby is trying to say.
  • Reinforce communication by smiling and mirroring facial expressions.
  • Because gestures are a way babies try to communicate, imitate your baby’s gestures, as well.

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Home cleaning products may up risk of childhood asthma

New parents who obsessively clean their homes to protect babies from germs might want to relax a bit, suggests a new study linking high exposure to cleaning products with an increased risk of childhood asthma.
Researchers surveyed parents about how often they used 26 common household cleaners over babies’ first three to four months of life. By the time the kids were 3 years old, children with the highest exposure to cleaning products were 37% more likely to have been diagnosed with asthma than those with the least exposure.

With greater exposure to cleaning products, kids were also 35% more likely to have chronic wheezing and 49% more likely to have chronic allergies, the study found.

“Parents are striving to maintain a healthy home for their children,” said study coauthor Dr. Tim Takaro of Simon Fraser University in Vancouver, Canada.

“We want parents to question the socially accepted norm that a home needs to smell like chemical-based cleaning products in order to be clean,” Takaro by email. “Instead, we propose that the smell of a healthy home is no smell at all.”

In other words, parents should read labels and look for items that are free of dye and perfume, and consider natural cleaning products instead of chemical alternatives.

The first months of life are critical for development of the immune and respiratory systems, and exposure to chemicals inside the home is particularly problematic because infants spend so much time indoors, the study team writes in the journal CMAJ.

Chemicals in cleaning products can cause chronic inflammation that may contribute to development of asthma or make symptoms more frequent or severe, the researchers note.

Most kids in the study were white, and most parents were non-smokers without any history of asthma.

Because asthma can be difficult to diagnose with breathing tests in very young children, researchers also tested kids’ skin for allergies and asked parents how often children experienced symptoms like wheezing.

The most commonly used cleaning products in the study were dishwashing soap, dishwasher detergent, multipurpose spray cleaners, glass cleaners and laundry soap.

The study wasn’t designed to prove whether or how any specific cleaning products or chemicals in these products might directly cause asthma symptoms.

The American Lung Association recommends against using cleaning products that contain volatile organic compounds, fragrance and other irritants, but manufacturers in Canada and the United States are not required to list all ingredients in cleaning products. Some “green” products may contain harmful substances, as these products are not regulated, the study team notes.

“While much remains unknown, we think that these cleaning products (and the chemicals they contain) act as irritants to the airways of growing children,” Dr. Elissa Abrams of the University of Manitoba, in Winnipeg, Canada, who wrote a commentary accompanying the study.

Young children who spend a lot of time indoors, and especially babies and toddlers who touch everything with their hands and mouths, may be especially vulnerable, Abrams said by email.

“The take-home message is that parents should be careful which cleaning products they use in the home,” Abrams said.

Parents Can Help Their Sleep-Deprived Teens

Mom and dad may be key in curbing the epidemic of drowsy teens, a new study suggests.

American teens aren’t getting enough sleep, which can lead to anxiety, depression and suicidal thoughts. Sleepy teens also are more likely to get into car crashes and have a greater risk of being injured while playing sports.

The lack of sleep may be due to too much homework, too many extracurricular activities, too much caffeine, early school start times and too much screen time, researchers say.

But parents can play a pivotal role in helping their teens get the rest they need.

“Greater enforcement of parent-set bedtimes for teenagers aged 14 to 17 are associated with longer sleep duration,” said study lead author Jack Peltz, who conducted the research while at the University of Rochester in New York. He is now an assistant professor of psychology at Daemen College in Amherst, N.Y.

For the study, teens kept a sleep diary over seven days and parents gave information about their enforcement of sleep-related rules and bedtimes.
The study found that enforced bedtimes, along with later school start times, had the greatest influence on sleep duration, daytime energy and depressive symptoms. But more than 50% of parents had no specific or enforced bedtime rules.

Contrary to their expectations, the researchers didn’t find that caffeine or screen time had any effect on how long teens slept.

The study team acknowledged that enforcing a specific bedtime for teens is difficult, but doing so improves their mental health.

“Ideally, parents should be able to work collaboratively with their teenagers to develop bedtimes that still support the child’s autonomy,” Peltz said in a University of Rochester news release.

Study co-author Dr. Heidi Connolly, chief of the Division of Pediatric Sleep Medicine at Rochester, said most teens need nine to 10 hours of sleep each night. That’s also the recommendation of the American Academy of Sleep Medicine and the American Academy of Pediatrics.

“It’s inherently more difficult for teenagers to fall asleep earlier than later because of their circadian rhythm,” Connolly said in the release. “That’s why it’s so important for high school start times to be later, as the American Academy of Pediatrics has recommended across the board.”

Getting enough sleep means feeling well-rested during the day, and waking up at your usual wake-up time even when allowed to sleep in, the researchers said.

When to Call a Pediatrician

It’s 2 a.m. Your baby is crying and you can’t soothe her. She has a fever and a stuffed nose. Do you call the pediatrician, or do you wait until morning?

New parenthood is full of uncertainty. When you’re a first-time parent, it’s easy to second-guess every decision you make.

“It can be hard sometimes to know when or when not to call,” says Katie Lockwood, MD, a pediatrician at Children’s Hospital of Philadelphia. “I reassure parents to follow their instincts. If something doesn’t feel right or if they’re not sure if something is normal or not, pediatrician offices would rather you err on the side of calling us.”

A few key symptoms can be your guide as you decide whether to grab your phone and call your pediatrician.
Fever
How to handle a fever depends on your child’s age. In a baby under 2 months old, a rectal temperature of 100.4 F or higher is an emergency.

“Go straight to the ER,” advises Lockwood. “Sometimes babies can have a serious infection, and the only sign is a fever.” The hospital will do a full workup that includes blood and urine tests, and sometimes a spinal tap.

In older children, the number on the thermometer is less telling than other clues. “Most important is how the child is acting with the fever and how long they’ve had it,” Lockwood says. “If a child has a 101 [degree] fever but they’re really irritable, they won’t eat, they’re not acting like themselves, or they won’t stop crying, that’s concerning to me.” This rule applies for vaccinated children; in unvaccinated infants, most fevers should be seen by a doctor right away.
Three days is usually the magic number for viral fevers to last, she says. Any fever that lasts longer deserves a call to your doctor. It may have turned into a bacterial infection like pneumonia.

Vomiting and Diarrhea
These symptoms usually signal a viral infection. On their own, they’re nothing to worry about. But when they’re too intense, they can be a problem.
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