Category: Pediatric Corner

Mental Health & Emotions

Mental Health & Emotions (an excerpt from the AAP)


Talking about mental health and our emotions this month of November, after our kids have been in school for a couple of months, seems like a good topic of conversation for us parents.

School-aged children and teens deal with emotions that sometimes can adversely affect their performance during the day. Anger, over issues both small and large, can create bad moods that affect not only the child/teen but everybody else around them.

Sometimes emotions may be a result of stress. This can cause issues like irritability, poor sleep, changes in eating and social withdrawal. If there is enough disturbance in their daily life and performance, then it’s a good idea to step in as parents to help them out.

You can start by extending an invitation for discussion but don’t be surprised, and don’t force the issue, if they are not ready to talk yet. Simply provide a physical and emotional presence as you wait for them to take you up on that invitation. If you have an idea about what is going on, you can share your feelings of similar situations you may have experienced yourself. Open ended questions in a non-judgmental way can lead to good discussions.

Real life experiences are a great way to teach them how to manage their emotions. If there is a final message on these teaching points, it is that they need to learn that emotions happen, and they do not control our lives. It is possible to approach this in a methodical way, and as a parent, we always have to make sure we remain emotionally in control and balanced. Learning how to identify these feelings is the beginning of knowing what is going on with that bad mood. It is possible that we may have to role model and talk it out for them if they are having difficulty identifying their emotions. Next up, we need to teach them they can regulate emotions and thereby reduce other behavior problems. For one child it may be sitting in a comfortable spot to read a book but for another it may be burning some energy in the back yard before they come back in for a snack. Teaching them to be responsible for their feelings (so they don’t take it out on others) and learning some resiliency (they can change their mood) is a good start to a healthy mental state.

Developing resiliency is a good way to realize they can be in control of their emotions… So not only can they can deal better with stress and anger, for example, but they can extend this to other emotions such as fear and anxiety that may lead to self-doubt and lack of confidence. Your child may be curious about trying out for the soccer team, but they are not sure. A gentle push and acknowledgement of these feelings can help them try it out. These opportunities, in turn, may lead to some failures and mistakes, that when framed in a positive and teachable moment, can lead to growth and eventual self-confidence.

Here are some other tips to help your child develop a positive mental health:

  • Enjoy the outdoors. Sunshine boosts your mood!
  • Get enough sleep. This is about 11-12 hours for a 5-year-old, 10 hours for a 10-year-old, and 8 hours for a 15-year-old.
  • Eat meals on a regular basis, starting with a good breakfast. Avoid sugar highs from junk food and fast food.
  • Help your child practice gratitude and appreciation.
  • Exercise on a regular basis.
  • Teach your child to be kind to people and help others. It’s amazing how happy our hearts feel when we get involved in helping others, from as simple as holding a door open for somebody.
  • Turn off the TV and electronics and play outside or play family board and card games.
  • Teach your child about mindfulness, yoga or meditation. These are good techniques to reduce stress.

If you feel that emotions and stress have led your child or teen to significant anxiety or depression, let us know as we may be able to help and may provide other solutions. We are here for you!

(I originally published this article on Bronson’s web site,

References and other reading:

Making Friends in School

It can be a challenge making friends in school if you are new to the school or neighborhood.  The beginning of the school year can be a lot of fun for kids as they share and exchange stories from the summer activities:  camping, fishing, making trips to see relatives, playing sports or going to camp. Seeing their friends in school is a great opportunity to share and exchange stories. But what if your child wants to make different friends from last year, or just simply make new friends?

Your child’s temperament can play a role if they tend to be shy. In addition, kids need to have the social skills to make connections with other kids. The challenge for any parent is how to help your child step out of their comfort zone and have the grace to create a relationship with another child.

For a child that is shy and perhaps introverted, helping them build social confidence can go a long way. Start out by setting examples at home.

Start at Home

A good place to help your child identify the values that are important to you is to practice at home. Talk with them about what you value most in a friendship, such as:

  • Showing respect for others
  • Playing in a fair way
  • Sharing with others
  • Talking in an encouraging and positive manner

Lead by Example

We should not underestimate how much our children are observing our behavior. When we have a good relationship with our child, we are more likely to influence them with our values. Having a good relationship with your child implies:

  • Being involved in activities together
  • Talking often (try doing the dishes together to set up for an easy conversation)
  • Showing affection for each other

This in turn will help your child seek out other children who may share the same types of values and feelings.

Be a Host

We can take opportunities to get to know other children through school activities, from neighborhood parties, sports events, art camps and other get togethers. By hosting get togethers, you can observe the type of play that other children exhibit and how they treat each other. This will help you select those friendships that you wish to promote as you help your child’s social circle grow.

Help Them Build Social Skills

In addition to helping your child build friendships, it is important that they build good social skills. Here are some thoughts to consider:

  • Teach your child how to start a conversation. This may be the biggest and earliest hurdle as we all want to put our best foot forward. Helping your child identify their interests so they can seek out children with similar interests can be the beginning for starting a conversation.
  • Teach them how to keep a conversation going by exchanging ideas and opinions, acknowledging that topics and other ideas may change as the conversation progresses.
  • Teach them how to read facial gestures so they can be empathetic with the other kid. By being understanding, they can foster a deeper relationship.
  • Teach them how to recognize pauses in the conversation so they can give the other kid an opportunity to talk.
  • Teach them how loud or soft-spoken they need to be depending on the setting. For example, yelling may be common when playing at the playground, but being soft-spoken may be better when talking one on one.
  • Teach your child about personal space and keeping their hands to themselves. Some kids get excited when they are trying to make new friends and tend to invade personal space. They should learn that other children may not feel comfortable with that type of action.

All these suggestions will need to be practiced at home, so your child learns these skills and becomes confident. Pretend play and pretend scenarios can be a good place to start!


Heading Back to School Safety Tips

It is hard to believe that summer is coming to an end and September is just around the corner. This means that kids are heading back to school to enjoy another year of friendships and academic learning. To ensure that your child has a good experience this school year, here are some safety tips to keep in mind. Consider reviewing some of these tips with your child and discussing with them why they are important.


  • Always use public sidewalks; if there is no sidewalk and you must walk in the street, walk facing the traffic
  • Always look both ways before crossing the street. Do not enter the street from between objects like parked cars, signs, trees or shrubbery.
  • Teach children to recognize and obey the traffic signals, signs and the pavement markings
  • Never dart out in front of a parked car
  • Parents: Practice walking to school with your child, crossing streets at crosswalks when available. Have a pre-established route that you both agree upon.
  • Walking with friends is always safer than alone.
  • Review your rule of talking with strangers. Never get into a car without parent’s knowledge and permission.
  • Never walk while texting or talking on the phone
  • Do not walk while using headphones

Bike Riders:

  • Always wear a helmet that is fits properly.
  • Check with the school at what age children can ride their bikes to school.
  • Children need to know the rules of the road: Ride single file on the right side of the road, come to a complete stop before crossing the street and walk the bike across
  • Practice the route to and from school
  • Ride bike with friends; there is safety in numbers.
  • Watch for opening car doors and other hazards
  • Use hand signals when turning
  • Wear bright-colored clothing

Bus Riders:

  • Arrive early to the bus stop so your child is not tempted to cut corners or run across the street while trying to catch the bus.
  • Line up six feet away from the curb as the bus approaches
  • When riding the school bus, wait for the bus to stop completely before standing. Make sure the bus comes to a complete stop before getting off the bus.
  • Do not shout or distract the driver.
  • Do not walk in the driver’s “blind spot” — this is the area from the front of the bus to about 10 feet in front of the bus.

Teen Drivers:

  • No texting while driving.
  • Do not take a call on your phone unless you have a hands-free option in your car.
  • Don’t change the music on your phone while driving
  • Plan to get to school early.  Accidents increase and defensive driving goes down when you are in a hurry to get to school.
  • Slow down for school zones
  • Students with a level two driver’s license in Michigan cannot take more than one passenger under the age of 21 in the car (with some exceptions)

More Resources

As we think about other topics of safety in the school environment, you can visit the State of Michigan web’s page for more information.


Tips for staying safe near water this summer

As we head into the summer, I thought I would share with you some tips for staying safe near the water this summer.  Here are some statistics to think about.

According to the Centers for Disease Control (CDC):

  • There are 4,000 unintentional fatal drownings every year in the U.S.
  • There are 8,000 unintentional non-fatal drownings every year in the U.S.
    • Nearly 40% of non-fatal drownings treated in the emergency departments require further hospitalization
  • More kids in the 1-4 years old age range die from drowning than any other cause of death

Drowning is one of the most common forms of unintentional deaths amongst kids and teens in the U.S. With the right preparation and training, we can help prevent accidental drowning.

Who is Most at Risk for Drowning?

Children ages 1-4

Kids between the ages of 1-4 are more likely than any other age group to drown. With this age group, drowning is most common when the child was not expected to be near water. This includes children gaining access to an unsupervised pool. In fact, home swimming pools are the most common drowning site for kids ages 1-4.

Older teens and adults

In the 15-year-old and older group, most drownings occur in natural water settings (lakes, rivers, oceans, etc.). Moreso, around 80% of young adults and adults who die from drowning are male. Why might this be? Many of these drownings are connected to alcohol and high-risk activities. If you have a teen at home, I highly encourage you to share this article with them as we approach summer.

Non-Age-Related Risk Factors

People with certain medical conditions like seizures, autism or a heart condition are also at an increased risk for unintentional drowning. For people with a seizure disorder, the bathtub is the most common site for unintentional drowning. If a loved one suffers from a medical condition where they may lose control of their body or may not be able to safely care for themselves in a stressful situation, be sure to pay extra attention when they are near water.

Prevention is Key to Avoiding Drowning

So how do we make our environment safer and reduce the risk of drowning? Have a layered approach to water safety. This means:

  1. Have multiple safety steps in place to avoid accidents before they happen.
  2. Educate yourself and your children on how to stay safe in and around water.

Here are some tips from CDC, the American Academy of Pediatrics (AAP) website (, and AAP patient education handouts.

Swim Lessons

It is never too early to get your child into swim lessons! You can find local swim lessons for kids starting at 4-6 months. At this early age, lessons are for both baby and parent and are focused on getting your little one comfortable in the water. As your child gets a little older, typically pre-school age, lessons should include basic swimming skills and water safety.

Home Pool

  • Fences:
    • The best option for securing a home pool is to install a fence that is at least 4 feet tall around all 4 sides of the pool. Ideally, this fence is not connected to the house. The gate to the pool should open out from the pool and have a self-close and self-latch that children can’t reach. Why is this important? Just as it is important to keep animals or neighbors out of your pool, you also need to protect your own pets and children from entering the pool without your knowledge.
    • If your pool is fenced in, but not separate from the house, install a secondary fence or net around all four sides of the pool. There are many designs and options available. No matter what, be sure that your pool is secured at all times.
  • Make sure your back door facing the pool has an alarm that will make noise when opened. Consider having locks adjusted to a height that cannot be reached by young children.
  • Children can be tricky and fast, so think about installing window guards on windows facing the pool. Reconsider pet doors that have access to the pool.
  • Make sure you have rescue equipment nearby. Consider equipment that is made of fiberglass or another material that does not conduct electricity.
  • Have life jackets that fit each of your children based on their size and age, as recommended by U.S. Coast Guard and tested by Underwriters Laboratories (UL). Remember, “floaties” are not a substitute for life jackets. They can create a false sense of security.


Learning to dive is exciting for a kid. However, diving in shallow areas can result in major injuries like neck/spinal cord injuries, head trauma, and potential life-long disability. Here are some suggestions to keep in mind as you talk with your child about diving safety:

  • Never dive in shallow water! Teach your kids to recognize when water is shallow or deep. It may be easier to see how deep the water is in in a pool, but you often can’t see the bottom of open water. When jumping in the water for the first time, always enter feet first.
  • Avoid diving into aboveground pools.
  • Avoid diving through inner tubes or other pool toys.

Water Safety in the Open Water

  • Never swim without adult supervision. No matter how old you are or how good of a swimmer you may be, it is always a good idea to have at least one person with you when swimming in open water.
  • Never dive into water unless you know how deep it is. For kids, they should know not to dive into a pool unless an adult says it is safe.
  • When boating, riding on a personal watercraft, fishing, waterskiing or playing in a river or stream, wear an approved personal flotation device (life jacket or life vest). This is important for both kids and adults. Water wings and other blow-up swimming aids (“floaties”) should not be used in place of life jackets.
  • Never try water sports such as skiing, scuba diving or snorkeling without instructions from a qualified teacher.
  • Never swim around anchored boats, in motorboat lanes, or where people are waterskiing.
  • Never swim during electrical storms.
  • If you swim or drift far from shore, stay calm and tread water, or float on your back until help arrives.
  • Teach your child to know their limits:
    • When they are too tired
    • When they are too cold
    • When they are too far from safety
    • When they have had too much sun
    • When they have had too much hard activity

Exceeding these limitations can set them up for danger.

Aside from lakes, rivers and ponds, other water hazards you may find around your house include canals, ditches, postholes, wells, fishponds and fountains. Watch your child closely if they are playing near any of these areas!

Life Jackets and Life Preserves

  • Always have a life preserver if you are in open water. This may seem obvious for kids, but it is important for adults too. I personally swam in college, and I still find that wearing a life vest while in a lake makes it easier for me to rescue a child in trouble.
  • Have your child wear a life jacket that is approved by the U. S. Coast Guard and was tested by the Underwriter Laboratories (UL). In addition, the jacket should fit for your child’s weight and age.
  • Teach your child how to put on a life jacket correctly.
  • Remember that “floaties” do not replace life jackets. This includes blow-up wings, rafts, noodles or air mattresses.

Water Safety Around the House

  • Never leave an infant or young child alone in the bathtub. Accidents can happen in the blink of an eye!
  • Empty large buckets of water when you are done with a project. Infants and toddlers can fit their heads in the buckets and stay stuck.
  • Consider bathroom doorknob locks or covers. Young children could wander into the bathroom and run the bathwater without adult supervision.
  • Consider getting a toilet lid latch so toddlers don’t play with the toilet water. Toddlers could stick their heads in the toilet and get stuck.

Be Prepared for an Emergency

  • Learn how to perform CPR. For all the technology we have in the intensive care units, the two bigger variables in helping a child survive a near-drowning event are:
    • Reducing the time the victim is under water.
    • Being ready and able to perform CPR when the victim is rescued from the water.

CPR classes are available throughout the community. Check as well as the local YMCAs and the American Red Cross.

If you are in an emergency, remember to dial 911 as soon as the drowning victim is pulled from the water.

(This article was originally published on May 25, 2023 at Bronson’s web page)


The Development of Your Two-Year-Old

It seems like just yesterday your toddler was just a baby! Where has the time gone? Read on to learn about the developmental changes your two-year-old is experiencing – including the fine-tuning of gross and fine motor skills, expanding their vocabulary, and learning to play well with other kids.

The fall leaves have turned yellow, orange and brown. It seems that about half of them have fallen to the ground and you find yourself in your backyard chasing two-year-old Amelia through the leaves as she giggles and laughs, firmly believing that you cannot catch her. It was just last weekend that you celebrated her birthday party, and you wonder where the time has gone.

During her second year of life, you saw her refine her walking and then progress to running. As you chase her in the backyard, you acknowledge that she is actually a pretty good runner. You wonder if she could turn out to be a soccer player, just like you! During their first two years of life, Amelia has focused a lot of her developmental energy on conquering gross motor skills (like walking and running) and fine motor skills (like holding a spoon and feeding herself). She has developed a sense of satisfaction with herself, which has led to building some self-confidence.

If you haven’t had the opportunity to contrast her present psychological state against her restless and insecure state as a one-year-old, maybe you could look at the way she walks into a room. Her chin is usually up, she often has a smile, and she wants to know if you are ready to play the next game of matching shapes. The constant repetition of doing a task and seeing herself conquer it has established a platform from which she feels she can master any situation. For you as a parent, this has become a great opportunity to continue to foster building her self-confidence. Your biggest challenge is trying to gauge what activities you can get her involved in so that she has a fair opportunity to see herself succeed.

Sometimes we feel stumped trying to come up with ideas on how to spend the day with her. Try:

  • Hot/Cold: Hide toys or objects throughout a room and use the words “warmer” and “colder” to help her find them.
  • Play Make-Believe: Have her sit on a blanket or towel and pull her around the house as if she is on a boat or train. Have her describe what she sees on her journey.
  • Taking Care of ‘Baby’: Have her dress a doll, talk to her doll, and take care of it – just like you take care of Amelia.

Find more ideas in this list of indoor activities from

As Amelia gets comfortable with her motor development, her energy shifts to speech development. Most children will have about two or three words in their expressive vocabulary at one year of age, gradually building to 25-50 words by age two. Whereas most of their development energy was concentrated on the motor skills during the first and second years of life, now her energy is going towards speech development. A big milestone at this stage is to be able to put two words together. In general, and there are always exceptions to the rule, girls are more likely to be around 50 words whereas the boys may be closer to 25 words. However, and something to look forward to, by three years of age both boys and girls vocabulary will explode to about 1,000 words and they will be talking in sentences!

Reading every day is a great way to expand her vocabulary. While you read, she hears you pronounce words as they relate to the story. She is also watching your lips and mouth as you enunciate the words. In the same way she used repetition to master her motor skills, she will often repeat words that you use to describe things. Start practicing the A-B-Cs so she can learn that words are made up of letters. Show her visually the letter as you say it. In time, she will learn from repetition and recognition. Amelia also finds colors fascinating. She has already developed a special interest in the color green – her “favorite color.” Teach her to count things as you introduce numbers to her. For example, at an outing, you could say, “How many kitty cats do you see?” and count with her. Or “How many balls do we have?” as you count one, two, and three. A fun way to use word repetition is by reading Dr. Seuss books and by rhyming in songs.

Socially, Amelia is moving from parallel play to sharing with others. Children at this age like to please parents so they can turn out to be big helpers. If you are wondering about her development at this age, check out the Ages & Stages Questionnaire for a two-year-old, which is labeled as ASQ-SE for Social Emotional Development. If you are adding a new baby to the family soon, the biggest challenge for a kid at this age is to redefine themselves. They have been getting all the attention up to this point and they may feel it is hard to share that spotlight. Take advantage of the fact they like to be helpers, and engage them as mommy/daddy’s helper for the new baby.

You may have noticed that sleep has been more peaceful lately. Amelia has been playing all day except for that middle of the day nap. Having a tired body lends for some good sleep at night. Bath time before getting into her jammies can be fun, too. Have her recall her day with you, and then play with her toys before getting out of the tub. If she is having a hard time relaxing after bath time, she might talk some more in bed before falling asleep – maybe telling a story to her bunny. Doing a bedtime story is another way to practice reading while also helping her relax before going to sleep. At this age, children usually need about 11-12 hours of sleep at night to be rested for the adventures of the next day.

One final item to address at this age: toilet training. There are three main ingredients that children need to start the process. Before beginning toilet training, kids should:

  1. Have some bladder control. For example, dry diapers after a nap.
  2. Be able to walk to the toilet on their own.
  3. Have the fine-motor control to help pull up and down their pants.

As long as they have the three skills above, it’s all about the psychology of being ready to go in a toilet – and this comfortability varies widely from child to child. Personally, I give parents reassurance that I have yet to see a child not potty trained by the time they start kindergarten.

There are multiple sources out there on toilet training, but I must admit I am partial to Dr. T. Barry Brazelton. He is a well-known and nationally-recognized developmental pediatrician. His book, Toilet Training the Brazelton Way, and the described method seems very gentle while always keeping in mind that you are assessing your child’s psyche as you try to avoid the development of resistance and defensiveness.

As you get ready for Amelia’s well-child exam, take a look at typical developmental milestones for a two-year-old. I hope you have a great fall season!


More Developmental Milestones

Dr. Spitzer has authored more articles on developmental milestones you can look forward to in your young children. Check them out below!

The Independence of an 18-month-old

“No, no, no …”  It is not uncommon to hear this from an 18-month-old who is flexing his muscle to let you know he is in control. It seems like it was only yesterday that he was so complacent and easygoing: Feedings were always fun. He smiled if you smiled. And those belly laughs made you laugh … Where did it all go?

Once a child begins to walk, they develop a sense of independence where it seems like life has no boundaries. This behavior and the desire to explore is very impulsive and not well thought out. Consequently, and appropriately so, they investigate everything. They want to see how things work, how things taste, and they want to explore cause and effect – i.e. If I pull on this, what will happen?

Learning boundaries is very hard for toddlers because it puts a limit on their desire to learn. This is where we as parents come in to help keep them safe. However, where the lines get drawn for boundaries is where difficulties often arise. Some boundaries are very clear cut. For example, we would never let a toddler run in to the street. Other boundaries, however, can be a little more arbitrary and vary depending on our temperament and how compulsive and careful we are as parents. In addition, the child’s temperament also factors into the conflict of where to set boundaries. Throw in our emotions as parents, how busy was our day, and whether we had much frustration at work, and you can see where we may have a recipe for an explosion at home.

The key to helping a toddler sort through this phase is understanding where and when they need to learn self-control.

Toddlers experience positive emotions when they accomplish something – like climbing onto the couch without any help. Once they get up, they smile, get down and try to climb back up.  And then another smile appears across their face. These are good opportunities for them to see us approve of their accomplishment. This creates confidence and they learn they can get that from us. Also, in the moment, this will lead to cooperation and caring on their part.

On the other side of the coin are the negative emotions where there may be frustration because they could not accomplish their task. Despite multiple attempts, your little one sees the same negative outcome over and over again.  As T. Berry Brazelton – an American pediatrician, author and developer of the Neonatal Behavioral Assessment Scale (NBAS) – explains, negative feelings must surface with positive emotions. Even we as adults experience this conflict of positive and negative emotions on a regular basis. It is this life-long conflict that children need to learn to live with, and in the process, learn self-control.

These battles where toddlers experience positive and negative emotions can bring on some insecurity. What initially started out as stranger anxiety around 6-9 months of age has now developed into separation anxiety. Your child feels the need to go forward and explore their surroundings, while always looking back over their shoulder to make sure you are still there.  Tantrums are likely to happen if you disappear momentarily from the picture.

In addition to the dynamics of positive/negative emotions and security/insecurity is the temperament of your child. A strong-willed child can display a lot of passion, which can make for some challenging days.

Here are some suggestions to help you guide your 18-month-old:

  • As best as you can, avoid having arguments with your toddler. As a parent, you should always try to remain in control. When you hit a point during the day where a decision needs to be made, rather than asking what your child would like to do, give them an option of two choices they can pick from. For example, at breakfast you could ask “Would you like cereal or pancakes?” The will feel satisfied when they choose an option, and you are satisfied because you can live with either option.
  • When an adverse situation comes up that could make you lose your cool, take a deep breath, exhale, and don’t say anything. Not reacting right away and taking a pause can defuse a situation that could otherwise quickly escalate and make both of you mad. In a very matter of fact tone, acknowledge the situation and move on to another option.  Toddlers have a short memory, giving you the opportunity to refocus on an activity.
  • Take advantage of your child’s desire to be grown up like you. “Can you help me pick this up?” or “Can you help me put this away?” will likely add to their satisfaction that they are behaving like a grown up. And of course, the compliment and thankfulness afterwards will bring a big smile to their face!
  • Learn the technique of ignoring to minimize negative behavior. If your child is doing something that is of small consequence, look the other way and let them learn from their mistakes. Once you see they have learned their lesson, you can reinforce that lesson with a simple, matter of fact statement.
  • Know when to intervene if you feel their behavior is escalating to a tantrum. Tantrums need to be addressed calmly and rationally by providing a “choice.” If your little one is really wound up, remove them gently from the situation and engage in a different activity. Assess if their scheduled needs have been met, i.e. feeding times, nap times, sleep or bedtime to get back on track.
  • With the same matter of fact tone, let them know they are doing a good job. It’s a good idea to praise the work your toddler does and try to avoid using “good boy” or “good girl.” Instead, “I like how you put the toys away, thank you!” can bring a smile to their face. Kids need to know they are accepted and loved just as they are, despite sometimes making mistakes.  But they are here to learn, and we can approve of that process!

More Resources

As you get ready for your toddler’s next well-child exam, take a look at  The AAP 18-month-old article to give you an idea of what questions you might like to ask at that visit. Also, take a look at the Ages & Stages Questionnaire for 18 months old to see where your child is with development. And finally, I found this Today’s Parent 18-month-Old article very educational in helping to enhance knowledge on parenting.



One Year Old Charlie

Happy Birthday Charlie, you are one year old!

The day has finally arrived to celebrate Charlie’s happy birthday!  You have the balloons out by the end of the driveway with a big 1 on them.  Your eyes carry you through pin wheels, teddy bears and yard signs as they line your walkway to the backyard.  Guests have arrived with their children, and grandma and grandpa have their favorite one-year old in their arms.  The trees in the backyard provide for great shade and the cool breeze this afternoon makes for a great celebration!

As parents, you step back for a moment to contemplate the scene and wonder how you ever got to this point.  Why, it only seemed like yesterday that this bundle of joy was so dependent on you for all the feedings, diaper changes and soothing to sleep.

The energy that goes into gross motor development

One of the biggest accomplishments for a one-year-old is learning how to walk.  The energy put into this accomplishment has been building for a long time.  Gross motor development in a child is very predictable, gradually developing strength from the neck and upper body as he learns how to hold his head steady by four months, to building core muscle strength so he can sit in a highchair by six months, and then developing those pelvic muscles and start to crawl by nine months.  Once he gets the idea that he can go places by crawling, he soon realizes that he can pull himself up on furniture, cruise along the furniture and eventually let go.  Those first few steps are exciting, not just for him as you see his facial expression of apprehension changing to smile and satisfaction, but for you as a parent as well as you feel so proud for his accomplishment.  Friends and parents must learn of this milestone, and we post it on Tik Tok, Instagram and Facebook.

What is interesting about the development of this independence is that he truly believes he can conquer everything.  Going over safety and making sure one more time that your home is child-proof is of paramount importance.  You can get a good checklist at American Academy of Pediatrics Home Safety Checklist .

Refining Fine Motor skills

Along with gross motor development, your child’s hands and fingers have become better at handling objects, including the spoon and fork.  Depending on how tidy you like to be, you might feel compelled to provide food for him on his tray and let him use the spoon and fork.  Sometimes, your springer spaniel Murphy gets to have some extra treats when Charlie is in his highchair.  The pincer grasp, with his thumb and index finger, which probably started around nine months of age, is now fully developed as he picks up cheerios and crumbs without difficulty.  His dexterity has also developed so that he turns pages in a book with care, gradually moving away from that stage where he used to mouth the book.

Speech Development at one year

Speech development is just starting to take off.  He has been listening (receptive language) a fair amount and you get the impression he can understand a good amount.  However, expressive language always lags receptive language, and at this stage in his life, he has about two to three words in his vocabulary that you can understand.  His frustrations are frequent as you play guessing games with what he wants, and this will continue for the next year.  What is interesting is that if he has older siblings, they seem to understand him better and they frequently speak for him.

Problem solving and social development

His curiosity continues to push him to explore his surroundings.  He is learning the concept of space and how objects can go into boxes, and he can then take them out.  Object permanency is also taking place so you can hide objects from him, and he can search for them.  And finally, he is learning to scribble on paper as he holds a crayon with an immature grasp (using all five fingers).

Socially, he is still exhibiting some stranger anxiety which had initially sprung up around six to nine months of age.   But if friends and family members can gain his confidence, he can play and interact with them as he shares toys and passes them back and forth or throws a ball across the room.  He is also participating better in getting dressed as he offers you his arms and legs while you try to put on his shirt and pants.

One of the challenges in trying to understand his pushing people away is that sometimes this stranger anxiety mixes in with his sense of independence.  He wants to do things himself and his way.  If we can see this difference, we can then adopt a role of a helper when he is trying to do things his way rather than us moving back a step if he feels stranger anxiety.  The more you do things for him, the more dissatisfied he is going to be and the more likely you are to see some of his frustration.  Then, the temper tantrums will start and sometimes it is hard to get out of that cycle.

His negative energy can make you feel frustrated, and everything can move in a downward spiral.  A good tip of advice: give him space to do it his way and be encouraging and supportive.   A good effort on his part should be celebrated.  Positivity begets positivity and creates the beginnings of a life-long trusting foundation of parental support for the child’s independence and endeavors.

So, for now, it is time to celebrate this magical moment of turning one year old.  I like chocolate cake, how about you?


  1. Ages & Stages Questionnaire
  2. AAP Pediatric Patient Education, Home Safety Checklist
  3. Touchpoints, The Essential Reference, by T. Berry Brazelton, M.D. Addison-Wesley Publishing Company, 1992.

So, You’re going to be a new parent?

First and foremost, congratulations!  You are going to be a new parent!

As you approach your baby’s due date, it is hard to believe the time has finally come. It’s common to experience a wide range of emotions at this time, including feelings of excitement to anxiety, and from confidence to feelings of insecurity. All of these thoughts and feelings are very normal!

It is certainly a time to rejoice, but just like any new adventure in life, there are always challenges. Here are some tips to consider as you get ready for the arrival of your new infant.

Take Care of Yourself Physically

Look at taking care of your new baby as a long run rather than a sprint. Here are a few suggestions to keep in mind as you become a new parent:

  • Eat properly, healthy and at the right times. Stay hydrated and drink plenty of fluids. Sometimes running low on fluids can affect our stamina, which can cause fatigue.
  • Sleep whenever you have the opportunity, particularly when the baby sleeps. It’s okay to take naps during the day because you will be up in the middle of the night with feedings and diaper changes.
  • Go for walks or try to exercise. Not only will this help you with your overall stamina, but it will be a good mental break. Just be sure to follow your doctor’s orders, and maintain a level of endurance close to the level you had before giving birth.

Take Care of Yourself Mentally

Treat yourself and your partner with kindness. It’s common for both of you as new parents to have anxieties at the beginning as your baby did not come with a manual. Here are some tips on how to navigate and deal with your uncertainties at the beginning:

  • Trust your instinct and adjust your expectations. Know that you are going to make mistakes and it will be okay. I find it amazing how resilient babies are despite the mistakes we make as parents.
  • Don’t forget to improvise on plan B. I heard this saying once and it has become a good way for me to operate in life. Sometimes our best laid plans don’t work out for reasons unforeseen. I then move to plan B and something else comes up that makes me improvise on that plan before everything works out. It takes patience!
  • Expect stress and therefore, learn to build resilience. Develop a belief that you can do it and before you know it, you will be conquering mountains!
  • Acknowledge there may be some feelings of uncertainty as you start to feel tired after the first four to six weeks of your baby being home. There’s an expectation you should be “happy” all the time, as everybody seems to be happy for you. However, you may also be wondering, “I can’t believe we are doing this.” You are not the only one to feel this way at this stage, and it will pass as your baby starts to become social and interact with you.
  • As a new parent, you are going to transform personally and will leave behind a little of that care-free person you used to be. Remind yourself, it’s okay to change.
  • Find your support group and don’t be afraid to ask for help. There will be some advice that makes sense to you, and some that will not. Use your common sense and acknowledge your limits on certain types of advice to know when to take it and when to leave it.

What Kind of Milk to Use?

Trying to decide between breast milk and formula can sometimes be a challenge. For some moms, this is not an issue as they may immediately feel comfortable with breastfeeding. However, for other moms and families this can be a challenge as there may be some uncertainty towards breastfeeding. Science has shown that breast milk is superior to infant formula, but the advances made on the development of formula has brought it pretty close to breast milk.

Rest assured, babies can grow up healthy whether on breast milk or on formula. In fact, if you were to line up a bunch of five-year-old’s going to kindergarten, you will not be able to separate who was breastfed and who was formula-fed.

Baby Development

It’s a good idea to understand baby development for the first few months as you gradually get physically and emotionally tired. Here are some key points:

  • The basics of baby care the first four to six weeks is about feeding, burping the baby, changing the diaper, and then having the baby go back to sleep. It’s easy to get physically exhausted doing this 24 hour a day, seven days a week. But right around four to six weeks of age, your baby will start to smile socially at you and will begin to communicate with you by making cooing sounds. This is exciting and adds a new dimension to your bond that makes parenting worth it!
  • Look forward to bonding with your baby. Similar to dating, you can learn about the baby’s temperament early on and what soothes them. Knowing how easily they can calm down after a noise (we call this habituation) and whether there were any difficulties during the pregnancy can help determine how noisy to let the house be. Stressful pregnancies, especially if drugs were involved, can lead to a baby that may “stress out” easily. This infant may need a quiet home for some time to gradually allow them to handle noise and stresses in the household. Some infants’ temperaments are such that, despite a normal pregnancy, they become irritated easily. These infants also may need to have their “daily dose” of household energy gradually increased, allowing the infant to adjust with time.
  • To create a relaxed and quiet environment in the house, try playing classical music. Not only will this be good for the baby, but you may also find yourself relaxed too!
  • Things will get easier after the first two months as your baby becomes more social and learns how to interact with you. In addition, after approximately four months of age, you can expect your baby to clock about 6-8 hours of sleep at night as they have doubled their birth weight and built up enough baby fat to maintain their blood sugar through part of the night.

Take Care of Your Partner

When parenting with a partner, working as a team is key to providing the best care possible for your baby. This means digging deeper into getting to know each other and trying to understand how you each react under certain circumstances. It is easy to accidently exclude your partner while taking care of the baby as you may subconsciously be thinking your way is better. Or it may be easy for you to become defensive as your partner suggests another option on handling a problem. Here are some questions to consider as you try to better understand one another and how you will blend your experiences/beliefs as you take care of your baby:

  • What was your home life like when you were a child?
  • How did your parents raise you?
  • How did your parents act when they ran out of patience?
  • Did your parents ever spank?
  • Did your parents have a good technique for handling stress?
  • Were both your parents involved in raising the children or was it a single parent mission?
  • Did your parents have any problems with anxiety or depression, and how did they cope with these mental health issues?

How About Daycare?

Planning daycare can be difficult. Dealing with the pain of separation is hard to measure as you contemplate your financial and professional needs. It’s common to experience feelings of anxiety as you explore daycare options. There is no correct decision, but only the one that suits your family, as stated by Robin McClure in Very Well Family, and as you gather information from family and friends. However, having a plan in place will relieve some stress as you near that time. And don’t forget, sometimes we must improvise on plan B!

Last but not least is one of my all-time favorite tips of advice: Don’t forget to keep dating! When parenting with a partner, the two of you are most important to each other and you need to continue to be on solid ground, making each other feel special.

If you have any questions or concern, your child’s pediatrician a call! Don’t have a pediatrician yet? Find one at

This article was first published at


Development in your six-month old

At six-months-old, your baby is rapidly developing with new skills!

It’s Memorial Day weekend and your parents have decided to visit with you, your spouse, and little six-month-old Maggie. The trip from the east side of the state is two hours long but they are here, ringing the doorbell and excited to see their two favorite girls. You exclaim to Maggie that Nana and Papa are here, but she just looks at you. You pick up Maggie and upon opening the front door, you feel your heart fill with joy as you haven’t seen your parents in a couple of months. Nana flashes a huge smile, opens her arms and with a long, melodic “Hello” gives you a hug and takes Maggie. Papa relishes the moment as he sees Maggie smile, hold her neck and trunk steady while she uses her right hand to touch Nana’s face and then proceeds to bounce up and down in Nana’s arms.

The joys and wonders of a six-month-old are hard to measure. You just simply feel it in your heart and wonder how did she so quickly come to be this person that just six months ago was a bundle of joy that cried for milk and very quickly went back to sleep. Not only did she double her birth weight at four months of age and grew in length an extra six inches, but her brain has been multiplying nerve cells at a very rapid pace, also hard to measure.

The bond that you and your spouse have created with Maggie feels comfortable and secure, one that has been building since she was born. Whereas those initial days were fraught with fatigue, insecurity with not knowing what to do, and sometimes reacting in a panic, uncertain if her cry signaled a real hurt or she was just tired and ornery, you both now communicate with real purpose on how to take care of her and how to plan for the day. You both have now grown as a couple and feel more comfortable in your roles as parents. Interestingly enough, Maggie has picked up that you communicate with each other using words and facial expressions.

Speech Development

Speech development begins to manifest itself around four to six weeks of age with cooing. You probably remember how exhausted you felt that first month where all she did was wake up, cry, have her diaper changed, feed, burp and then she was back to sleep. After about two to four hours of sleeping, the cycle would repeat itself… 24 hours a day! You are giving and giving, and gradually become physically and emotionally tired from the lack of good sleep. Then, one day around four to six weeks of age, she socially smiles at you and coos. She is now giving back to you, and it feels wonderful! And so begins your mutual interaction where sometimes it felt like she was telling you of her wonderful day by rhythmically cooing in a sweet melodic tune.

Around four months of age, you might remember, she began to make “raspberry” sounds and spewing spit as she exercised her lips, her diaphragm, and her lungs to make sounds. By six months, she has now started to put two syllable words together without any special, social connotation: da-da-da-da, mum-mum-mum-mum or ba-ba-ba-ba. What’s interesting is that you have gotten excited by her calling out mum-mum-mum. She gradually will make a mental note that she gets your attention when she says that and will later, by nine months to one year of age, give a social meaning to it, and so begins the building of her vocabulary.

Cognitive Development

Another interesting aspect of her using her voice (with crying) is that she is cognitively learning how to solve problems. When crying at first was used as a means of survival (I am hungry), now she has been using it to get your attention. At this age, Maggie is beginning to expect responses from you and your spouse when she cries. In addition, she is learning that she can produce a response from either of you when she cries. Have you heard her “fake cry?” It is good to use proper language with the right tone when you respond to her, rather than talking down to her in a “baby voice.” She will learn to speak more clearly this way.

In addition to using her voice, she has been using her hands to better explore objects. She must mouth and taste them to begin to form concepts in her brain as to what these things are. She likes to touch or grab everything.

The world around her is very interesting as her vision has improved. A newborn’s vision is about 20/400 so they can perceive light, but everything is very blurry. Slowly they begin to form concepts in their brain about straight lines and round objects, to what is dark and bright, to eventually conceptualize objects in their brains. By 6 months of age, their vision is 20/20 and they can see clearly. You may have noticed how difficult it is to change her diaper as she wants to roll to grab a toy or grab your necklace. How about doing baths? Aren’t they so slippery when slathered with soap and they try to check the washcloth? Always a good idea to keep one hand on her for safety while you are trying to do something with her.

With improved vision and having had six months to form a strong bond with you, she has started to recognize you as the person who is there to save the day! In addition, with all her touching, she has been curious about your face, eyes, ears, nose, and lips to begin to form personal awareness. This is the beginning of “object permanence” where you could disappear for a moment, and she knows you are just around the corner. Along with this concept, she will soon start to experience “stranger anxiety” when seeing other people (especially if they want to hold her) and may start protesting when you have these separations.

Gross Motor Development

Along with her interest to investigate everything comes her desire to acquire these objects. Movement, and the progression of gross motor development, goes in a very predictable fashion from the head down to the toes. First, muscle strength and coordination began at the neck and by four months of age, you might remember, you could pull her up from laying on her back and she did not have any more head lag. In addition, if you placed her on her tummy, she could put weight on her elbows and raise up her neck. The chest was off the table a little, but her stomach was flat on the table. Now, at six months, she can push up with her hands and raise her chest and tummy, but her pelvis and legs are flat on the floor. She has learned to “army crawl” or creep. If you stand her up, she stiffens her legs and pretends to jump, although her feet never leave the ground. Rolling over was a reflex at four months, sometimes startling her, but she does it now routinely. You can prop her up in a sitting position, but she does need her arms to “tripod” herself. If she tries to reach for an object, she falls easily because the tripod fell apart. She is not able to get to a sitting position by herself, but she will soon learn around nine months of age how to sit up by herself when she has learned how to crawl.

Her life is filled with frustration as she continues to exercise daily trying to accomplish these milestones, but it is in a way, a “happy frustration” because she is meeting goals. As part of this wonderful bond, you have formed with her, you have learned to be sensitive to her needs and know when to come to her aid when she seems defeated.

Fine Motor Development

Touching and grabbing to form concepts in her brain has been part of her development since birth. To develop her fine motor skills, however, she first had to get rid of her “primitive reflexes,” reflexes that she was born with, including the grasp reflex. By two months of age, she started to open her hands and was transferring objects from one hand to the other by four months of age. When she grabs objects, she uses the “rake” approach where she uses all her fingers and hand to grab an object. It will be exciting for you when she is around nine months of age, and you see her using her thumb and index finger as a pincer grasp to get an object.

So now that you are done reminiscing about her development for the past six months, it’s time to enjoy your visit with your parents. We hope you have a nice Memorial Day weekend!

A health article from Dr. John Spitzer, a pediatrician at Bronson Primary Care Partners (first published on the Bronson Health web site)


  • Touchpoints: Your Child’s Emotional and Behavioral Development by T.Berry Brazelton, M.D.  A Merloyd Lawrence Book, Addison-Wesley Publishing Company, 1992.
  • Solving Your Child’s Sleep Problems by Richard Ferber, M.D. Simon & Schuster, 1985.

Teenage Mindfulness this Spring

With the stresses of daily life and ongoing uncertainty in the world, it is no surprise that teens may feel disinterested and just want to tune everything out.  Is it possible that we can help our teenagers be mindful in the moment?   Is it possible we can invite them to experience other ways to relax and release some tension?

The laughter coming from the backyard catches my attention as I look out our kitchen window and contemplate the sun piercing through the clouds and blue sky. I can see the play structure as my son standing in the tower chats with his friend Trevor, who sits at the bottom of the slide. Richie is swinging pretty high after being pushed by Lauren, and Joe is chasing Billy with a water gun as they loop around the fortress (names have been changed to protect their privacy). It is mid-afternoon Saturday and they have chosen to escape their “teenage” world and dive into the playground, reminiscing and enjoying their days when they were much younger and did not have to worry about the challenges of being in high school.

Teens face many challenges as they move from middle school to high school. Not only do they desire to have more independence as they seek more activities, but more responsibility is thrown their way as well – both from parents and teachers. The way that they handle the stresses of life can depend on so many factors, including their temperament and personality; their previous life experiences, and the resilience they may have developed through these experiences; the activities they participate in and how busy they feel; their friendships and whether or not they feel support from those relationships; and their home life and family support. Add to the mix that they start to experience growth spurts, hormone changes and romantic feelings, and life can feel complicated.

Mental Health Problems

Anxiety can pop up easily in teenagers as they try to navigate their adolescence. About 1 in 3 teens may be diagnosed with an anxiety disorder with symptoms that become significant enough to disrupt their daily life. One of the major factors that often lead to anxiety and mental health problems amongst teens is high expectations. This can include the expectation to perform well, or act, look or “be” a specific way. These expectations may be self-imposed, be caused by parental pressure, or simply our American culture to achieve and be the best.

COVID-19 and Uncertain Futures

Mental health has been exacerbated by the COVID-19 pandemic, which has brought on virtual learning and major uncertainty about their futures (as highlighted in a recent New York Times article, titled 12 Teenagers on What Adults Don’t Get About Their Lives). Additionally, a recent Washington Post article mentions the concern that the CDC has for declining mental health in teens. In “A Cry for Help:” CDC Warns of Steep Decline in Mental Health, Moriah Balingit stated that “more than 4 in 10 teens [report] they feel ‘persistently sad or hopeless,’ and 1 in 5 [say] they have contemplated suicide.”

Social Issues, War and Violence

In addition, our world continues to be complicated by social issues, which seem to always be bombarding our psyches. Poverty, homelessness and hunger affect not only developing countries but here in our own country as well. Other areas of concern include climate change, civil rights and discrimination, gender inequality and gender dysphoria, and immigration challenges The current generation of kids and teens are very socially conscious and want to make an impact in our world.

The war in Ukraine has touched all of us. It is natural to feel empathy and sadness, particularly for those who have relatives there. Schools continue to have lockdowns and drills to address shootings, which can potentially cause emotional stresses perhaps not too different from the Ukraine war. The COVID-19 pandemic forced us to restrict activities and to wear masks on a regular basis. It is no wonder that going out in public can create some degree of stress and anxiety, even for us adults – so again, no wonder our teens may be feeling this way too.

Social Media and The Need to “Fit In”

being connected to social media has its positive effects, but can also create enormous negative energy. Today’s teens are very connected and aware of what is going on, not just in their friends’ lives, but also in the lives of everyone around them and so many larger world events. Imperfections are all erased, and “only edited for perfection,” unattainable standard is loud and clear. Appearances carry a lot of weight, to the point that it can be very distressing when posts are negative or offensive to others, or a teen is lead to believe everyone else’s life is perfect.

With all of these daily stresses and looming uncertainty, it is no surprise that sometimes teens feel like just going to their room and tuning things out. They find security in their chats and by posting how they feel. But is it possible we can invite them to experience other ways to relax and release some tension?

More likely than not, there’s going to be some resistance, as venturing out into another activity may rock their boat. But with a little love, some humor and teasing, maybe using words to expand their imagination, we can talk them into going on an adventure with us and enjoy nature, even if it’s just for a couple of hours on a Saturday afternoon. We may not have to go far to experience the wildlife here in our own home of southwest Michigan. One of our nurses used to keep in our office a book about the different birds in our area so kids could identify them as the birds flew by our exam rooms and kids could see them through the windows. Try taking your camera or your phone and capture some of the birds perched on a branch or chasing each other as if they were flying and playing in their own backyard. Perhaps do a nature scavenger hunt walk with phone cameras.

What Can We Do? Where Can We Go?

  • The Kalamazoo Nature Center website shares its mission statement, “A not-for-profit organization whose mission is to create relationships & experiences that welcome and inspire people to discover, enjoy, value and care for nature. KNC envisions a resilient community where all people have strong interconnections with the natural world.”
  • Asylum Lake is a 274-acre parcel owned by Western Michigan University, located by Drake Road and Parkview Avenue. It supports multiple habitat types including oak savanna, prairie, forest, wet meadow, emergent marsh, shrub carr and two lakes. Birds fly in every so often so it’s good to have your camera ready.
  • The Kleinstuck Preserve is also a 48-acre nature preserve owned by Western Michigan University. As stated on their webpage, “This unique ecosystem includes upland forest, swamp forest, shrub carr and marshland which are home to a wide variety of plants and animals. Some of Kleinstuck’s special features include a beautiful showcase of native wildflowers in the springtime and a highly diverse bird population. The property is open to the public for passive recreation and is used by WMU and other educational institutions for research and education.”
  • Celery Flats in Portage, as stated on their website, “Is really a ‘park within a park.’ A key element of the Portage Creek Bicentennial Park, Celery Flats, has two distinct settings. On the north side of Garden Lane, the Celery Flats Pavilion offers a nice open-air seating area, picnic tables, restrooms and an air station. The Celery Flats Historical Area, with several relocated and restored buildings, is located south of Garden Lane. The Historical Area is the site of many community events and several of the buildings can be reserved for private group use.”
  • The Kal-Haven Trail is, as stated on their website, “33.5 miles between Kalamazoo and South Haven in southwest Michigan. The trail rests on an abandoned railroad bed constructed in 1871. The converted rail-trail winds through gorgeous scenery including wooded areas, farmlands, streams and rivers.”

Consider getting the All Trails: Hike, Bike & Run app as a guide to the outdoors. I found a number of other app’s on my phone that help me discover what’s in my “own backyard.”

So as spring rolls around the corner and we find ways to get outside and experience life, perhaps this might be an occasion to create some bonding time with your teen and spend it in nature. A couple of hours away from the house and disconnected from social media might release some Dopamine from that “feel-good” center of the brain. And who knows, this just might be the break that the doctor ordered to help our kids get back their self-confidence, release some tension and stress, and tackle that school project they’ve been wanting to finish.

(A health article from Dr. John Spitzer, a pediatrician at Bronson Primary Care Partners, was first published on Bronson’s Blog Page on April 15, 2022)