Q&A with Our Doctors

Recently we sat down and answered some of the most pressing questions we get from parents.

What are important cognitive milestones for my one year old?

One-year- olds are curious about most everything and try hard to explore the world around them. A typical 12-month- old: explores objects in many different ways (shaking, banging, throwing, dropping); finds hidden objects easily; looks at the correct picture when an image is named (i.e., will focus on a picture of a “dog” when asked); imitates gestures and sounds; and begins to use objects correctly (drinking from cup, brushing hair, dialing phone, listening to receiver). In terms of language skills, a typical 12-month- old: pays increasing attention to speech; responds to simple verbal requests; responds to “no;” uses simple gestures, such as shaking head for “no;” babbles with inflection; says “dada” and “mama” though not always appropriately; uses exclamations, such as “oh-oh!”; and tries to imitate words.

What are the developmental stages of babies from 12 to 24 months?

A great deal of rapid cognitive and motor development occurs between ages 1 and 2. Many babies are starting to take first steps by 12 or 13 months and ought to be walking alone by 18 months. Other motor skills include: pulling toys behind when walking; beginning to run; standing on tiptoe; kicking and throwing a ball. Important verbal and social development skills include: following simple commands (initially when the adult speaks and gestures, and then later with words alone); getting objects from another room when asked; pointing to a few body parts when asked; pointing to interesting objects or events to get you to look at them too; bringing things to you to show you; and pointing to objects so you will name them. At this age, babies will name a few common objects and pictures when asked and should learn about 1 new word per week between 1½ and 2 years. They will use gestures and words with you or with a favorite stuffed animal or doll. By 2 years, children should be able to use simple 2-word phrases. Around this time, children also start to enjoy pretending (for example, pretend cooking).

What does walking normally look like in toddlers?

Learning to walk takes a lot of practice, which can go on for a long time. Most children take their first steps around their first birthday, but the normal range for reaching this milestone is up to 18 months. Kids who are learning to walk are called “toddlers” because that’s exactly what they do — they “toddle,” keeping their legs wide apart and seeming to hesitate between each step, jerking from side to side as they move one foot forward, then the next. Soon after your toddler takes her first steps, she’ll learn to stoop down and then stand back up again. If your child’s an early walker, she probably loves toys that she can push or pull as she toddles. About 6 months after taking their first steps, toddlers develop a more mature gait, holding their hands at their sides (rather than out in front for balance) and moving with their feet closer together. They also tend to move their feet in a way that looks more like walking and less like waddling, moving from the heel to the toe.

How do I know if my child is ready for toilet training?

In order for a toddler to be successfully toilet trained, she needs to be able to sense the urge to go, be able to understand what the feeling means, and then be able to verbalize that she needs your help to make it to the toilet and actually go. The first steps in this process involve bodily sensation awareness and usually take place at around 12 – 18 months.  As time passes, your child may demonstrate discomfort over a dirty diaper, try to remove her diaper or resist being diapered. Understanding the link between needing to eliminate and doing so is an important step in toilet training readiness. More development is necessary before your child can begin picturing the potty when she needs to go, plan how she will get to the bathroom and urinate into the potty, and remember her plan long enough to carry it out. Acquiring simple words to describe her body and its workings helps your child think more fully about the process of elimination. Waiting until your child is truly ready will make the experience much faster and more pleasant for everyone involved. Gentle training can usually begin between 2 and 2 ½ years with mastery generally achieved by 3 years.

How can I make sure that my toddler gets enough sleep?

Toddlers need plenty of sleep, about 11- 14 hours a day including naps, to grow up healthy. Here are some important things you can do to help your child get enough sleep: set a regular bedtime for everyone each night and stick to it; establish a relaxing bedtime routine, such as giving your child a warm bath and reading her a story; after 1 year of age (or after able to pull to a stand and cruise well), let your child pick a doll, blanket, stuffed animal, or other soft object as a bedtime companion; do not allow a TV or computer in your child’s bedroom; avoid giving children anything with caffeine within six hours of bedtime, and limit the amount of caffeine children consume; keep noise levels low, rooms dark, and indoor temperatures slightly cool. Talk to your pediatrician about any significant sleep concerns.

How can I keep my child healthy at school?

Germs love to run amuck through classrooms. Good handwashing can help prevent infections from spreading, and the key is to encourage your child to wash her hands thoroughly and throughout the day. Many classrooms also encourage hand sanitizer use. Good nutrition is important to maintain health and also to feed your child’s brain during school hours. Plan to have your child buy or bring lunch depending on the options available, choosing healthier options when possible. Talk with your child about bullying and what to do if she is bullied or witnesses another student being bullied. Go over school bus and playground safety with your child. Talk with your child about when to see the school nurse. Make sure your child’s school has any emergency medications (i.e. epinephrine injectors or asthma inhales) that your child may need along with administration instructions.

Is an hour a day of exercise enough for children?

Physical activity in children and adolescents improves strength and endurance, builds healthy bones and lean muscles, develops motor skills and coordination, reduces fat, and promotes emotional well-being. Activities should be appropriate for their age and fun, as well as offer variety. The daily recommendation for children is at least 60 minutes per day of moderate to vigorous physical activity.  More than 60 minutes per day is great as long as it is done safely and your child is continuing to enjoy what he’s doing. The 60 minutes does not need to be done all at once. Physical activity can be broken down into shorter blocks of time. For example, 20 minutes walking to and from school, 10 minutes jumping rope, and 30 minutes at the playground all add up to 60 minutes of physical activity. If your child is not active now, start from where you are and build from there.

What is a growth spurt?

A growth spurt is a rapid increase in weight and length/height over a short period of time.  Appetite will increase during this period as will need for sleep. Increased irritability is also sometimes a symptom.  The largest increases in growth occur during a child’s first year of life and then again during puberty. Generally, each individual growth spurt will last a few days up to a week, though we sometimes refer to a teen’s total growth spurt as lasting a year or more. Toddlers and school age children do continue to gain weight and height every year generally at a slower steadier pace, though they too may experience brief periods of rapid growth.

How can I keep my child safe from injury?

All children experience injuries as some point. Falls, collisions, and accidents do happen. But there are some things we can do to try to keep children as safe as possible. Proper car seat, booster seat, and seatbelt use is vital to keep children safe during a car accident. Children should wear a well-fitting helmet while riding on anything with wheels (bikes, scooters, skateboards, and rollerblades). Children love to play in water. NEVER leave your child alone in or near a bathtub, pail of water, wading or swimming pool, or any other water, even for a moment. If you choose to keep a gun in your home, keep it unloaded and in a locked place, with the ammunition locked separately. Ask if the homes where your child visits or is cared for have guns and how they are stored.

How can I tell if my child’s abdominal pain indicates a serious illness?

There are many potential causes of belly pain.  Any pain that is severe or prolonged deserves a visit to the office.  Call your pediatrician or seek emergency care if:

  • the abdominal pain is severe, preventing walking or normal movement
  • the pain is located in the right lower part of the abdomen
  • your child has refused to eat or drink at all since the onset of the pain
  • your child refuses or is unable to jump up and land on their heels without the pain becoming significantly worse
  • there is a distended abdomen (looks like a balloon in their belly)
  • there is severe irritability (constantly crying) or significant lethargy
  • your child recently had a seemingly minor or moderate trauma to the abdomen and now has significant pain
  • your child has frequent urination and/or pain with urination
  • your child has signs of dehydration with vomiting and/or diarrhea (bloody diarrhea needs immediate attention)
  • there is any possibility of a poisoning or toxic exposure
  • there is have a high fever
  • there is accompanying significant cough with signs of distress (see cough)

How much weight gain is healthy for children and teens?

General guidelines regarding healthy appropriate weight gain during infancy and childhood follow:

  • Newborns gain approximately 30 g per day (1 oz per day) until 3 months of age.
  • Infants gain approximately 20 g per day (0.67 oz per day) between three and six months of age and approximately 10 g per day between 6 and 12 months.
  • Infants double their birth weight by four months of age and triple their birth weight by one year.
  • Children typically gain 4-6 pounds per year between 2 years and puberty.
  • During puberty this childhood growth rate doubles, but because some kids start developing as early as age 8 and some not until age 14, it can be normal for two kids who are the same gender, height, and age to have very different weights. Children gain on average between 30-40 pounds (13.5- 18.0 kilograms) between ages 11-14. A child can gain 20 pounds (9 kilograms) or more in one year during this time.

How can routine health checkups benefit my child later in life?

Keeping up with routine health visits will assure that your pediatrician is kept up to date with your child’s development along with any health concerns. Pediatricians go over what to anticipate developmentally as your child grows so that you can know what to expect and spot issues early. Prevention is often the best medicine, and maintaining good routine pediatric care will allow you and your pediatrician to address concerns early before they become severe. Since immunizations are also usually given as part of routine checkups, keeping up with the checkup schedule will guarantee that your child stays protected from vaccine-preventable diseases.

Why do children learn things much faster than adults do?

Kids have more neurons actively creating new connections than adults do. This is why they can learn new languages, learn to play an instrument, or pick up a new sport more easily than adults can. To encourage these connections and brain flexibility, expose kids to lots of different experiences and activities early and often.

How do I know if my child is having an allergic reaction to a medication?

Allergic reactions to medications are relatively common and occur more often in people who have a family history of allergies to a specific medication. Most allergies to medications are mild and produce skin symptoms only, usually in the form of hives that may start locally but often spread to cover most of the body. You can give oral diphenhydramine (Benadryl) to relieve itching in children over 12 months of age. Anaphylaxis is a sudden and severe allergic reaction that occurs within minutes of exposure. Immediate medical attention is needed for this condition. Without treatment, anaphylaxis can get worse very quickly and even lead to death. Symptoms of a Severe Reaction (Anaphylaxis) include: swelling of the face, eyes, or tongue, wheezing or cough, high-pitched breathing sounds (stridor), difficulty breathing or swallowing, abdominal pain, vomiting, or diarrhea. If your child is having a severe allergic reaction – always call 911. Do not wait to see if the reaction is getting worse.

How can I work with my pediatrician to get the best care for my child?

Good communication is the foundation of a good working relationship between your family and your pediatrician. Keeping up with routine health visits will assure that your pediatrician is kept up to date with your child’s development along with any health concerns. Prevention is often the best medicine, and maintaining good routine pediatric care will allow you and your pediatrician to address concerns early before they become severe. With good communication, your pediatrician can help you and your child access and coordinate specialty care, other health care and educational services, and public/private community services that are important to the overall well-being of you and your child.