Button Batteries & Honey, Retro Toddler – PediaCast 408

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  • Dr Anne Zachry visits the studio as we explore her new book from the American Academy of Pediatrics, Retro Toddler: More Than 100 Old-School Activities to Boost Development. We also consider the benefit of giving honey when children swallow button batteries. We hope you can join us!

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  • Button Batteries & Honey
  • Retro Toddler (Book)

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Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike!

Dr. Mike Patrick:  Hello, everyone! And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It's episode 408 for June 21st, 2018. We're calling this one "Button Batteries & Honey, Retro Toddler". Wanna welcome you to the program. If you have a baby or toddler at home, this gonna be a fantastic episode for your family. 

0:01:01

And if you know someone who has a baby or a toddler at home, please do share this episode with them. We'll be covering some terrific information. Dr. Anne Zachry is here. She is an assistant professor of Occupational Therapy at The University of Tennessee Health Science Center in Memphis. She's also a child development expert and author of a new book from The American Academy of Pediatrics, called "Retro Toddler: More than 100 Old-School Activities to Boost Development".

And here's a thing. We, pediatricians, are always saying, "Let's lighten up on the screen time and the tablets and the smartphones", especially when we're talking about young children because babies and toddlers, they need real world engagement with people, and places, and toys, and physical activities to develop and boost their thinking skills, their language, their social skills. It's important stuff. And the results of this brain development, they last a lifetime.

0:02:00

The problem is somewhere along the way, we sort of lost best practices for nurturing this development. Things that used to be passed on form great grandparents to their children, and from grandparents to today's parents. A lot of it is not being passed on anymore. Old fashioned toys and activities are quickly being replaced with high-tech gadgets, and tablets, and smartphones. But those old-fashioned toys, and games, and activities, they worked very well, in fact. And we don't wanna lose the benefit they provided which was developmental boost for toddlers.

So we're gonna attempt to make the old new again and we're gonna base it in evidence and research. That's all happening today on the programs as we chat with Dr. Anne Zachry, and explore old school activities that boost toddler development. And again, evidence-based. So it's time to crack out those old toys, and play those old games, and put the tablets and the smartphones away.

0:03:01

Alright. Before we get in, unless you're listening to the podcast of course. Before we get in, I have an interesting pediatric news story for you from the good folks here at Nationwide Children's Hospital along with our colleagues from the Children's Hospital of Philadelphia. A team of ear nose throats specialists has demonstrated that eating honey after swallowing a button battery, it has a potential to induce serious injuries in small children. It's based on findings in laboratory animals. And the research suggest that this common household product, honey, may significantly reduce injury and death from a highly caustic batteries when the button battery is swallowed.

Dr. Anne Jacobs, one of the principal investigators on the project and director of The Center for Pediatric Airway Disorders at The Children's Hospital of Philadelphia. He says, "Button batteries are ingested by children more than 2,500 times a year in the United States, with more than 12-fold increase in fatal outcomes in the last decade compared to the prior decade.

0:04:06

And since serious damage can occuring 2 hours of ingesting a button battery, the interval between ingestion and removal is a critical time to act in order to reduce injury to the esophagus. The team study was recently published in the journal, Laryngoscope, because of their size, can be like shape, and shiny metallic surface, button batteries imposed a risk for toddlers for decades. When the battery reacts with saliva or spit, and the tissue of the esophagus, which is the tube that connects to the back of the throat down to the stomach, it creates a hydroxide-rich alkaline solution that essentially dissolves tissue. Children with an esophageal button battery may present with symptoms of sore throat, cough, fever, difficulty in swallowing, poor oral intake, or noisy breathing. This can cause severe complications like esophageal perforation, vocal cord paralysis, and erosion into the airway or major blood vessels, all are very, very bad things. The longer it takes for the battery to be removed, the higher the risk for these children, particularly those without access to hospitals with specialized doctors experienced in moving foreign objects.

0:05:15

The research team wanted to determine successful interventions for lessening these injuries in both home and clinical setting, and test their effectiveness in alive animal model. In this case, laboratory pigs. Specifically, the researchers sought tasty viscous liquids that could create the barrier between the tissue and the battery, as well as neutralize harsh alkaline levels. The team screened various options, including common household beverages, such as juices and sports drinks. Dr. Kris R. Jatana, another principal investigator on the project and director Pediatric Otolaryngology Quality Improvement at Nationwide Children's Hospital says, "We explore the variety of common household liquids, as well as medicine options. And our studies show that honey and sucralfate demonstrated the most protective effects against button battery injury, making the injuries more localized and superficial. Sucralfate, by the way, is a prescription medicine that hospitals have on hand, not something you're gonna have at home. So that makes honey important for home use and sucralfate can be used in the hospital setting."

0:06:18

He adds, "The findings of our study are gonna be put immediately in the clinical practice and incorporated into the latest national capital poison center guidelines for the management of button battery ingestions. Prior published studies by this team had tested weekly acidic liquids like lemon juice as a proof of concept. However, many children do not enjoy drinking lemon juice. By contrast, the sweet taste of honey is much more palatable to young children. Dr. Jacob says, "Our recommendation would be for parents and caregivers to give honey at regular intervals before a child is able to reach a hospital, while clinicians in a hospital setting can use sucralfate before removing the battery." However, the authors cautioned against using these substances and children who have a clinical suspicion of existing sepsis, or overwhelming infection, or perforation of the esophagus. Known severe allergy to honey or sucralfate would be another reason not to use it. Or in children less than one year of age due to a small risk of botulism.

0:07:14

Dr. Jacobs adds, "While future studies could help establish the ideal volume and frequency for each treatment, we believe these findings serve as a reasonable benchmark 

for clinical recommendations. Safely ingesting any amount of these liquids prior to battery removal is better than doing nothing."

Dr. Jatana concludes by saying, "Button batteries are commonly found in households, and they should always be stored in a secured container, out of the reach of children. Parents and caregivers should check all electronic products in the home and make certain that the battery is enclosed in a compartment that requires a tool to open and periodically check to ensure it stays secure over time."

And of course, if you have any concern at all that your child may have swallowed a battery, seek emergency medical help right away. Very important. Good stuff and important to keep in mind, especially if you have toddlers in the home.

Speaking of toddlers, we're gonna move on to our interview with Dr. Anne Zachry, author of "Retro Toddler" in just a moment. I give a couple of other household keeping items for you.

0:08:16

Don't forget you can connect with PediaCast on social media. So we're really excited about this. We are on Facebook and Twitter, and actually have been in those places for a very long time. And now, also on Instagram. So you can look up PediaCast on Instagram and what I'm doing there is a little bit different than Facebook and Twitter. Facebook and Twitter, we're talking about the program, making it easy for you to connect with the latest episode, and also some other episodes in our archive, and of course, the latest pediatric news and parenting information that I think will be helpful for you. On Instagram, it's a little but more personal. Just going on in the day-to-day life of me, and our family, and PediaCast. And I'd love to connect with you there and see what's going on in the lives of your families as well.

0:09:08

So if you have not connected with us on Facebook, Twitter, or Instagram, please do so. Just to give you an example of some of some of the things that we're talking about in the Facebook and Twitter universe, tips for surviving road trips with little ones, travelling with chronic illness such as asthma, diabetes, bleeding disorders. Summer is a time when a lot of folks are travelling, so that's important to keep in mind. Diaper rash basics. That was a blog post written by a friend of mine, Dr. Jamie Friedman, a pediatrician at San Diego. Another blogpost, "Is Miralax Safe?", that one written by Dr. Kristen Stuppy, also a friend of mine, a pediatrician in Kansas City. 

And then, finally, three common skin conditions you should know about, but don't often get a lot of press, those would be Pityriasis Rosea, Pityriasis Alba, and Tinea Versicolor. These are conditions that don't have common easy names. Just difficult ones. I think it's probably one of the reasons why they're not discussed much in the media. The reporters don't wanna have to figure out how to say Pityriasis Rosea. But Dr. Christina Johns from New York, also a pediatrician, also a friend of mine. She wrote a blogpost about these conditions that could help you out. And again, you could find those on Facebook, on my Twitter, so that we can just provide some more information beyond just the podcast for you in terms of pediatric news and parenting content that I think will be helpful.

0:10:29

Don't forget that if there is a topic that you would like us to do a cover here on PediaCast, easy to get in touch with me. Just head over to pediacast.org and click on the contact link. One other reminder that I have for you that I think we have a lot of, not just parents in the audience, but actually there are a lot of pediatric providers who listen to PediaCast as well.

And particularly, if you're in the Central Ohio area, I wanna let you know about a conference that's coming up. It's called "The 2018 Pediatric Pearls Conference".

0:11:05

And the topic this year is harnessing the power of social media to improve health outcomes. It's gonna happen onThursday, August 30th 2018 from 8 AM to 4 PM, here at Nationwide Children's Hospital. And we're gonna be talking about social media engagement for healthcare professionals. So if you are a pediatric provider and how do you connect and engage in the most effective way in the midst of a busy office practice and how do you set goals, figure out your target audiences, thinking about the needs of your audience and then matching up your educational goals with your audience's needs, what are best practices for using Twitter, and Facebook, and curating good content, writing blogposts, dealing with folks who come along and complain about your practice or what it is that you're writing. And so, I think that would be an interesting conference. It's available for continuing medical education because practicing medicine these days really does involve the use of social media.

0:12:01

And there are good ways to do that, and not so good ways, effective ways, not so effective ways. So we're gonna discuss this during this conference. Again,Thursday, August 30th 2018 8 AM to 4 PM here are Nationwide Children's. And I'll put a link in the show notes so you can find out more information about the conference and register, and especially if you're in Central Ohio, it's easy for you to come over to the hospital on aThursday. We're gonna have some general pediatric topics as well during the conference. We're gonna cover some pediatric gynecology, gender dysphoria in youth, tongue-tie for babies, and even dyslexias. So mostly, the morning and early afternoon, are gonna be the social media stuff and then some general pediatrics in the mid to late afternoon for you as well. So please do consider checking that out, especially if you're a pediatric provider here at Central Ohio.

Also, I wanna remind you before we take our break and get to the interview, the information presented in every episode of this podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you do have a concern about your child's health, be sure to call your doctor, and arrange a face-to-face interview, and hands-on physical examination.

0:13:08

Also, your use of this audio program is subject into the PediaCast terms and use agreement which you can find at pediacast.org.

Alright. Let's take a quick break, and then I will be back with Dr. Anne Zachry to talk about her book, "Retro Toddler". That's coming up, right after this.

[Music]

Dr. Anne Zachry is a pediatric occupational therapist. She's an expert in child development and author of a new book from The American Academy of Pediatrics called "Retro Toddler: More Than 100 Old-School Activities to Boost Development".

0:14:07

That's what she's here to talk about today: boosting toddler development with old school toys and activities. So let's give a warm PediaCast welcome to Dr. Anne Zachry. Thank you so much for joining us.

Dr. Anne Zachry: Thank you for having me. I'm excited to be here.

Dr. Mike Patrick:  Really appreciate you stopping by. So you have a new book from the American Academy of Pediatrics and the foreword of the book was written by my good friend, Dr. David Hill, who is also an author and a pediatrician. "Dad to Dad: Parenting Like a Pro" is his book. He's also chair of the ASP Council on Communications and Media, so we know each other quite well. And he had glowing things, just say about your book. So tell our listeners about "Retro Toddler". What is it all about?

Dr. Anne Zachry: Well, it's a follow-up to the original book, "Retro Baby". And as the theme flows through those books of just getting back to the basics with parenting and limiting screen time, baby equipment for the earlier book or things like carriers and that sort of thing. 

0:15:12

And just more active play physical activity and some tips on how to deal with some of the challenges that we often face with toddlers.

Dr. Mike Patrick:  Absolutely. And one of the things I love about the book is, it's really evidence-based. So a lot of the suggestions and recommendations that you make, you have references. And this is why I feel this is important. I think that's really important because parents get advice from all sorts of places and it's nice to know that the information in your book is really well researched.

Dr. Anne Zachry: I think that's so important as well and I'm assistant professor and chair of the program in occupational therapy at The University of Tennessee Health Science Center. So that's my background. I do a lot of research. 

0:16:01

And I think it can get a little nerve-wracking, some of the things you can read just on blogs that are advice recommending parents certain strategies and that sort of thing. So I think it's important to do the research and find out what's evidence based.

Dr. Mike Patrick:  Absolutely. And then, not only do you talk about the research in the book, but you then go on to say, "Hey! Here are some fun activities that kids used to do.", and really recommend, "This is why it helps boost, whether it be problem solving skills, or social skills, language development." Really, these are some things that will help boost those. And research has shown this is why and this is what you can do to sort of translate those findings into you own family.

Dr. Anne Zachry: Exactly. I guess that's the occupational therapist than me coming out because the creativity is always so important for children and I know that from my background and training. And they would teach to just make something out of what you have and work forward with it and have fun.

0:17:05

So, love the activities. Most of them were things that I did when I was younger or that I did with my children. And we were very crafty. So that came from a lot in the book.

Dr. Mike Patrick:  Absolutely. So in terms of, if we kinda go through the important aspects of development, I think if we just start from what is normal, what kids should be doing, and then, the activities kind of flow from that. So in terms of the toddler years, as we think about cognitive development or problem solving…the development of problem solving skills, starting in about 12 years of age and then sort of working up to 36 months of age, what are some of the things that toddlers really ought to be doing in terms of problem solving?

Dr. Anne Zachry: Well, early on, around 12 to 18 months, they start to search for an object that's hidden from view, and that's object permanence. It's the fancy term for that.

0:18:10

But before that, if you were to hide a little toy, a rattle, under a blanket they would probably just turn their head away and not pay any more attention, but at this point, they start to reach and try to remove the towel or blanket and search for the hidden item. And so that shows that the cognitive development is advancing and coming along. And then around 18…

Dr. Mike Patrick:  And I'm sorry to interrupt you, but that's why they like peek-a-boo, right?

Dr. Anne Zachry: Exactly. It is because if you do it too early they would still be excited to see your face removed. But at this point, they know you're behind there and they can anticipate that you're coming.

Dr. Mike Patrick:  Get that big smile and grin of their face.

Dr. Anne Zachry: They do. It's so fun. It's so fun. So 18 to 24 months, it's just more…you see more problem solving. For example, they might turn an upside spoon, or maybe fork right side up, and a cup that if you hand them a cup upside down, of course you wouldn't have anything in there, they might turn it right side up.

0:19:13

So they're figuring things out and you're manipulating them better as well. So you start to see that problem solving coming through. And also, some frustration if they can't figure out how to do what they're trying to do. So there's a little bit of emotional reaction that goes on during this time which can be a little challenging. And then, about 24 to 30 months, they start to pretend. And that is one of my favorite age ranges because you can see, and I saw it in the airport yesterday. A young child had his parent's cellphone and it was turned off, but she was toddling around about that age with it up to her ear and just babbling away. So she was pretending to talk on the phone, but they'll pretend that an object is something other than it is. So they might take the block and hold it up to their ear and pretend that they're talking on the phone.

0:20:10

So that's around 24 to 30 months. And then, 30 to 36 months, you'll see a lot more going on, but the example that I gave in the book is that they'll…if they want to reach something that's out of reach, rather than just cry and be frustrated, they might take a chair or a stool and crawl up on it to reach it. So you can see their problem solving advancing as they go through these stages. It's kind of a continuum. It's pretty exciting to see because you think: "Wait. They wouldn't have done that several months ago and now they know." And know you really have to safety proof everything in the house because they can get to whatever they want to if they're strategic about it.

Dr. Mike Patrick:  Absolutely. It's really important to really help kids to do these things, to give them opportunities to do some of the things that you're talking about.

Dr. Anne Zachry: It is, because if we just reach up and grab the item and hand it to them, they're missing out on the opportunity to work through that and problem solve.

0:21:14

And I think that could be a challenge in parenting. I mean it was even for me that I didn't want my children to be frustrated, but it's through the frustration that they are learn and think: "What's another way that I could solve this. What else that I could do to reach that item?" I think it's a critical period for parents not to jump in and rescue but also not to get them overly frustrated. If they're totally not moving toward it, not coming up with a solution, then maybe you can just kind of, what we call, scaffold or just get to the level right beyond where they are and be successful, but still really have to push themselves a little bit.

Dr. Mike Patrick:  'Cos it's not like a switch goes on and suddenly: "Hey I'm gonna use a chair to get an out of reach item." It's you sort of work up to it and you give this rage of: this is 30 to 36 months.

0:22:05

So if you're getting much beyond that, you certainly would want to let a medical provider know that: "Hey. I think my child is not developing on track." But kids got through these sort of stages on their own pace.

Dr. Anne Zachry: They do. And I think, that's why there's such a wide range there. As you said, 30 to 36 months because you don't look at 30 months and have a checklist out and think, "They're not doing this. Oh no. There's a problem." But you start watching for it, and if you don't, by the 36 months mark, seeing it emerging. Then, yes. It's definitely worthwhile to mention it to the pediatrician and just get his or her thoughts on it.

Dr. Mike Patrick:  And as we progress through your book, we'll talk more about some specific examples of things, activities that you can do to help with cognitive development with each age group. But in terms of overall development, in addition to problem solving skills, language is really developing during the toddler years. What should parents be doing generally to help boost language?

0:23:11

Dr. Anne Zachry: Well, there is so much research that says, the most important thing that you can do to your baby are really to just talk to your baby using complete sentences and clear speech, and read to your baby. So those are the big ones. And I tell parents all the time that just even if you're around the house, narrate what you're doing. "Look. Mom is emptying the dishwasher. This cup is red." And if there's a plastic cup, let them help you empty the dishwasher and try to get them to engage into language and imitate you as much as possible, but labeling everything in the environment because they're just soaking it up and learning that language as you go.

Dr. Mike Patrick:  One thing I love about the book is the really old nursery rhymes and songs scattered throughout the book. And as I was going through, there were some that's like: "Oh! I haven't thought of that in a really long time." So if you're coming up short on things to read to your kids, your book has a lot of examples.

0:24:17

Dr. Anne Zachry: It does. I love the old nursery rhymes and even in doing research for the book, I went back to some of the nursery rhymes books that I had as a child and pulled those out. And it's just language and rhyming is so…it catches their attention. And especially, if you end up just kind of singing along to a song, those are all, research has shown that that helps improve language and it increases their interest. And it's fun.

Dr. Mike Patrick:  Absolutely. And then, we go on to the development of emotion and sort of self-control which can be very difficult in toddlers, especially if they're prone to tantrums.

Dr. Anne Zachry: It is. And this is a really challenging time because a lot of the times, their brain is thinking faster than their mouth can create words and language for worse.

0:25:10

So they have frustrations there's things that they want to do or want to even physically be able to play a certain activity and their motor skills won't cooperate. And so, you'll see a lot of frustration building and a lot of temper tantrums which is perfectly normal for this age. But it's also important to keep a close eye on them and not let them get too frustrated. So if there's some sort of delay, possibly with motor skills that is causing the frustration to be on top and talk to the pediatrician about that.

Dr. Mike Patrick:  One thing that I found interesting in your book that you shouldn't necessarily completely avoid boring situations. So I mean, it's important to wait patiently sometimes.

Dr. Anne Zachry: There's a saying that I cannot remember who told it to me, but I think it's great, not necessarily for toddlers. I would not say this is my toddler, but for older children, a friend of mine once said, her mother used to say, "If you say you're bored, then you're boring." And it's funny because at first I thought, "That's so mean." And in a way it is, but I do think, the root of what it's saying is true because you have to be able to come up with activities and thoughts, even just thoughts, to entertain yourself when you're bored because if not, you become reliant to other people, or screens, or what have you to keep yourself entertained. And boredom is the root of creativity. It really is. I mean, if you read about some of the greatest inventions, you'll read that they started with boredom, and the thought process, and creative thinking lead to those things.

Dr. Mike Patrick:  So if you're standing in line at the grocery store, and it's a long line, and you're child's getting antsy, make up a game.Play something fun, and then soon, they'll be making up those games.

0:27:18

Dr. Anne Zachry: Exactly. And modeling. That is so important, what you just said, because modeling it for them triggers that and they think, "Oh. Mommy came up with this idea. What can I come up with?" And you end up working together and I think that's really key because they, especially like in a grocery line. I mean, now you know I see. It breaks my heart. They all have a screen. I mean, toddlers either iPads or iPhones where it would be so much better to be talking about the color of the gum and the packaging or the shade. There's so much in the grocery store that you can teach and talk about.

Dr. Mike Patrick:  And then you go in to mention empathy. That empathy is really important for the development of social skills. How do we develop a sense of caring about others and other people's thoughts and feelings? How do you do that in a positive way for the preschool aged kids?

0:28:13

Dr. Anne Zachry: One of my favorite ways is books to look at. When you're reading a book with a child, looking through it, and if you see a character that is crying or sad or throwing a temper tantrum, to get them to label what they see. So, "Oh look! Johnny looks…What's wrong with him? Something's wrong." And if they don't have the words for it, then you say: He's angry. He's frustrated. He's stomping his foot." And then, you can even work through if there's a peer nearby. So, "Oh. I'm glad that he stopped his foot and didn't hit his friend." So there's lots of ways to encourage empathy and then just telling them about, it they do something that hurts your feelings. Do explain to them, "That made me feel sad."

0:29:00

Because they're just now getting to that point where they can understand that they…everything is not about them. So they're getting a little slivers of: "Oh wait" that this person has feelings and they're separate than me.

Dr. Mike Patrick:  And you mentioned pets too can help develop empathy.

Dr. Anne Zachry: Yes. Yes, and I always had had animals and my children have animals. And I think it is, is a possibility for a family to have a pet? That's a great way to work on empathy with a child. Research shows that kids who grow up with pets are more empathetic than those who don't. And I think that's fascinating.

Dr. Mike Patrick:  And then, you go on to talk about motor skills. And I think, as we think about child development, a lot of times, these are the ones that we sort of focus on. Are they meeting their milestones? I think coz they're easy to observe and they say, "Hey, they can walk now. They can run, they're climbing, they can kick a ball." Just sort of marches through what normal motor development looks like from 12 months up to36 months.

0:30:11

Dr. Anne Zachry: So I'll start with fine motor. You would see a child around from 1 year of age starting to put objects into a container and dumping those objects out. So they really can keep themselves entertained for a long period of time by just…if you give them a box of blocks that they'll dump them out, take them out, put them back into the container.

And then, around 18 to 24 months, they might take those blocks and start to stack them. She they'll attempt. They may not be able to stack more than two blocks or maybe three around that age, but they're attempting to create something or to build.

Around 24 months, they'll start to help with dressing which is nice. And I tell parents, you're rushing in the morning, so don't feel like you have to do the dressing lesson in the morning when you're getting ready to go somewhere.

0:31:10

But when you get home, removing socks, coats, hats, and mittens, those are things that they should be able to start doing around this age because they for manipulative skills to grasp and pull. So let them do as much as they can on their own, and that's how they'll develop those skills even more.

And then about 30 months, they will be much more manipulative with their hands. They've got more control of their fingers. So they can do things like string large beads, they're stacking more blocks, and manipulating small items in their hands. But you wanna make sure they're still…at this age, the choking hazard. So you don't wanna give them anything that they can swallow. Because they might put them in their mouth then swallow it. But if you give them finger food, they can manipulate those well, with a little grasp and bringing them to their mouth.

0:32:03

Dr. Anne Zachry: Right on age three, they'll start to work a puzzle and even attempt to manipulate some fasteners. So that is really, really fun to see when they start to do those things that you thought you're gonna be doing forever.

Dr. Mike Patrick:  Yes. Yes, absolutely. And your book has just a ton of simple activities that parents can do with their kids to encourage these kind of skills.

Dr. Anne Zachry: Yes, there is so much out there that can be found to do. And it's things around the house. For example, taking a piece of yarn and stringing macaroni. It's something that you have in the house. And one suggestion I give in the book is: It's hard to start out stringing when the hand and the string is loose and wobbly, so you can take

wobbly, so you can use a piece of tape then roll it around the ends just like you would on the shoelace, then have that firmness and that will help make the task a little easier for the younger children who have problems.

0:33:09

So that's a fun activity, any kind of activities where they can build and create because I just love that that stimulates the creativity. So building blocks and that sort of thing. And you don't have to have store-bought blocks. You can get boxes out of the pantry and use those. So the book is just full of different ideas and things like that.

Dr. Mike Patrick:  We all order something every now and then online, and it comes packaged. And there's usually bubble wrap in there. Don't miss that opportunity right?

Dr. Anne Zachry:Right, you think: "Oh, toss that." or "Save it for the next package." But that's great to work on strengthening their little pincer grasp when they hold something and squeeze it with their thumb and index finger. And it really almost mimics snapping because you have to align the bubble just right to pop it.

0:34:01

And how exciting is it to hear the pop that's almost addictive when you start doing it. You just wanna make sure you supervise your baby while they're doing that.

Dr. Mike Patrick:  Yes. Yes. And then take the plastic away from them as soon as they're done popping it.

Dr. Anne Zachry:Absolutely, absolutely.

Dr. Mike Patrick:  And then you also talk about gross motor skills and lots of activities there as well. And you kinda march through what's normal so parents can have a good understanding of that. And again, just a ton of activities. One that I found really interesting was "fly like an airplane".

Dr. Anne Zachry: Yes. That's one of my favorite activities and it's, or you can also, say, fly like superman. Just have the child lay on their tummy and stretch their hands out as if they're an airplane and try to hold the posture. And you can do it with them. It's a great workout for mom or dad too because it really works those core muscles that are so important for kind of the foundation of the fine motor skills.

0:35:00

I also love wheelbarrow walking, and this is something that we used to do as kids, and it's just easy. You can start out having your child on their hands like in a crawling position and you lift them and hold them right at the waist and have them take a few steps. And then as they get stronger and more coordinated, you can lie down and hold on more to their knees or ankles. And that's great for strengthening the shoulders, the muscles, and those core muscles that are important for future riding and driving and cutting and coloring motor skills.

0:35:38

Dr. Mike Patrick:  And as we think about coordination, you bring up "Mommy Says", kind of a take on "Simon Says".

Dr. Anne Zachry: Yes, that was one of my children's favorite. They have to process that, so if you say, "Mommy says clap your hands five times," they can do that. But they still have to attend so in the future if you say "stomp your foot" and they stomp it, you're like, "Oh no! Mommy didn't say!" So it's just a perfect game, but it's a fun take on Simon Says because you're the one that's leading the way with the game.

0:36:14

Dr. Mike Patrick:  That's really a lot of fun. And again, as I was going through the book, something that I hadn't thought of in quite a while, and it seems like it's so easy to put kids in front of a screen, or to get them interested in an app on a tablet that we sometimes forget these things.

Dr. Anne Zachry: We do, and I mean, this is how the research for my book started with because I noticed kindergarteners and preschoolers, I was working in a school system, and I was getting more and more referrals for kids for handwriting and fine motor issues, and this was in the late 90s. And I started, I'm just going to do a little bit of informal research, and I sent some questionnaire home, and had just a bunch of developmental questions asking.

0:37:03

And the one thing that I noticed that came back with these children who were having the challenges with that they didn't have much Tommy Tom, and I didn't spend much on their hands and knees crawling or just playing in Tommy Tom when they were young. And so that has kind of spurred the whole beginning of the research for this series, book series. It's really important to just let your kids have time to roll around, play, make obstacle courses that they can crawl over and under that physical body because core muscles are keys. They're the foundation for everything that move forward from there.

0:37:45

Dr. Mike Patrick:  And in your book, you give lots of other examples as well on how old fashion play, the things that we're talking about without screens, and tablets, and such, really do play a critical role during the toddler years. And just simple things like playing a lot as a kid reduces disruptive behavior.

Dr. Anne Zachry: It does, because children are able to express themselves and especially when they are playing with a peer, they learn how to work together, to take turns. There's so many skills, I mean, we say in the occupational therapy field that play is a child's work. And that's their occupation, and really it is, because that's how they learn about life, when they learn about this skill that we talked about earlier. Empathy, and patience, and those sort of things. And they don't learn things from the screen, and then the research has shown us that you can have someone explain something to a child, just person-to-person in front of them, and they will understand better if you recorded that message and I watched it on the screen. So something is lost in translation there when it goes from the life to the screen.

0:39:02

Dr. Mike Patrick:  And unfortunately, we're seeing lots of screen time, more and more and more. And of course there's some good to screen as well, right? When we're using it to connect with family members who may live across the country. And there's, of course, school work now often times does involve screens, but when we're talking about toddlers, it's really much more important to do that face-to-face interaction and play with them. There was one study cited "When mother and child pretend play together frequently, that's associated with a higher IQ by the time that they're starting kindergarten.

Dr. Anne Zachry: Yes, that study was fascinating to me. And it just shows that the pretend play promotes those problem-solving skills and fosters those skills that translate over into the ability to read, and write, and those things that are associated with school age activities.

0:40:01

So play, play, play as much as you can. And physical play that, they ask that because of the movement and exercise that it's better for health and wellness, and there's such an epidemic of obesity in our country. And so the more physical activity that young toddlers can have, the earlier they start, the more likely they'll carry through with it as they grow old.

Dr. Mike Patrick:  Such important stuff. You also mentioned in your book, you bring up this idea of a parenting style. What is a parenting style and why is that important as we think about toddler development?

0:40:38

Dr. Anne Zachry: So parenting styles are just the different approaches that parents use to parent their children, it kind of directs how they parent. And there's different styles and this influences actually the relationship that the parent has with their child. So there's four main parenting styles: authoritative, permissive, and then one authoritarian, which is often confused with the word authoritative, and uninvolved.

So the permissive parent is just, really, anything that the child wants, they jump on it and give it to him. And these kids is they want something they usually get it, and their parents are trying to avoid conflict and don't want to deal with the confrontation. So these children don't hear the words "no, no, no" a lot. And these kid sometimes can have some challenging behaviors and limited self-control.

0:41:43

And then on the other end, you have authoritarian. And that's more rigid and controlling. And you just say no just to be able to say no, because you have the control as the parent. And you have strict rules and there's no discussion, and you're the strict authority. And a lot of people, parents use this style, but it can impact a level of affection that you have with your children. These kids actually tend to have lower self-esteem and more challenges with their social interactions, and they even be at risk for depression. So that is a little concerning, obviously.

0:42:26

And then, there's the balanced parenting style, which I like to refer to that, the authoritative. So it kind of gets confused with authoritarian, but this is kind of the middle ground. So it's a healthy approach where you are supportive, you have realistic expectations for your child, but you're also responsive. So you're responsive to their needs, and you set clear, consistent limit. So these kids tend to be more well-adjusted, do better in school, and don't have that risk of having depression.

0:43:01

And then, of course, the last one is very obvious. It's uninvolved or disengaged, where the parents aren't responsive. And those children really have risks for many, many behaviors and hopefully that is not embraced to many parents.

Dr. Mike Patrick:  And for parents who are interested, and hopefully all of you are because this is such an important thing, there's lots of examples of how you can be a good balanced parent in the book. And one of the things that really sort of occurred with me was just being supportive, setting the boundaries, setting the rules, but then having realistic expectations. Because toddlers aren't going to get it right all the time. In fact, none of us get it right all the time.

0:43:44

Dr. Anne Zachry: Oh no, we don't. And we have to, if we, it's hard to do, but to try to put ourselves in their position of where they are developed mentally. So the expectations that you have for yourself should never be the same as what you have for a toddler who is still growing and developing and doesn't have so many of those skills, social-emotional skills, cognitive skills, and motor skills that we have. And I did just wanted to point out that the parenting styles are not my research. They're based on research that has been done ongoing for a long time. And so the references for that, the different parenting styles are all available in the book.

0:44:25

Dr. Mike Patrick:  And I think even though if they have names and you can get confused, I think we all have an idea on our head of what a permissive parent looks like versus an authoritarian parent. And that we really wanted to try to be somewhere in between those two.

Dr. Anne Zachry: It's funny that you say that, because I love airports. When I go to the airports I watch families and children. And you can almost recognize in just a few minutes what style the parent has depending on how they correct their child and the interaction that they have with them. And I'm just a silent observer, but you're right. You can see when there's that parents that have that balanced approach that seems to be more healthy and the outcomes of the children are better. You can recognize that compared to someone who is really strict and setting limits and almost limiting exploration and learning.

0:45:21

Dr. Mike Patrick:  Absolutely. Let's move on and just talk about some toys and other fun activities that you can do, but let's by age group this time. So if you are a parent to a 12 to 18 month old, so 1 to 1 and a half years of age, what are some toys that you really ought to think about having around the house that would be helpful in terms of development, sort of some old-fashioned toys.

Dr. Anne Zachry: Well, my favorite, favorite, favorite, is blocks. I love a set of blocks that they can stack and build because there's just unlimited opportunities.

0:46:03

Board books at this age are great because they're firm enough to hold up to a toddler's rough little ways. And they can throw them around, and drop them, and pull on them, but they still can be exposed to reading. I call them sorting or nesting toys in the book. But these are fun and they require problem solving because maybe you have to learn how to line them up by size and put them inside of each other. And then if it all possible, if a child can be outdoors and play like a little, or even indoors. The plastic shovel and bucket, but it's fun to see them trying to scoop and poor into the bucket, balls of different sizes, but you want them to be larger at this age because their manipulative skills haven't kicked in yet. They love push toys and just basic puzzles like with knobs on them, and not, another one of my favorite commercial toys that you can also make is a shape sorter. 

0:47:06

So where they put the different shapes through the correct slide in the box. So those are some great toys for that age range.

Dr. Mike Patrick:  And it's important to really get down on the floor with your toddler and play with these things.

Dr. Anne Zachry: It is, and it's fun.

Dr. Mike Patrick:  Yes, even for dads.

Dr. Anne Zachry: Even for dads, yes. Absolutely, because your child is watching you and it's, they will treasure that time. It's part of the bonding process that you have with your child. But they're also watching how you manipulate and create and build and they model, model after you. And that's how they learn.

Dr. Mike Patrick:  Yes. And then, other important components of just normal developmental things that can sometimes be an issue for new parents. Dealing with separation anxiety, for example. 

0:48:00

Tips for discipline. How do you do time out effectively for a young toddler? And these are all important things that sometimes we don't get taught. And so, Retro Toddler, the book has lots of information even about these sorts of things.

Dr. Anne Zachry: It does. I tried to go to the research and find tips and suggestions. And I mean, we're all learning, so there's no…I don't think there's any strict recipe for how to do these things. But some of these research-based tips can be useful. And they're easy to find in the book. The book's user friendly, so if a parent is having a certain issue, they can flip through and find the research that surround that action or activity and get some useful information.

Dr. Mike Patrick:  As we move on to a year and a half to two years of age, so 19 to 24 months of age, now, what are some of the toys, the old-fashioned stuff that we really should have in the house?

49:04

Dr. Anne Zachry: At this age, I think, dress up clothing is really great for the little toddlers because they're starting to learn how to remove clothes, and you can help them with putting them on if they can't get them on, but the fasteners, but then, pretend and imagination component comes into it. So they can dress up as a pirate or dress up as a princess. And these things don't have to be fancy, expensive clothing. But they just need to be something that they can put on and pretend that they're someone or something else.

I also love play dough at this age. And there's so many activities that you can sit at the table on a rainy day with your child and there's a recipe for play dough too, so you don't have to have store-bought play dough. In fact, I love the play dough that's homemade. It's much more easy to manipulate. 

0:50:00

And if you use it when it's fairly fresh, it can sometimes still be a little warm. So it's fun to… And then, puppets and dolls come in to play because of the pretend aspect and a lot to pretend. It's either baby or the puppets. You can manipulate the puppet or have them put the puppet o their hand and pretend with it. And then musical instruments are also at the stage because it goes back in, I mean everything kind of comes back to the creativity and pretend around the stage. Because that's when everything is coming in to play where they're starting to understand those concepts. And then as far as books, at this stage too, they've gotten that object permanence we talked about earlier. So the list of flap books are really fun.

Dr. Mike Patrick:  Yeah, where you manipulate it and see what's hiding behind the bush for example.

Dr. Anne Zachry: Yes. They love to. "Oh what's behind here?" And let them lift the flap. And use their little grasp to do that.

0:51:05

Dr. Mike Patrick:  And then, some other topics to the 19 to 24 month range that you cover in the book, just some tips on sleeping and napping, injury prevention from toys, and then dealing with those pesky temper tantrums.

Dr. Anne Zachry: Yes, that's what everybody seems to think about when it comes to a toddler, but I think it's important to know that is so typical for this age. And you get their suggestion for working through working on those times.

Dr. Mike Patrick:  Yes. So once we crossed that 2-year-old threshold and we're kinda marching out the age 3, what are some things that we ought to have around the house for the early 2-year-olds?

Dr. Anne Zachry: So I love them. Again, blocks can be for all of these ages. So those kind of run the game and puzzles, at this age, can start to do more in-set-puzzles, the 4 to 5 pieces, where they're problem solving and figuring out which piece goes with which piece.

0:52:06

Dr. Mike Patrick:  And a lot of those blocks have, a lot of times, ABCs and numbers on them. So now, instead of just stacking, you can start playing with the alphabet a little bit.

Dr. Anne Zachry: Right. And that's where you can go back into narrating and the language component with your child. So when you're building with them, you can say: "Look, I'm gonna stack A. Now can you find B?" So you can talk about sequencing or, "Here's 1. Where's 2?" And they'd learn these concept that are going to be important for preschool and school while also working on their manipulation and bonding with you.

So another activity that I suggest is sidewalk chalk because there's so many, I mean there's pretty much unlimited games that you can come up with sidewalk chalk. And that's fun for a rainy…I mean a sunny day when you're outdoors and can draw on the sidewalk, and hopscotch, and those kinds of things.

0:53:04

Dr. Mike Patrick:  Yeah, lots of fun there. And also, finger paints. So when it is raining outside and you have to go in, the finger paints…

Dr. Anne Zachry: They can. And there's a recipe for finger paint, I believe, in here. But you can find that at the store, even at the dollar store. And the kids love that because kids have the permission to get messy. And it's okay, they're all washable. You can put their clothes in the washing machine after they have fun with it, but they work on being creative. And then, manipulating with their fingers, and drawing, and creating.

Dr. Mike Patrick:  Yes. And you also talk about picky eaters. That becomes more of an issue around age 2. And then, certainly introduce manners to your child. Again, being patient with reasonable expectations, a bit introducing manners is gonna be important as you're turning 2.

Dr. Anne Zachry: It is. That'sa critically time. And they're watching you and that's, I feel, like a really wonderful way to teach manners is to model manners for your child because they're watching everything you do. And so they're going to imitate. And that's a perfect way to get that through to them.

0:54:15

Dr. Mike Patrick:  Yes. And then, as we head on to almost 3 years old, so 2 and a half to age 3, now they're really becoming more adapted that creativity. And what are some things that we can have around the house and activities we can do to really nurture that creativity in the late 2 to 3 year old range?

Dr. Anne Zachry: Well I think, the little plastic people or wooden people that we used to have the ones that are wooden but I think most of them are plastic now, are fun for pretend and manipulating. And dolls and dollhouses are fun for little girls or little boys if they like those. There are…I love just bubbles because it's really great for breath support and blowing those bubbles, popping the bubbles, and it helps with their eye tracking because they're having to watch the bubbles as they move to the air.

0:55:10

And another fun thing that I recommend for young children are tongs. And I know that sounds odd, but if you can find like plastic child friendly tongs, they're great for kids to pick things up, and put them, mix all items from one bowl to another or from one container and to another. And that actually works for the little muscles that are important for scissor skills. So it helps them when it comes time to start snipping with scissors. They kind of understand that if you squeeze, and open, and squeeze, that that's the motor sequence there.

Dr. Mike Patrick:  Yes.

Dr. Anne Zachry: No, go ahead.

Dr. Mike Patrick:  Oh no, go ahead.

Dr. Anne Zachry: I was just gonna say, the other thing I like at this age is lacing cards and you can make those out of a little piece of poster board and a hole punch and some yarn.

Dr. Mike Patrick:  Yes. Yes. That sounds fun. And then, in terms of books, we're kind of advancing now to more picture books at this point, with pages that littler kids might destroy. But it's important for kids to really get in there and start telling stories with picture books.

0:56:17

Dr. Anne Zachry: It is. I mean once again, it goes back to their language and just some of the social skills that they're working on at this stage like sharing, taking turns, are usually incorporated into the stories in their books for this stage range. And so that's a great way for them to learn lessons about what to do when you're angry or what to do when your sibling makes you mad. They can read about it with you. You read the story. And at this point, they'll even…they know the books if you've read them.

Dr. Mike Patrick:  Yes, yes.

If you try to skip a word or a phrase, they'll say, "No! That's not what it says!" And the other fun thing I like to do at this stage with them is to say, if they don't know that book, "What do you think happens next?"

0:57:03

So pause for a minute while you're reading the story. And let them create what they think happens. And then when you read it together, it's fun to see if they were correct or accurate in what they predict.

Dr. Mike Patrick:  That sounds like a lot of fun. And we used to do that and even when they knew the book, we would say, "Okay. Let's now come up with a different story. So using these pictures, let's start from scratch and tell something new.

Dr. Anne Zachry: It's fun to do that. And it's great for a child who really is fixed in a routine and doesn't like to think outside the box because I had my oldest with that way, and he didn't want anything. If he knew the story, you can change it. But it was good for him to learn some flexibility as it's still that way in the book, but you can think of another way the story can get…

Dr. Mike Patrick:  We usually want in a direction of silliness.

[Laughter]

So that's what would usually go. And then you're all laughing and rolling around the floor. So…

Dr. Anne Zachry: I love that. Exactly. The more silly, the more fun.

0:58:00

Dr. Mike Patrick:  Yes, yes, that's the way it is in our house still, even with older kids. So and writing and coloring are also gonna be important skills to start introducing around this time.

Dr. Anne Zachry: Yes. And in a fun way. So I always encourage parents to not feel like they have to sit their child in a little small table with a writing utensil and practice writing letters. But even just starting to use crayons to color and explore, and manipulate, and then the finger paint still are okay because they're still developing their grasp and manipulative skills. But you can start having them imitate some strokes, circles and shapes that are really basic, and you can do it hand over hand with them as they're not catching on quickly. And then that'll help them understand how it feels to make the move. And then, so this is a really fun age for the motor, the fine motors skills because there's so much coming in.

Dr. Mike Patrick:  Definitely. Well we really appreciate you stopping by today. Let folks know where they can find your book, "Retro Toddler: More Than 100 Old-School Activities to Boost Development"

0:59:10

Dr. Anne Zachry: It is available on Amazon and on the American Academy of Pediatrics website, bookstore.

Dr. Mike Patrick:  Great. And we'll out links to the book in the show notes for this episode 408 over at pediacast.org, so folks can find it very easily. I'm also gonna put a link to the American Academy of Pediatrics Family Media Use Plan. So if screens are already an issue in your home. And by the way, we didn't cover this and I think it's important. As you try to get away from too much screen time, or maybe even if you find your parenting style is not that balanced approach, it's never too late to change things up, right?

Dr. Anne Zachry: And they're suggesting in the books is how to go about doing that. And just do it gradually and use the tips and techniques.

Dr. Mike Patrick:  Yes. And if you're really trying to come up with a media plan that's appropriate for your kid's age, that American Academy of Pediatrics Family Media Use Plan can be a useful tool for you. And we'll put a link to that in the show notes as well.

1:00:13

Alright. Well, Dr. Anne Zachry, pediatric occupational therapist and child development specialist, author of "Retro Toddler". Thank you so much for stopping by today.

Dr. Anne Zachry: Thank you. This had been fun. I appreciate you having me.

[Music]

Dr. Mike Patrick:  We are back with just enough time to say thanks to all of you for taking time out of your day, and making PediaCast a part of it. Really do appreciate that, as always. Also thanks Dr. Anne Zachry

pediatric occupational therapist, child development specialist, and author of the book "Retro Toddler". 

1:01:10

Lots of really great information in that book. I really encourage you checking out. And again, we'll have links in the show notes for you so you can find it easily.

Also, I wanna remind you, if you're a pediatric provider in Central Ohio, we have a conference coming up. You may be interested in The 2018 Pediatric Pearls Conference: Harnessing the Power of Social Media to Improve Health Outcomes. It is happening here at the campus of Nationwide Children's Hospital from 8 in the morning to 4 in the afternoon onThursday, August 30th 2018. I will be speaking at the conference and are gonna cover social media engagement for healthcare professionals. We're gonna talk about how to figure out what your goals are. 

And being in social media, who is your target audience, what is your target audience's need, how can you best match your educational goals with the audience's needs, how to effectively use Twitter, and Facebook, and curate content, blog writing, troll control, how do you deal with the people who have different opinions that may not be as evidence-based as you do who attempt to engage you online. We'll talk about that.

1:02:11

And we'll also have some general pediatric topics for you: pediatric gynecology, gender dysphoria, and youth tongue-tie and dyslexia. And I'll have a link in the show notes for this episode 408 over at pediacast.org, so you can get the information and even register if you'd like to attend the conference.

Don't forget you can find PediaCast in all sorts of places. We're in the Apple Podcast app, iTunes, GooglePlay, iHeartRadio, Spotify, and most mobile podcast apps. And of course, the landing site,pediacast.org, where you will find our entire archive of past episodes, our show notes, transcripts, terms of use agreement, and that contact page to suggest topics and ask questions. Point us in the direction of news, journal articles, really do appreciate that when you out in your input into the program.

We are also part of the Parents On Demand Network which is a collection of podcast for moms and dads. 

1:03:05

The collection includes PediaCast, along with many other terrific podcasts for parents, including Liz's Healthy Table. Liz was on the program back our last episode 407. We talked about healthy summer meals. She also does a podcast. She's a registered dietitian, a terrific cook. And her podcast is called Liz's Healthy Table, and I'll put a link to that in the show notes for you as well. Also, the Preschool and Beyond Podcast covers lots of topics and interviews, experts-related to education, development, and health, pertaining to preschool years which kind of fits along nicely with the topic that we just covered today on the program. Again, I'll put links to both of those podcasts for you in the show notes.

Don't forget, you can connect with us on Facebook and Twitter where we share content, not only form the podcast but other realms of pediatric news and parenting tips and hopefully helpful hints. And then, also on Instagram where things are a little more personal.

1:04:03

And that we hope that you can connect with us. Just search for PediaCast and please do consider following us there on Facebook, Twitter, and Instagram. Also, we really appreciate it when you talk up the show with your friends, face-to-face conversation outside of screen time which is so important with your family, friends, neighbors, co-workers, baby sitters, really anyone who has kids or takes care of kids, please do let them know about our evidence based podcast for parents. And that includes, by the way, your child's pediatric healthcare provider. Please let them know about the program, so they can share it with their other families.

And while you have their ear, please let them know we have a program for them too. It is called PediaCast CME, which stands for continuing medical education. It is similar to this program, we turn up the signs a couple of notches. We do offer free Category 1 Continuing Medical Education credit for those who listen. Shows and details are available at the landing site for that program which is pediacastcme.org. That one is also in Apple Podcast, iTunes, GooglePlay, iHeartRadio, Spotify, most mobile podcast apps. Simply search for PediaCast CME, and it should be able to find pretty easily.

1:05:06

Alright. Thanks once again for stopping by and until next time. This is Dr. Mike saying, stay safe, stay healthy, and stay involved with your kids. So long everybody!

[Music]

Announcer 1: This program is a production of Nationwide Children's. Thanks for listening! We'll see you next time on PediaCast.

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