Q&A: toddler stripping off clothes

Pamela writes:

"Feel funny, asking for a friend. Her extremely cute, 3 1/2 yr old toddler is developmentally delayed. She would like some advice on just one issue. Her child frequently strips off all her clothes. She will sometimes refrain from stripping if there is a ton of stuff going on (lots of kids, lots of toys). She also doesn’t do it at school, because she is never unsupervised for even a second there. Home is
obviously a different matter.

Friend would not mind in general, but the two problems are:

1. if younger child sees, she will frequently follow suit, strip, and immediately urinate on carpet. (NEVER does this otherwise)

2. even more importantly, on the days when friend needs to get stuff done that involves child being dressed (ya know, like going to the park, going to the store, stuff) she is coming close to losing her temper a lot. Yes, she should probably stick to dressing and putting shoes on kid just before locking door, but it just isn’t always possible. Any helpful hints?"

This week has just been a nostalgic walk through all the toddler bad behavior, with the head-banging and the night-peeing and now the clothes-removing. What a lovely stage that is, isn’t it? You think you’re ready to leave the house and then you turn around and your child is naked as a jaybird and you’re staring at a big 10-minute melee of dressing.

But who am I to complain (even retroactively)? I didn’t have a younger child who’d imitate the stripping and pee on the carpet. Aieeeee! Once would be kind of funny, in a "I’ll tell this story at the child’s rehearsal dinner" kind of way. But more than once is just wrong.

To deal with the first problem of the younger sister stripping and peeing, I’d need to know how old the sister is. If the child is close to potty-training age, your friend could start working on the idea that you pee in a potty. She could put a potty in the living room and encourage the child to pee there, and hope that that helps sidestep the carpet-peeing problem (and also gets the younger one closer to potty-training). If the younger child isn’t close to potty-training age, maybe put the kid in some kind of outfit that’s really hard to get out of? I’ve also heard of people putting diapers on backwards, since kids don’t always know how to remove them when they’re fastened at the back. So that might be worth a try.

I really don’t know how to approach the actual stripping with a developmentally delayed child. When my son was doing the strip-down thing, it only lasted for a few months, and I just planned in that extra 10 minutes it would take to redress him. But again, I only had one child at the time, and I knew my son would cooperate with getting dressed about half the time, and I’d just shove him into his clothes as he screamed "Mamaaaaa! I don’t want to get dressed!" the other half of the time. But I don’t feel comfortable recommending the brute force method on a kid with developmental delays.

If I’d been really on top of things, I would have designated specific Naked Times during the day (maybe with the use of a timer shaped like an animal or other object), and then required clothes at other times. But I also don’t know if that’s something your friend’s daughter would understand or connect with.

Does your friend’s child have a therapist or aid that works with her regularly at school? If so, I’d ask the therapist or aid what s/he recommends. The therapist will have both theoretical knowledge of how to deal with behavioral blips like stripping, and also in-depth knowledge of the specific child and how best to motivate her to keep her clothes on.

Good luck to your friend. This sounds like the kind of thing that could drive a person around the bend very quickly.

Q&A: nighttime potty-training

I received two questions about preschoolers in diapers at night, so I thought I’d combine them into one post. They’ve got the same problem but are coming at it from two different angles.

Anna writes:

"My daughter is just over three years old and has been potty trained for about a year.  However, she is still wearing a pull-up at night and most of the time it’s wet in the morning.  To date, after making a couple abortive attempts at night-training her, I haven’t worried about it too much, but I am getting tired of buying pull-ups.  I guess my question is two-fold, do you think she’s ready/able to give up the pull-ups at night?  And, if so, what are your suggestions on how to do so?

Currently, I don’t let her drink anything after 6:00 p.m. (her bedtime is about 7:30), and recently we’ve started getting her up to put on the toilet when we go to bed (10-11:00 p.m.).  She usually pees when we get her up, but her pull-up is still usually wet in the morning (6-6:30 a.m.).  Another thing is that we had a hard time motivating her to potty-train in the daytime last year.  Although she’s in daycare, peer pressure had no motivation at all for her, as she’s never cared what other kids are doing.  Also, she was in cloth diapers full-time for her first year, and while at home for her second year, and never cared about being in a wet/dirty diaper, she was quite happy to sit in her own mess until I checked her (which of course made me somewhat compulsive).  It wasn’t until I put her in underwear (so the pee would actually run down her legs) that it bothered her, and we rewarded her with stickers everytime she went, that we had success."

Suzanne (who blogs in a language that’s not her native tongue even, which makes me feel more than a little inadequate) writes:

"I have a question that may be unusual, at least it’s something I haven’t seen discussed elsewhere. My almost 3.5-year-old is very frustrated, because he’s still needing diapers at night. During the day there is no problem, with the exception of minor accidents that happen because he doesn’t like to interrupt his play. He has started to go to preschool in February. He loves it, but it’s still exiting for him. He’s desperate to become a "big boy", and only two or three weeks ago he decided to give up his binky. The binky-weaning was no problem, I had realized that he fell asleep without one on his occasional naps, and asked him if he wanted to try going asleep without one at night as well.

I’d think that the beginning of preschool and the binky-weaning would have been enough for him, but he thinks that he wants to do it all at once. I told him, if he had dry diapers three mornings in a row, he could leave the diapers off at night. I even told him that a) most three-year-olds still wear diapers in the night, even if they tell him otherwise, and b) that this is something he has to grow into, not something to determine by willforce.

He is devastated. Every morning, his diaper is wet. I’m at a loss, because there’s nothing I can do to help him, his body’s just not ready. Any idea? I’d be happily washing seven diapers a week for the next one or two years, but he wants to grow up fast. It’s like when he learned going potty. He started at 18 months to try it, at about 27 months he decided that he didn’t want the diapers anymore, but it took him another six months to really get it. (And in between every diaper change became a power struggle.)"

It’s interesting to me that Anna, who wants her daughter to be out of diapers at night, and Suzanne, who doesn’t want her son out of diapers at night, are both thinking it through and wondering how it can happen since their kids are both still having wet diapers in the morning.

I was at that same point about 4 months after my older son was potty-trained during the day (he was day-trained at 28 months, so it was around 32 months)–wondering how to make the transition to underpants at night, too. What I’d heard was that he had to wake up dry anywhere from 3 to 5 nights in a row before I could take off the diaper at night. He’d go two nights in a row, then pee the third night. Or he’d wake up dry every other night for two weeks. It was starting to make me a little nuts, and I despaired that he’d ever be out of diapers at night.

I was beginning to have the suspicion that he wasn’t ever going to just start waking up dry every morning. As I thought about it, it started to make sense that if he was wearing a diaper there was no motivation not to pee at night. There also wasn’t much feedback, since even the cloth pull-up type of diaper prevented wet pajama-leg and cold wet sheets. Then I started to think about that adage about dressing for the position you want to have instead of the position you currently have, and wondered if that applied to nighttime potty-training, too. (I think this was while I was in the induction phase of the South Beach Diet, so my mind was going a little loopy from lack of carbs.)

I was almost at the point at which I was going to pick a start date and just go diaper-free at night, when serendipity in the form of bad communication occurred. I thought my husband was going to buy more diapers, and he thought I was going to buy them. So there stood my son after his bath, with no diapers in the house. My husband and I looked at each other and decided that was the night. So we explained to our son that he was a big boy who didn’t need diapers at night anymore, and if he had to pee he should wake up and go to the bathroom. If he had an accident and peed in his pajamas he should come and wake us. Then we put the waterproof mattress pad on his bed under the sheet and hoped for the best.

He stayed dry for 2-3 out of every 4 days for those first few weeks. Sometimes we’d hear thump-thump-thump to the bathroom, followed by peeing and flushing, then thump-thump-thump back to his bead. Other nights we’d hear thump-thump-thump over to my husband’s side of the bed and a stage-whispered "Daddy! I peed in my pajamas!" We’d change him and the bed and he’d go back to sleep. By the end of the first month he was wetting the bed maybe once a week, and changing his own pajama bottoms and just climbing in with us for the rest of the night. Within a few months he was having an accident maybe once a month, if that.

Now obviously I’m not saying that what happened with my son is going to happen exactly the same way with Anna’s daughter and Suzanne’s son. But I am saying that I think a parent could wait a looooong time for a kid to wake up dry every night if the kid is wearing diapers to bed. So why not just try going diaper-free for two weeks to see what happens? Pick a date, stock up on waterproof pads and bottom sheets (you can layer them in a little liquid-repellant napoleon so you can just peel off the top layers in the middle of the night), talk it up with your child to get him or her on board, and then just go diaperless on the appointed day.

After two weeks you can see where you are. If your child is waking up dry more nights than not, keep going. If s/he’s still wetting the bed most nights, talk about it together. Maybe your child will want more help staying dry (like Anna’s idea about waking her daughter up to pee when she and her husband go to bed), or maybe your child will want to go back into diapers for a month or two before trying again.

It’s definitely going to make more laundry for you for the first couple of weeks, but it could go so well that your child will be mostly accident-free within a month. You never know if you don’t try. And the worst-case scenario is that you wash a bunch of peed-on sheets and still end up back where you are right now. Especially in Suzanne’s case, since her son so desperately wants to be out of diapers at night, it seems like it’s more painful for him not to be allowed to try than it would be to try and fail, so why not let him try?

Did anyone else just go cold turkey out of diapers at night? If so, how old was your child, and how long did it take to have mostly dry weeks?

Q&A: cutting out the last night feeding for a toddler

Mayberry writes:

"My son is 13 mo and we’ve
finally, after much time and effort–but not including CIO–gotten him
into a decent sleeping pattern; he goes to bed between 7 and 7:30 p.m.
and usually sleeps through until 4ish, when he nurses for 15-20 min and
then goes back to sleep until about 7 a.m. At the end of July, I’ll be
going away for 3 nights. So that’s roughly my deadline for
weaning him; this is the only nursing session we still do and I’m ready
to be done.

I’m wondering if it’s better to try to
eliminate that feeding by having my husband go in when my baby wakes,
for as many nights as it takes until he’s sleeping through it; or if we
should try to gradually push that feeding from 4ish to 6ish or later.
Any thoughts?"

Before we go any further, I’m going to say that I think whatever nightweaning you do is going to go more smoothly as he gets closer to 14-15 months. They seem to be kind of clingy and in a little bit of flux around a year but get more independent at 15 months, so keep that in mind when you figure out your timetable for weaning. Also, teething could really screw you up, so all bets are off if he’s teething and you might as well back off and just bide your time for a week or so while the teething is in full swing.

The first thing I think you should decide is whether you want this to be your problem or not. If you want to assume responsibility for it, then try pushing the feeding back slowly. It could work or it could cause a big early-morning struggle. I think it’s honestly a crapshoot about how smoothly it will go.

If you want this to be your husband’s project (which is the way I’d go, personally, because I feel like if the nursing is my deal then I shouldn’t have to be point person for weaning, too) then you can either work on it now, or just let it happen while you’re gone.

There are arguments for both ways. The argument for doing it now is that you’d be able to step in if it wasn’t going well. You’d also know he was OK with going all night by the time you left. And the weaning would happen sooner than later.

The arguments for waiting until you’re away are that he’d be a few months older so it would probably be easier. Since you won’t physically be home, you wouldn’t be tempted to give in and nurse (thereby prolonging things) and stomp all over whatever rhythm your husband and son have going together. Also, it would just be natural that when you’re not there he doesn’t nurse, so in some ways it would be less abrupt.

So I guess you have to figure out how involved you want to be in the process and let that be what guides you. Your son is going to be fine and will release that feeding eventually no matter which course of action you take, so it seems to me that this is more of an issue of division of nighttime parenting duties. I know how it splits up in my household, but that’s not going to help you except maybe as a data point. But I do think it’s totally valid to say to your husband, "You’re going to be the only one in charge while I’m gone, so it’s your issue to solve." You’re not going to plan out all the other meals for everyone in the family for while you’re gone, so this is just an extension of letting your husband really be in charge completely while you’re away.

And who knows if your son will even wake up while you’re gone? Sometimes the tricky little buggers don’t even wake up if they know the milkwagon isn’t on the premises.

Q&A: toddler banging head and grandparents not child-proofing

Anne writes in with this double-whammy:

"First question: My boy is 14 months old and has been walking for a while.  He’s very steady on his feet, can run a little bit and is always trying (and usually succeeding) to climb things like couches etc.  The problem is if I tell him "no" and remove him from a precarious situation or if he is trying to do something and he fails after a few attempts, he will get so frustrated that he throws himself on the ground, face down, and bangs his forehead against the floor.  Sometimes he will stand up and bang his head on the wall or anything else he can find.  Sometimes there is a red mark and sometimes he actually grazes his skin because he bangs his head so hard.  I’m worried he will hurt himself.  I know he’s frustrated but I’m not sure what I can do to help him cope.  Is this normal behaviour?  Is it just a phase?

My second question has to do with a visit to grandparents.  We only visit them a few times a year because of distance.  Our next trip is our first one since the boy started walking.  They have some very steep stairs in their house but are not willing to put in a gate because they don’t want to ruin the wallpaper and beam on their stairway.  The stairs are very steep and several adults have fallen on them in the past.  When we try to talk about it we are told "they’ll think of something" and "we’ll just watch him the whole time" but they absolutely refuse to install a hardware mounted gate. My 13 month old tries to climb and holds onto the gates we have and he has pulled over pressure gates we had been using (not at the tops of stairs) and he is very fast.  I will already be on high alert for our entire visit because their property fronts onto water and there is no fence and they have a big dog.  How can we overcome the gate issue?  Any ideas?"

Until I opened your email, Anne, I had completely forgotten about the head-banging toddler stage. I think memory must be merciful, because all the wailing and flinging and forehead bruises and clunking had slipped away into the ether, although they came right back as I read your story.

In my experience, the head-banging phase was just that–a (fortunately) brief phase that passed. I say "brief," but what I really mean is that every day felt like an eternity of my son bruising his own cranium, but then it stopped and he moved on to the next thing. (I can’t remember what that next thing was, but it may have been gagging himself with his fist, head-butting my chin, or scaring the cat. I am really not such a huge fan of young toddler behavior. Give me a Terrible Two instead any day.)

I think this is yet another one of those things kids do when they can’t express themselves verbally.  That age has such deep receptive language and cognitive ability, but they just don’t have the ability to verbalize their feelings yet even if they can coagulate them. So the only thing left is to just freak out and bang their heads or kick or scream or do the arched back thing or limp-noodle thing, or any of the other Toddler Greatest Hits we all know and hate.

So, yeah, normal. Bizarre and kind of awful, but normal.

There are a couple of things I can think of to help him. The first is to teach him sign language if you’re not already, which will help him communicate more easily throughout the day. The second is to give him a big, tight hug when he gets upset to help him physically manage the tension in his body. While you’re hugging him, you can also verbalize for him what he’s probably feeling. "I bet you’re really angry right now because you couldn’t climb up on the table. It makes you feel mean! And angry! And it makes you want to bang your head!" That way he’ll know you understand what he’s feeling and he won’t feel as strong a need to bang his head.

The other thing you could try is to see if you can help him do a "re-do" of whatever it was that he couldn’t do. If he was trying to jump off the couch, you could come up with something else that he is allowed to do, like jumping up and down on the floor. Suggest it to him and do it with him. Or if he was trying to climb some playground equipment but couldn’t quite do it, ask him if he wants to do it with you, and then help him over the rough spots so he can do it with you. This isn’t something that will always work, since sometimes he’ll just be way too riled up, but if he can get in the habit of stepping back and trying again when he can’t do something instead of getting angry and frustrated, that will be a skill that will help him for the rest of his life.

To your second question: Stay in a hotel. I’m totally serious about that. Big dog + open water + unsecured stairs + grandparental lack of concern for any of these three things = potential death for your child. Even if nothing happens, you aren’t going to be able to relax for a single second of the trip. You didn’t specify whether it’s your parents or your partner’s parents. Whichever one of you is related to the grandparents in question needs to be the one to break it to them that it’s just not safe for you three to stay with them, but you’ll be happy to come over for visits and to meet them at other places in the area. And that in a few years when the stairs and open water aren’t an issue you’ll be able to stay with them, but it’s just not safe this year. If they object, keep repeating the phrase "It’s just not safe" until they offer to install the stairway gate and help rig up some kind of outdoor enclosure (to contain either your child or the big dog) or they accept that you’ll be at a hotel.

People stay at hotels so they don’t have to worry about their kids breaking Lladro figurines or inhaling secondhand smoke for 48 hours, neither of which are as dangerous as a staircase that has caused adults to fall or a big dog (who might get hinky around a scurrying toddler s/he’s not used to) or open water. I cannot believe the grandparents aren’t concerned about this. It’s going to be an uncomfortable conversation, but easier than the one that could happen at the hospital.

In a few years the stairs won’t be an issue, and the dog won’t be an issue, and you can teach your son to swim so the water will only be minorly terrifying. But this year you’re staring right at the dictionary definition of "deathtrap." So unless one of the readers can offer a sure-fire solution to the stairs, open water, and big dog, you can look forward to a pleasant stay at a local hotel.

Q&A: finding a pediatrician

Mary writes:

"Everyone tells us we need to go out and start interviewing
pediatricians (I’m 30 weeks pregnant).  Ok, fine, but what do we ask
them?  And how do we find ones to interview?  A coworker recommended
one that she used to work with but other than that, we’re kind of
clueless, as we are with most of this baby stuff."

Choosing a pediatrician is a lot like planning a wedding. There are a hundred things to think about, and things you have strong opinions about will be completely unimportant for other people, and vice versa. The trick is to figure out what you care about. Then you can ask those questions and just not worry about the other things.

To find doctors to interview in the first place, ask everyone you know who they use(d). Also go to your insurance company’s website and get a list of names. Once you’ve figured out what you’re looking for (which I’ll cover below), call up and ask your first level of weed-out questions over the phone. You may not have to interview more than one or two people in person.

The first thing I’d think about is your parenting style. Are you going to be laid-back or highly managerial? When my son was maybe 10 weeks old he had some rash that I asked my doctor about. He told me, "Squirt some breastmilk on it. At this point breastmilk, either in him or on him, is pretty much the cure for every problem he could have." I was happy with that answer (and the breastmilk did clear up the rash), but a more highly managerial parent would have been upset that there wasn’t a definite diagnosis with a clear treatment path including a plan for contingencies. If you call and ask a question, do you want to know exactly why things are happening, or just that they’re normal? A mismatch between your style and the pediatrician’s style will leave you feeling inadequate and judged or frustrated and angry.

Don’t confuse this with the parenting philosophy you follow, which is another thing you should ask potential doctors about. If you have definite opinions about things like scheduling, feeding, sleeping, pacifiers, vaccinations, circumcision, etc. you want someone who’s going to support you, not someone who makes you feel like a bad parent for choosing those things. Your pediatrician doesn’t necessarily have to agree with you about everything, but s/he does have to support you without being judgmental. If you say, "We intend to cosleep. How do you feel about that?" the correct answer should be something like "There are a number of families in my practice who cosleep" at a minimum (because it doesn’t necessarily imply endorsement, just familiarity and acceptance) or "I think cosleeping is wonderful for babies and parents" as an ideal. If you hear "I don’t recommend it. You’ll end up with a 5-year-old in your bed," move on to the next doctor on your list. (Obviously the same thing goes if you want to have your child sleeping in a crib and you get a less-than-enthusiastic response from an interviewee ped. Next.)

There are, of course, going to be some things you don’t care about. Just don’t ask about those. If you have someone who matches your views on the things you are most concerned with it doesn’t really matter if you match on the other things. Make sure you take into consideration the style issue, though.

Breastfeeding is another thing to ask about. Every pediatrician (unless s/he’s stupid) will claim to be supportive of breastfeeding. But claiming to be supportive and actually being supportive and having the knowledge to help with common nursing problems are two vastly different things. How many mothers in the practice nursed for 6 weeks? 6 months? 1 year? The answers to those questions are going to tell you how much emotional support the doctor gives to breastfeeding and how much practical help the doctor gives (that includes being able to recommend and partner with a good lactation consultant). Medical school still does not teach much about human lactation, so what pediatricians know about breastfeeding is what they’ve chosen to learn. A good ped either has made the effort to become educated about breastfeeding (beyond the info pamphlets the formula companies send–at a minimum the doctor should have taken the same 3-hour class you took) or recognizes that an IBCLC lactation consultant is an expert on breastfeeding and treats her as a colleague and not an underling.

Antibiotics are another hot issue. Some doctors prescribe them at the drop of a hat, some are more circumspect, and others only prescribe them under duress. Here’s a pretty concise overview of why overuse of antibiotics isn’t a good idea. You want someone who will reserve use of antibiotics for when there’s an actual bacterial infection present.

I’m sure you’ve heard the old chestnut "What do you call the person who graduates at the bottom of his or her med school class?" "Doctor." You should also use interviews to try to weed out doctors who are ignorant or just plain stupid. A friend of mine (who is 5 feet tall with a husband who’s 5’6") was told by her pediatrician that her daughter was "too short" and that he was concerned because "We want every child in our practice to be in the 50th percentile." Where do you even start with a doctor who doesn’t understand the basic concept of a bell curve? Or that a child with short parents will probably be on the short side of the curve? He then continued by telling her that he thought her "extended" breastfeeding (their baby was 9 months old at the time) was stunting the baby’s growth, and he wanted her to cut down on nursing and feed the baby more apples and green beans to make her grow taller. Um, yeah.

You don’t want to end up with a doctor who’s so ignorant on so many levels, or one who’s overly concerned about things that are normal. If your baby is likely to be particularly short or tall or skinny or fat or pale or of Asian descent (and thus prone to those birthmarks that can look like bruises) or bald or hairy or a carrier of a genetic disease or whatever, bring that up at the interview and ask the doctor what s/he thinks. Any answer like "Someone’s got to be in the 95th percentile, so someone else’s got to be in the 5th percentile" or "It would be ridiculous to expect that a child with parents as tall as you are won’t be off the charts" or something else that recognizes that kids are all different and should be taken on a case-by-case basis is what you’re looking for.

Any answer that starts with "We want all the kids in our practice to" is bad news. My friend’s pediatrician got all worried because her son wasn’t walking at 18 months (the range of normal is around 9-16 months for walking, so he was late). The ped gave my friend the "We want all the kids in our practice to be walking by 18 months" line (to which I said, because I’m a smartass like that, "I’m not really sure that it matters what she wants, now, does it, if he’s not walking?") and sent him to be evaluated for cognitive developmental delays. In the meantime, the child was drooling constantly and his speech was extremely hard to understand, but his responsive language was way ahead of his chronological age and he was ahead of the curve with imaginitive play and stuff like that. It turned out that he had low muscle tone in the jaw and chest (which explained why he wasn’t walking yet, was drooling, and couldn’t enunciate) which was treated easily with regular physical therapy. The pediatrician absolutely missed the boat and focused on the wrong thing because she was so concerned with what she "wanted" all the kids in the practice to be doing.

Another thing to consider is whether you want to go with a pediatrician or a family doctor. There are advantages to both. A pediatrician is going to be more focused on specific childhood illnesses and conditions. A family practice doctor is going to have more of a long-range view and might not be as concerned about things that are only issues for a short time. A pediatrician is going to be dealing with huge numbers of kids so s/he’ll have a real picture of where your kid is compared to other kids. A family practice doctor will be able to treat your entire family. Think about which model you prefer.

There’s an excellent list of questions to ask your child’s doctor here. It covers things like whether the doctor will come check out your newborn in the hospital or wait until the baby comes home (a hospital pediatrician or intern will check out your baby in the hospital if your own ped doesn’t–it’s routine and no big deal). It also covers procedures for scheduling appointments, after-hours problems, and getting sick kids in for emergency visits.

Often times these things are a balancing act. I love my doctor (a family practice doctor who treats me, too) because he’s very laid-back and treats me like a true partner in care (not someone who needs to be told what to do). He asks things like "Are you happy with the kids’ sleeping arrangements? If you’re not, I can help you troubleshoot" and he gets my jokes. But the downside is that he’s only in the office a couple of days a week and he’s always overscheduled. For me it’s worth it to be so happy with what he does for us when we need him that I just accept the burden of scheduling way in advance. We’ve also been lucky in that our only emergencies have been off-hours so he was pageable. Other parents are going to want easier, more immediate access and will put up with more editorializing from their doctors. As long as you know what you want and choose a doctor based on that, you’ll be happy.

Another thing to think about is where the emergency room your doctor admits to is. All other things being equal, you should go with the doctor who admits to the closer ER. (Within reason. If there’s only a few minutes difference in travel time, go with the better ER.) When your baby can’t breathe from croup in the middle of the night, you don’t want to have to drive 30 minutes to the ER.

The bottom line, though, is that you have to feel good on an interpersonal level with your doctor. A doctor can be brilliant and knowledgeable, but that doesn’t mean s/he’s kind or humane. If there’s something you don’t like about the doctor don’t go with him or her, even if everyone you know raves about the doctor. You don’t want to feel any hesitation (ever) about calling to ask a question or bringing your child in to the office. So it’s important that you feel good about the person professionally and personally.

Again, read the list of questions from The December List here. Other than that stuff, is there anything we forgot?

Q&A: potty training or weaning?

Clare writes:

"My son’s three and a
third, very smart, physically well-coordinated, and absolutely determined not to
use the potty. He’s tried, and succeeded at, using both the little toilet seat
on top of the big toilet and the potty, but really doesn’t want to–we suggest
it and he says ‘no, thank you,’ and, if we get more insistent, gets less polite
about his refusals. The last time I tried letting him run bare-naked at home, he
got out a changing pad, lay down on it with his legs in the air, and shouted: ‘Put On My Diaper!’

Part of the problem
is that he goes to a babysitter during the day while my husband and I work, and
she and I haven’t yet coordinated–she’ll suggest it to him, he bursts into
tears, and she drops the question.

I’d be fine with
letting him wait until he’s ready, but he’s signed up for half-day preschool in
September–which I think he’ll really enjoy–and this school requires them to
use the toilet and just sends the kids home if they have accidents–and, after
all, it’s pre-k, I can see their point. I’d hate for him to miss the chance to
start school with a terrific teacher, which he’s mildly excited about, because
he’s behind with the potty training.

I’ve let the matter
drop for now, except for sometimes mentioning it to him in passing. We’ve got a
family vacation coming up at the beginning of June, and when we get back, I
thought I’d get the babysitter on board and just have him wear underwear all the
time while he’s awake. Is that reasonable? Any suggestions?

The other thing is:
he’s still nursing. Just at bedtime and when he first wakes up in the
morning, but he’s so enthusiastic and aggressive about it, I don’t see him
self-weaning, or even weaning with mild pressure, anytime soon. I’d always
planned to nurse for the first year, but the last two have been all his
idea–I’m willing to keep doing it a bit when it seems so important to him, but
I’d like to stop sometime in the foreseeable future. Any thoughts? He co-sleeps
with us, which means he’s very used to his routine nursing then, and often (but
not always) nurses to sleep, but he’s able to fall asleep without nursing when
I’m not there."

Heh. He sounds wonderful and hilarious and like the kind of strong-willed and assertive
kid who is going to alternately drive people crazy and completely charm
them. Perhaps a future senator or maverick CEO of a high tech company.

It seems daunting that he has to be trained for a September deadline, but it’s good that you know you can’t let it drag on indefinitely. You really don’t want him to be older than 4 and still working on potty-training anyway. The trick is going to be figuring out how to glide softly into full training by the end of the summer so the first week of school isn’t a huge trauma.

It sounds like you’re asking if I think the nursing is a problem and if you should think about weaning. I think you can either wean or potty train, but not both at
the same time. Pick which one you want to do first, and just forget
about the other one until the first thing really takes. When I was in
this situation I decided I could stand to nurse until my son went away to
college (and I would have been willing to FedEx bags of milk) if it
would finally get rid of the diapers. I think he actually nursed a
little bit more during the real transition period of the potty
training, but then once we did wean (after he’d been out of diapers for 5 months) it was relatively easy. (Except
that I felt guilty about it, and then he got the worst cold of his life
exactly two weeks after we weaned, and I was convinced it was my fault.
Right. I think a mother’s natural state is Guilt.)

Since he can fall asleep without nursing and without you, I
think when he is ready to stop (or ready to be convinced to stop) it
won’t be such an issue. Since you don’t seem to be bugged by the
nursing, I’d just focus on the potty stuff first.

I think you’re totally on target with switching him to
underwear after the vacation. If you read my post on switching into underpants, I talked
about the two kinds of training pants. Think about which kinds you’ll use most and get them. Since you live in the city and are out and about at playgrounds, I’d also get the $10 portable potty (excuse me, "potette")
from the website or Buy Buy Baby so you and your babysitter can have it along at the playground.

And you’re definitely right about needing to get on the same page as your babysitter. Not only should you both be committed to potty-training, but you both need to agree on how to do it. My first line
of psychological offense might be peer pressure. So if the babysitter
has other kids there, she should let your son "help" them go to the
bathroom as much as possible. If she’s one-on-one with him, see if
she/you can arrange some playdates with potty-trained kids so he can
catch the toilet-training fever. If it’s not possible for your babysitter to do this, see if you can get together with another kid on the weekend who is potty-trained to see if that will do it. (Or maybe you’ll luck out on your vacation and he’ll end up spending a bunch of time with another kid and he’ll decide to potty-train during that week. A mom can dream, can’t she?)

This age is so tricky for potty-training because it seems to degenerate into a real power struggle very easily. That’s why I’m suggesting peer influence instead of a method that involves your convincing, cajoling, or bribing him to do it.

DId anyone do anything with an over-3 potty-trainer that got past refusal?

Q&A: pelvic pain in pregnancy

Megan writes:

"I’m almost 6 months pregnant and about a month ago I’ve noticed a lot
of pain around my lower back/sacrum.  After some research I found
that I’m experiencing "posterior pelvic pain", mostly due to the
loosening of tendons (thanks to relaxin,
a pregnancy hormone) and the extra pressure of the baby’s weight in the
pelvic cavity.  I know that this is a common pregnancy ailment but
I haven’t been able to find much useful information on how to alleviate
my discomfort.  Some resources recommended a pelvic belt.  Do
those work?  The pain is so bad that I often have a hard time
standing or walking, especially after sitting or lying down for long
periods of time.

Do you (or your readers) have any advice?"

I’ve never used a belly belt, but friends have reported that they helped relieve some pressure and pain. I think your most direct route to relief, however is going to be the combination of chiropractic care and Pilates or yoga.

You should find a chiropractor who specializes in pregnant women and is trained to do the Webster Technique (the adjustment that helps relieve hip pain and turn a breech baby head-down). I’d ask your midwife or OB for recommendations. If they don’t know of anyone, look up a chiropractor who specializes in children, because there’s usually a lot of overlap between chiropractors who specialize in pregnancy and who specialize in children. You’ll probably have to go for 2-3 treatments before you feel significant relief, but after that you should be able to maintain with visits every week or so. Chiropractic in pregnancy is very gentle, and the chiropractor won’t do any x-rays to assess you.

Taking a prenatal Pilates or yoga class should also help keep your back pain-free. If you can’t find a prenatal Pilates class in your area, there are several DVDs you could get. If you’re not usually an exerciser and want something to help you stretch but not to tax you too much, get Pilates in Pregnancy. It moves reeaaallllyyy slowly, but if you can stay awake you’ll get a nice stretch. If you’re already used to Pilates and want more of a workout, try Pilates During Pregnancy with Niece Pecenka. Pregnancy yoga is all about breathing and stretching, and you may find it easier to get into some of the tougher poses because you can stretch so much more easily with the relaxin.

Another suggestion is to try to sit upright as much as possible (facing backward on a chair with a back or on an exercise ball) instead of reclining. This will help put the baby in the best position both for birth and to relieve the pressure on your back. The website spinningbabies.com is full of information about positioning for comfort and easier labor, as well as an explanation of how to figure out which way your baby is turned in the womb.

You could also try acupuncture, which does really well at alleviating nausea and muscle pain, so you may want to give it a shot for this, too. SInce it’s noninvasive you don’t have much to lose in trying it.

Anyone else? Any specific recommendations for a brand of belly belt? Was there something that relieved your posterior pelvic pain?

Q&A: mom eating nothing but junk food

A reader I’ll nickname "Sunshine," who wrote me a few months ago about easing her encroaching PPD, writes:

I have another question for you but it’s more
general, sort of to see what your opinion is since the opinions I’ve found on
the internet (Mothering.com, babycenter.com, kellymom.com and elsewhere) vary
widely.  I searched your archives and couldn’t find a similar question, but
I apologize if I missed it.

The question is, do you believe it’s detrimental to
eat junk food while BF?  I started out eating a great diet and really tried
to hold the line on trans fats since I know they pass into the milk, but for the
past few months (depression?) I have been eating increased amounts of processed
and fast foods.  I mean, I eat fast food pretty much every day
now.  I still take supplements – a multivite with iron, probiotics, and
Omega-3’s (right now: cod liver oil) but I basically eat like crap.  Almost
no fresh fruits and veggies and I never cook at home; the best I can do is
Annie’s Organics meals.  🙁  I feel so guilty about it but can’t seem
to pull myself out of the cycle.  On Mothering.com I have basically been
made to feel that I am poisoning my baby and that she would be better off with
formula.   Anyway, I have a
feeling I’m being defensive at MDC about the issue because I suspect they are
right.  However Kellymom disagrees.  I so want to believe Kellymom,

I feel like a bad mother in so many ways right now…but this has been weighing on me…

So, I just wanted to get your opinion.  Also,
I think I am finally going to see someone about the depression.  I have
been avoiding it because I hate dealing with mental health professionals. 
Hate it, hate it.  And I’m not sure (from prior experience) that there is
much they can offer me.  But I have to do something; I’m becoming more and
more apathetic and my daughter deserves better.

In the past when I suffered depression it was
all-consuming.  I find that this is not the case with what I am
experiencing now.  My daughter brings me much joy, and I am not living
under a black cloud.  But still, I do not feel right – I have little energy
and am very critical and crotchety and feel hopeless and overwhelmed almost
every day, and like I’m not a good-enough mother.  So that is depression,

Honestly, I think it’s malnutrition, with a sweet lacy overlay of depression.

I don’t know how detrimental it is to your milk to eat nothing but junk food while breastfeeding. I do know that breastmilk has benefits formula will never have even when it has high concentrations of PCBs or other chemicals and even when the mother smokes. Breastfeeding is a robust process. We’re designed to feed our babies even under horrible conditions. Women kept and keep their children alive breastfeeding in concentration camps, in droughts and famines, in refugee camps. Unless you’re taking drugs that will hurt your baby or are in danger of passing HIV to your baby, your milk is always the best choice from a health standpoint.

However, your milk is going to be better quality the better you eat. We know that cows’ milk from cows that eat grass instead of grain is higher in nutrients and CLA (conjugated linoleic acid). We know that eating oatmeal increases the quantity of human breastmilk. Anecdotally speaking, I know of someone who was pumping and when she started taking alfalfa (the leaves, but mashed into tablet form) she noticed her milk had a thicker cream layer than when she wasn’t taking alfalfa. Babies prefer to drink milk that is flavored with garlic that their mothers have eaten than milk without garlic flavors. It just makes sense that the better the food that goes into your mouth, the better the food that comes out of your breasts.

Junk food and fast food are addicting. It doesn’t surprise me one bit that you feel powerless to start eating better–those foods are designed by the manufacturers to make you want to eat more and more of them. It’s like being addicted to a drug. But you’re going to have to struggle as hard as you can to work yourself free. It’s the only way you’re going to feel any better.

Any responsible mental health professional is going to ask you about your lifestyle and diet before prescribing any medications. And s/he isn’t going to prescribe anything without also asking you to get back on track with your diet as soon as possible. Anyone who does prescribe meds for you at this point without looking at your diet is only going to do you a disservice. Yes, in the short term you might feel better (although many anti-depressants take a few weeks to kick in fully), but unless you start eating better and taking care of yourself physically and emotionally, you’re going to get weaker and more drained and lifeless and you’ll have to keep upping your dose.

So call to make an appointment, but start changing your diet today. That way, by the time you get in to see the doctor or therapist you’ll have a truer picture of your mental health. You’ll know how much of what you’re feeling is depression and what is because you’re not giving your body the fuel it needs to keep you mentally healthy and full of energy. If you do decide to go on anti-depressants, they’ll work that much better because your body will be healthy and functioning better.

You can do this. You can change your diet. For yourself and for your daughter.

After you read this, have a little cry. Then pack up your daughter and go to the grocery store. While you’re there I want you to buy:

  • a bag of baby carrots
  • a pint of grape tomatoes
  • a bunch of broccoli
  • 2 cucumbers
  • 2 bell peppers
  • a bunch of bananas
  • 6 apples
  • a tub of garlic hummus
  • some crystallized ginger
  • a package of frozen peas

Cut up the cucumber, broccoli, and bell pepper as soon as you get home from the store and leave them in a Tupperware in the refrigerator. Before you seal the top of the container, eat a few pieces.

In the morning when you wake up, drink a big glass of water and eat a banana. Then get out a handful of baby carrots, a handful of tomatoes, half a cucumber, some spears of broccoli, and half a bell pepper. Put them on a plate in the living room or playroom or wherever you spend time with your daughter. Try to eat a few bites every half hour or so, either nude or dipped in the garlic hummus.

If you do end up going to a fast food place, force yourself to order a salad, or at the very least get lettuce and tomato on your burger. (Pickles, while delicious, don’t count as vegetables.)

When you hit the 3 o’clock slump, eat an apple (with peanut butter or cream cheese, if you want) and a few pieces of crystallized ginger.

While you’re cooking your mac and cheese, grab a big handful of frozen peas and put it in the bottom of the strainer. When you pour the pasta through the strainer the water will thaw the peas and the pasta will heat them up. Toss them together with the cheese sauce so you have mac and cheese and peas.

If you just eat a little bit of any kind of vegetable at a time, before you know it you’ll have eaten 5 servings a day. In a few days you’ll start to feel a little better, and a little more energized. You might find the strength to stay away from the fast food places and eat better meals.

I know so many of us have been stuck in a trap of needing to use food to regulate our moods, even when we know the foods are just making things worse. If you can just take baby steps and keep checking in, we can help you get out from under the junk food depression. I wish I lived near you and could just bring you a big salad and some pasta primavera and a hug.

You’re a good mom. All you can ever do is the best you can at that
moment. You’re having a crappy time right now, but you’re still the
perfect mother for your daughter. Things will get better.

Q&A: diaper rash problem

Lihpovela, who titled her email "long time listener, first time caller" (heh), writes:

"My sister has a baby who is 11 months old and has very sensitive skin and absolutely terrible diaper rash–to the extent that the poor little guy cries when you lay him down for a change because he knows what is coming.  My mother and I have tried to convince my sister to switch to cloth diapers to alleviate this problem, but she does not want to (too yucky!).  She seems instead to want to just grit it out. While I’d love to hear ideas about how to convince her to switch, if you think that would help his buns, I’m equally interested in other ideas about treating the rash.  She uses wet wipes with every change, even if there is only pee.  Is this gratuitous? (I don’t do this myself with my cloth diapered 10-month old, I use some baby oil every change and a wet rag if there is an actually mess that needs cleaning). How about zinc oxide- every time? How to know if you need something stronger?"

"Grit it out"? Easy for her to say when it’s not her butt on fire! I can’t recall having a diaper rash, but I imagine it feeling about as uncomfortable as a yeast infection. She definitely needs to make some changes. (I don’t want to make alarmist predictions, but she really needs to get this fixed before he starts holding in his pee and poop because he’s afraid of the feeling. She could be causing a huge, I’ve-been-in-therapy-for-12-years-about-this, ostracized-at-summer-camp problem by not taking this seriously.)

My husband calls me the Forensic Poopologist, and the further into the game of dealing with other people’s butts I go, the more I learn than less is more. Instead of going with something stronger, I’d actually back up and see if removing things from her routine will cause less irritation.

The very first thing I’d do in her situation is give him 2-3 regularly scheduled air baths a day. Put him on a waterproof pad or take him outside and let him go diaperless and pantless for 10-15 minutes to let his poor butt air out.

Then I’d take a look at their diaper situation. (Has she read about how easy and non-yucky it is to use cloth diapers? Plus it saves a bundle of money.) While switching to cloth diapers can eliminate or ease diaper rash for many babies, if your sister’s not willing to try that she can still go with less irritating diapers. If she’s using national brand diapers with scents or lotions or "rash-guard" or a whole bunch of bells and whistles, she should switch to a brand with the least technology possible. She could try the Seventh Generation diapers with no bleach (they do have the absorbant polymer things) and see if that helps alleviate the problem. She could also try Tushies, which use cotton as the absorbant layer.

If she uses wipes with each change, that could be making the problem worse by irritating his sensitive skin. Even the ones that claim to be "natural" or for sensitive skin often contain alcohol or sodium laureth sulfate or other things that are flaming her son’s tush. She could switch to a non-irritating brand like Seventh Generation, or, even better, go to washcloths or unbleached paper  towels with plain water or a homemade wipe mix. With my first son I wiped at each change (even just pee), and we used our own mix of water, aloe gel, and a few drops of tea tree oil. (Readers, feel free to leave your recipe for wipe solution in the comments.) With my second son I only wipe after poop or if the diaper seems wet to the touch.

I would NOT use zinc oxide cream at each change, and would consider switching away from zinc oxide cream altogether. ("Harmful if absorbed through skin. Causes irritation. Prolonged skin contact can cause dermatitis called oxide pox.") If you walk into your local health food store and go into the baby care aisle there will be several good zinc oxide-free choices. I’d look for one that contains calendula, but I’m sure someone will make a specific brand recommendation in the comments.

Now once she’s giving air baths, has switched to the lowest-tech diaper she can find, has ditched the irritating wipes, and has gotten rid of the zinc oxide, she may need to try to figure out what’s causing the rash in the first place (if it’s not as simple as a contact allergy or irritation to the diaper, wipes, or cream). Teething often causes diaper rash either by causing a rash to appear directly (some kids get a rash around their mouths, some get a rash around their anuses, and some get both) or by making the poop so acidic that it causes a rash as it comes out. There’s nothing to be done about teething rash except to change a diaper as soon as the baby poops and to allow him more time to air out during periods of heavy teething.

Some babies get rashes when they eat certain foods that make their poop almost seem to burn their skin. Common foods that cause this problem are acidic foods like citrus, citrus juices (although I can’t imagine an 11-month-old is drinking orange juice anyway), and tomato products, and sometimes grapes. She should think about his diet and observe to see if the rash gets any worse when he eats certain foods.

It’s also possible that he has a fungal infection instead of a straight-up rash. A fungal infection rash looks like burn marks on the skin–red patches that are slightly raised that may have kind of oozy-looking centers. The only way to get rid of a fungal rash is to treat it with anti-fungal cream (sold OTC for athlete’s foot as Lotrimin).

If she eliminates everything else and he’s still got a nasty rash, she’ll need to go to the pediatrician and see if it’s a problem that could be resolved by hydrocortizone cream. I’d never advise that as a first-line strategy (if only because even if it resolved the immediate problem, if she’s still using irritating products the rash is bound to return), but if nothing else is contributing to the rash and it still won’t resolve, it might be what finally knocks it out.

I hope you can get her to pay more attention to this problem. Her poor baby! Imagine how you’d feel if your butt and crotch hurt all the time. Maybe you and your mom can give her painful wedgies until she agrees to try to figure out the problem and fix it.

A great website plug

(Scroll down for today’s Q&A.)

So I got this email a week ago with the same "I thought your readers might want to know about this" line that I get sometimes from people wanting me to pimp their products on Ask Moxie. Sometimes they’re things I already know about and was planning to mention anyway, and sometimes they’re things I see no use for so I don’t mention, and sometimes they’re scary things like trying to get you guys to sign up to expose your parenting style to ridicule on national television.

But this thing was cool. Way cool.

It’s called Amiglia.com, and it’s a website that is basically an interactive family tree. Each person in your family has a profile page with photos (you can upload easily from Flickr or your hard drive) and stories and recipes and music. You connect the people so they make a family tree. You can upload tons of photos and tag and edit them so they go together in albums (like "family reunion 2005" or "cousins" or things like that). You can send a general email to everyone in your family tree through the program. It reminds you of whose birthday is coming up. You can set it up so the tree is viewable by the public or only people with the password, and allow anyone with the password to upload to the site or only you. There’s also a cool toddler game (it has sound so turn your speakers off if you’re at work) that’s like a talking photo album slide show.

Last year at my huge family reunion (125 people) we were talking about how cool something like this would be, but the one we envisioned wasn’t half as robust as this one. I’m in love.

Here’s the best part: They’re in beta now, so anyone who joins now gets a free membership. (I think the listed prices they’ll charge once they officially roll out were absolutely reasonable anyway.) So go join now.