Category: Pediatric Corner

Raising Your Preschool Child with a Positive Touch

Raising your pre-school child can be a lot of fun. They are likely curious, chatty and always asking questions. They spend a lot of time running around and participating in gross motor play. They are exploring fine motor skills with activities like drawing and coloring. Reading together is enjoyable while you embrace the quiet time and love for each other.

It wasn’t that long ago they were babies. They were so dependent on you as a parent. Now, their language has become clearer and they can express their needs. This new phase of independence can bring on a different set of joys and challenges compared to the newborn and infancy phases.

Trying to help your child maneuver through the pre-school years is filled with challenges as they want to adventure out from their comfort zone and experience life while you are trying to guide them, both for learning purposes and for safety reasons. I like to equate this stage of development as a prelude to the teenage years. They are trying to branch out, but they still need to learn from you. How do you walk that fine line of giving them freedom while still guiding them with love and wisdom?

Children, and for that matter adults, learn best when they are in a positive environment, receiving instructions in a positive and constructive manner. Acknowledging that they are in learning mode, you expect them to make mistakes on a regular basis. As parents, you can have a better understanding of their behavior and have expectations for performance if you can understand the main areas of development, including gross motor, fine motor, language, social and problem solving.

When children come into the office for their well-child visits, we assess these areas of development through the Ages and Stages Questionnaire (ASQ). You can access these questionnaires online, provided by Dr. Michael Taymor, MD. This can help you understand some reasonable expectations of your child. Some additional helpful tools I suggest checking out include:

Below are some tips and guidelines that can help you foster healthy and happy development for your pre-school child:

Helping Your Child Take Care of Their Body

  • Proper nutrition: When children are eating properly and sleeping well, they are likely to be rested the next day. They are also more likely to regulate their emotions and listen better. Check out these recommendations from the AAP website,
  • Good sleep: Ensure your child is getting enough sleep at night. On an average, kids between ages 3-4 need about 11-12 hours of sleep at night. It’s unusual to see a 4-year-old taking naps in the middle of the day, but some 3-year-old may take a 1-2 hour nap during the day.
  • Routines: Establish routines and predictable times for eating, playing, reading, and sleeping. Children like to know what is next, it gives them a sense of comfort and security.
  • Talk it out: Plan to have a “therapy” session with your child at the end of the day. Encourage them to express to you three things: what they thought was fun for the day, what was a challenge, and what was frustrating. This session can happen at bath-time or maybe when you cuddle in before reading together. As best as you can, try to be a good listener, empathizing with them. Their release of thoughts and emotions will help them have a good sleep. They will also be able to use you as a sounding board as they learn how to problem solve, explore feelings and express themselves. Repeating this nightly routine deepens your relationship with your child and creates a foundation that promotes them sharing with you long into your future relationship.

Create Positive Experiences

  • Reading together: Reading to your child is fun for children because they get to use their imagination. Not only are you helping them develop their language, but you are also fostering their ability to solve problems. Typically, good books showcase someone with a problem that needs to be solved. While reading the book, stop and periodically ask them how else that problem could have been solved, what would they do differently, or how the book makes them feel. This exercise might call for them to express feelings, learn empathy, and problem solve.
  • Play games: Simple board games and card games are a good way to have fun together. Your child will learn how to follow directions, move a playing piece, count spaces, have successes, and learn to handle their emotions when things don’t go their way. They will learn how to wait their turn and how to play by the rules.
  • Get outside: Go to the park. You can talk about the different birds flying around, the trees or plants that line the walking paths. These moments help discover the value of being at peace. They help reduce anxiety. Preschool-aged kids can learn to self-soothe by being in nature.
  • Be active: Go for a bike ride or a walk in your neighborhood. Have your child describe what they see. This is a fun activity that helps with language development and observation skills.

Promote Social Development

  • Set up play dates for your child: This will help them leave their ego-centric world and begin to understand others. By age 4, children have a good vocabulary. This will help kids when they are playing together as they pick what games to play, what rules to set. You may need to prompt a play activity, like a nature scavenger hunt, then let them play with their play date.
  • Play together: Make sure to put your cell phone away when you play with your child. They crave your attention.

Promote a Sense of Responsibility

  • Helping out: Have your child help with tasks around the house. Let them set the table, sort the laundry or pick up sticks in the yard. This can help them foster their independence.
  • Give praise: Praise them when they get ready by themselves in the morning. This can include getting dressed, brushing their hair and teeth and putting on their own shoes. Perhaps the night before, they can pick out the outfit they would like to wear the next day.

Promote Problem Solving Skills

  • Thinking out loud: When they encounter a problem, have them think out loud with you. Have them describe the problem and how they would like to solve it. It may be tempting to give them the solution, especially if you feel in a hurry. But taking the time to be patient and listen to what they have to say will help them develop confidence and solve problems by themselves.
  • Stay calm: Portray calmness as both of you encounter a problem. If you can think and talk calmly, you can help them learn to be calm, too. Good techniques include taking a couple of deep breaths or counting to ten. This will help relax the body and then have a clear mind.

I recently read with pleasure an article published by The University of California Davis Children Hospital, The Power of Positive Parenting. In the article, they describe the acronym PRIDE to help parents develop five skills for positive parenting:

  • Praise: A positive statement that expresses approval. Praise helps children feel good and validates what they are doing is important.
  • Reflection: Repeating back a child’s words and elaborating on what they said. By doing this, you are letting them know you are paying attention and making them feel important.
  • Imitation: Playing or making similar gestures that your child makes. When you do this, you let them know you are all in their activity and this makes them feel special.
  • Description: Describing what your child is doing like a sportscaster is doing in a play by play of a game. This lets them know they have your undivided attention.
  • Enjoyment: Where you express warmth and positivity with words and actions while you play with your child.

Every child’s temperament is different, not good or bad. Finding out the best way to address your child’s temperament is so important. This article in might give you some insight if you are having a difficult time relating with your child. Talk to your child’s pediatrician if you have concerns that we can address and help you with.


I originally published this article at Bronson’s website,

Peanut Consumption and Allergies

Many parents hesitate to introduce peanut butter to infants because of the high risk for fatal or near-fatal allergic reactions.  We used to think that avoiding peanut butter early on might reduce the risk to developing an allergy to peanut butter.  However, we have found that early peanut consumption can minimize an allergy development.

Recent research in the past few years has shown that it is safe for infants to get peanut butter in infancy.  A recent study looked at children who received peanut early on were still able to tolerate it in their adolescence.

As noted in the AAP News from June 3, 2024,  “In the original 2015 study, called Learning Early About Peanut allergy (LEAP), 640 infants between 4 and 11 months old with severe eczema, egg allergy or both were given skin-prick tests for peanut allergy. Children in each of the two resulting cohorts then were randomly assigned to consume or avoid peanuts until reaching age 60 months.

On the initial allergy test, 530 had negative results. At 60 months, 13.7% of those infants in the avoidance group developed a peanut allergy compared to 1.9% in the consumption group. Among the 98 infants with positive initial results, 35.3% of those who avoided peanuts developed allergy compared to 10.6% of those who consumed peanuts.”

A recent study published in the New England Journal of Medicine, May 2024, called LEAP-Trio, “examined 508 of the initial 640 participants at age 12 years, and 497 of them had enough data to determine whether they had developed a peanut allergy. Of those, 15.4% in the avoidance group had peanut allergy compared to 4.4% in the consumption group.”

We have developed a comfort level with introducing peanut butter to infants.  With infants who have severe eczema and/or a strong family history of food allergies, we feel it’s a good idea to work with an allergist/immunologist.   To learn more about introducing allergenic type foods in infancy, You can read this  the AAP site HealthyChildren.Org article.


AAP News, June 3, 2024

Follow-up to Adolescence after Early Peanut Introduction for Allergy Prevention, New England Journal of Medicine May 2024

When Can I Start Feeding My Baby Peanut Butter in HealthyChildren.Org.

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

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