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2 YEAR OLD
Proactive in your child’s care.
Empowering families for over 50 years.
Please take the time to read through this material. We provide this information because
we see value in educating our patients.
Mansfield Office454 Chauncy StreetMansfield, MA 02048
(508) 339-9944
Westwood Office541 High Street
Westwood, MA 02090(781) 326-7700
www.wmpeds.com
2 Year Visit: Immunizations
Your child is due to receive the following screening tests at this visit:
Hgb (Hemoglobin Screen)
Lead (Lead Screen)
Your child is due to receive the following immunizations at this visit:
NONE
In addition, we strongly recommend that all patients 6 months of age
and older receive an annual Influenza (flu) vaccine.
Please review the enclosed Vaccine Information Sheets (VISs) prior to
your visit for more information.
For our complete immunization schedule:
wmpeds.com/topic/immunization-schedule
Mansfield Office454 Chauncy StreetMansfield, MA 02048
(508) 339-9944
Westwood Office541 High Street
Westwood, MA 02090(781) 326-7700
www.wmpeds.com
VIDEOS
Let us help you be proactive and educated
in your child’s care!These following videos are just a few that we feel may help you and
your child at this specific age. Please view our website at
www.wmpeds.com for these and many more.
2 Year
Fever
Ear Infections – including information on Swimmer’s Ear
Rashes – information on a Basic Rash, Diaper Rash, Fifth Disease,
Hand - Foot and Mouth Disease and also Hives
Cough/Croup – information on when to worry and a demonstration
on Croup and Stridor
Vomiting and Diarrhea
Colds
Toddler – Information on behavior, nutrition, toilet training and new
siblings
Constipation
Mansfield Office454 Chauncy StreetMansfield, MA 02048
(508) 339-9944
Westwood Office541 High Street
Westwood, MA 02090(781) 326-7700
www.wmpeds.com
My Spirited Child
Oh my strong will child.
Some feel you’re so wild.
You’re so bright and can be so joyous.
But your anger and frustration can really annoy us.
We look to others for support.
But if they have no such experience,
Negative vibes is what they purport.
We must prepare you for so many situations in advance.
Anticipation is crucial for a peaceful daily dance.
Sometimes I must speak-up and defend you.
Sometimes I must set a limit.
Yet my urge to blame and shame can get in the way,
And I can’t always dam it.
Your spirit is so inspiring.
Keep dreaming and aspiring.
By: Dr. Hartman
Follow Dr. Hartman on Twitter @DrHartmanWMPEDS
*Raising Your Spirited Child by Mary Sheedy Kurcinka.
Excellent reference!
Mansfield Office454 Chauncy StreetMansfield, MA 02048
(508) 339-9944
Westwood Office541 High Street
Westwood, MA 02090(781) 326-7700
www.wmpeds.com
Constipation and Its Role in Toilet Training
What you need to know…
Most 2-2 ½year old children are physically ready to toilet train. Emotionally, however, they
may need some coaching to get there. Parents must be sensitive to this, and spend time withtheir children looking at DVDs and reading books about toilet training. Parents must put a
“positive spin” on peeing and pooping. Help your child “befriend” a potty!
Two common scenarios:
1. “My child is constipated before we start toilet training.”
Constipation will often interfere with the process of toilet training. If it hurts to poop, a child
will often “hold it in” so as not to feel pain. This makes constipation worse and, ultimately,
complicates (and delays) the child using the potty. It is important to get your child’s bowel
movements as regular as possible before starting to toilet train. This may require the use of
medication (both Miralax and Benefiber are two over-the-counter, effective, and very safe
options). Talk with your provider for more information.
2. ‘The Holder’ and ‘The Dancer’
Some children find having bowel movements to be an unpleasant experience. Stooling may
be painful for a variety of reasons including constipation (see above) which may cause a
small fissure (tear) around the anus. Once children experience pain with pooping, it may take
several months to “unlearn” this pain and let go of the fear of having pain. It is important tobe aggressive with stool softeners to ensure that a tear does not recur (as this would prolong
their withholding behavior even more!). Place your child on the toilet 3-4 times daily when
they are not in the middle of holding – don’t force them on the toilet when they are “doing thedance!”
If your child is dealing with these issues, please discuss this with your provider.
For more information visit our website: www.wmpeds.com
2/2012
Mansfield Office454 Chauncy StreetMansfield, MA 02048
(508) 339-9944
Westwood Office541 High Street
Westwood, MA 02090(781) 326-7700
www.wmpeds.com
Establishing the Dental Home
The concept of the "dental home" is derived from the American Academy of Pediatrics concept of the "medical
home." The American Academy of Pediatrics states, "the medical care of infants, children, and adolescents
ideally should be accessible, continuous, comprehensive, family centered, coordinated, compassionate, and
culturally effective. It should be delivered or directed by well-trained physicians who provide primary care and
help to manage and facilitate essentially all aspects of pediatric care." Pediatric primary dental care needs to be
delivered in a similar manner. The dental home is a specialized primary dental care provider within the
philosophical complex of the medical home. Referring a child for an oral health examination by a dentist whoprovides care for infants and young children 6 months after the first tooth erupts or by 12 months of age
establishes the child’s dental home and provides an opportunity to implement preventive dental health habits
that meet each child’s unique needs and keep the child free from dental or oral disease.
The dental home should be expected to provide:
An accurate risk assessment for dental diseases and conditions
An individualized preventive dental health program based on the risk assessment
Anticipatory guidance about growth and development issues (ie, teething, digit or pacifier habits, andfeeding practices)
A plan for emergency dental trauma
Information about proper care of the child’s teeth and gingival tissues
Information regarding proper nutrition and dietary practices
Comprehensive dental care in accordance with accepted guidelines and periodicity schedules for
pediatric dental health
Referrals to other dental specialists, such as endodontists, oral surgeons, orthodontists, and
periodontists, when care cannot be provided directly within the dental home
Anticipatory Guidance and Parent and Patient Education
General anticipatory guidance for the mother (or other intimate caregiver) before and during the colonization
process should include the following:
Oral hygiene—the parent should be instructed to brush thoroughly twice daily (morning and evening)
and to floss at least once every day.
Diet—the parent should be instructed to consume fruit juices only at meals and to avoid all carbonated
beverages during the first 30 months of the infant’s life.
Fluoride—the parent should be instructed to use a fluoride toothpaste approved by the American Dental
Association and rinse every night with an alcohol-free over-the-counter mouth rinse with 0.05% sodium
fluoride.
Caries removal—parents should be referred to a dentist for an examination and restoration of all active
decay as soon as feasible.
Delay of colonization—mothers should be educated to prevent early colonization of dental flora in their
infants by avoiding sharing of utensils (ie, shared spoons, cleaning a dropped pacifier with their saliva,etc).
Xylitol chewing gums—recent evidence suggests that the use of xylitol chewing gum (4 pieces per day by
mother) had a significant impact on decreasing the child’s caries rates.
General anticipatory guidance for the young patient (0 to 3 years of age) should include the following:
Oral hygiene—the parent should begin to brush the child’s teeth as soon as they erupt (twice daily,morning and evening) and floss between the child’s teeth once every day as soon as teeth contact one
another.
Diet—after the eruption of the first teeth, the parent should provide fruit juices (not to exceed 1 cup per
day) during meals only. Carbonated beverages should be excluded from the child’s diet. Infants shouldnot be placed in bed with a bottle containing anything other than water. Ideally, infants should have
their mouths cleansed with a damp cloth after feedings.
Fluoride—all children should have optimal exposure to topical and systemic fluoride. Caution should be
exercised in the administration of all fluoride-containing products. The specific considerations of the
judicious administration of fluoride should be reviewed and tailored to the unique needs of each patient.
Review articles with applicable fluoride recommendations and
Mansfield Office454 Chauncy StreetMansfield, MA 02048
(508) 339-9944
Westwood Office541 High Street
Westwood, MA 02090(781) 326-7700
www.wmpeds.com
Dental ProvidersBy age three every child should have their first visit to the dentist! (If your child is in the SKIP Program, was born
prematurely, has ear tubes, or is on medication for GE reflux, they should see a dentist by age 1.)
Westwood Area
Dr. Michael Curtin
541 High St
Westwood, MA
#781-326-2133
Dr. Mark Stone☼
761 Washington St
Norwood, MA#781-762-7900
Dental Associates of Walpole
Dr. John Ficarelli1428 Main St
Walpole, MA
#508-668-8008
Dr. Agamov☼
47 Pond StSharon, MA
#781-784-8435
Dr. David Gale☼346 South Main St
Sharon, MA
#781-784-3218
Dr. Caterina Raffa
Pediatric Dental Arts521 Mt. Auburn St
Watertown, MA
Waban Dental Group☼
1180 Beacon St
Newton, MA#617-527-6061
Dr. John Caravolas
20 Hope AveWaltham, MA
#781-647-0804
Chestnut Dental
87 Chestnut St
Needham, MA#781-444-6650
38 Pond St
Franklin, MA#508-520-6660
Mansfield Area
Dental Associates of Walpole
Dr. John Ficarelli
1428 Main St
Walpole, MA#508-668-8008
Children’s Dental Health Care Center1256 Park St
Stoughton, MA#781-341-0030
Dr. Roxana Delcea☼
100 Copeland DrMansfield, MA
#508-339-3055
Easton Pediatric Dentistry
165 Belmont St
S. Easton, MA#508-238-0900
Dr. Raymond Martin
200 Chauncy StMansfield, MA
#508-337-8555
Kid Care Dental
1613 Central St
Stoughton, MA#781-341-0320
Pediatric Dental Center of Mansfield
905B South Main St
Mansfield, MA#508-337-3307
Dr. Daniel Slavsky☼
98 North Main StMansfield, MA
#508-339-7171
These Dentists take MassHealth
Connors Pediatric Dentistry, PC
450 N. Main StSharon, MA 02067
#781-784-2565
Dr. Pettengril☼74 Taunton St
Plainville, MA#508-699-2221
Norwood Pediatric Dentistry
38 Vanderbilt AveNorwood, MA
#781-349-8170
To make an appointment at any of
these locations call: 800-910-7186
1 Porter SqCambridge, MA
2181 Washington St
Roxbury, MA
137 Hathaway Rd
New Bedford, MA
1096 Revere Beach Pkwy
Chelsea, MA
For Patients with MassHealth that needhelp finding dentists they can call either
call #800-207-5019 or visitwww.masshealth-dental.net
Indicates dentist will see children
from age 1
☼ Indicates dentist will see children
from age 3
KidsHealth.org
The most-visited site
devoted to children's
health and development
Calcium and Your Child
Milk and other calcium-rich foods have always been a must-have in kids' diets. After all, calcium is a key building block for
strong, healthy bones. But most kids ages 9 to 18 don't get the recommended 1,300 milligrams of calcium per day.
That's not surprising when you consider that many kids now drink more soda than milk, which is one of the best sources of
calcium. And teens who smoke or drink soda, caffeinated beverages, or alcohol may get even less calcium because those
substances interfere with the way the body absorbs and uses calcium.
But at every age, from infancy to adolescence, calcium is one nutrient that kids simply can't afford to skip.
What Calcium Does
During childhood and adolescence, the body uses the mineral calcium to build strong bones — a process that's all but
complete by the end of the teen years. Bone calcium begins to decrease in young adulthood and progressive loss of bone
occurs as we age, particularly in women.
Teens, especially girls, whose diets don't provide the nutrients to build bones to their maximum potential are at greater risk
of developing the bone disease osteoporosis, which increases the risk of fractures from weakened bones.
Younger kids and babies with little calcium and vitamin D intake (which aids in calcium absorption) are at increased risk for
rickets. Rickets is a bone-softening disease that causes severe bowing of the legs, poor growth, and sometimes muscle pain
and weakness.
Calcium plays an important role in muscle contraction, transmitting messages through the nerves, and the release of
hormones. If blood calcium levels are low (due to poor calcium intake), calcium is taken from the bones to ensure normal cell
function.
When kids get enough calcium and physical activity during childhood and the teen years, they can start out their adult lives
with the strongest bones possible. For optimal bone health, the Institute of Medicine (IOM) recommends:
1 to 3 years old — 700 milligrams of calcium daily
4 to 8 years old — 1000 milligrams
9 to 18 years old — 1,300 milligrams
Getting enough calcium is just part of the equation. Kids from 1 to 18 years old also should get 600 IU of vitamin D daily. If
you don't think your kids are getting the nutrients needed, talk to your doctor about modifying their diet or using vitamin
supplements.
Good Sources of Calcium
Of course, milk and other dairy products are good sources of calcium, and most contain added vitamin D, which is also
important for bone health.
But don't overlook the many other healthy calcium-fortified foods, including orange juice, soy products, and bread. Here are
some dairy and nondairy products that provide quite a bit of this vital nutrient:
Serving Size Food or Beverage Calcium
8 ounces (237 milliliters) milk 300 milligrams
8 ounces (237 milliliters)calcium-fortified orange
juice300 milligrams
2 ounces (57 grams) American cheese 300 milligrams
1½ ounces (43 grams) cheddar cheese 300 milligrams
4 ounces (113 grams) tofu fortified with calcium 260 milligrams
6 ounces (177 milliliters) yogurt 225 milligrams
½ cup (118 milliliters)collard greens (cooked
from frozen)178 milligrams
4 ounces (113 grams) ice cream, soft serve 120 milligrams
½ cup (118 milliliters) white beans 110 milligrams
1 ounce (28 grams) almonds 80 milligrams
½ cup (118 milliliters) bok choy 80 milligrams
½ cup (118 milliliters) rhubarb, cooked 75 milligrams
4 ounces (113 grams) cottage cheese 70 milligrams
½ cup (118 milliliters) red beans 40 milligrams
½ cup (118 milliliters) broccoli, cooked 35 milligrams
Minding Your Milk
Milk and other dairy products are among the best and most convenient sources of calcium you can find. But just who should
get what kind of milk and when?
Infants under 1 year old shouldn't have regular cow's milk because it doesn't have the nutrients a growing baby
needs. Stick with breast milk or infant formula as your baby's major source of nutrition during the first year.
Kids between 1 and 2 years old should have whole milk to help provide the dietary fats they need for normal growth
and brain development.
After age 2, most kids can switch to low-fat or nonfat milk.
The good news is that all milk — from skim to whole — contains about the same amount of calcium per serving. The 2010
Dietary Guidelines recommend 2 cups (473 milliliters) of milk per day for kids 2 to 3 years, 2½ cups for kids 4 to 8 years (354
milliliters), and 3 cups (710 milliliters) for kids 9 years and older.
When Kids Can't — or Won't — Eat Dairy
Some kids can't or won't consume dairy products. Here are some ways to make sure they get enough calcium:
Kids with lactose intolerance: Kids with lactose intolerance don't have enough of the intestinal enzyme (lactase) that helps
digest the sugar (lactose) in dairy products. These kids may have cramps or diarrhea after drinking milk or eating dairy
products.
Fortunately, low-lactose and lactose-free dairy products are available, as are lactase drops that can be added to dairy
products. Also ask your doctor about tablets that kids with lactose intolerance can take that allow them to eat dairy products
and thus benefit from the calcium they contain. Hard, aged cheeses (such as cheddar) are also lower in lactose, and yogurts
that contain active cultures are easier to digest and much less likely to cause lactose problems.
Kids with milk allergy: The proteins in milk might cause allergic reactions in some people. Casein is the principal protein in
cow's milk, accounting for about 80% of the total milk proteins. Casein is what makes up the curd that forms when milk is left
to sour. The remaining 20% of cow's milk proteins are contained in the whey, the watery part that's left after the curd is
removed. Someone may be allergic to proteins in either the casein or the whey parts of milk and sometimes even to both.
Talk to your doctor if you think your child may be allergic to milk. Formula-fed infants with a cow's milk allergy may need to
be switched to soy-based or hypoallergenic formula. For older kids, good alternatives to milk and milk products include
calcium-enriched rice or soy milk (if soy is tolerated), vegan products (such as vegan cheese), and other soy-based (again, if
soy is tolerated) or rice-based frozen desserts, sorbets, puddings, and ice pops.
Vegetarian kids: Parents of kids who are ovo-vegetarians (they eat eggs, but no dairy products) or vegans (they eat only
foods from plant sources) may be concerned about whether a dairy-free diet can supply enough calcium.
Although it can be more of a challenge to get the recommended amounts of calcium in a vegetables-only diet, good sources
of calcium include dark green leafy vegetables, broccoli, chickpeas, and calcium-fortified products, including orange juice, soy
and rice drinks, and cereals.
Teens who think dairy products are fattening: Adolescent girls, in particular, may decide to diet and avoid eating dairy foods
they think will make them fat. But it's important for your teen to understand that an 8-ounce (240-milliliter) glass of skim
milk has only 80 calories and zero fat and supplies one quarter of a teen girl's recommended daily calcium intake.
In fact, people who eat diets rich in calcium may actually weigh less and have less body fat. In one study, adolescent girls who
had an extra 300 milligrams of calcium each day, which is equivalent to one glass of milk, weighed up to 2 pounds (907
grams) less than girls who didn't get the extra calcium.
You can also offer low-fat and nonfat dairy products as healthy alternatives to whole milk products — and instead of sodas
and sugary fruit drinks that have very little nutritional value. If your teen drinks juice, offer calcium-fortified 100% fruit juices
(not too much juice, though, as that can contribute a lot of sugar and calories).
Also talk to your teen about osteoporosis and the importance of dairy products and other calcium-rich foods in a healthy
diet.
Kicking Up the Calcium
Of course, some picky eaters just don't like the idea of dairy products. To make sure they get enough calcium, try these
creative tactics.
Add cheese to meals and snacks:
Put some cheddar in an omelet.
Add a slice of American, Swiss, or provolone to sandwiches.
Use whole-grain soft-taco shells or tortillas to make burritos or wraps. Fill them with eggs and cheese for breakfast;
turkey, cheese, lettuce, tomato, and light dressing for lunch; and beans, salsa, taco sauce, and cheese for dinner.
Create mini-pizzas by topping whole-wheat English muffins or bagels with pizza sauce, low-fat mozzarella cheese, and
toppings like mushrooms, green peppers, tomatoes, or chunks of grilled chicken.
Serve whole-grain crackers with low-fat cheese as an afternoon treat.
Make grilled cheese sandwiches or piece of cheese appealing by using cookie cutters to create hearts, stars, and
favorite animal shapes.
Top vegetables (especially those that usually prompt an "Ick!" or an "Ew!") with melted low-fat cheese.
Put some pizzazz in regular milk by adding a touch of strawberry or chocolate syrup (which doesn't add a significant amount
of sugar or calories). Steer clear of store-bought flavored milk drinks, though, which can be packed with unnecessary sugar.
For breakfast, add fresh fruit or unsweetened apple butter to cottage cheese or yogurt.
For dessert or an afternoon snack:
Serve low-fat or fat-free frozen yogurt topped with fruit.
Create parfaits with layers of plain yogurt, fruit, and whole-grain cereal.
Give kids a glass of ice-cold milk to wash down a couple of favorite cookies or graham crackers.
Serve nondairy foods that still pack a calcium punch:
Add white beans to favorite soups.
Top salads or cereals with slivered almonds and chickpeas.
Serve chili with red beans and cheese.
Pour a tall glass of calcium-fortified juice for breakfast.
On grocery-shopping excursions, look for calcium-fortified foods, including breads and cereals.
Serve more dark green leafy vegetables (such as broccoli, kale, collard greens, or Chinese cabbage) with meals.
Caring About Calcium
Although it's best for kids to get the calcium they need through a calcium-rich diet, sometimes it's not possible. Discuss
calcium supplements with your doctor if you're concerned that your kids aren't getting enough calcium.
Vitamin D is essential for calcium absorption, so it's important that kids have enough of this nutrient too. Made by the body
when the skin is exposed to sunlight, vitamin D also is found in fortified foods, fish, and egg yolks.
Also, don't forget to motivate kids to be involved in regular physical activities and exercise, which are very important to bone
health. Weight-bearing exercises such as jumping rope, running, and walking can also help develop and maintain strong
bones.
Most of all, act as a role model and consume low-fat dairy products and other calcium-rich foods — you could probably use
the calcium, too!
Reviewed by: Mary L. Gavin, MD
Date reviewed: September 2011
Children and Media: TV and Kids under Age 3By now, most parents have heard about studies that discourage exposing very young children totelevision. But the reality is that almost three quarters of infants and toddlers are exposed to TVprograms before they turn 2.So what exactly are the dangers? Are any programs or videos acceptable for infants and toddlers?Studies on TV and toddlers are fairly rare, but children's media expert Shelley Pasnik has scoured theresearch to answer parents' most common questions about young children and television.
1. How prevalent is TV in the lives of very young children?2. Has there been much research done on the effects of TV on infants and toddlers?3. Does TV viewing take the place of other activities, such as playing outside?4. Does it matter what very young children watch?5. Does the American Academy of Pediatrics recommend against TV viewing for children under the
age of 2?6. Are there differences between girls and boys viewing?7. Can a very young child understand what's on TV?8. Does TV viewing lead to obesity?9. Does having a TV on in the background matter?10. Can TV help a young child's language development?11. Can parental rules influence TV viewing?
How prevalent is TV in the lives of very young children?Extremely.
Consider these findings from a study conducted by the Kaiser Family Foundation:For children under the age of 2:
More than four in 10 (43%) of children under the age of 2 watch TV every day and nearly one infive (18%) watch videos or DVDs every day.
Most parents (88%) of these under-2-year-olds who watch TV every day say they are in thesame room with their child while they are watching TV either all or most of the time.
74%of all infants and toddlers have watched TV before the age of 2.For children under the age of 6:
On average, they spend about two hours a day with screen media - the same amount of time asthey spend playing outside, and three times as much time as they spend reading or being readto.
77%turn on the TV by themselves 71%ask for their favorite videos 67%ask for particular shows 62%use the remote to change channels and 71%ask for their favorite videos or DVDs.
For more information: Kaiser Family Foundation's report on Children and Electronic Media.
Has there been much research done on the effects of TV on infants and toddlers?Surprisingly little.
Over the last three decades many studies have focused on television and children, with a fair amount ofemphasis on preschool-aged children. To date, infants and toddlers have received limited attention. Thisis starting to change given the big boom in programs and products directed at the very young - videosfor infants, for example, have exploded in recent years-but a great deal more research is needed.A review of current research has been published by the London-based National Literacy Trust and bythe Kaiser Family Foundation. Although several studies suggest age-appropriate programs can helppreschoolers learn language, there have been far fewer studies focused on toddlers. There is someevidence that 18-month-olds will respond to the visuals of programs with words, especially if thecontent is of high quality. But other studies suggest children under the age of 22 months learn wordsless effectively from TV than from interactions with people.
Does TV viewing take the place of other activities, such as playing outside?Not really, for children between the ages of six months and 3 years.
However, among four- to six-year-olds, who tend to have greater mobility and independence, there maybe a connection. Heavy viewers in this age group spend an average of 30 minutes less per day playingoutside and eight minutes less per day reading than children who are not heavy TV watchers. It is notclear why this happens. For example, children who watch more TV may do so because they are unable togo outside or it may be that they do not go outside because they are watching more TV.Does it matter what very young children watch?Yes.
Programs that are well designed and take into consideration children's developmental stages are morelikely to have educational merit than shows not geared toward their healthy growth. Even moreimportant than the content and construction of a show, however, is the role a caregiver can play. Bywatching with the child, a parent can find ways to interact during the viewing and take advantage oflearning opportunities embedded in a program.
Does the American Academy of Pediatrics recommend against TV viewing for children under the age of2?Yes.
In 1999 the American Academy of Pediatrics issued a policy statement about media and children. In it,the organization discussed the benefits media education can have as well as the health risks TV poses tochildren, especially those under the age of two. Specifically, the AAP said: "Pediatricians should urgeparents to avoid television viewing for children under the age of 2 years. Although certain televisionprograms may be promoted to this age group, research on early brain development shows that babiesand toddlers have a critical need for direct interactions with parents and other significant caregivers (eg,child care providers) for healthy brain growth and the development of appropriate social, emotional,and cognitive skills. Therefore, exposing such young children to television programs should bediscouraged." To read the full statement: American Academy of Pediatrics policy statement on MediaEducation
Are there differences between girls and boys viewing?No.
Differences in how girls and boys use TV typically do not appear until the preschool years. Then, boysare known to spend more time playing video games and are more likely to imitate aggressive behaviorthey see on TV.
Can a very young child understand what's on TV?Probably more than we realize, but more research is necessary.
Examining children's comprehension of TV programs is no easy task, but here's what the research that'sbeen done so far has revealed:
When television content is not understandable to children, they pay less attention to it.Likewise, the proportion of time that children look directly at the television screen increasesduring the preschool years.
Children as young as two years old were found to have established beliefs about specific brandsthat were promoted by television advertising and parental behavior.
One-year-olds avoided an object after they watched an actress react negatively to it on video,suggesting that infants can apply emotional reactions seen on television to guide their ownbehavior.
Does TV viewing lead to obesity?There may be a connection but more research is needed to understand all of the variables thatcontribute to a child's health.
The media landscape is riddled with marketing messages than undermine healthy choices. In 2006, theInstitute of Medicine (IOM) released a report titled "Food Marketing to Children and Youth: Threat orOpportunity?" The report was requested by Congress and sponsored by the U.S. Centers for DiseaseControl and Prevention. Included in the report is a review of the scientific evidence on the influence offood marketing on diets and diet related health of children and youth. Although many factors contributeto a child's dietary habits, including genetics and cultural background, the report concluded that currentfood and beverage marketing practices put children's long-term health at risk. According to the report,"If America's children and youth are to develop eating habits that help them avoid early onset diet-related chronic diseases, they have to reduce their intake of high-calorie, low-nutrient snacks, fast foods,and sweetened drinks, which make up a high proportion of the products marketed to them."
The amount of time a child spends watching TV also impacts obesity rates. According to one study, thelikelihood of obesity among low-income multi-ethnic preschoolers (between the ages of 1 and 5)increased for each hour per day of TV or video they viewed. Children who had TV sets in their bedrooms(40%of the sample in this study) watched more TV and were more likely to be obese.
Does having a TV on in the background - either in another room or in the same room where a child isplaying matter?Yes, background TV can be a disruptive influence.
According to a recent study conducted by a group of scholars and published in American BehavioralScientist, the television is on approximately six hours a day on average in American homes. Yet little isknown about the impact of growing up in the near constant presence of television. They studied theprevalence and developmental impact of "heavy-television" households on very young children frombirth to age 6 drawn from a nationally representative sample. Thirty-five percent of the children lived ina home where the television was on "always" or "most of the time," even if no one was watching.Regardless of their age, children from heavy television households watched more television and readless than other children. Furthermore, children exposed to constant television were less likely to be ableto read than other children. Also, other research has shown that one-, two-, and three-year-olds' playand attention spans are shorter in length in the presence of background television, and parent-childinteractions are also less frequent in the presence of background television.
Can TV help a young child's language development?Yes and no, depending on what the child is watching.
Studies have found that children at 30 months of age who watched certain programs (one study focusedon Dora the Explorer, Blue’s Clues, Clifford and Dragon Tales) resulted in greater vocabularies andhigher expressive language whereas overall television viewing (including adult programs) has beenassociated with reduced vocabulary.
Can parental rules influence TV viewing?Yes, though not all rules are the same.
A recent study found some parents have rules about programs—pertaining to which shows children areallowed to watch—and some have rules about time—how long the TV can be on. Parents who set timerules reported their children spent less time watching television whereas parents who set program rulesreported their children watched more television. Parents with program rules were more likely to havepositive attitudes toward television and more likely to be present when their children were viewing.
PBS parents.org2011
Sibling Rivalry
My children have trouble getting along. How can I help them?No matter how hard you try to keep the peace, your children are likely to fight over toys, tattle on one another, andtease and criticize each other. Sibling rivalry is a natural part of growing up. Here are some tips on managing conflictbetween your children.
Remember that each child's needs are different. Some parents feel it's important to treat theirchildren the same way. Yet children often complain that things are "not fair" and that they are notreceiving what the other sibling gets. Treating your children differently doesn't mean you are playingfavorites. It's a way of showing that you appreciate how special they are.
While it's natural to notice differences between your children, try not to comment on these infront of them. It is easy for a child to think that he is not as good or as loved as his sibling when youcompare them. Remember, each child is special. Let each one know that.
As much as possible, stay out of your children's arguments. While you may have to help youngerchildren find ways to settle their differences, do not take sides. If your children try to involve you,explain that they need to figure out how to get along. Of course, you must get involved if the situationgets violent. Make sure your children know that such behavior is not allowed. If there is any reason tosuspect that your children may become violent, watch them closely when they are together. Preventingviolence is always better than punishing after the fact, which often makes the rivalry worse. Praise yourchildren when they solve their arguments, and reward good behavior.
Be fair. If you must get involved in your children's arguments, listen to all sides of the story. Also, givechildren privileges that are right for their ages and try to be consistent. If you allowed one child to stayup until 9:00 pm at 10 years of age, the other should have the same bedtime when he is 10.
Respect your child's privacy. If it is necessary to punish or scold, do it with the child alone in a quiet,private place. Do not embarrass your child by scolding him in front of the others.
Family meetings can be a great way to work out sibling issues. Some parents find that sharingsome of their own experiences about growing up can help too. Just listening to your children can alsohelp. Remember, this is their opportunity to learn about the give-and-take of human relationships.
Why Siblings Get Along the Way They DoMany things affect relationships between brothers and sisters. Some of these are
Personality: Parents often wonder how children from the same parents growing up in the same home can be sodifferent. In fact, siblings are sometimes more different than alike. Even if siblings are alike in some ways, it isimportant for parents to recognize the unique personality of each of their children.
Age: Children of different ages behave differently. For example, younger children may fight in more physical ways.As they get older, their fighting may be more like arguments.
Gender: Gender affects relationships as well. Many parents find that children of the same sex compete with eachother more than do opposite-sex children.
Family size, spacing, and birth order: No two children view the family the same way. An only child's experience isdifferent from that of a child in a larger family. Children who are less than 2 years apart sometimes have more conflictthan children who are spaced further apart.
Last Updated 1/4/2012Source Sibling Relationships (Copyright © 2007 American Academy of Pediatrics, updated 3/07)
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Tips for Getting Your Children to Wear Bicycle HelmetsEstablish the helmet habit early.Have your children wear helmets as soon as they start to ride bikes - evenif they are passengers on the back of an adult's bike. If they learn to wearhelmets whenever they ride bikes, it becomes a habit for a lifetime. It'snever too late, however, to get your children into helmets.
Wear a helmet yourself.Children learn best by observing you. Whenever you ride your bike, put on your helmet. Plan bicycle outings duringwhich all family members wear their helmets to further reinforce the message. The most important factor influencingchildren to wear helmets is riding with an adult who wears a helmet.
Talk to your children about why you want them to protect their heads.There are many things you can tell your children to convince them of the importance of helmet use.
1. Bikes are vehicles, not toys.2. You love and value them and their intelligence.3. They can hurt their brains permanently or even die of head injuries.
Most professional athletes use helmets when participating in sports. Bicycle racers are now required to use them whenracing in the United States and in the Olympics.
Reward your kids for wearing helmets.Praise them; give them special treats or privileges when they wear their helmets without having to be told to.
Don't let children ride their bikes unless they wear their helmets.Be consistent. If you allow your children to ride occasionally without their helmets, they won't believe that helmet usereally is important. Tell your children they have to find another way to get where they are going if they don't want to usetheir helmets.
Encourage your children's friends to wear helmets.Peer pressure can be used in a positive way if several families in the neighborhood start making helmet use a regular habitat the same time.
REMEMBER:Accidents causing head injuries can occur on sidewalks, driveways, bike paths, and parks as well as on streets. You andyour children cannot predict when a fall from a bike will occur. It's important to wear a helmet on every ride, no matterhow short.
NEVER RIDE AT NIGHTAlways put your bike away when the sun goes down.
VACCINE INFORMATION STATEMENT
Influenza VaccineWhat You Need to Know
(Flu Vaccine, Inactivated)
2013-2014
Many Vaccine Information Statements are available in Spanish and other languages. See www.immunize.org/vis
Hojas de información sobre vacunas están disponibles en español y en muchos otros idiomas. Visite www.immunize.org/vis
1 Why get vaccinated?Influenza (“flu”) is a contagious disease that spreads around the United States every winter, usually between October and May. Flu is caused by the influenza virus, and can be spread by coughing, sneezing, and close contact.Anyone can get flu, but the risk of getting flu is highest among children. Symptoms come on suddenly and may last several days. They can include:• fever/chills• sore throat• muscle aches• fatigue• cough• headache• runny or stuffy noseFlu can make some people much sicker than others. These people include young children, people 65 and older, pregnant women, and people with certain health conditions—such as heart, lung or kidney disease, or a weakened immune system. Flu vaccine is especially important for these people, and anyone in close contact with them.Flu can also lead to pneumonia, and make existing medical conditions worse. It can cause diarrhea and seizures in children. Each year thousands of people in the United States die from flu, and many more are hospitalized. Flu vaccine is the best protection we have from flu and its complications. Flu vaccine also helps prevent spreading flu from person to person.
2 Inactivated flu vaccineThere are two types of influenza vaccine: You are getting an inactivated flu vaccine, which does not contain any live influenza virus. It is given by injection with a needle, and often called the “flu shot.”A different, live, attenuated (weakened) influenza vaccine is sprayed into the nostrils. This vaccine is described in a separate Vaccine Information Statement.
Flu vaccine is recommended every year. Children 6 months through 8 years of age should get two doses the first year they get vaccinated.Flu viruses are always changing. Each year’s flu vaccine is made to protect from viruses that are most likely to cause disease that year. While flu vaccine cannot prevent all cases of flu, it is our best defense against the disease. Inactivated flu vaccine protects against 3 or 4 different influenza viruses.It takes about 2 weeks for protection to develop after the vaccination, and protection lasts several months to a year.Some illnesses that are not caused by influenza virus are often mistaken for flu. Flu vaccine will not prevent these illnesses. It can only prevent influenza.A “high-dose” flu vaccine is available for people 65 years of age and older. The person giving you the vaccine can tell you more about it.Some inactivated flu vaccine contains a very small amount of a mercury-based preservative called thimerosal. Studies have shown that thimerosal in vaccines is not harmful, but flu vaccines that do not contain a preservative are available.
3 Some people should not get this vaccine
Tell the person who gives you the vaccine:• If you have any severe (life-threatening) allergies. If
you ever had a life-threatening allergic reaction after a dose of flu vaccine, or have a severe allergy to any part of this vaccine, you may be advised not to get a dose. Most, but not all, types of flu vaccine contain a small amount of egg.
• If you ever had Guillain-Barré Syndrome (a severeparalyzing illness, also called GBS). Some peoplewith a history of GBS should not get this vaccine. Thisshould be discussed with your doctor.
• If you are not feeling well. They might suggestwaiting until you feel better. But you should comeback.
4 Risks of a vaccine reactionWith a vaccine, like any medicine, there is a chance of side effects. These are usually mild and go away on their own.Serious side effects are also possible, but are very rare. Inactivated flu vaccine does not contain live flu virus, so getting flu from this vaccine is not possible. Brief fainting spells and related symptoms (such as jerking movements) can happen after any medical procedure, including vaccination. Sitting or lying down for about 15 minutes after a vaccination can help prevent fainting and injuries caused by falls. Tell your doctor if you feel dizzy or light-headed, or have vision changes or ringing in the ears.Mild problems following inactivated flu vaccine: • soreness, redness, or swelling where the shot was
given • hoarseness; sore, red or itchy eyes; cough• fever• aches• headache• itching• fatigueIf these problems occur, they usually begin soon after the shot and last 1 or 2 days. Moderate problems following inactivated flu vaccine:• Young children who get inactivated flu vaccine and
pneumococcal vaccine (PCV13) at the same time may be at increased risk for seizures caused by fever. Ask your doctor for more information. Tell your doctor if a child who is getting flu vaccine has ever had a seizure.
Severe problems following inactivated flu vaccine:• A severe allergic reaction could occur after any
vaccine (estimated less than 1 in a million doses). • There is a small possibility that inactivated flu vaccine
could be associated with Guillain-Barré Syndrome (GBS), no more than 1 or 2 cases per million people vaccinated. This is much lower than the risk of severe complications from flu, which can be prevented by flu vaccine.
The safety of vaccines is always being monitored. For more information, visit: www.cdc.gov/vaccinesafety/
5 What if there is a serious reaction?
What should I look for?• Look for anything that concerns you, such as signs of
a severe allergic reaction, very high fever, or behavior changes.
Signs of a severe allergic reaction can include hives, swelling of the face and throat, difficulty breathing, a fast heartbeat, dizziness, and weakness. These would start a few minutes to a few hours after the vaccination.
What should I do?• If you think it is a severe allergic reaction or other
emergency that can’t wait, call 9-1-1 or get the person to the nearest hospital. Otherwise, call your doctor.
• Afterward, the reaction should be reported to the Vaccine Adverse Event Reporting System (VAERS). Your doctor might file this report, or you can do it yourself through the VAERS web site at www.vaers.hhs.gov, or by calling 1-800-822-7967.
VAERS is only for reporting reactions. They do not give medical advice.
6 The National Vaccine Injury Compensation Program
The National Vaccine Injury Compensation Program (VICP) is a federal program that was created to compensate people who may have been injured by certain vaccines.Persons who believe they may have been injured by a vaccine can learn about the program and about filing a claim by calling 1-800-338-2382 or visiting the VICP website at www.hrsa.gov/vaccinecompensation.
7 How can I learn more?• Ask your doctor.• Call your local or state health department.• Contact the Centers for Disease Control and
Prevention (CDC): - Call 1-800-232-4636 (1-800-CDC-INFO) or - Visit CDC’s website at www.cdc.gov/flu
Vaccine Information Statement (Interim) Inactivated Influenza Vaccine
42 U.S.C. § 300aa-26
07/26/2013Office Use Only
