This cute little smile cost us several thousand dollars later to straighten it out….but worth it!
There is nothing cuter than a toothless grin of a baby. Next the cute little pearly whites that erupt create a darling smile, then there is a toothless grin again as the tooth fairy starts to make visits to your home, and then soon your child will have two big front teeth that look way too big for their mouth. As your child grows, their dental needs change too. Why is dental health so important for children? Dental decay is the most common chronic childhood illness. There are at least 4 million preschoolers that have had at least one cavity. Forty to fifty percent of children will have cavities before the age of five. 51 million school hours are lost each year due to dental health problems. The American diet is high in sugar, and we are using more and more non-fluoridated bottled water for drinking. This all adds up to an increase in dental cavities, and a decrease in dental health of our children. Children with cavities in their primary or “baby” teeth have more problems with poor weight gain, iron deficiency, speech problems and poor dental health as adults. Taking care of our children’s teeth is part of good health care!
I. When do baby teeth form and erupt?
- The primary teeth or baby teeth begin to form before your baby is born at about the 14th 19th week of pregnancy. The crown, or the white part of the tooth that is seen, continues to develop until several weeks to several months after your child is born.
- Total of 20 baby teeth, 10 on top and 10 on the bottom by about age 3.
- The first tooth to appear usually is the lower central incisors (the bottom two teeth) around 6 months of age. Don’t panic if your baby’s first tooth isn’t the lower two teeth…some babies teeth to the beat of their own drummer!
- Teething can be painful for infants. Babies explore their world with their mouths, and during teething this can be uncomfortable. There can be redness, swelling in the gums, drooling, increase in finger sucking, and the need to bite and chew on any object. Some babies will pull at ears or rub their jaw line, teething pain is often referred to the ear area.
- Sometimes parents will see a “blister” where the tooth is about to erupt, this is normal.
- Many babies like a clean teething ring, frozen wash cloth, frozen fruit in a mesh feeder, frozen bagel or mom’s fingers to rub the gums.
- You can give acetaminophen, or ibuprofen (after 6 months of age) to help with the pain. Ibuprofen is a bit more effective for inflammation of the gums, but wait until your baby is at least 6 months to use this!
- Do NOT place oral numbing ointments on your baby’s gums. This can cause a decrease in the gag reflex and could be dangerous.
- Teething pain usually occurs for 3 to 4 days prior to the tooth breaking through the gum. Pain should decrease once the tooth breaks through the gum line. There may still be some discomfort for a few days after. It is not a month-long process unless your baby is cutting multiple teeth one after the other.
- Teething does NOT cause a fever, vomiting, diarrhea or cold symptoms. If your baby has any of these symptoms with teething, he or she is probably ill too.
- Teething can cause an increase in drooling which can lead to a rash or irritation around the mouth and on a baby’s chest. Keep the area dry by changing shirts frequently, using absorbent bibs, and “water proofing” the skin with ointments.
II. When is the first dental visit?
- The first dental visit should be at about age 1 to 1 and 1/2 or 6 months after the first tooth. It is important to have your child’s first teeth examined. Dental problems can begin early. Children with healthy teeth can eat better, develop better speech, and dental cavities can cause a permanent state of infection in your child.
- Usually the first visit is just a visual exam—usually on mom of dad’s lap. Going to the dentist is just like a well child exam at your child’s doctor. We want to be sure we support healthy teeth, not just see the dentist when there is a problem!
III. How do you care for the first teeth?
- Wipe your baby’s first teeth using a wash cloth or gauze or a soft bristled baby toothbrush. Ideally, your baby’s teeth should be wiped or brushed twice a day. Once in the morning and once before bed. The earlier your child becomes accustomed to wiping or brushing their teeth, the easier it will be.
- You can use a small smear (about the size of a grain of rice) of fluoride toothpaste on your child’s tooth or teeth until age 3 and then a pea size amount after age 3. Fluoride is important! It helps strengthen your child’s teeth and prevent decay.
- You should help your child brush teeth until at least age 6. Children are not coordinated enough to brush teeth well before that. Sometimes this will be a battle, but it is worth the battle. We want to form good dental hygiene habits early! Do what you have to do to get teeth brushed.
- Have your child sit on your lap facing out, or you sit on the floor and lean your child back into your lap to brush.
- Let your child brush after you brush. Use circular motions on the teeth and brush along the gum line.
- Use stickers, games, songs, whatever it takes to get the tooth brushing done. If your child cries, brush quickly…but at least the mouth will be open!
- Never put your baby to bed with a bottle of formula or breast milk. This will result in decay in your baby’s first teeth!
- Never put juice or any other sugared drink in a bottle.
- Do not allow your child to walk around with a sippy cup of juice or milk all day long. This will leave a continual coating of sugars on your child’s teeth.
- You can begin to floss your child’s teeth when they start to touch. Again, this is a good habit to start young!
- As your child begins to eat table food, try to avoid high sugar snacks. Sticky snacks are the worst. Fruit snacks, dried fruit like raisins and any other sticky food must be brushed out of your child’s teeth.
IV. When do I worry about thumb sucking, finger sucking and pacifiers?
- It is perfectly normal for infants and young children to need to suck. Sucking decreases stress in young children and makes for a happier child!
- It should be discouraged starting at about age 18 months. Parents should limit pacifier use to bedtime and nap time.
- All thumb sucking and pacifier use should be discouraged after age 3.
- Most children stop on their own, but some need help. Most will then quit with encouragement from the dentist and parents. Do not use negative reinforcement like hot sauce on a thumb, taping fingers, or putting mittens on your child.
- Prolonged sucking can create crowded, crooked teeth or bite problem. The fingers, thumb and pacifier all affect the teeth the same way.
VI. My child grinds his teeth, is this bad?
- Teeth grinding happens in many toddlers. The toddler’s molars are very smooth, and children will often grind.
- Most children outgrow the habit by about age 6.
- If teeth grinding continues after permanent teeth arrive, then speak with your child’s dentist.
VII. What should I do if my child injures his mouth and teeth?
- Be sure and ask your dentist when he or she would like to be contacted for a tooth injury.
- If a child knocks out a permanent tooth, keep it moist or drop it into cup of milk and call the dentist immediately or head to the ER.
- If a child is hit in the mouth–always call the dentist for an exam even if there is no obvious damage.
- If a child chips a tooth–call the dentist even if there is no sensitivity.
- Your child should use a mouth guard for sporting activities!
Start good dental habits early…find your child a dental office home where both you and your child are comfortable. Dental care should not be scary but just a part of good health. Take care of your child’s smile, it is one of the most beautiful things a parent sees!
Take a breath, enjoy the joyful moments of each day, and remember you don’t have to be perfect to be the perfect parent.
Kaitlyn was a typical toddler, she definitely had an opinion!
You wake up one day, and it is a whole new ball game. You now have a toddler. Toddlers are so much fun, but can also be a challenge. We are not used to our child having an opinion, and a toddler has one and often expresses it very loudly! Toddlers can be having a tantrum one minute and laughing the next!
Your toddler’s biggest developmental task is to start to develop independence. Your child will begin to separate from you at times, and be very clingy at other times. Every day and sometimes every minute,is a new adventure when you have a 1 to 3 year old!
We know that toddlers are a bundle of energy. Everything is an adventure! Kitchen cupboards, knobs and buttons, computers, and even the drain in the tub is interesting. Toddlers are busy discovering and really don’t have time for naps and potty training, although both are important for toddlers! Toddlers are free little spirits and have very little self-control, which often results in your precious child throwing himself on the floor in a fit of frustration and anger. To better understand your toddler, there are a few principles of toddler psychology…..
- A toddler is developing creativity, independence, curiosity, and imagination. The whole world is open and exciting! Your child is not misbehaving when he smashes peas, climbs on the table, or puts his finger in a place it should not be, he is exploring. Exploration is developmentally appropriate for your toddler!
- A toddler has very little self-control and tolerance to frustration. Sometimes it is so frustrating that a puzzle piece will not fit, or he can’t climb on the counter, or you break up his cracker that he wanted whole! Because a toddler has very few words and a limited repertoire to handle frustration, the “logical” thing for him to do is melt down, kick, cry, and let his opinion be heard by all!
- Toddlers want attention. Attention is attention to a toddler, whether it is negative attention or positive attention. As parents, we need to limit our words of explanation to a toddler. A 2-year-old doesn’t really care if he will fall off the table, he just wants to climb on it. You will never convince him otherwise…there will be no moment of epiphany when he understands your safety talk! We must not reinforce behavior by giving extended attention to unwanted behavior. Give lots of positive words to positive behavior….very few words to negative behavior.
- Toddlers need predictability and routine. Your child will behave much better when there is a routine in place at home. The amount of frustration and the number of tantrums will decrease when you establish routines and rituals.
- Toddlers need some sense of control. Give your child true choices. “Do you want the bananas or the apple sauce?” “Do you want to wear this shirt or this one?” “Do you want to read your story before your bath or after?” Do not give choices when there are no true choice. Only ask a yes or no question if you are happy with the answer being “No!”
- Toddler temper tantrums are a result of frustration, being overly tired, being hungry and learning that they work!
Between 12 and 15 months your toddler should:
- Have tripled his or her birth weight.
- Start to combine syllables like saying Ma Ma and Da Da.
- Start walking alone.
- Bang two objects together.
- Like to read interactively.
- Follow one step directions.
- Begin to use spoon or fork.
- Begin to limit pacifier use to the crib only. Use during waking hours will limit speech.
- Like to explore.
- Begin to point. Respond by saying the name of the object he is pointing to.
- Take 1 to 2 naps a day and sleep 11 to 12 hours at night. Be sure to have a good bedtime routine.
By the end of the 18th month your toddler should:
- Be able to walk backwards, walk up steps, and kick a ball.
- Be able to say 10 to 25 words and name 3 body parts.
- Be able to turn pages in a book.
- Be able to stack 2 blocks.
- Play next to a playmate, but not with a playmate.
- Not be able to share! Sharing does not happen without parental guidance until about the end of the 3rd year.
- Attach to a “lovey” if one has been encouraged.
- Continue to love to explore.
- Take 1 nap a day and sleep 11 to 12 hours at night.
- Not separate easily. Separation anxiety peaks between 18 and 24 months.
- Know the difference between how Mom and Dad parent and play. Many will prefer one parent over the other at times. Toddlers cannot intentionally do things to hurt your feelings at this age. Connecting with one parent over the other may be because your toddler is learning male and female roles, may need more nurturing from mom or more physical play from dad. Roll with it!
By age 2 your toddler should:
- Be able to put on simple clothing with some help.
- Be able to stack 4 to 6 blocks.
- Be able to combine words into at least 2 word sentences at age 2. Your child should have a vocabulary of over 50 words and be 1/2 understandable by others.
- To follow two-step directions.
- Know his body parts.
- Continue parallel play with peers.
- Have 1 nap a day and 11-12 hours of sleep at night.
- MAY develop fears. Explain loud noises, show what things are, introduce new people slowly, read books about things he is afraid of, and let him handle objects that are causing fear.
- MAY continue to have separation anxiety. Do not leave without saying good-bye. If he cries when you leave, remind him you will be back. Leaving and coming back helps diminish separation anxiety.
During the 3rd year your toddler should:
- Dress himself.
- Stack 9-10 blocks.
- Walk up steps using alternating feet.
- Be able to jump, hop, walk on toes.
- Use his imagination for play.
- Have a large vocabulary and use 3-4 word sentences. Speech should be 3/4 understandable to others.
- Be able to tell stories, sing nursery rhymes.
- Be able to sort objects by shape and color.
- Be able to play cooperatively now and share and develop friendships.
- Show an interest in words, numbers, and letters. No need to force learning these, but plan activities around this interest. Show your child his name, write it out, point out letters on signs and in books, talk about colors, shapes, and point them out in your child’s world.
- Still sleep at least 11 hours at night and have 1 nap a day or an extended “rest time” without the TV.
Parenting activities for toddlers include:
- Toddler “field trips”. Bring your toddler to museums, parks, library story times, the post office, the grocery store, fire stations, apple orchards, and play groups.
- Play matching games, sorting games, shape and color games and puzzles.
- Read, read, read! Try to read 30 minutes a day broken into short time slots.
- Encourage crayons, finger paints, and clay to develop fine muscle control for writing. Writing on an easel or blackboard is easier for young children because larger muscles are used.
- Encourage water play, sand or dry rice play, filling and dumping.
- Play with puppets.
- Allow your child to feed himself, encourage use of utensils.
- Help to expand your toddler’s language by talking to him. Help him finish words and sentences. If he says “cup”, you can respond, “You want your blue cup with milk.”
- Play pretend with your toddler. Play kitchens, dolls, stuffed animals, trains, cars, dress up….
- Play follow the leader with your toddler.
- Encourage rhymes and songs.
- Play musical instruments with your toddler.
- Respond to wanted behaviors with positive words and ignore unwanted behaviors. Use time outs for behaviors like hitting, biting, and shoving.
At your child’s 18 month and 24 month well child visit, your physician should be screening for signs of autism. Red flags that a parent might see are:
- Your child repeats words but does not try to participate in conversations.
- Your child does not respond to his name when you say it.
- Your child does not make eye contact with you or others.
- Your child avoids social contact or physical touch.
- Your child has not developed speech or is losing words rather than building a vocabulary.
- Your child does not play with toys like his peers and does not use imaginative play.
- Your child seems to be under sensitive or overly sensitive to stimulations such as sound, touch, and texture.
Remember, if your child is reaching developmental milestones, no worries! Many times children will not be able to do something that is expected because they have never been encouraged or have never had the opportunity. Be sure to provide the opportunity for your toddler to reach milestones, even if it takes longer to allow your child to complete a task, or it is messy!! If your child is not reaching developmental milestones, contact your doctor, and refer to your state’s early intervention program. The earlier the intervention, the better the outcome.
Important links that will help you:
- “Learn the Signs. Act Early.” Campaign
This campaign educates parents about childhood development, including early warning signs of autism and other developmental disorders, and it encourages developmental screening and intervention. It will give you tips on how to determine if your child needs screening.
- Overview of Early Intervention
Learn more about early intervention services from the National Dissemination Center for Children with Disabilities. Find out about your state’s early intervention program and how to access it.
- Bright Futures
Bright Futures materials for families are available for parenting tips for children from birth to 21 years of age. This is provided by the American Academy of Pediatrics.
- Developmental Surveillance and Screening Guidelines
This American Academy of Pediatrics website provides guidelines on surveillance and screening for developmental delays in children.
- National Association for the Education of Young Children (NAEYC)
NAEYC provides accreditation for early childhood programs and preschools that meet certain standards. You can search for an accredited program or preschool near you. NAEYC also provides resources, tools, and information for parents.
Toddlers can be exhausting, but exhilarating! Looking through your toddler’s eyes, you will learn to enjoy the small wonders of the world again. Tie up your running shoes, you have a busy toddler!
Take a breath, enjoy the joyful moments of each day, and remember you don’t have to be perfect to be the perfect parent.
From one day to one year, what a difference a year makes!
The first few months of my children’s lives sometimes felt like a blur. Parents get VERY little sleep and are just trying to get to know their baby. I can remember feeling that the first year just flew by and all of a sudden I would have a toddler on my hands! There are so many changes that come so quickly with your baby that first year!
During that first year, your baby is learning that he or she will be loved and cared for. It is important to foster that development of trust. Don’t let your baby cry for long periods of time, especially in the first 6 months. Crying is your baby’s way of communicating. Soon you will learn what different cries mean, like “I’m tired”, “I’m hungry”, “I’m wet”, “I need to be held”, “I am bored”….Responding to your baby’s needs helps your little one develop trust in you and the world. You cannot spoil a baby! Older children can be spoiled, but not infants, so just enjoy catering to their needs and loving your baby.
Growth and development should be steady and progressive. That is more important than comparisons with other children. It is common for new parents to look at other babies and start to worry and compare. Try not to compare, just know what important milestones your baby should be reaching.
How big your baby is at birth is a poor predictor about the size of your child by adulthood. The size at birth has more to do with the conditions of uterine development. Most children will find their growth curve and stay at that curve. A child that is smaller than 75 percent of other babies his or her age can be perfectly healthy, that may just be the growth curve that child has. By the end of the 2nd year, the size of your child will more truly reflect his or her adult size.
We parents know that our children are special! However, reaching developmental milestones faster than other children does not necessarily predict your child’s intelligence. As long as your child is reaching his or her developmental milestones on target, there are no worries!
By the end of the 2nd month your baby should:
- Look at you!
- Start to try to self soothe. May bring hands to mouth and suck
- Begin to smile at people
- Start to coo
- Turn towards sounds
- Follow things with eyes
- Pay attention to faces
- Hold up head and begin to push up during tummy time
Activities for parents:
- Talk to your baby
- Show simple objects
- Give your baby different looks at the world, change his or her scenery!
- Play the silly face game, open and close your eyes, stick out your tongue etc.
- Start the routine of a daily walk weather permitting
- Help baby with tracking objects, babies love mobiles, shapes and movements
- Imitate your baby’s sounds and expressions as your baby starts to learn to communicate
Your baby’s growth:
- Growth will be about an ounce per day in the first 2 months
- Growth will continue at about a pound a month after the first couple of months
- Birth weight doubles by 5 months
- Birth weight triples by one year
By the end of the 4th month your baby should:
- Like to play and interact with you!
- Copy some movements and even facial expressions like smiling
- Babble even with expression
- Cry in different ways for different needs like hunger, or being tired, or lonely
- Reach for a toy or rattle
- Track with eyes well side to side
- Be able to roll from tummy to back
- Push up on elbows during tummy time
- Like colors now and be drawn to them
- Continue to talk, talk, talk
- Build reading into your daily routine
- Respond to your baby’s coos and babbles…carry on a conversation!
- Continue to show your baby the world!
By the end of the 6th month your baby should:
- Recognize a familiar face and begin to have some stranger anxiety
- Like to look at self in the mirror
- Use vowel sounds when babbling and takes turns in a “conversation” with you!
- Begin some consonant sounds when babbling
- Respond when you say his or her name
- Transfer things from hand to hand, easy to hold toys are important
- Try to get things that are out of reach
- Roll over in both directions
- Sit with support
- Like to “stand” with you holding and might bounce
- Start to push up and may rock back and forth on hands and knees
- Start to scoot and move arms like a swimmer
- Sometimes show frustration if he can’t reach something he wants
- Teething may begin with the average baby cutting their first tooth by the end of the 6th month
- Should start the “dropping game” between 7 and 8 months (helps your baby learn object permanence)
- Should begin clapping between 7 and 8 months
- Remember stranger anxiety starts at about 6 months and peaks at about 9 months. This is normal. Help your baby by gradually introducing strangers. A stranger is someone your baby does not see everyday! Never force a situation quickly when your baby is afraid of a new face. Hold your baby, sit on the floor and let your baby explore with you holding him or staying near at first.
- Start to teach finger games like “so big”, waving “bye-bye”, playing patty cake
- Continue to read and talk to your baby
- Make sure you are establishing routines, especially bed time and nap time routines
By the end of the 9th month your baby should:
- Begin to have favorite toys
- Understand the word “no”
- Copy sounds you make and gestures you make
- Pick up small things with thumb and index finger “pincer grasp”
- Play peak a boo
- Look for hidden items
- Look where you point
- Sit well without support
- Start to scoot and crawl
- Start to pull up to stand between 9 and 12 months
- Continue to play finger games like “Itsy Bitsy Spider”
- Continue waving bye-bye
- Build things for baby to crawl under and over
- Let your baby play with every day objects like pots, pans, plastic containers
- Encourage your baby to imitate your behavior like brushing hair, talking on the phone
- Encourage pretend play with keys, phones, dolls, chunky trucks etc.
- Play with pop up toys, a jack-in-the-box is a great way to teach object permanence
- Play in and out games
- Let your baby hold your fingers to walk
By the end of the 12th month your baby should:
- Point at items
- Pull up to stand and may walk
- Cruise around furniture
- Squat and stoop to pick up things
- Throw a ball
- Understand one step directions from you
- Turn pages of a toddler board book
- Look for missing objects in last seen location
- Say Ma Ma and Da Da and maybe a few other words like ball, dog
- Start to show fear, will cry when you leave
- “Help” get dressed by holding out arms etc.
- Put things in a container, takes things out, likes to dump items
- Help baby with push toys, wide based push toys that children can walk behind are fun!
- Play games that the baby has a part in like puffing up your cheeks and letting her push the air out
- Look at books and make up stories about the pictures
- Teach body parts Where is your nose? Where is your tummy?
- Play with musical instruments that shake and bang
- Play music your baby loves to move and dance
Time for that nap! Don’t miss the window for naps….toddlers need naps to sleep well at night! Establish good sleep routines for naps and night-time!
It was 8:30, I was tired, and my 2-year-old seemed to be gearing up for the evening. My patience was short and soon everyone ended up melting down. Not a very pleasant way to end the day! I hated when an evening in our home ended in a melt down! I always felt like such a terrible Mom, but evenings like that made me re-group and remember that naps, early bedtimes and calming routines were the cornerstone to good sleep for everyone. Besides, when the kids were in bed early, I always had time to take a breather, visit with Brad and reward myself with a bowl of ice cream for making it through another day!
Often children are sleeping pretty well as they enter the toddler years, and then it seems that overnight, bedtime becomes a battle. So many parents will tell me that their toddler “must not require much sleep” because they can’t get them to sleep in the evening. Soon the pattern becomes a toddler who is up until late, a parent that has no down time, and a household that is stressful every evening. The fact is, toddlers need about 13 to 14 hours of sleep in a 24 hour period. Without that sleep, tantrums increase, whining becomes the norm, and a toddler’s day is not filled with discovery and play but frustration and tears. These are some reasons families with toddlers often develop “bedtime blues”.
- If a toddler is not sleeping enough—they are harder to get to sleep consistently. How hectic are your days? If he is over scheduled or over stimulated you might want to slow it down for sleep’s sake. When a child is constantly on the go, it is hard to settle down for sleep. We need positive associations with sleep, not negative ones brought on by tantrums, yelling and harshness prior to bedtime.
- Separation anxiety is a true toddler fear, often this separation anxiety is the start of sleep problems during the toddler years.
- Toddlers are exploring control and testing. Your child will test to see if bed time is negotiable! Sometimes a tired parent will give in pretty easily setting the precedent for the following nights.
- Toddlers don’t want to miss anything! They realize that life goes on when they are napping or sleeping.
- Most parents underestimate their child’s need for sleep. Toddlers need between 13 and 14 hours of sleep in a 24 hour period. An increase in tantrums, whining, crying, even misdiagnosis of hyperactivity can come from a child who is chronically sleep deprived. Toddlers are wired “early to bed, early to rise” !
- Sleep is a health issue. Parents need to control this health issue just like you do routine health care. You wouldn’t let a child eat whatever they want for dinner, and you shouldn’t let a child decide his or her own bedtime. Sleep is a basic need like food or clothing, and you are the parent!
- There is no research that shows that letting a toddler fuss it out to sleep causes any psychological damage. A child who is consistently loved and cared for during the day will thrive, even if there are several nights of “crying it out” to go to sleep.
So what is a parent to do?
1. Watch your toddler’s behavior and do not let them become overly tired. Remember that an overly tired toddler has a difficult time going to sleep and staying to sleep. Usually, a toddler should not be up longer than a 5 hour stretch. If your toddler rises at 7:30 in the morning, he or she will be ready for a nap about 12:30. There should be about 5 hours between the nap wake time and bedtime. So a toddler that sleeps from 12:30 to 2:00 or 2:30 is ready for bed by about 7:30 in the evening.
2. Create a reasonable bedtime routine. The routine should be calming and repeatable each evening. Don’t let this routine take on a life of its own! Thirty minutes of bedtime preparation is all that is needed. A routine that is predictable will help your toddler calm down and know that bedtime is near. This routine should include calming the house about an hour before bed by dimming the lights and turning off the TV. Establish a routine that both you and your child enjoys. This routine might include taking a bath, brushing teeth, cuddling and reading a story, singing a song, saying prayers, talking about the day and planning tomorrow, providing a “lovey”, and giving another snuggle before leaving the room.
3. After the routine, your child may call or cry for you. Be strong and consistent. You can peek in and tell your child that it is night-time and time to sleep, but do not go back and rock and comfort to sleep. Your child will learn to fall asleep on his or her own. This is a learned skill, and an important one! Give your child suggestions. “You don’t have to sleep, just read your books or snuggle with your bear.” Leave a night-light on if necessary.
4. Establishing a sleep routine usually takes about three to four nights of consistency. Parents need to be on the same page and tackle this as a team! Do not confuse your child with two different approaches to sleep. Make a plan, and stick to it. Remember that sleep is a health issue, you are being a good parent!
If you establish good sleep habits with your toddler, your daytime hours will be much more fun! It is amazing how the “terrible twos” may just become terrific if you have a child that is not overly tired.
More to come….how to handle specific night-time challenges!