Four Basic Guidelines about Toilet Training

• Relax.Toilet training is often the first task that parents take a strong stand on. Sure, it is important to you, but adding tension and pressure to the process will not make it any easier for you or your child, and may make it worse. Remember, unlike eating, sleeping, and playing, there is no natural, immediate payoff for your child when he or she uses the toilet. Your child may not always cooperate with you during toilet training, but your tension will just make things worse. You know your child eventually will learn to use the toilet, so don’t make it a contest of wills. Be calm and patient, and allow your child some time to get the idea.
• Wait.Most children are toilet trained when they are 2, 3, or 4 years old. A few children are ready earlier, but just to be on the safe side, wait until your child is at least 2 years old.
• Make sure you are ready.As a parent you need to make sure you are ready to invest the time and effort in toilet-training your child before you start. The process can be slow and long drawn. Have the grandparents and any other care-giver let up on their pressure about toilet training. Remember, toilet training need not be a community affair. Has the crisis at work passed? Is the household relatively stable now, and will it continue to be so for a few weeks? Having other parts of your life running smoothly will help ease the chore of toilet training.
• Make sure your child is ready.If you are really ready to toilet train, see if your child is ready. Parents and others (grandma, aunt, friends) sometimes push toilet training before there are clear signs that the child is ready. Your child is not ready:
  • Just because he’s told you he wants to wear “big boy” pants.
  • Just because she wants the Big Wheel you promised as a reward.
  • Just because he or she has had some dry days playing on the potty chair. (Many children do this around 18 months of age.)

What Is Readiness?

Age: Your child should be at least 20 months old and preferably 2 years old or older.

Physical readiness: Your child should be able to pick up objects, lower and raise his or her pants, and walk from room to room easily.

Bladder readiness: Your child should already be staying dry for several hours at a time, urinating about four to six times a day, and completely emptying his or her bladder. If your child is still wetting a small amount frequently (7 to 10 times a day), you should wait.

Language readiness: Your child should understand your toileting words, words like “wet,” “dry,” “pants,” and “bathroom.” If your child does not understand what you are talking about, you should wait.

Instructional readiness: Your child should be able to understand simple instructions, such as “Come here, please” and “Sit down.” Just as important, your child should be following the reasonable instructions you give. If your child opposes you much of the time and has frequent temper tantrums, you will probably have problems with toilet training.

Bladder and bowel awareness: Your child may indicate that he or she is aware of the need to void or eliminate. Children usually indicate this awareness not through words but through actions – making a face, assuming a special posture like squatting, or going to a certain location when they feel the urge to urinate or defecate. This may be a positive sign that your child is ready to begin toilet training.

Getting Your Child Ready

You can take some steps now that will help your child when, at some time in the future, you begin toilet training.

Let your child watch you. Your child can learn a lot about how to use the toilet correctly by watching a parent. Frequently let your child come with you when you go to the bathroom. Use simple words to explain what you are doing (for example, “Mommy is going pee-pee in the potty.”).

Teach your child to raise and lower his or her pants. You can do this gradually when you are dressing or undressing your child. With your daughter, for example, you can first pull down her pants with little or no help from her. Then, do less pulling and let her do more. This process may take many weeks, but it is worthwhile. Later, when you begin toilet training, you will be glad that your child already knows how to pull down his or her pants and that you don’t have to tackle that learning task in addition to toilet training.

Help your child learn to follow your instructions. Make sure you have your child’s attention when you give an instruction. Immediately praise your child if he or she does what you ask. If your child does not follow your instruction right away, gently guide him or her through what should be done, and do not give another instruction until the first one has been followed. If your child starts to cry, ignore the crying. When your child has calmed down, repeat your instruction. If you often have trouble getting your child to follow your instructions, ask your health care provider for guidelines on managing your child’s behavior.

Set out a potty chair. A few weeks, or even months, before you think you will start toilet training, make a potty chair available to your child so that he or she can get used to it. Put it in the bathroom or in another room so your child has a chance to investigate it. Let your child get used to sitting on it, with clothes on. Encourage your son to sit on the potty (instead of standing in front of it) so that he will be used to sitting when you start toilet training. (Later on, when he is well past being toilet trained, he can stand.)

Praise your child. Every time your child does something the right way, be sure to let him or her know. Praise your child with words that are brief and to the point, such as “You did a good job pulling down your pants.” Or, give your child a smile, a hug, or a kiss. This attention is how you teach your child what behavior pleases you.

Summary

Just remember the things you can do before beginning to potty train:

• Frequently let your child watch you go to the bathroom.
• Teach your child to raise and lower his or her pants.
• Teach your child to follow your instructions.
• Make sure you are ready before you try to toilet train your child.
• Make sure your child is ready.
• Wait until your child is at least 2 years old.
• Set out a potty chair so your child can get used to it.
• Relax.
• Praise your child every time he or she does any part of toileting behavior correctly.

What is time-out?

Time-out is a way of disciplining your child for misbehavior without raising your hand or your voice. Time-out involves removing your child from those things they seem to enjoy, for a small amount of time, immediately
following misbehavior. Time-out for children is similar to penalties used for hockey players. When a hockey player has misbehaved on the ice, he is required to go to the penalty area for two minutes. The referee does not scream at, threaten, or hit the player. He merely blows the whistle and points to the penalty area. During the penalty time, the player is not allowed to play, only watch. Time-out bothers hockey players because they would rather play hockey than watch. Keep this hockey comparison in mind when using time-out for your child. Children usually do not like time-out because they would rather play than watch other kids play. So when you use time-out in response to a misbehavior, remove your child from whatever he or she is doing and have him or her sit down.

Where should the time-out area be located?

You do not have to use the same location each time. Just make sure the location is convenient for you. For example, using a downstairs chair is inconvenient when the problem behavior occurs upstairs. An adult-sized chair works best, but a step, footstool, bench, or couch will also work. Make sure the area is well-lit and free from all dangerous objects. Also make sure your child cannot watch TV or play with toys while in the time-out area.

How long should time-out last?

The upper limit should be one quiet minute for every year your child has been alive. So if you have a 2-year-old, aim for two quiet minutes. Keep in mind, children do not like time-out, and they can be very public with their opinion. So it may take some time to get those two minutes. This is especially true in the beginning when children do not know the rules and still cannot believe you are doing this to them. For some reason, the calmer you remain, the more upset they are likely to become. This is all part of the process. Discipline works best when you administer it calmly.

So, do not begin the time until your child is calm and quiet. If your child is crying or throwing a tantrum, it does not count toward the required time. If you start the time because your child is quiet but he or she starts to cry or tantrum, wait until your child is quiet again and then start the time over. Do not let your child leave time-out unless he or she is calm; your child must remain seated and be quiet to get out of time-out. Some programs suggest using timers. Timers can be helpful but are not necessary. If you use one, remember the timer is to remind parents that time-out is over, not children.

What counts as quiet time?

Generally, quiet time occurs when your child is not angry or upset, and is not yelling or crying. You must decide when your child is calm and quiet. Some children get perfectly still and quiet while in their time-out. Other children find it hard to sit still and not talk. Fidgeting and “happy talk” should usually count as being calm and quiet. For example, if your son sings or talks softly to himself, that counts as quiet time. Some children do what we call “dieseling,” which is the quiet sniffling that usually follows a tantrum. Since a “dieseling” child is usually trying to stop crying but cannot find the off switch, this also should be counted as quiet time.

What if the child leaves the chair before time is up?

Say nothing! Calmly (and physically) return your child to the chair. For children who are 2 to 4 years old, unscheduled departures from the chair are a chronic problem early in the time-out process. Stay calm and keep returning the child to the chair. If you tire or become angry, invite your spouse (or any adult who is nearby) to assist you as a tag-team partner. If you are alone and become overly tired or angry, retreat with honor. But when help arrives or when your strength returns, set the stage for another time-out.

What if my child misbehaves in the chair?

Say nothing and ignore everything that is not dangerous to the child, yourself, and the furniture. Most of your child’s behavior in the chair is an attempt to get you to react and say something, anything. So expect the unexpected, especially if you are a nagger, screamer, explainer, warner, reasoner, or just a talker. And I mean the unexpected. They may spit up, wet, blow their nose on their clothes (you may be tempted to say “Yecch” but…do not), strip, throw things, make unkind comments about your parenting skills, or simply say they do not love you anymore. Do not worry. They will love you again when their time is up, believe me.

When should I use time-out?

When you first start, use it for only one or two problem behaviors. After your child has learned to “do” time-out, you can expand the list of problem behaviors. In general, problem behaviors fall into three categories:

• Anything dangerous to self or others;
• Defiance and/or noncompliance; and
• Obnoxious or bothersome behavior.

Use time-out for “1” and “2” and ignore anything in category “3.” If you cannot ignore something, move it into category “2” by issuing a command (e.g., “Take the goldfish out of the toilet.”). Then if the child does not comply, you can use time-out for noncompliance. Be sure to use time-out as consistently as possible. For example, try to place your child in time-out each time a targeted behavior occurs. I realize you cannot be 100 percent consistent because it is in our nature to adapt. But be as consistent as you can.

In general, immediately following a problem behavior, tell your child what he or she did and take him or her to time-out. (With older children, send them to time-out.) For example, you might say, “No hitting. Go to timeout.” Say this calmly and only once. Do not reason or give long explanations to your child. If your child does not go willingly, take him or her to time-out, using as little force as needed. For example, hold your daughter gently by the hand or wrist and walk to the time-out area. Or, carry her facing away from you (so that she does not confuse a hug and a trip to time-out). As I suggested earlier, avoid giving your child a lot of attention while he or she is being put in time-out. Do not argue with, threaten, or spank your child. And what should you say? Hint: Starts with “No”’ and ends with “thing.” Answer: Say nothing!

What do I do when time is up?

When the time-out period is over, ask your child, “Are you ready to get up?” Your child must answer yes in some way (or nod yes) before you give permission for him or her to get up. Do not talk about why the child went into time-out, how the child behaved while in time-out, or how you want your child to behave in the future. In other words, do not nag. If your child says “No,” answers in an angry tone of voice, or will not answer all, start time-out over again. If your child chooses to stay in the chair, fine. It is hard to cause real trouble in time-out.

What do I do when my child leaves the chair?

If you placed your child in time-out for not doing what you told him or her to do, repeat the instruction. This will help teach your child you mean business. It also gives your child a chance to behave in a way that is good for business. If he or she still does not obey the instruction, then place him or her in time-out again. In addition, add in a few other easy-to-follow, one-step commands. If he or she does them, praise the performance. If not, back to time-out. Generally, use this opportunity to train your child to follow your instructions when those instructions are delivered in a normal tone of voice without being repeated.

The general rule for ending time-out is to praise a good behavior. Once time-out is over, reward your child for the kinds of behaviors you want him or her to use. Catch them being good.

Should I explain the rules of time-out to my child?

Before using time-out, you should explain the rules to your child once. At a time when your child is not misbehaving, explain what time-out is (simply), which problem behaviors time-out will be used for, and how long time-out will last. Practice using time-out with your child before using the procedure. While practicing, remind your child you are “pretending” this time. They will still go “ballistic” when you do your first real time-outs,but you will be reassured that you have done your part to explain the fine print.

Summary

• Choose time-out areas.
• Explain time-out.
• Use time-out every time the problem behaviors occur.
• Be specific and brief when you explain why your child must go to time-out.
• Do not talk to or look at your child during time-out.
• If your child gets up from the chair, return him or her to the chair with no talking.
• Your child must be calm and quiet to leave time-out once time is up.
• Your child must answer yes politely when you ask, “Would you like to get up?”
• If you wanted your child to follow an instruction, give him or her another chance after time-out is over. And, in general, deliver a few other easy-to-follow commands so your child clearly learns who is in charge and who is not.
• Catch them being good.

Family is the most important influence in a child’s life, but television is not far behind. Television can inform, entertain, and teach us. However, some of what TV teaches may not be the things you want your child to learn. TV programs and commercials often show violence, alcohol or drug use, and sexual content that may not be suitable for children or teens.
Studies show that TV viewing may lead to more aggressive behavior and less physical activity. By knowing how television affects your children and by setting limits, you can help make your child’s TV-watching experience not only enjoyable, but healthy too.

How TV affects your child

There are many ways that television affects your child’s life. When your child sits down to watch TV, consider the following:

10 things parents can do

As a parent, there are many ways you can help your child develop positive viewing habits. The following tips may help:

1. Set limitsLimit your child’s use of TV, movies, and video and computer games to no more than 1 or 2 hours per day. Do not let your child watch TV while doing homework.
2. Plan your child’s viewingInstead of flipping through channels, use a program guide and the TV ratings to help you and your child choose shows. Turn the TV on to watch the program you chose and turn it off when the program is over.
3. Watch TV with your childWhenever possible, watch TV with your child and talk about what you see. If your child is very young, she may not be able to tell the difference between a show, a commercial, a cartoon, or real life. Explain that characters on TV are make-believe and not real. Some “reality-based” programs may appear to be “real,” but most of these shows focus on stories that will attract as many viewers as possible. Often these are stories about tragedy and violence. Much of their content is not appropriate for children. Young children may worry that what they see could happen to them or their family. News broadcasts also contain violent or inappropriate material. If your schedule prevents you from watching TV with your child, talk to her later about what she watched. Better yet, videotape the programs so that you can watch them with your child at a later time.
4. Find the right messageEven a poor program can turn out to be a learning experience if you help your child find the right message. Some television programs may portray people as stereotypes. Talk with your child about the real-life roles of women, the elderly, and people of other races that may not be shown on television. Discuss ways that people are different and ways that we are the same. Help your child learn tolerance for others. Remember, if you don’t agree with certain subject matter, you can either turn off the TV or explain why you object.
5. Help your child resist commercialsDon’t expect your child to be able to resist ads for toys, candy, snacks, cereal, drinks, or new TV programs without your help. When your child asks for products advertised on TV, explain that the purpose of commercials is to make people want things they may not need. Limit the number of commercials your child sees by watching public television stations (PBS). You can also tape programs and leave out the commercials or buy or rent children’s videos.
6. Look for quality children’s videosThere are many quality videos available for children that you can buy or rent. If you have questions about children’s videos or just want some suggestions, contact The Coalition for Quality Children’s Media at 505/989-8076 or visit their Web site at http://www.cqcm.org.
7. Give other optionsWatching TV can become a habit for your child. Help your child find other things to do with his time, such as the following:
   • Playing
   • Reading
   • Activities with family, friends, or neighbors
   • Learning a hobby, sport, instrument, or an art
8. Set a good exampleYou are the most important role model in your child’s life. Limiting your own TV viewing and choosing programs carefully will help your child do the same.
9. Express your viewsWhen you like or don’t like something you see on television, make yourself heard. Write to the TV station, network, or the program’s sponsor. Stations, networks, and sponsors pay attention to letters from the public. If you think a commercial is misleading, write down the product name, channel, and time you saw the commercial and describe your concerns. Call your local Better Business Bureau, or send the information to:

   Children’s Advertising Review Unit
   Council of Better Business Bureau
   845 Third Ave
   New York, NY 10022

   Encourage publishers of TV guides to print ratings and feature articles about shows that are educational for children.

10. Get more informationThe following people and places can provide you with more information about the proper role of TV in your child’s life:
    • Your pediatrician may have information about TV or can help you get it through the American Academy of Pediatrics. Ask for the AAP brochure Understanding the Impact of Media on Children and Teens
    • Public service groups publish newsletters that review programs and give tips on how to make TV a positive experience for you and your child. Check with your pediatrician.
    • Your local Parent/Teacher Association (PTA).
    • Parents of your child’s friends and classmates can also be helpful. Talk with other parents and agree to enforce similar rules about TV viewing.

The Children’s Television Act of 1990

The Children’s Television Act ensures that TV stations pay attention to the needs of children from age 2 to 16. Under this law, stations must air at least 3 hours of educational and informational shows for children each week. They must also limit advertising during children’s shows to 12 minutes per hour on weekdays and 10.5 minutes per hour on weekends.

TV stations that do not follow the law risk losing their licenses. The Federal Communications Commission (FCC) makes sure stations obey the law. For the law to be even more effective, keep tabs on TV stations in your community and report any violations to the FCC. If a station does not appear to be complying with the Children’s Television Act, inform the FCC by sending a written complaint to:

TV Parental Guidelines and the V-Chip

In 1996, Congress passed a law that gives parents the ability to control what their children watch on television. The law set up a rating system called the TV Parental Guidelines. The ratings can help parents avoid programs that contain sex and violence. By using a computer device called the v-chip, parents can block these programs from their televisions. Since the year 2000, all new television sets with screens 13 inches or larger have the v-chip.

The ratings apply to all TV programs except news and sports. They can sometimes be found in your local TV listings and appear for 15 seconds at the start of a program. The ratings are as follows:

This ratings system was created to help parents choose programs that are suitable for children, even without the use of the v-chip. Before watching, check your local TV listings to find out if a program contains violence, sexual content, or strong language. Remember that ratings are not used for news programs, which may show content that is not suitable for young children.

Also, TVs with screens smaller than 13 inches will not have the v-chip. So, if your child is allowed to watch TV alone, choose a set that is at least 13 inches so you can use the v-chip to block programs. Avoid putting a television in your child’s bedroom.

When used properly, television can inform, educate, and entertain you and your family. By taking an active role in your child’s viewing, you can help make watching TV a positive and healthy experience.

This information should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on the individual facts and circumstances.

© COPYRIGHT AMERICAN ACADEMY OF PEDIATRICS, ALL RIGHTS RESERVED. American Academy of Pediatrics, 141 Northwest Point Blvd., Elk Grove Village, IL, 60007, 847-434-4000

Resources for the Male Child

Here are a some suggestions of useful resources to help in parenting your young male child. These are only suggestions and are provided as additional tools for your consideration and should not be construed to mean our implicit or explicit endorsement of their content. Please use your parental discretion.

What’s Happening to My Body? Book for Boys: A Growing Up Guide for Parents and Sons

by Lynda Madaras

About this title: Written for pre-teens and teens (with a special introduction for their parents), this in an introduction to the physical and emotional changes most boys go through during puberty. Topic covered include body hair, acne, sexuality, and what happens to girls during puberty. Illustrations accompany the text.

My Body, My Self for Boys: The “What’s Happening to My Body?” Workbook

by Lynda Madaras, Area Madaras

About this title: This fact-filled and fun journal/activity book, inspired by thousands of letters from boys all over the world, encourages boys to address their concerns about puberty head on. Includes illustrations & quizzes.

What’s Going on Down There?: Answers to Questions Boys Find Hard to Ask

by Karen Gravelle, Ph.D.

About this title: Describes the physical and emotional changes that occur in boys (and, to a lesser extent, in girls) during puberty and discusses sexual activity, homosexuality, AIDS, and other related topics.

AMA Boy’s Guide to Becoming a Teen

by American Medical Association, Kate Gruenwald Pfeifer, Amy B. Middleman (Editor)

About this title: Becoming a teen is an important milestone in every boy’ s life. It’s even more important to get answers and advice to the most common health issues boys face from a trusted source. The “American Medical Association Boy’s Guide to Becoming a Teen” is filled with invaluable advice to get you ready for the changes you will experience during puberty. Learn about these important topics and more: Puberty and what kinds of physical and emotional changes you can expect— from your developing body to your feelings about girls The importance of eating the right foods and taking care of your body Pimples, acne, and how to properly care for your skin Your reproductive system— inside and out Thinking about relationships and dealing with new feelings.

The Teenage Guy’s Survival Guide: The Real Deal on Girls, Growing Up and Other Guy Stuff

by Jeremy Daldry

About this title: A humorous guide for boys ages ten to fourteen, offering advice on dating, sex, body changes, and social life.

The Guy Book: An Owner’s Manual: Maintenance, Safety, and Operating Instructions for Boys

by Mavis Jukes

About this title: A humorous yet informative look at the changes and pressures that adolescence brings into the lives of boys. Topics covered include hygiene, nutrition, personal relationships, and sex. Illustrations accompany the text.

From Boys to Men: All about Adolescence and You

by Michael Gurian, Daphne, Brian Floca (Illustrator)

About this title: Answers questions about the physical, emotional, sexual, and social changes that teenage boys undergo during adolescence.

Changes in You and Me: A Book about Puberty Mostly for Boys

by Paulette Bourgeois, Louise Phillips (Illustrator), Kam Yu (Illustrator)

About this title: As natural as puberty is, boys 10 to 13 are often confused and hesitant about the changes they can see and feel going on in their very own bodies. Changes in You and Me provides easy-to-understand information, colorful illustrations, and acetate overlays that lift the mystery to show the changes. Over 50 line drawings.

Puberty Boy

by Geoff Price

About this title: An invaluable source of information for growing boys, parents, and caregivers, this beautifully packaged guide offers pre-teen boys an appealing and fresh take on entering adolescence. Straightforward, conversational advice presents young boys with answers to the questions they may be too embarrassed to ask. This celebration of maturing bodies and spirits is invariably positive and provide factual information on acne, sexual development, body odor, and other physical changes. Also honestly detailed are the emotional changes that young boys encounter, as well as advice on interacting with girls. Complete with real-life stories from other boys and grown men, this book includes colorful photographs of real boys that create a sense of shared community, while instructional illustrations teach young boys about their changing bodies.

Fearfully and Wonderfully Made: A Christian Health and Puberty Guide for Preteen Boys and Girls

by Lori Stubbs, Robert Earl Stubbs (Illustrator)

About this title: A Health Guide for preteens stressing abstinence and Christian principles.

For Parents

Real Boys. Rescuing our Sons form the Myths of Boyhood.

by William Pollack

Helpful Websites

http://www.bbc.co.uk/science/humanbody/body/interactives/lifecycle/teenagers/

http://kidshealth.org/kid/grow/boy/boys_puberty.html

http://www.teengrowth.com/index.cfm?action=info_article&ID_article=1348&category=body&catdesc=Body&subdesc=Puberty

http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/adolescent/pam.html (for the parents)

Resources for the Female Child

Here are a some suggestions of useful resources to help in parenting your young female child. These are only suggestions and are provided as additional tools for your consideration and should not be construed to mean our implicit or explicit endorsement of their content. Please use your parental discretion.

Care & Keeping of You: The Body Book for Girls

by Valorie Lee Schaefer, Norm Bendell (Illustrator)

About this title: This guide to health and hygiene for preteen girls covers such subjects as acne, menstruation, bad breath, and developing healthy eating habits. Color illustrations accompany the text.

Growing Up: It’s a Girl Thing: Straight Talk about First Bras, First Periods, and Your Changing Body

by Mavis Jukes

About this title: A humorous yet informative look at the changes and pressures that adolescence brings into the lives of girls. Topics covered include getting your period, buying a bra, sexual orientation, sexually transmitted diseases, birth control, and dealing with an unplanned pregnancy. Also discussed are general health topics, eating disorders, sexual abuse, and advice on handling the temptations of drugs, smoking, and alcohol.

Ready, Set, Grow!: A What’s Happening to My Body? Book for Younger Girls

by L. Madaras

About this title: From the award-winning author of the best books on puberty comes this book written especially for girls who have a curiosity about their soon-to-be changing bodies.

American Medical Association Girl’s Guide to Becoming a Teen

by Kate Gruenwald Pfeifer, Amy B. Middleman (Editor)

About this title: Becoming a teen is an important milestone in every girl’ s life. It’s even more important to get answers and advice to the most common health issues girls face from a trusted source. The “American Medical Association Girl’s Guide to Becoming a Teen” is filled with invaluable advice to get you ready for the changes you will experience during puberty. Learn about these important topics and more: Puberty and what kinds of physical and emotional changes you can expect— from your developing body to your feelings about boys The importance of eating the right foods and taking care of your body Your reproductive system inside and out Starting your period— what it means and how to handle it Thinking about relationships and dealing with new feelings.

Growing and Changing: A Handbook for Preteens

by Kathy McCoy, Charles Wibbelsman, M.D.

About this title: For more than 15 years, “Growing and Changing” has been helping kids cope with the transformation from child to adult. This new edition of the popular guide provides authoritative answers to kids’ most frequently asked questions. Illustrations.

What’s happening to me? : The answers to some of the world’s most embarrassing questions.

by Peter Mayle, Arthur Robins

About this title: Discusses the mental and physical changes that take place during puberty.

Puberty Girl

by Shushann Movsessian

About this title: Offering a fun, sassy, and girl-power-inspired approach to understanding puberty, this beautifully packaged guide offers tweens an appealing and fresh take on entering adolescence. This celebration of maturing bodies and spirits is invariably positive, while providing factual information on menstruation, pubic hair, acne, eating disorders, and other issues essential to girls entering puberty. The emotional challenges of this stage are also addressed, including information on sexual abuse, bullying, maturation reluctance, and conflict resolution. With straightforward and conversational advice on everything from tampons to teasing, “Puberty Girl” is a trustworthy resource for girls seeking answers to embarrassing questions and looking for a way to embrace their new selves. Inspiring photographs of real girls create a sense of shared community, while instructional illustrations teach young girls about their changing bodies.

It’s Perfectly Normal: A Book about Changing Bodies, Growing Up, Sex, and Sexual Health

by Robie H. Harris

About this title: Providing accurate, unbiased answers to nearly every imaginable question, from conception and puberty to birth control and AIDS, “It’s Perfectly Normal” offers young people the information they need–now more than ever–to make responsible decisions and to stay healthy.

What’s Happening to My Body? Book for Girls: A Growing-Up Guide for Parents and Daughters

by Lynda Madaras, Area Madaras, Marcia Herman-Giddens (Foreword by)

About this title: Written for pre-teens and teens (with a special introduction for their parents), this in an introduction to the physical and emotional changes most girls go through during puberty. Topic covered includes body hair, acne, sexuality, and what happens to boys during puberty. Illustrations accompany the text.

Girl Stuff: A Survival Guide to Growing Up

by Margaret Blackstone, Elissa Haden Guest, Barbara Pollak (Illustrator)

About this title: Matter-of-fact yet friendly advice for girls. Topics covered include how to buy a bra, dealing with acne, and what to wear when you have your period. Also included is information on anatomy, sexual orientation, self-defense, and how to make good friends. Illustrated with drawings.

Helpful Websites

http://www.girlshealth.gov

www.kidshealth.org

http://www.lpch.org/DiseaseHealthInfo/HealthLibrary/adolescent/paf.html (for the parents)

http://www.teengrowth.com/index.cfm?action=info_article&ID_article=1346&category=body&catdesc=Body&subdesc=Breast

http://www.bbc.co.uk/science/humanbody/body/interactives/lifecycle/teenagers/

Male Circumcision

Male circumcision consists of the surgical removal of some, or all, of the foreskin (or prepuce) from the penis. It is one of the most common procedures performed all over the world. In the United States, the procedure is commonly performed during the newborn period.

Evaluation of current evidence indicates that the health benefits of newborn male circumcision outweigh the risks, and the benefits of newborn male circumcision justify access to this procedure for those families who choose it. However, parents should weigh the health benefits and risks in light of their own religious, cultural, and personal preferences, as the medical benefits alone may not outweigh these other considerations for individual families.

The three most common operative methods of circumcision for the newborn male include:

1. The Gomco clamp
2. The Plastibell device
3. The Mogen clamp

There are also other variations derived from the same principle on which each of these devices is based.

Care Of The Circumcised Penis

One of the first decisions you will make for your new baby boy is whether or not to have him circumcised.

Taking care of your son’s circumcision is usually very easy. After the procedure is performed, your pediatrician will instruct you on how to do this. If a Plastibell ring or device was used for the procedure, there is usually nothing to do. And generaly the device will come off after a few days.

However, if one of the other methods, Gomco or Morgan clamp, was used, you will need to apply a suitable lubricant regularly to the penis after circumcision. This is usually done with each diaper change, and a non-perfumed lubricant, such as Vaseline, should be sufficient.

Care Of The Uncircumcised Penis

If you have chosen not to have your son circumcised, there are some things you should be aware of and teach your son as he gets older.

What is Foreskin Retraction?

Sometime during the first several years of your son’s life, his foreskin, which covers the head of the penis, will separate from the glans. Some foreskins separate soon after birth or even before birth, but this is rare. When it happens is different for every child. It may take a few weeks, months or years.

After the foreskin separates from the glans, it can be pulled back away from the glans toward the abdomen. This is called foreskin retraction.

Most boys will be able to retract their foreskins by the time they are 5 years old, yet others will not be able to until the teenage years. As a boy becomes more aware of his body, he will most likely discover how to retract his own foreskin. But foreskin retraction should never be forced. Until separation occurs, do not try to pull the foreskin back – especially an infant’s. Forcing the foreskin to retract before it is ready may severely harm the penis and cause pain, bleeding, and tears in the skin.

What is Smegma

When the foreskin separates from the glans, skin cells are shed. These skin cells may look like whitish lumps, resembling pearls, under the foreskin. These are called smegma. Smegma is normal and nothing to worry about.

Does my Son’s foreskin need special cleaning?

Your son’s intact or uncircumcised penis requires no special care and is easy to keep clean. When your son is an infant, bathe or sponge him regularly and wash all body parts, including the genitals. Simply wash the penis with soap and warm water. Remember, do not try to forcibly retract the foreskin.

If your son’s foreskin is separated and retractable before he reaches puberty, an occasional retraction with cleansing beneath will do. Once your son starts puberty, he should retract the foreskin and clean beneath it on a regular basis. It should become a part of your son’s total body hygiene, just like shampooing his hair and brushing his teeth. Teach your son to clean his foreskin in the following way:

• Gently pull the foreskin back away from the glans.
• Rinse the glans and inside fold of the foreskin with soap and warm water.
• Pull the foreskin back over the head of the penis.

Is there anything else I should watch for?

While your son is still a baby, you should make sure the hole in the foreskin is large enough to allow a normal stream when he urinates. Contact our office or call your pediatrician if any of the following occurs:

• The stream of urine is never heavier than a trickle
• Your baby seems to have some discomfort while urinating
• The foreskin becomes considerably red, swollen or painful to touch.

[Adapted from the AAP   www.aap.org]

Is My Baby Getting Enough Formula, Or Too Much?

Signs that your baby may be getting too little formula are:

• Slower-than-normal weight gain
• Diminished urine output
• A loose, wrinkly appearance to baby’s skin
• Persistent crying or fussiness

If your baby is showing signs of being underfed, increase the amount of milk offered. Feed more volume and or at more frequent intervals. Burp as needed.

Signs that your baby is being fed too much at each feeding are:

• A lot of spitting up or vomiting immediately after the feeding, more than considered normal
• Colicky abdominal pain (baby draws his legs up onto a tense abdomen) immediately after feeding
• Excessive weight gain

If these signs of overfeeding occur, offer smaller-volume feedings more frequently, burp baby once or twice during the feeding, and occasionally offer a bottle of water instead of formula.

Choosing Nipples

Nipples can be made of rubber, latex and silicone substitues and come in a variety of contours all claiming to imitate the natural action and shape of the mother’s breast. None actually do!

Latex nipples are softer and more flexible, but they don’t last as long and some babies are allergic to them. Silicone nipples are firmer and hold their shape longer.

Nipples are also available in a range of sizes and flow speeds. You may have to try a few sizes to find the one that works best for your child.

Watch to make sure your baby isn’t having a hard time getting milk or isn’t getting so much that he’s choking or spitting up. Don’t alter a small nipple to increase its flow and, of course, discuss any feeding concerns with your baby’s doctor.

Because you can’t know beforehand which type or size nipple your child will prefer, it’s best to play it safe and buy one of several types. Once you’ve determined your child’s preference, you can purchase enough to last for months.

Orthodontic- type nipples

• Insert farther back into baby’smore natural milking action of the tongue, but inconveniently require a “which way to turn the nipple” decision. Be sure baby sucks on the widened base of this nipple, not just the mouth, allowing a tip.

Expandable rubbin nipples

• Designed to elongate during sucking but only if baby opens his mouth wide enough and sucks hard enough to draw the nipple farther in. Most, however, only suck on the protruded part. This nipple should be avoided for the breastfeeding baby, who may learn lazy latch-on habits from it.

Standard bulb-type nipples

• The easiest, with a wide base that best allows baby to form a tighter seal.

For the full-time bottle feeding baby, simply experiment with various types of nipples to see which one works best for your baby. If baby is both breastfeeding and bottle feeding, use a nipple with a wide base.

To lessen the rubbery taste of an artificial nipple and to sterilize them, boil for five minutes before first use. To avoid the possibility of a baby choking on a nipple, carefully follow the manufacturer’s caution advice on the package.

When To Replace Nipples

Formula should drip steadily out of a nipple. If it pours out in a stream, the hole is too big and the nipple should be replaced. Check nipples periodically for signs of wear, such as discoloration or thinning, and replace worn ones, which could break and become a choking hazard.

If the nipple becomes cracked or torn, discard it. Some nipples come with a variety of hole sizes to fit the type of liquid and the age of the baby. The nipple hole should be large enough for the formula to drip at an approximate rate of one drop per second when you hold a full, unshaken bottle upside down. Larger nipples and nipple holes are available for older babies.

Once the decision to breast feed is made, the next important thing is to select the type of formula you want to use. For most babies who are bottle fed, this process is usually initiated in the newborn nursery, and if the chosen formula is being well tolerated, there is really no need to switch to a different formula.

If there is a need to change to another type of formula, please call your pediatrician, or contact our office, to make an appointment to have your child evaluated. We will be very happy to discuss the options with you.

Choosing a Formula

Be sure to choose a DHA-enriched formula. Most, if not all of the US formula companies offer AA/DHA-enriched formulas.

There are some subtle differences among the major brands of infant formulas which may affect how your baby tolerates one formula over another. The vitamins and minerals in all formulas are similar, however, the nutritional fine points of the fats, carbohydrates, and proteins differ from one brand to another.

Standard formulas are those that are tolerated by most infants. Infants with special digestive needs require special formulas.

You may click here for some guidelines on how standard formulas differ and compare formula content. This may be of help in matching the formula to your baby’s needs.

Bottle Feeding Basics

Most mothers who make the decision to bottle feed their babies usually have a lot of questions about the process. There are several things to consider if you choose to bottle feed. These include formula preparation, sanitizing utensils, and feeding positions.

Here are seven simple steps that you can follow to successfully bottle feed your baby.

1. Make sure all bottles, nipples, and other utensils are clean.
   If the water in your home is chlorinated, clean the utensils in your dishwasher or wash them in hot tap water with dishwashing detergent and then rinse them in hot tap water. If you have well water or non-chlorinated water, either place the utensils in boiling water for five to 10 minutes or use a process called terminal heating.In terminal heating you clean, but do not sterilize, the bottles in advance. You then fill them with the prepared formula and cap them loosely. Next, the filled bottles are placed in a pan with water reaching about halfway up the bottles, and the water is brought to a gentle boil for about 25 minutes.
2. Read the directions.
   Be sure to follow the manufacturer’s directions exactly for the formula type you choose. Too much water and your baby won’t get the calories and nutrients she needs; too little water and the high concentration of formula could cause diarrhea or dehydration.
3. Preparing the formula.
   Bring the water you plan to use in the formula to a boil for approximately one minute. Then add it to the formula powder. If you’re preparing this in advance, be sure to store it in the refrigerator. If the formula is left out of the refrigerator for longer than one hour or if you don’t use refrigerated formula within 24 hours, throw it out.
4. Warm the refrigerated formula.
   Refrigerated formula doesn’t necessarily have to be warmed up for your baby, but most infants prefer it at least at room temperature. The easiest way to warm refrigerated or frozen milk is to place the container in a pan of water on the stove at low heat and rotate it frequently. Microwave ovens should not be used for heating bottles; this can overheat the milk in the center of the container. Even if the bottle feels comfortably warm to your touch, the superheated milk in the center can scald your baby’s mouth. Also, the bottle itself can explode if left in the microwave too long.If you warm a bottle or use it immediately after terminal heating, test it in advance to make sure it’s not too hot for your baby. The easiest way to test the temperature is to shake a few drops on the inside of your wrist.
5. Place your baby in a proper feeding position.
   Cradle her in a semi-upright position and support her head. Don’t feed her lying down — formula can flow into the middle ear, causing an infection. To prevent your baby from swallowing air as she sucks, tilt the bottle so that the formula fills the neck of the bottle and covers the nipple.
6. Take note of your baby’s intake.
   The pediatrician will probably ask you how much your baby has eaten, so be prepared to answer the question. Your newborn will probably take between two and four ounces per feeding during his first few weeks (during the first few days, he may take less than an ounce at feedings), and will probably be hungry every two to four hours. It’s best to feed your baby on demand.Don’t force your baby to finish the bottle if he or she is not interested. And if your baby is still sucking enthusiastically when the bottle is empty, offer more.
7. Burp your baby.
   Babies get fussy and cranky when they swallow air during feedings. This happens more often with bottle fed infants, though breast fed infants can also swallow air. To prevent a tummy full of air, burp your baby frequently — after every two or three ounces of formula. If your baby doesn’t burp after a couple of minutes of trying, resume feeding. Here are the three best positions:
   • Over the shoulder: Drape your baby over your shoulder and firmly pat or rub her back.
   • On the lap: Sit your baby upright, lean her weight forward against the heel of your hand, and firmly pat or rub her back.
   • Lying down: Place baby stomach-down on your lap and firmly rub or pat her back.

Types of Formula 

• Ready To Feed – Premixed liquid. Do not add water. Be sure to shake well before feeding as it may have settled.
• Liquid Concentrated – Mix with equal amount of water. Be sure to shake well before mixing to blend ingredients.
• Powder – Mix 1 level unpacked scoop of powder, using the scoop that comes with the container, with 2 ounces of water. Be sure to shake all together.

As they grow and develop, children come in contact with, and may sometimes suffer from, a variety of common illnesses. Fortunately, most of these illnesses and diseases are mild and self-limited. In order words, they go away either without or with minimal intervention.

Some may require a visit to the doctor. Others may last a few days to weeks and vary in severity.

Germ Prevention Tips (Online presentation)

Germ Prevention Tips (Downloadable Powerpoint format)

Acetaminophen Dosage Chart

Ibuprofen Dosage Chart

Family traditions can go a long way in helping to create and maintain a healthy family life.

Family traditions can be an avenue for family members to get together and fellowship with one another. Such gatherings tend to foster a better family relationship, unity, and understanding.

If you do not already have family traditions, now is the perfect time to start a ritual, celebration or habit of your own.

Your family can celebrate the holidays in many ways. Here are a few examples of traditions that may work for you:

• Prepare special foods that honor your family’s ethnic, religious or cultural heritage
• Create at-home activities that everyone gets involved in: decorating the house, making dinner, eating together, watching a favorite video, playing games or cards, singing carols.
• Take a family outing; they can be as elaborate as ski vacations or as simple as trips to a local museum or attraction
• Volunteer some time for a charitable cause: serving food at a soup kitchen or shelter, visiting residents of a nursing home
• Attend worship services together as a family

As your family marks holidays or special events, be sure to talk to your children about the specifics of your family celebration. Make sure your children help plan the celebration and assist with preparations, such as helping to choose the menu and activities, set the table or greeting guests.

As your children grow older, you can provide more details about how your family traditions got started and why they are important. These details will help your children understand the traditions so they can carry them on when they are adults or adapt them to their own lives as they get older. Traditions provide each generation with links to the past.

For some, memories of holidays and special events may not be pleasant. If that is true in your family, try to establish different traditions that give new meaning to these special days.

Whether it is with special foods or one-of-a-kind activities, traditions create fond childhood memories and bring everyone in the family closer together.