Toddler Behavior – PediaCast 526
- Dr Kristina Jiner and Dr Ariana Hoet visit the studio as we consider toddler behavior. We explore normal behavior and the many challenges that arise during playtime, bedtime, mealtime and pottytime. Also covered: strategies for correcting problems. We hope you can join us!
- Toddler Behavior
- Big Lots Behavioral Health Services at Nationwide Children’s
- Psychiatric Crisis Department at Nationwide Children’s Hospital
- On Our Sleeves: The Movement for Children’s Mental Health
- PediaCast Behavioral Health Playlist on SoundCloud
- The Power of Play in Childhood – PediaCast 519
Announcer 1: This is PediaCast.
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.
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 are in Columbus, Ohio.
It's Episode 526 for October 12th, 2022. We're calling this one, "Toddler Behavior". We want to welcome everyone to the program.
Our Behavioral Health panel is back in the house this week. And we really need them as we consider a topic that is often on the minds of parents with young children. And that topic is toddler behavior.
Because toddlerhood can be a bit of a mystery, right? I mean it's a time of discovery and developing independence, terrific. It's also time of tantrums and breakdowns and opposition.
Raising toddlers is definitely challenging work, but we can ease that challenge by first understanding the behaviors that are normal for toddler. In other words, what is expected? Because if know what is normal, we have a better idea of what is outside of normal and the instances in which our toddler's behavior might need a little attention and/or correction.
We'll cover many aspects of toddler behavior today, including what is normal of course, but also what sort of difficulties arise in the course of playtime, bedtime, mealtime and potty time. Because those are really the big times a day for toddlers, right? They're either playing, eating, sleeping or going to the potty. We'll also consider daycare and toddler difficulties outside of the home.
And to help us consider all of these things, our Behavioral Health panel is here once again. Doctor Kristina Jiner is a pediatric psychiatrist at Nationwide Children's Hospital, and Doctor Ariana Hoet is a pediatric psychologist at Nationwide Children's.
You may be wondering what's the difference between a psychiatrist and a psychologist. We'll provide a refresher for that question. And we'll also take a dive into normal toddler behavior, common challenges parents are certain to face, and practical strategies for effectively meeting toddler challenges head on.
However, before we get to our guests, I do want to remind you, you can find PediaCast wherever podcasts are found. We're in the Apple and Google podcasts apps, iHeartRadio, Spotify, SoundCloud, Amazon Music, and most other podcasts apps for iOS and Android. If you like what you hear, please remember to subscribe to our shows so you don't miss an episode.
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Also, I want to remind you the information presented in every episode of the podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, be sure to call your healthcare provider.
So, let's take a quick break. We'll get our expert panel settled into the studio and then, we will be back to talk back about toddler behavior. That's coming up, right after this.
Dr. Mike Patrick: Doctor Kristina Jiner is a pediatric psychiatrist at Nationwide Children's Hospital and an assistant professor of psychiatry at the Ohio State University College of Medicine.
Dr. Ariana Hoet is a pediatric psychologist at Nationwide Children's. She also serves as Clinical Director of the On Our Sleeves movement, more on that to come. And she is an assistant professor of Pediatrics at Ohio State.
Both are passionate about helping young kids and families live their best lives, which includes raising awareness about normal toddler behavior and empowering parents to engage toddlers effectively and implement strategies to correct behavior when things go sideways, which can be a common occurrence as we think about toddlers.
Much more on all of this come, but first, let's say hello to our guests, Dr. Kristina Jiner and Dr. Ariana Hoet. Thank you both so much for visiting with us again.
Dr. Kristina Jiner: It's great to be back, thank you.
Dr. Ariana Hoet: Thanks for having us.
Dr. Mike Patrick: Yeah, absolutely. We have done several episodes on PediaCast, and we have all of the episodes plus some more behavioral health topics packaged together in a playlist over on SoundCloud. And I'll put a link to that playlist in the show notes so people can find it easily.
But just some of the things that we've talked about, depression and anxiety in kids and teens, preventing teenage suicide. We've talked about managing holiday stress, which would be a good one to listen to again as the holidays will be soon approaching, helping kids and teens through the school year, tackling boredom, bullying, self-care, and wellness for moms, and much more.
So please do check out that playlist over on SoundCloud. We have all those episodes packaged together.
Before we get started with toddler behavior, Dr. Jiner, could you just sort of remind us. I mentioned that you're a psychiatrist. Dr. Hoet is a psychologist. What's the difference between psychiatrist and psychologist, and when would a family need one or the other?
Dr. Kristina Jiner: Sure, so great question. As a psychiatrist, I am a physician. So, I was trained in medical school, then went on for additional training. I typically will meet families when there is a concern for the need for treatment involving medication or the need for more diagnostic assessment.
Dr. Mike Patrick: Okay, and then the psychologist?
Dr. Ariana Hoet: So, psychologists go to graduate school to get a PhD or a PsyD in Clinical Psychology. And so, when it comes to behavior, we're trained in how parents can respond to a child's behavior, how do we know what's developmentally appropriate, as you've mentioned, when do we start to worry. And then, we can do assessments and evaluations or diagnosis.
Dr. Mike Patrick: That makes sense. So, a psychiatrist is a medical doctor who then goes into behavioral health, and a psychologist, it's a graduate degree, so you don't have to study all the rest of the body, just the brain, the nervous system, and the behavior.
Dr. Ariana Hoet: Correct.
Dr. Mike Patrick: And development, it's probably an important part of that, too.
Speaking of behavior and development, we did mention we wanted to start with kind of what's normal for toddlers. Because I think a lot times our expectations are the toddler is going to sit there like a school-aged child can do, and pay attention to something, and follow directions. But that's not always the case, right?
Dr. Ariana Hoet: No, this is definitely a time of limit testing. And we start to see their preferences and again, just pushing the boundaries. They're building independence. They're building their sense of self. They start to identify who they are and how they are different from others.
They also have curiosity, lots of questions about the world. And so, it's a lot of changes during the toddler years, definitely.
Dr. Mike Patrick: I love that you started with they're gaining independence. They're exploring. They're very curious, all these things.
And then, you can sort of understand why that all of a sudden turns frustrating, if they're trying to understand something and they can't. Or they really are wanting to exert their independence and maybe you're not letting them. And so, this is also a time when kids can be oppositional.
What are some good practices for dealing with oppositional behavior when toddlers don't want to do what you want them to do?
Dr. Ariana Hoet: And one thing that just came to mind as you were talking is, I often remind parents that toddler brain or the child brain is not developed yet. And it won't be for many many years. And so having the expectation that they're not seeing the world or processing the world like we are important.
When it comes to oppositional behaviors, there's things we can do to try and prevent them. Routines are super powerful for toddlers; it gives them a sense of control. They know what to expect, but it also may avoid power battles. If we do the same time the same bedtime routine every day, they know what to do, they know what to expect. We don't have to argue as much about it.
It's also helpful to be clear with our expectations when we're talking to toddlers. So, saying be good, be respectful, it means something different to them, than it means to us. So, trying to talk to them more specific. "I want you to sit quietly", "I want to share your toy car", and being really specific with what behaviors we want.
And then, no matter what, even if we have those routines and we're talking to them clearly, they're still toddlers. They're still going to push and sometimes be oppositional.
And so, some of my favorite strategies are giving them choices, giving them that sense of control, "Do you want to PJs on first? Or brush your teeth first?" and let them tell you what to do. You're still kind of giving them the two choices that you're okay with them choosing.
Another strategy is thinking about toddlers often tell us what they're feeling with their behaviors. So being able to help them with emotion regulation. They're still learning what emotions are. They're still learning to express them.
Sometimes we need to give them space. Let them have their moment, their meltdown and that's okay. Sometimes, we have to help them regulate, "Do you need my help to calm down?"
Label their feeling, "I can tell you're really angry and that it's frustrating that we have to put our toys away to go to bed." And then help them maybe do bubble breathing together, belly breathing, and helping them regulate and calm down.
It's really really important that we pay attention to how we're responding to the oppositional behavior because we can accidentally reinforce it.
Dr. Mike Patrick: If we're giving them more attention, if they get attention with bad behavior, then "Hey, it's attention".
Dr. Ariana Hoet: Yes. Or we give them that thing they're crying about, right? Then they're learning by accident, that "Hey, every time I cry, I'm going to get that thing that I want." So sometimes we have to be aware of that.
We validate the emotion and the frustration, but we stick to, we still have to put that away. Or sometimes even implementing consequences, taking something away because they're not following through.
Dr. Mike Patrick: I think one little thing that parents can do even just to get started with that, is to be careful what you threaten, so to speak. So, in other words, make sure it's something you're really going to follow through with.
I can remember we were at the Ohio State Fair this year, there were several kids who were tired of being there and really cranky. And the parents were like, "If you don't stop, we're going to go home." And I just thought you just paid however much money for these tickets; you're not taking that kid home. So, make sure you really can follow through with it, or they will learn that they can still get their way.
Dr. Ariana Hoet: They're smart, so they'll learn like "Oh, my caregiver just says that" right? And so yes, that's very important.
And I recently had an experience with my daughter where she wasn't letting me do bedtime routines. So, I said "Well, we're not going to read a book unless you put your PJs on."
And I thought that that's something I can easily implement, and she was so sad. I mean, it was heartbreaking. And that’s something I hear from parents all the time, right? Like I don't want to make my child sad.
And she was heartbroken, and kept saying "Well, now, I'll listen. Now, I'll listen." It took everything in me to say, "We'll try again tomorrow, but today you lost that privilege. And I understand you're sad," and kind of helping her distracted and regulate that emotion. But it's really hard.
Dr. Mike Patrick: Yeah, yeah. So maybe in the future, you would've picked a different consequence?
Dr. Ariana Hoet: Yeah, or maybe we read two books and maybe I would have said now we're only going to read one and make it less severe than taking both away.
Dr. Mike Patrick: Yes, yes, exactly. Speaking of toddlers being smart, they do ask a lot of questions. And sometimes it can wear you down, just a number of questions. What are some good practices for engaging the questions but also helping turn them off when it's enough?
Dr. Ariana Hoet: Yeah. That's hard. Again, they're curious. They're learning about the world.
And so being able to answer their questions at the developmental stage, so small tidbits of information, if they're asking more, they want to know more. But sometimes you notice you give them that answer and they kind of stop, they're processing, they're thinking about it. So, they kind of hit their limit of the information they needed.
And then, sometimes we may have to say like, "I'm really busy right now, let's talk about this. Let me finish this job that I'm doing and then we can talk about that situation." But definitely engaging them as much as possible.
Dr. Mike Patrick: And if you do put it off, maybe set yourself a timer, just to remember. And it's going to mean a lot to them, when "Okay, now, I'm fresh, I'm ready to answer their questions." And from their point of view, you're coming to engage to answer their questions, that's kind of a cool thing, I would think.
Dr. Ariana Hoet: And visuals are helpful, a sand clock for example. They can't read time yet; they can see that sand clock's running out.
Dr. Mike Patrick: Oh, you'll answer their questions when the sand is gone, I love that.
Playtime, I imagine, is really important for toddlers. And we did a show. It was actually Episode 519, called "The Power of Play in Childhood". It was actually the Sports Medicine people that did that.
It's a really good episode on just how we learn so many life skills through playing. But especially during the toddlers years, you may have to jumpstart that playing a little bit. We have both sort of the structured play and then unstructured play.
So, what's the importance of those and how can parents best encourage their kids to have productive playtime?
Dr. Ariana Hoet: Playtime is great, all the reasons you mentioned, and we also use it a lot in therapy to build the relationship between the child and the parent. We do something called child-directed play often, where we ask parents to pick 10 to 15 minutes a day where it's just them and the child. And they're letting the child lead, what the child wants to play. And really, it's all about showing the kid "I'm here. I'm paying attention."
So, we recommend reflecting back, so saying what you hear the child say, just echoing it describing, "I see you put the blue block on the red block." Mimicking, so if they're jumping, you're jumping. If they're coloring, you're coloring. And then praising, making it fun.
And try not to ask questions, try not to get directions, just again letting the child lead and feel listened to, attended to. Building that positive relationship with the parent is a wonderful way to use playtime.
Dr. Mike Patrick: Yeah, so really want a nice mix of both of those things, right? Where you are getting down and playing with them, but then when you also encourage them to start using their imagination and making stuff up on their own.
Dr. Ariana Hoet: Right, right. And kids love having our attention and we often notice that they tend to act out when we are distracted, when we're not paying attention. So, encouraging that independent play too is really important and saying okay, like you said, using your imagination. Letting them be bored and figure out how to play is really important because they're, again, learning and that encourages that alone time, too.
Dr. Mike Patrick: And again, we'll put a link to the "Power of Play in Childhood", PediaCast Episode 519 in the show notes so that folks can find it easily.
Now, one thing that could frustrate a lot of parents is you think if I got a room full of toddlers, that they'll all just play together and keep each other entertained and then we can do something parently.
That's not really true, though, is it? I mean, at what point can we expect toddlers to be able to play with one another? Versus just independently playing in the same space.
Dr. Ariana Hoet: It's a great question, around two years old, we start seeing toddlers do what's called parallel play. So, they're playing next to each other but not with each other. And from two to four maybe, they're playing with the same toys in the same area, but they're still not doing what's called the cooperative play.
We see that more at four years old on. And that's when you see them maybe build that block tower together, right? And not just next to each other. So, it does take until around four years old to start kind of distracting and entertaining each other.
Dr. Mike Patrick: To think that they will just get along and cooperate with one another and play together may be unrealistic before age four?
Dr. Ariana Hoet: Sure, yeah. And it takes a lot of setting expectations and practice and rules, for sure.
Dr. Mike Patrick: And then, how do you go about resolving conflicts once they are playing together? Because even four or five years old, like if it's my toy, I may not want to share it with someone else. Or you're really learning to take turns sometimes too, right? That can be tough lessons.
Dr. Ariana Hoet: Absolutely. I always say if it's not hurting anyone, if it's not disruptive, let them figure it out, right? Again, we want them to develop that problem solving skills, the social skills, let them talk through it. If it does get to a place where the behavior's disruptive or someone's getting hurt or they're coming to you, then it's okay to help them guide through it.
What are you feeling? What's happening? Let each child express what's going on and then help them with the problem solving. Again, establishing expectations very clearly, the rules very clearly, and practice, practice, practice.
Dr. Mike Patrick: But then if they're in danger of harming themselves or each other, or objects or property in the house, then you may need to intervene.
Dr. Ariana Hoet: Yes. And in those cases, again, as I've mentioned earlier, think about what reinforces behaviors. And thinking of if it did get too disruptive, someone's getting hurt, we may have to give a consequence. We take away that toy, we have a timeout from each other, and just making sure that they learn this is not acceptable behavior.
Dr. Mike Patrick: As we think about acceptable behavior and consequences, and just ways of dealing with behavior that we may not like, so for some people it may be just distracting them and you're okay with that. Others, you may want more concrete rules and if you break this rule, this is the consequence.
So, houses even can sort of deal with these things in a little bit of a different way. And then when we add daycare or going to the babysitters, they may be handled in a completely different way there.
How can parents best juggle their kids being in more than one supervised environment where maybe the rules are a little different?
Dr. Ariana Hoet: Yeah, it's an excellent question, because do need that consistency. And so, talking to the daycare providers, a lot of them will often ask you for their routines in writing. My daycare has asked me, when she's upset, how does she calm down? How can we support her?
And so, allowing that communication between the childcare provider and the caregiver to talk about the routines, how do we implement consequences, how do we help calm down, that's really important to make sure everyone's on the same page.
And I would say the reverse sometimes in therapy, I hear families tell me, Oh, they're perfect at daycare, but then at home, they're not." And so, we've talked about how we implement the daycare routine, in the home. How do we replicate school at home?
Dr. Mike Patrick: And that may be tough too because kids are more comfortable around their parents, right? So that filter for going ahead and doing the bad behavior because you may know, it's not quite right. And so, when you're with strangers, you may be able to hold on to that but not when you're at home. What do you do in that case?
Dr. Ariana Hoet: Yeah, and there's peer influence, too.
Dr. Mike Patrick: Like all my friends are behaving so maybe I should behave, too. So how do you, I don't want to say get rid of that familiarity at home? How can you make kids take the rules seriously at home, with the same amount of seriousness that they do in daycare? I guess picking the right consequences.
Dr. Ariana Hoet: Yeah, its consistency, right? I always want to remind parents to validate the emotion that it's okay to feel angry, it's not okay to throw that toy. And so, we're supporting that they continue to feel safe at home, and to be themselves at home, while also being consistent with consequences that do matter to them.
Dr. Mike Patrick: And then, how should parents respond when the daycare comes to them and says, "Hey, your kid's been acting up." They have been involved in behavior that we don't condone. How do you deal with that in your kid? Because a lot of parents are surprised, that they're child may be Little Billy, right?
Dr. Ariana Hoet: Right, right. Yeah, if the child at home is not around ten other kids, their behavior is going different at daycare than it is at home. So, it can be surprising.
And I think that's where communication is key. For me, I want to know what's happening before that behavior, what's happening after, how are we responding?
I recently had an incident where my daughter was biting at daycare. and I've never seen that at home. So, I asked the teachers what's happening right after. And they were putting her in her own little space, giving her a little toy to play with. Then I say, "Well, that's actually reinforcing the behavior. And now, she gets her own alone time and her own toy."
And so, I told them, as a parent, it is okay for me, if you take all the toys away, take all the kids away, and say biting is not okay. And you give her kind of a timeout from attention and fun, and she's going to cry, and I'm okay with that. So, it does take that communication between the caregiver and the daycare to figure out what the consequences and saying it's okay for you to do that.
Dr. Mike Patrick: And we have to think about the consequences, whether this is something that they would like to do or not. Because otherwise, it's like who can I bite next, so I can get my…
Dr. Ariana Hoet: Then I get my own toy.
Dr. Mike Patrick: I mean that's smart, right?
Dr. Ariana Hoet: Yeah, great.
Dr. Mike Patrick: Now, what about when the opposite is true, when maybe your child is getting bitten? Now, it's only a matter of, "Hey, this is not appropriate behavior" but like how then do we assimilate the child back into the room and sort of get everybody trusting one another again?
Dr. Ariana Hoet: It's again that communication, right? Figuring out what's going on, is there certain moments that are leading to that confrontation between the kids? How can we prevent it?
And then, one thing that's important is continuing to expose the child to those environments, right? You mentioned how do we get them back into that environment,
And talking to the little one. So yep, that happened, and we talked to the teacher, we're going to find ways to make it better so that that doesn't happen again. And continuing to take them to the daycare and encourage those pro-social behaviors.
Dr. Mike Patrick: At what age can you talk about what happened? So, a child who did get bitten may have a lot of feelings about what happened and maybe why that happened. And not only now maybe fearful, but wondering like are they a good person, or a bad person? Do you know what I mean?
Dr. Ariana Hoet: Yeah.
Dr. Mike Patrick: So, what age could you start talking through feelings with young kids?
Dr. Ariana Hoet: It's hard because they understand a lot more than they can express to us. And so, I would say start talking about it right away.
But at first, they may not be able to share back, so we more of the behavior, right? Maybe they come home and they're extra sad, they're crying a lot or they're not listening. And so, that tells us today was hard at daycare, that that incident did upset them. And so, just talking to the child through it and helping them regulate distractions.
But as they get older, and they have language, they can tell you a little bit of "I'm sad" or "I'm angry" and being able to let them express their emotion, validate the emotion.
And then problem solve, how can you respond next time? How do you say, "Don't touch me", "Don't bite me.”? Teach those assertiveness skills from a very young age.
Dr. Mike Patrick: Seems like it would be an important thing for all of us to talk about our feelings more within the context of the safe space of the family, to be able to explain how you're feeling and talk through that. And part of that is also parents being in touch with their feelings and being able to share their feelings with their kids. And then, your kids will pick up on that and hopefully start sharing their feelings back once they have the language.
Dr. Ariana Hoet: Absolutely. I think parents often feel like I should hide those things. I need to protect them but then that sends the message to kids that it's not okay to feel certain emotions. So instead talking about them is really good.
Dr. Mike Patrick: Now, obviously, if you're feeling sad as a parent all the time, maybe need to get professional help, it's not something do you want to be talking 24/7 with your kids, but it's a part of that everything in moderation and being transparent with one another.
Let's move on from playtime. I mentioned that we're also going to talk about mealtime, sleep time and potty time.
And Dr. Jiner, let's start with mealtime. Toddlers can certainly be picky eaters. What are some ways that we can encourage them to try more things?
Dr. Kristina Jiner: Absolutely, toddlers, they're exploring their world and now there's more foods to try. And one day, they may love a food and the next day they may want nothing to do with it.
And so again, like you said, how do we help support that? A couple recommendations is making mealtime enjoyable. So, a family sitting around together, eating the same foods, and role modelling, "Hey I'm going to try this carrot" or "I see big sister trying a carrot, maybe I'll try a carrot, too."
Offering a child, a safe food, a food that they're more than likely to eat, but other new things on the plate as well. Making the food fun, so fun shapes, triangles or stars, or moon shapes, so a child can pick them up pretty easily. Kids love to eat with their hands, so encouraging that as much as possible.
Giving them things to dip into, so kids love to dip, whether it's ketchup, whether it is sour cream, yogurt. Giving them some options and allowing them to play with food.
So sometimes we're taught like, "No, no, don't let kids play with their food" but this is how they explore. So, it's okay if they put the food to their lips, if they lick it, but then put it back on the plate. Or if they put it in their mouth and spit it out. They're exploring.
And research has shown that it can take many many many tries of a new food before child can be like, "Yeah, I like that. I'll eat that again."
So, I think again, trying to make mealtime as pleasant as possible. So, we don't get into power struggles. I always say, parents decide what there is to eat, and children decides if they're going to eat it or not.
And just being consistent, you may have to try those green beans multiple times before they'll even acknowledge that's it on their plate.
Dr. Kristina Jiner: And that's okay. That's okay.
Dr. Mike Patrick: It seems like you want to be there for your kid at mealtime to make sure they're not going to choke, that they're being safe. But other than that, you might want to put blinders on because I can just imagine like watching a kid make a mess out of their meal when maybe you worked hard to put it together.
And you're proud of this meal and you want a nutritionally complete dining experience for your child. And they're throwing it on the floor. But you may just need to ignore that little bit, right? Distract yourself with the other grownups on the table and just turn the other cheek.
Dr. Kristina Jiner: Exactly yeah. Enjoy yourself, have conversations that isn't about food. Mealtime shouldn't be stressful for the child. It shouldn't be stressful for caregivers either, so enjoy yourself.
Dr. Mike Patrick: You just have to get the older kids to clean up.
Dr. Kristina Jiner: Yes.
Dr. Mike Patrick: That makes it easier.
Toddlers often are also slim eaters. When I did primary care pediatrics, this is something that I've heard almost on a daily basis. You'd have toddlers come in and they don't eat like they used to eat.
And I would always show parents the growth chart, and say, "Look, when they're babies, you look at the curve is going straight up, they're really growing. And then when you hit two, things start leveling off until school age."
And so, that toddler years are not growing anything like they were when they were little babies. And we eat to grow. And so, of course, your appetite is going to be less if you're not growing as much.
So, I would always reinforce, "Let's look at the growth chart. And if they're where they are supposed to be on the growth chart, then they're eating the right amount."
When should parents worry, that maybe their kids aren't eating enough, or they aren't eating enough of a variety of foods?
Dr. Kristina Jiner: That's a great question, one thing I think is to kind of look at the big picture, right? So maybe lunch today doesn't go well, but what's eating like over a week's time?
So, is the child eating something? You certainly worry if children stop eating altogether or if they're refusing to drink, or if there's other signs that something's going on. So, they're not acting like themselves. They're vomiting, diarrhea constantly. Those are reasons to get them, of course, to the doctor.
But like you said, if the growth curve looks good, that's reassuring. And I think that can help parents take a deep breath.
I think the other thing too is, remember, their portion size is going to be a whole lot smaller than it is for even a school-aged child. So, a couple of tablespoons could be a serving of vegetables. And so, not like the cup size of vegetable that an adult might put in their plate.
And so, each little bit counts. And so, every bite counts but I think really working with your healthcare provider to know where is my child from a health standpoint?
Dr. Mike Patrick: Yeah, and that's an easy thing to do, because they have that growth chart right there on the screen, that they can pull it up and show you, and then give you hopefully some reassurance. Or let you know, "Yeah, we do need to get extra help."
And there are feeding clinics for kids who may have aversions to certain textures. And there's very small number of foods that a particular kiddo eat for one reason or another. And it can be a problem if they're not getting all the food groups in.
So definitely keep in touch with your child's doctor, for sure. Now, you had mentioned the parent’s job is to pick which foods, and the child's job is to pick kind of how much and when. So, what do you do when a kid refuses to eat, especially at mealtime, like time and time again?
Dr. Kristina Jiner: So, I think one of the things too is we don't want to get into a power struggle about that. And so, we do want children to learn to listen to their bodies. And so, it's within reason, of course, to say, "You're listening to your body, you're not hungry right now. Okay, mealtime's over."
Now, if the child reappears five minutes later and wants a cookie, that's a little different. We can offer the foods that were offered at the meal before. So, we don't have to say, "Okay, well, if you don't eat now, but five minutes later you can come back for a snack of a cookie or ice cream," or something like that.
I think again just being consistent about mealtime. So, kids thrive on consistency. And so, "This is the time to eat. This is the time to sit down."
Again, just involving kids with food. Like I said, they like to play. So, maybe having them help prepare meals or help pick out foods at the grocery store that they're interested in. Of course, they may not eat any of it at mealtime, but they're getting involved.
And then I think the other thing too is to remember, there's no good foods, there's no bad foods. So, food is food. And like you said, we eat to grow, so modelling that for kids as well, too.
And then, making sure not to use food as a reward or a punishment, because kids will really pick up on that, and see that "Oh, I did something nice, then here comes a cookie for me. And so now, I'm going to hold out for the cookies" or things like that.
So, I think again, following up for your primary care provider. If a child's growing well, then we know, even though it may not look like it on the surface, that they're eating well.
And it's hard, it's frustrating, of course especially after you've prepared a very nice meal, but to remember that they're listening to their bodies, and we definitely want to encourage that.
Dr. Mike Patrick: Listening to their bodies, then they may not be hungry at dinnertime, especially if they had a big snack in the afternoon. And a lot of parents, you don't think of juice as being a big snack. But it actually is full of sugar, and it really satisfies your body's hunger.
And so, you may not be hungry at dinnertime if you had a big glass of juice in the middle of the afternoon. So just kind of keep in mind what your kids are eating during the day. And I love what you said about even if they come along half hour later or even an hour later, it's probably okay to warm up that meal, right?
Dr. Kristina Jiner: Absolutely.
Dr. Mike Patrick: "You're not getting the cookie when you didn't touch your dinner at all." That's how it was in my house.
Let's move on to potty training. This one is really a question that a lot of parents have. When do you start? How do you know when to start potty training?
Dr. Kristina Jiner: A couple things to kind of keep in mind is the child has to be ready. And when we say ready, that's ready from a variety of standpoints.
So, one, physically ready. So can a child pull off their pants, for example. Kind of elastic band of, we don't expect buttons or anything like that. Can a child physically walk to the potty?
If they're not walking, if they're not able to do those things quite yet, then they're not quite ready. Everything is just physiologically, right? The body is really not ready until you can get to about 12 to 18 months. You have to be able to stop urinating, in order to make it to the potty. And so, if your body's not ready to do that yet, potty training isn't going to be successful.
And also, you want a child who is ready, who is interested. If you get out a potty and the child wants nothing to do with it, you talk about using the potty and the child screams, runs into the next room, probably not ready. And yes, you could try, but it's going to be really challenging for you as well as for the child, versus a child who you put a play potty out, their animals are pottying, they're sitting on the potty clothed or otherwise and really shows an interest.
And they're like, "Hey, I want to do this," or "I have a wet diaper, I don't want this on anymore." So really looking for those clues.
So, every child's different, of course, but usually after about two, closer to three, where you start to see that all the stars align, if you will, and then they're ready to go.
Dr. Mike Patrick: So, when they start talking about it, when they're asking to be changed, when they're showing interest, usually at that point, they're physically ready, usually. So that can give you an idea.
And when you said make mealtimes fun, potty time can also be fun in many ways. There are books about potty training. And you know how kids like to read the same book over and over and over, you know what I'm talking about.
Reading and having a character who is learning how to go to the potty, maybe someone that your child can identify with. And they want to hear that story over and over again. And there are books out there.
And then, of course, one of my favorite all-time children's books is the "Poop Book." have you seen that one? Like "All Things Poop" or "Everybody Poops," oh, that is a wonderful book. One-humped camels make a one-hump poop, right?
Dr. Mike Patrick: I can still like picture it.
So, there are a lot of fun things, and then of course positive reinforcement stuff like sticker charts. And a reward system can always be motivating and fun. But we also want to be careful not to punish failure because that could make things more difficult, right?
Dr. Kristina Jiner: Absolutely. So, again, it's a learning process. And just like any of us are learning, there will be some good days and there will be days that aren't so good.
And so, children, they're people pleasers. They want their caregivers to be proud of them, to be happy with them. And so, we don't want to develop that shame.
So, one thing you could say to a child who may be just had an accident is, "I know you're trying, and I know this can be challenging sometimes. And I know you can do it. We're going to get you cleaned up and go about your day."
That's, of course, easier to do the first time it happens. Not so easy the tenth or twelfth time it happens in the same day. But remember, the child's learning. And so, the more calm we can remain and not punishing, not being punitive, the more likely the child's going to be successful.
Dr. Mike Patrick: Is there ever a time when you're like, we just need to take a step back from this and we'll try it again in a couple months?
Dr. Kristina Jiner: Absolutely, so I always think too, not only does the child need to be ready, but life needs to be ready. So, if a new sibling just came into the home, that's probably not a great time.
Maybe there's a new job, a parent is stressed with that, maybe not the greatest time. Or a family member gets ill. And it's okay to take a pause.
The vast majority of children are potty trained. I've heard it's said children don't go to college in diapers. So, you'll get there, it will happen. And so, it's okay to take a break if you need to. It doesn't mean that you've done something wrong or the child's done something wrong.
Dr. Mike Patrick: Yeah, maybe you just weren't ready yet. Yeah, that makes sense.
Let's move on to bedtime, which can actually also be quite a struggle and a battle of wills sometimes. What are some good bedtime routines that will lead to success at kids staying in bed?
Dr. Kristina Jiner: Much like eating and toilet training, this can be a bit of a challenge. So, I think one thing is again, having that routine.
We recommend, this is for children of all ages, of course, to turn those electronics off an hour before bed, and not have electronics in the room if at all possible.
And then, having your routine, whether it's a bath and PJ's, brushing teeth and story, or whatever that routine is.
Giving your child choices like we talked about, "So do you want to wear the blue pajamas today or the green ones?" "Do we brush our teeth first?" "Do we put our PJs on first?" "We've got three books, which book should we start with first?"
So, giving as much control as you can. Making sure that a child has perhaps something that is very special to them, whether it's a stuffed animal or a blanket, that can provide a lot of security when the caregiver leaves the room. Helping to make sure that is a night light necessary? Does the child prefer the door to be open versus shut? Those are all things that can set the child up to be successful.
Dr. Mike Patrick: Yeah so, really important because if they're playing, and having a great time, and there's a lot of energy and activity going on, and all of a sudden boom, its bedtime, that's probably not going to work out well.
Dr. Kristina Jiner: No. So definitely having that kind of wind-down time, which it may not be, especially for busy families, bedtimes not probably going to happen in under five minutes. And so, allowing yourself that time that they do need to be successful.
Dr. Mike Patrick: And you need that wind-down time, but it also helps if there's a period of pretty good activity before the wind-down time starts. So not right before bed, but after dinner, having a little action might help wear them out a little bit.
Dr. Kristina Jiner: Absolutely, yep. Plenty of physical activity will help.
Dr. Mike Patrick: What about how much sleep do toddlers need? We always hear seven to eight hours of sleep for adults. What about toddlers?
Dr. Kristina Jiner: So, from one to two years of age, they really need anywhere between 11 to-14 hours. And of course, that includes naps. By that time, closer to two, they will definitely be down to one nap a day. Even that might be two or three hours.
And certainly, if you're noticing problems getting them to sleep on time, may be that nap's too late in the day or it's too long. Your child will let you know. But definitely they need more sleep.
And so, we know that overtired children will have a hard time getting to bed. And so sometimes, if a child's too tired and it's just frustrating every night, you actually need an earlier bedtime, rather than a later one.
Dr. Mike Patrick: And not enough can make you cranky. And so, some toddler behavioral problems might in and of themselves be fixed by getting more sleep.
Dr. Kristina Jiner: Oh yes, I think that's true for all of us, regardless of age.
Dr. Mike Patrick: Absolutely. And the other thing I want to really point out for folks, you mentioned that naps count. So, when we say that young kids need 11 to 14 hours of sleep, that's in a 24-hour period, not necessarily just overnight. Really important to remember.
And then, what about those troubled kids who, you get them off the bed and they're in a toddler bed now, and they know how to open doors. And you're ready for adult time, and your kid keeps coming down. How do you get them to stay in bed?
Dr. Kristina Jiner: Yeah, that's also a challenge. So, one is trying to kind of anticipate reasons that they might have a valid reason to get out of bed. Do they need to use the potty? Do they need a drink of water?
Are they full? Some children depending on what time dinner was, maybe they're hungry. And so, kind of a rich, protein, or healthy fat snack before bed can help keep them full.
Addressing things like anxiety, some kiddos that we know fear can show up in this age and show up in a variety of ways. And so, sometimes you might need to be looking for monsters under the bed or behind the closet, making sure we have lights that the child can see.
And then, if you kind of address all of that, and now you just have a kiddo who's coming out. We don't want to give it too much attention. So oftentimes, just walking the child back to bed. Again, not having a conversation. Not letting them know that like "Oh, hey, if you come out, Mom's going to talk with you and play with you."
Don't worry and get your child back into bed and will continue to do this. Over time, the kid learns like, "Yeah, nothing fun happens, and parents aren't doing anything fun either, so might as well stay put."
You can do things certainly as kids get a little bit older like a bedtime pass, where you say, "Okay, here's your ticket, you get one trip out. And if you still have any unused ticket or if you have a ticket left over, then let's just move forward the next day." Can be helpful. Usually, that's much of an older child.
Dr. Mike Patrick: Yeah, absolutely. My daughter, it's funny how kids can be so different one to the other. My son even during the toddler years, you'd lay down, he go to sleep.
My daughter, she's just going to miss everything. And so, she's got to come up and see what's going on. And we did a sticker chart for her that worked pretty well.
And it was one of those, you got two strikes before you're out. So, you're allowed to come out twice, but the third time that's three strikes. And so then, you wouldn't get to put a sticker on in the morning. And so, it's like how did the night before going?
I don't know if you remember the poly pocket sets. And there was one, like this mega set that we found on sale. It had like a ton of little houses and stuff.
And so, we would say, "You get ten stickers. And then you can take just one, not the whole package, but like pick one house." And that lasted us for like, I don't know, probably six months, just on this one poly pocket set. And things went pretty well. And then I think in college, she slept fine.
M: With her poly pockets.
All right, so many ways in which toddlers keep us busy, right? And because when you think about playtime, mealtime, sleep time, potty time, that's like all the time, right? With toddlers.
My hat goes off to parents and I think that's why younger parents have toddlers than older parents. For the folks who have more than one toddler at home, that really has to be a lot of work, as you can imagine.
Dr. Kristina Jiner: I guess.
Dr. Mike Patrick: Yes, absolutely. All right, well, thank you both again so much for stopping by and talking with us today.
I do want to remind folks about Behavioral Health Services here at Nationwide Children's, because we've got the quite the developed program, right?
Dr. Kristina Jiner: We do. We have a full kind of continuum of care. Everything from crisis emergency care and our psychiatric crisis department, to traditional outpatient setting, whether that be therapy or psychiatry, with medication management, to additional programs for those who might need a higher level of care, whether that's an intensive outpatient program, or partial hospitalization program.
And then, at the highest level is our in-patient psychiatry for those who need it.
We are involved in most of our medical clinics as well, providing support, as well as providing support out in the community. And so definitely a wide variety of options.
Dr. Mike Patrick: Perfect. We'll put a link to Big Lots Behavioral Health Services in the show notes, if folks are interested in learning more about the program. Also, our Psychiatric Crisis Department here at Nationwide's Children's, we'll put a link to that in the show notes as well.
And then, Ariana, tell us about On Our Sleeves, the movement for children's mental health. What is that all about?
Dr. Ariana Hoet: Sure, so we are all about the promotion of mental health and wellness. So, we do that by giving any adult with a child in their life the tools and strategies that they may need to support that child's mental health, just how we promote physical health by eating healthy and exercising. We want adults to know what are the tools that they need for kids to be mentally well.
And so, all of our resources are created with the experts at Nationwide's Children's Behavioral Health Department, and all based on science and what we know works for children's mental health.
Dr. Mike Patrick: And we'll put a link to On Our Sleeves, the landing site for that program in the show notes as well, so that folks can find that easily.
And we'll also put a link to the Behavioral Health playlist that we had talked about on SoundCloud and then the Power of Play in Childhood, PediaCast 519. I think that would be a good supplement to this program, if you've not listened to that particular episode before.
All right, well on that note, Dr. Kristina Jiner and Dr. Ariana Hoet, thank you both so much for stopping by today.
Dr. Kristina Jiner: Thank you, my pleasure.
Dr. Ariana Hoet: Thank you for having us.
Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
Also, thanks to our guests this week, Dr. Kristina Jiner and Dr. Ariana Hoet, both with Nationwide Children's Hospital, really appreciate them stopping by today as well.
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Thanks 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.
Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.