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Monday, September 30, 2013

Developmental Milestones

Some parents were asking me to provide them with some developmental milestones. See below:
Language Development Milestones by American Speech-Language-Hearing Association

Makes pleasure sounds
0-3 months
Repeats the same sounds a lot (cooing)
Cries differently for different needs
4-6 months
Babbling sounds more speech-like with many different
sounds, including p, b, and m
Tells you (by sound or gesture) when he wants you to do something
7 months - 1 year
Babbling has both long and short groups of sounds such as “tata upup bibibibi.”
Uses speech or non-crying sounds to get and keep attention
Has 1 or 2 words (“uh-oh,” “bye-bye,” “dada,” “mama,”“no”) although they may not be clear
1-2 years
Says more words every month
Uses some 1-2 word questions (“Where kitty?” “Go byebye” “What’s that?”)
Puts 2 words together (“more cookie,” “no juice,” mommy book”)
2-3 years
Has a word for almost everything
Uses 2-3-word “sentences” to talk about and ask for things
Speech is understood by familiar listeners most of the time
3-4 years
Talks about activities at school or at friends’ homes
People outside family usually understand child’s speech
Uses a lot of sentences that have 4 or more words
4-5 years
Uses sentences that give lots of details (eg, “I like to read my books.”)
Tells stories that stick to topic
Communicates easily with other children and adults
Says most sounds correctly except a few, like l, s, r, v, z, j, ch, sh, th

Other Development by the end of 2 years
  • Walks alone
  • Pulls toys behind her while walking
  • Carries large toy or several toys while walking
  • Begins to run
  • Stands on tiptoe
  • Kicks a ball
  • Climbs onto and down from furniture unassisted
  • Walks up and down stairs holding on to support
Hand and Finger Skills
  • Scribbles spontaneously
  • Turns over container to pour out contents
  • Builds tower of four blocks or more
  • Might use one hand more frequently than the other
  • Points to object or picture when it's named for him
  • Recognizes names of familiar people, objects and body parts
  • Says several single words (by 15 to 18 months)
  • Uses simple phrases (by 18 to 24 months)
  • Uses two- to four-word sentences
  • Follows simple instructions
  • Repeats words overheard in conversation
  • Finds objects even when hidden under two or three covers
  • Begins to sort by shapes and colors
  • Begins make-believe play
  • Imitates behavior of others, especially adults and older children
  • Increasingly aware of herself as separate from others
  • Increasingly enthusiastic about company of other children
  • Demonstrates increasing independence
  • Begins to show defiant behavior
  • Episodes of separation anxiety increase toward midyear then fade
Developmental Health Watch
Because each child develops at his own particular pace, it's impossible to tell exactly when yours will perfect a given skill. The developmental milestones will give you a general idea of the changes you can expect as your child gets older, but don't be alarmed if he takes a slightly different course. Alert your pediatrician; however, if he displays any of the following signs of possible developmental delay for this age range.
  • Cannot walk by 18 months
  • Fails to develop a mature heel-toe walking pattern after several months of walking, or walks exclusively on his toes
  • Does not speak at least 15 words by 18 months
  • Does not use two-word sentences by age 2
  • By 15 months, does not seem to know the function of common household objects (brush, telephone, bell, fork, spoon)
  • Does not imitate actions or words by the end of this period
  • Does not follow simple instructions by age 2
  • Cannot push a wheeled toy by age 2
Developmental Milestones by the End of 5 Years
  • Stands on one foot for 10 seconds or longer
  • Hops, somersaults
  • Swings, climbs
  • May be able to skip
Hand and Finger Skills
  • Copies triangle and other geometric patterns
  • Draws person with body
  • Prints some letters
  • Dresses and undresses without assistance
  • Uses fork, spoon and (sometimes) a table knife
  • Usually cares for own toilet needs
  • Recalls part of a story
  • Speaks sentences of more than five words
  • Uses future tense
  • Tells longer stories
  • Says name and address
Cognitive Milestones
  • Can count 10 or more objects
  • Correctly names at least four colors
  • Better understands the concept of time
  • Knows about things used every day in the home (money, food, appliances)
  • Wants to please friends
  • Wants to be like her friends
  • More likely to agree to rules
  • Likes to sing, dance and act
  • Shows more independence and may even visit a next-door neighbor by herself
Emotional Milestones
  • Aware of sexuality
  • Able to distinguish fantasy from reality
  • Sometimes demanding, sometimes eagerly cooperative
Developmental Health Watch
Because each child develops in her own particular manner, it's impossible to predict exactly when or how your own preschooler will perfect a given skill. The developmental milestones will give you a general idea of the changes you can expect as your child gets older, but don't be alarmed if her development takes a slightly different course. Alert your pediatrician, however, if your child displays any of the following signs of possible developmental delay for this age range.

  • Exhibits extremely fearful or timid behavior
  • Exhibits extremely aggressive behavior
  • Is unable to separate from parents without major protest
  • Is easily distracted and unable to concentrate on any single activity for more than five minutes
  • Shows little interest in playing with other children
  • Refuses to respond to people in general, or responds only superficially
  • Rarely uses fantasy or imitation in play
  • Seems unhappy or sad much of the time
  • Doesn't engage in a variety of activities
  • Avoids or seems aloof with other children and adults
  • Doesn't express a wide range of emotions
  • Has trouble eating, sleeping or using the toilet
  • Can't differentiate between fantasy and reality
  • Seems unusually passive
  • Cannot understand two-part commands using prepositions ("Put the cup on the table"; "Get the ball under the couch.")
  • Can't correctly give her first and last name
  • Doesn't use plurals or past tense properly when speaking
  • Doesn't talk about her daily activities and experiences
  • Cannot build a tower of six to eight blocks
  • Seems uncomfortable holding a crayon
  • Has trouble taking off clothing
  • Cannot brush her teeth efficiently
  • Cannot wash and dry her hands      

Potty Training

I was asked to help with a Potty Training. It is not as hard as we think. We must observe our child for readiness, give a helpful hand, be gentle but persistent.

Most children show signs of readiness to begin using the toilet as toddlers, usually between 18 months and 3 years of age. These signs include staying dry for at least 2 hours at a time, having regular bowel movements, being able to follow simple instructions, being uncomfortable with dirty diapers and wanting them to be changed, asking to use the potty chair, or asking to wear regular underwear. You should also be able to tell when your child is about to urinate or have a bowel movement by his/her facial expressions, posture or by what he says. If your child has begun to tell you about having a dirty diaper you should praise him/her for telling you and encourage him/her to tell you in advance next time.
You should choose a potty chair once your child has shown that he/she is ready to begin toilet training. You can have him/her decorate it with stickers and sit on it with his/her clothes on to watch TV, etc. to help him get used to it. Whenever your child shows signs of needing to urinate or have a bowel movement you should ask him/her if he/she wants to use the potty or take him/her to the chair and explain what you want him/her to do.
Only keep a child seated for a few minutes at a time, don't insist and prepared to delay training if he/she shows resistance. Until a child is going in the potty, you can try to empty his/her dirty diapers into a potty chair to help demonstrate what you want him/her to do.
Things to avoid when toilet training your child are beginning during a stressful time or period of change in the family (moving, new baby, etc.), pushing your child too fast, and punishing mistakes (treat accidents and mistakes lightly). Be sure to go at your child's pace and show strong encouragement and praise when he is successful.
Below is the guideline I used. Good Luck!

Potty Training Readiness

As children approach 2 years of age, parents frequently start thinking about toilet training. What is the "right" age? Depending on whom you ask, the "right" age may range from as young as 6 months to 3 years. While age can be used as a determining factor, there are several others to address. The most important factors are not necessarily age, but rather physiologic, physical and psychological readiness.
Before a child can be "toilet trained", she must have attained a certain amount of physiologically readiness, namely "bladder readiness". In infancy, babies frequently are unable to hold large amounts of urine in their bladder and void small amounts. As a child grows older, her bladder becomes more mature, and is able over time to hold larger amounts of urine between voids. This comes hand in hand then with the additional ability to be able to increase the interval between voids. When you notice that your child is dry at longer intervals (i.e. dry after a nap or for at least 2 hours) and is voiding large amounts at a time, then that is a sign that your child may be physiologically ready for toilet training.
Another component, which overlaps with psychological readiness, is the ability of your child to recognize that she is voiding (i.e. if your child does not recognize when she is voiding, toilet training is virtually impossible). Some children start showing some signs of "bladder readiness" around 2 years of age. Most will attain it by three years of age.
Another component of readiness is physical readiness. This includes the ability to walk well (to and from the bathroom), to be able to pull pants up and down, and the ability to get on and off the toilet/potty chair fairly independently. While this may seem like a "given", think about grandmas who claim their children were toilet trained at 6 months or a year of age. Some kids are not even walking at a year, how could they be toilet trained?
The last component is probably the most important: psychological readiness. Or what I like to call willingness! If a child is not bothered by a wet or dirty diaper, if she is uninterested or unwilling to sit on the potty, believe me, you are not going to get very far. As the saying goes, you can place a toddler on a potty, but you can't make her pee. Toddlers quickly learn that they can control their bodily functions.
Once your child is showing all these components of toilet training readiness, most experts recommend waiting at least three months before you start toilet training to ensure that all is set. This is a good time to "set the stage" for toilet training as well (letting her observe others using the toilet, introducing books or videos on the subject, starting to talk about them using the potty soon).
Last but not least, look at yourself and your family situation. In order for toilet training to be as painless and smooth as possible, make sure that you AND your child are ready. Some kids toilet train quite easily, while for others it becomes what seems like a long drawn out battle. If you are incredibly busy at work, moving to a new house or a new baby is due soon, it's ok to wait a few months to let things settle down. This is probably one of the biggest steps for your child and it's worth it to wait.
Just remember, all good things come with time. Or as my then 3 and a half year old son said "You have to be patient, and then the pee will come".

Starting Potty Training

You've been waiting for the signals. Your child seems to recognize when she is peeing or pooping. And, miraculously, your child is actually telling you from time to time! ("I peed!" or "I pooped!"). She is dry after naps and occasionally upon awakening in the morning.
Now is the time to set the stage if you haven't done so already. Discussing using the toilet, reading about it, and even watching videos is just as important as the process itself. The more your child understands, the more successful toilet training will be.
Discussions of using the toilet are just that. If you haven't done so already, let your child see you and other family members using the toilet (modeling). Let your child know that when she is ready, she can do the same thing. If she has a little friend that is about the same age that is using the toilet, that can also be mentioned (nothing like some peer pressure!). If you notice that she is peeing or pooping, remark on it: "Are you peeing?"...especially if she is in the tub or naked and both of you are observing this act. Follow the observational comment with something positive, like "Let me know when you are ready to try peeing/pooping in the potty!" or "Next time we can try peeing in the potty if you like". Ongoing observational remarks and comments of "when you are ready" let the child know that there is no pressure to start, and that the choice is hers.
Books and videos are wonderful adjuncts to the discussions you have with your child. They help reinforce the ideas you have discussed. And, they see other "kids" or "characters" undergoing the same process, which will help your child understand the whole process.
If you haven't done so already, now is a good time to get the potty "ready" (i.e. purchase a potty chair or child sized potty seat that fits over toilet seat) and to buy some underwear or pull-ups.
Some things to consider regarding your potty "set up" is that there are several potty chairs out there. You needn't spend a fortune on one, but:
  • Make sure that it is sturdy. The last thing you want is for it to collapse while your child is sitting on it!
  • Make sure the "pot" part (where the pee and poop end up) of the chair is secure and empties easily for easy cleaning and minimal spilling.

It is also a nice idea, if your child is interested, to have your child help pick the potty chair. If there is something about the potty chair your child does not like (and believe me, you never know what a 2-3 year old might find fault in!), she may be resistant to using it........and that's the last thing you need!
Most children do start out with a potty chair, but if your child is older (around 3 years of age or older) or has an older sibling, she may prefer to use the "real" toilet first. In this case, a child-sized seat which fits over the toilet would be most helpful. Stability of the seat is probably the most when picking a potty seat. Find one that has the least amount of "wiggle" and does not feel like its going to collapse under the weight of the child. Make sure also, that there aren't any parts that may pinch the child. If your child doesn't feel secure on the potty seat, she may not feel comfortable enough to pee or poop in it.
The next consideration is pull-ups vs. underwear vs. training pants.
Things to keep in mind:
  • Pull-ups are very convenient and useful when first starting out. They are great for bedtime and naps. However, some children learn quickly that it is just like a diaper, and start using it as such. Similarly, some children may not care if they have peed/pooped in their pull-up because it is as absorbent as a diaper, and hence a wet/dirty pull-up does not motivate the child to use the potty. I would recommend pull-ups when the child is showing a lot of interest but not much consistency. It is nice to use the pull-up when they are running to the bathroom frequently (as diaper tabs generally start to wear out after awhile) with or without success. Not only are the pull-ups easier when using the potty, but they are "different" from diapers and the child will feel more "grown-up". Once your child gets the hang of it, transitioning to underwear would be the next step.
  • There is not too much difference between training pants vs. underwear. Training pants do have a layer that is meant to absorb more urine than regular underwear, but I have found that there is still a puddle on the floor after an accident regardless of the type of underwear. However, a little help may be better than none. The advantage that underwear has over pull-ups, is that the child definitely feels when she is wet/dirty which can help encourage/motivate a child to use the potty. Also, cleaning up after an accident takes longer and hence may serve as a deterrent to further accidents.

**A word of caution: some children may find toilet training discouraging or humiliating if they have too many accidents in underwear. So it is a good idea for the child to have some "successes" either in diapers or pull-ups before you put underwear on.**
With these thoughts in mind, we are getting closer and closer to independent toileting. Making sure your child is both physically and psychologically ready, and setting the stage are two of the most important steps in toileting success!
Finish preparations and go!

By the time you've finished with the preparation (discussions, videos, books), purchasing the potty chair and underwear/pull-ups, most children will have started making some associations between peeing/pooping and the potty. For some it may be peeing in his/her diaper, announcing that she needs to pee and running to the potty after the fact. For others, it may be actual successes on the potty. And yet, for others it may be the mere recognition of peeing in his/her diaper. This is the time to start watching your child's body signals closely.
Most children will have a tell tale stance, facial expression ("the look"), or routine (running to another room) when having a bowel movement. When you notice that your child is about to have a bowel movement (especially helpful if there is a particular time of day your child does it) this is the time to say "Shall we go sit on the potty?" If willing, take your child to the potty. Sometimes reading books will help your child relax while sitting on the potty. However, this may also end up being a "reading fest" so I would try to limit the book reading to only what's necessary. Additionally, some children may want "privacy" and helping them sit on the potty and then leaving (letting them know that when they are done they should let you know) may prove the most successful.
Recognizing when your child is urinating is a bit harder. Some children, especially as they get older and are voiding less frequently, will stop momentarily to pee. Some will even squat. Frequently watching their fluid intake is more helpful. If your child has had a large amount of fluid, taking him/her to the potty 30 minutes to an hour after drinking will maximize success, and help your child recognize the connection between bladder fullness and peeing.
Every child is different, and some children will be "bowel" trained before being "bladder" trained and vice versa. Whichever may be first, keep in mind that it is usually one before the other and not both simultaneously. Additionally, day-time dryness almost always comes before night-time dryness and may precede it by several months.
Now that the process has started, here are some additional things to keep in mind:
Patience! Patience! Patience! Two steps forward, one step back.
Toilet training is a big process. Some experts feel that it is the first and biggest developmental step your child will take. The process generally takes several weeks to several months to complete.
Don't be discouraged if you have a few good days followed by a few bad. Again, it's a process that's going to take time. Also keep in mind that when your child is tired or upset this is the most common time for accidents or setbacks to occur.
Know when to back off
If you are pushing too hard, your child may "push" back with more accidents and/or resistance. Take the control out of the issue and step back. It is ok to take a few days or even few weeks "off". Your child will recognize the power struggle is gone and relax and respond to it.
A final word: As hard as it may be to admit or realize, toilet training is truly in the control of your child. All you can do is be supportive and encouraging and set the stage for success. Keep in mind that your child will probably be toilet trained when she is ready, NOT necessarily when you are ready. If you are experiencing major difficulties, it may be time to sit back, re-examine the situation and ask yourself if your child is truly ready (see article on readiness). If you are meeting up with a lot of resistance in a child that is ready, it is time to examine those issues.

Potty Training Resistance

While most children show signs of physical readiness to begin using the toilet as toddlers, usually between 18 months and 3 years of age, not all children have the intellectual and/or psychological readiness to be potty trained at this age.
Signs of physical readiness can include your being able to tell when your child is about to urinate or have a bowel movement by his facial expressions, posture or by what he says, staying dry for at least 2 hours at a time, and having regular bowel movements.
Signs of intellectual and psychological readiness include being able to follow simple instructions and being cooperative, being uncomfortable with dirty diapers and wanting them to be changed, recognizing when he has a full bladder or needs to have a bowel movement, being able to tell you when he needs to urinate or have a bowel movement, asking to use the potty chair, or asking to wear regular underwear.
Things to avoid when toilet training your child, and help prevent resistance, are beginning during a stressful time or period of change in the family (moving, new baby, etc.), pushing your child too fast, and punishing mistakes (treat accidents and mistakes lightly). Be sure to go at your child's pace and show strong encouragement and praise when he is successful.
Even after he begins to use the potty, it is normal to have accidents and for him to regress or relapse at times and refuse to use the potty. The process of being fully potty trained, with your child recognizing when he has to go to the potty, physically goes to the bathroom and pulls down his pants, urinates or has a bowel movement in the potty, and dresses himself, can take time, often up to three to six months for most children. Having accidents or occasionally refusing to use the potty is normal and not considered resistance.
While it is recommended that you don't insist that he sits on the potty and you should be prepared to delay training if he shows resistance, at some point if his resistance to using the potty persists, especially after he is 3 -3 1/2 years old, then you should consider him resistant to potty training and you will need to change your methods.
Early on in the training, especially if your child is less than 3 - 3 1/2 years old, resistance should be treated by just discontinuing training for a few weeks or a month and then trying again. At this age (18 months to 3 years), resistance is usually because your child just isn't ready to begin training.
Potty training resistance usually occurs because your child has had a bad experience at some point during potty training, especially if he was started before he was intellectually or psychologically ready. Other times, especially with strong willed or stubborn children, it may have nothing to do with your technique or timing, and you may have done nothing wrong.
Reasons for developing a resistance to potty training can include:
  • being scared to sit on the potty chair
  • flushing the toilet may have scared him from wanting to sit on the toilet
  • being pushed too early or fast before he was ready
  • severe punishment for not using the potty or being forced to sit on the potty
  • inconsistent training, especially among different caregivers
  • he may have had a painful bowel movement from being constipated. If this is the case, treat his constipation and wait until he is having regular, soft bowel movements before you begin training again.
  • or he may just be stubborn and is involved in a power struggle with his parents and is using his control over where he has a bowel movement
  • he may enjoy the negative attention he gets from not using the potty or from having accidents
  • although rare, there are medical conditions that can make it difficult for your child to hold in or delay urinating or having a bowel movement. Discuss with your Pediatrician if there are any medical reasons why you may be having a hard time teaching your child to use potty, especially if he seems to have other delays in his development.

At this point, if your child is totally resistant to being potty trained, then it is best to just make him responsible for when he wants to use the toilet. This includes not punishing him for mistakes and not reminding him to use the potty. If he seems fearful, you can try and discuss calmly what it is about using the potty that scares him.
While you may get a lot of negative feedback from friends or family members about not being more aggressive with getting your child potty trained, you should be firm and let them know that you are working on it and remind them that not all children potty train at the same time.
In addition, it can be helpful if you:
  • Establish a reward or incentive for using the potty. This should include lots of praise and attention when he uses the potty. It can also include a star or reward chart on which you child can place stickers whenever he uses the potty. After a certain number of days that he has stickers, then he can get a reward, such as toy, etc. 
  • Have your child be involved in changing himself when he wets or soils himself. This can include getting a new diaper, taking the dirty diaper off, cleaning himself (although he will probably need help after bowel movements), and throwing the dirty diaper away.
  • At some point you can change him into regular underwear. You can talk about it beforehand and maybe have a ceremony where he throws away the left over diapers or you may just decide not to buy any new ones. Now, when he does wet or soil himself, you can have him help to clean out his underwear in the sink or bathtub. You may even have him put them in the washing machine and wait with you while they are getting washed and dried. He should then dress himself. This method is not for everyone, but is usually very effective. You can also have him clean up after himself if he wet or soiled the floor.
  • Limit him to having BMs in the bathroom. This isn't always possible, but is easy if he always asks for a diaper just to have a bowel movement. Next, have him sit on the potty to have a bowel movement, even if he continues to wear his diaper. Then work on getting his diaper off by opening it and eventually taking it off. During this process, you should give lots of praise and rewards during each step.
  • If he is having a hard time learning to use the potty, but isn't necessarily resistant to the idea, then developing a regular daily routine of sitting on the potty for five or ten minutes every few hours may be helpful.
  • Most importantly, avoid physical punishment for not using the potty, even in an older child. It can be appropriate to verbally let him know that you disapprove of his not using the potty, but this should not get to the point of yelling, shaming or nagging.

Potty Training problems
You are in the midst of toilet training. Things appear to be going relatively well. Your child appears to understand when she needs to use the potty, and is using it with some regularity. However, there's just one thing...

Problem #1: Your child is toilet trained at daycare/preschool but refuses to use the toilet at home.

This can be particularly frustrating for parents, as you know that your child can do it, but is just refusing to do it at home. Interestingly, I have found that this tends to occur in younger children (closer to 2 years of age), hence it may be more of a maturational issue.
Things to keep in mind:
  • Your child may be feeling little to no pressure at school/daycare to use the potty as it may be merely “part of the routine” (all the children go to the bathroom at the same time so your child is not singled out).
  • Copying what other kids do (or better yet, the older kids) is terrific incentive for a child, as opposed to parental pressure.
  •  As frustrating as it may be, kids will sometimes do things for teachers they won’t do for parents (i.e. they know which buttons they can push in whom!).
So what's a parent can do? Here are some things to try:
  • Depending on your child’s age, level of language ability, and developmental level (i.e. a child closer to 3 years of age or older), it may be worthwhile trying to discuss this with your child. Keep it neutral and without pressure (“That’s so wonderful you are using the potty at school, your potty is here waiting when you are ready to use it at home”).
  • Discussions with daycare providers/teachers may also shed light on the problem (What is their routine? what do they say or do with the children?).
  • But most importantly, in this situation, especially if your child is closer to the age of two years, mere patience and backing off will frequently do the trick. Your child has taken a big step in using the potty at daycare. For whatever reason, s/he may not be ready to use the potty at home. You know s/he is capable; it’s just a mindset to get over. If there is no pressure on your part, your child will come around eventually.

Problem #2: Your child is completely urine trained. However, she continues to refuse to use the potty for bowel movements and specifically requests a diaper when she needs to have a bowel movement.

This problem is not all that unusual, and it may be attributed to either a fear of having a bowel movement in the toilet, the security of a diaper, or a coordination issue.
Things to try:
  • Again, being patient and backing off may be your best bet, especially if your child is on the younger side (less than three years of age).
  • If ongoing for several months, now may be the time to take some parental initiative. Now may be the time to have the child go to the bathroom for bowel movements, gradually have the child sit on the potty with a diaper on, and eventually take it off to have a bowel movement. For those children who the diaper seems to lend much security, some experts even recommend cutting a hole in the diaper and allowing the child to wear the diaper on the potty, but having the BM go into the toilet.
  • If you notice that your child always stands to have a bowel movement, posture may be more the issue than the security of the diaper. Focus on having your child stand (or whatever transitional stance s/he needs) over the potty and then gradually go to sitting. In one particular example, a mother told me that she let her child be naked from waist down and allowed him to run back and forth to the bathroom, essentially allowing him to experiment with different stances, until he was able to have a bowel movement sitting on the potty. She found that once he was successful sitting on the potty, he was able to do it subsequently.

Problem #3: You know that your child can use the potty, but she is being very erratic and staying motivated seems to be the problem.

Here is a situation where you may want to consider offering rewards for using the potty.
On the pro side:
  • Experts and parents alike have found rewards to be helpful.
  • It is frequently the incentive your child needs to get started (or to stay motivated).

On the down side:
  • Other experts discourage use of rewards for behavior, as they feel that the child should be motivated from within to use the potty.
  • Some children may not clearly understand and want a reward when unearned. This may cause more trouble than it’s worth.
  • Candy, a very powerful and frequently used motivator, is the worst reward. Not only is it problematic with dental care, but it may also interfere with meals; and it is not uncommon to have a child peeing a drop of urine every 5 minutes for a candy treat.
  • Certain children may prove stubborn (or should I say resilient) enough and prolong the reward system for months.
  • Some children no matter what you try will not be enticed by stickers, small toys or other rewards.

  • Rewards do work for some, but not all children.
  • Keep rewards tangible and simple (i.e. 10 stickers to get a small prize may be too many for some children).
  • If a child does not understand or is easily frustrated by the reward system you create, it’s best to not use it.
  • For the sake of your child’s teeth and dietary habits, don’t use candy!
  • Know when to end it. When mastery is achieved, it’s time to stop the rewards. Frequently kids lose interest as their mastery of toilet training occurs and you may have no trouble. Others may hang on. Sometimes in a very stubborn child one can trade the reward chart/system for one “final toy”.

Final words on toilet training:

Patience and Perspective! It is true, your child will not be in diapers forever, and patience is a necessary component on the parent’s part. Also, it’s good to keep perspective when you hit a stumbling point: this is just a small snag and your child will be toilet trained.

Potty Training Internet Resources:

Anxiety and Stress in Children - Tips and Techniques to Help

Especially with the young children you have to be very sensitive, take time to get back to the routine, prepare the child for the new chapter, engage the child in organizing the room, choosing the backpack or school equipment, organize a play date with the old school friends, walk to see the school building, read a letter from the new teacher, build the excitement, tell stories about yourself, find good books about other kids staring the school, talk about feelings, expectations, fires.
Grand Turk Island, 2013

Check some more specific steps how to reduce your child's anxiety and stress:

  1. Teach to face the fear, rather then run away.
Let me Try, 2011
When we are afraid of situations we avoid them. However, avoidance of anxiety-provoking situations maintains the anxiety. Instead, if a child faces his or her fears, the child will learn that the anxiety reduces naturally on its own over time. The body cannot remain anxious for a very long period of time so there is a system in the body that calms the body down. Usually your anxiety will reduce within 20-45 minutes if you stay in the anxiety-provoking situation.

  1. Teach that it’s fine not to be perfect.
Children Museum of Art, NY 2012
Often we feel that it is necessary for our children to succeed in sport, school, and performance situations. But sometimes we forget that kids need to be kids. School becomes driven by grades, not by enjoyment of learning if an 85 is good, but not good enough. This is not to say that striving is not important. It is important to encourage your child to work hard but equally important to accept and embrace your child's mistakes and imperfections.

  1. Teach how to stay positive.
Happy Me, 2010
Many times anxious and stressed children can get lost in negative thoughts and self-criticism. They may focus on how the glass is half empty instead of half-full and worry about future events. The more that you are able to focus on your child's positive attributes and the good aspects of a situation, the more that it will remind your child to focus on the positives.

  1. Teach to take time to relax.
Resting Time, 2010
Children need time to relax and be kids. Unfortunately, sometimes even fun activities, like sports, can become more about success than they are about fun.  Instead, it is important to ensure that your child engages in play purely for the sake of fun. This may include scheduling time each day for your child to play with toys, play a game, play a sport (without it being competitive), doing yoga, paint, have a tea party, put on a play, or just be silly.

  1. Model approach behavior, self-care, and positive thinking.
Performing, 2012
Your child will do what you do. So if you avoid anxiety-provoking situations, so will your child. If you face your fears, so will your child. If you take care of yourself and schedule time for your own needs, your child will learn that self-care is an important part of life. If you look for the positive in situations, so will your child. Children learn behaviors from watching their parents. So when you think about your child's psychological well-being think about your own as well.

  1. Always reward for a brave behavior.
Niagara Falls, 2011
If your child faces his or her fears, reward this with praise, a hug, or even something tangible like a sticker or a small treat. This is not bribery if you establish this as a motivator prior to your child being in the situation. If you reward behaviors your child will engage in them more often.

  1. Teach good sleeping pattern.
Healthy Sleep, 2013
Set a bed time for your child and stick to that bed time even on weekends.  Also have a 30-45 minute bed time routine that is done every night.  This helps your child to transition from the activities of the day to the relaxed state necessary to fall asleep.

  1. Teach your child to express his/her anxiety.
"Angry Girl" by Basia P., 2012
Let's Talk, 2013
If your child says that he or she is worried or scared, don't say "No you're not!" or "You're fine."  That doesn't help your child.  Instead, it is likely to make your child believe that you do not listen or do not understand him/her.  Instead, validate your child's experience by saying things like "Yes, you seem scared. What are you worried about?"  Then have a discussion about your child's emotions and fears.

  1. Help your child to solve a problem.
Vietnam, 2013
Once you have validated your child's emotions and demonstrated that you understand your child's experience and are listening to what your child has to say, help your child to problem solve.  This does not mean solving the problem for your child.  It means helping your child to identify possible solutions. If your child can generate solutions, that is great.  If not, generate some potential solutions for your child and ask your child to pick the solution that he or she thinks would work best.

  1. Stay calm. 
Science Museum, NY 2012
Children look to their parent to determine how to react in situations. We've all seen a young child trip and fall and then look to their parent to see how to react. If the parent seems concerned, the child cries. This is because the child is looking to their parent for a signal of how to react to the situation. Children of all ages pick up on their parent's emotions and resonate with them. If you are anxious, your child will pick up on that anxiety and experience an increase in his/her own anxiety.  So when you want to reduce your child's anxiety, you must manage your own anxiety. This may mean deliberately slowing down your own speech, taking a few deep breaths to relax, and working to ensure that your facial expression conveys that you are calm.

  1. Teach your child relaxation exercises
Thailand, 2013
Sometimes really basic relaxation exercises are necessary to help your child to reduce their stress and anxiety. This might mean telling your child to take a few slow, deep breaths (and you taking a few slow breaths with your child so your child can match your pace). Or it might mean asking your child to image him or herself somewhere relaxing, like the beach or relaxing in a backyard hammock. Ask your child to close his/her eyes and imagine the sounds, smells, and sensations associated with the image. For example, close your eyes and picture yourself on a beach. Listen to the sound of the surf as the waves come in and go out.  In and out. Listen to the sound of the seagulls flying off in the distance. Now focus on the feel of the warm sand beneath your fingers and the sun warming your skin. Your child can do these techniques on his or her own during anxiety-provoking times.

  1. Never give up!
Kuala Lumpur, Malaysia, 2013
Anxiety and stress can be a chronic struggle and often the source of a child's anxiety changes over time so it can feel as though you are always putting out fires. With repetition of the anxiety and stress management techniques, your child will learn how to lower his/her anxiety level and how to cope with anxiety-provoking situations. The key is repetition so keep it up!
Thailand, 2013
Vietnam, 2013
Parents should be concerned and look for the professional assistance if their child regularly complains about feeling sick or often asks to stay home from school with minor physical complaints. In some cases the child may simply refuse to leave the house. The child's panic and refusal to go to school is very difficult for parents to cope with, but these fears and behavior can be treated successfully, with professional help.

Anxiety Disorders Association of
OCD Foundation:
Child Anxiety Network:
Anxiety Social Net:
"At The Sea" by Basia P., 2013

Friday, September 27, 2013

Back to School - Exited or Frightened?

The Red Mountains in Arizona, 2013
I have a 1st grader and this is our story.
By the Baltic Sea, Gdansk, Poland, 2013
At the first week of the new school year, patiently waiting for a bell to ring, scrambled in a small school yard I found many kids smiling, laughing, hugging, jumping for joy or the one who were like my daughter, frowning, crying, hiding behind or pulling on my jacket. I couldn't believe my eyes. I didn't understand what had happened to my jolly girl.
Becoming a Junior Ranger in Grand Canyon, 2013
I knew the fact that going to school is usually a thrilling and enjoyable occurrence for many children but for some alarming and frightening.
With the cousins, Poland, 2013
I knew that refusal going to school often begins following a summer fun vacation, a relaxing holiday break, a period of staying at home due to brief illness.
MMI, Phoenix, Plying Theremin, 2013
I knew that it also may follow a stressful occurrence, such as a change in schools, or a move to a new neighborhood. It was not our case.
Science museum, Warsaw, Making fire, 2013
I knew that not wanting to go to school may occur at anytime, but is most common in children 5-7 and 11-14, times when children are dealing with the new challenges of elementary and middle school.
With the Grandparents, Poland, 2013
I also knew that some children may suffer from a paralyzing fear of leaving the safety of their parents and home, that they may complain of a headache, sore throat, stomachache or vomit shortly before it is time to leave for school, and that the symptoms subside after the child is allowed to stay home, only to reappear the next morning before school.
With the friends, Poland, 2013 
Knowing the facts, my daughter’s age and character I tried to prepare her for a shortly approaching school year. As a mindful parent and educator I went by the book and followed all the steps below:

  • took time to get back to the routine,
  • prepared for changes by announcing them gradually showing my excitement,
  • engaged her in organizing the room, choosing own backpack and school equipment,
  • organized a play date with the old school friends,
  • walked to see the school building,
  • read a letter from a new teacher,
  • talked about feelings, fires and solutions,
  • told stories about my experience when I was a child and the happy outcomes,
  • read books about other children starting a school, moving to a new places, meeting new friends.

Swimming, Arizona, 2013
As a New Yorker I did it all in a super speedy way, shortening it to one weekend. Guess what? It didn't work. I learned the hard way. All the symptoms I've mentioned above I saw in my 6 year-old daughter.
At the Grand Canyon, 2013
What did I do wrong? - Time management. What did I learned? I learned that no mater what happens around us, we must give our child as much time as she/he needs for the good healthy transition. After tree weeks of school and three weeks from our arrival to NY we are slowly coming back on the truck.
Cooking, Poland, 2013