Q&A: teeth!

Today I’ve got an easy tooth question and a tougher one.

Amber writes:

"Is it okay to brush my son’s teeth. He is 9 months old? If so what kind of toothpaste do I use?"

Yes! There are a couple of ways you can go with tooth-brushing, but they both involve xylitol. Xylitol is a sugar from birch trees, and it kills the bacteria that
causes tooth decay. It’s got a pleasant, mild flavor. The children of mothers who use xylitol toothpaste
and/or gum in the first two years of their children’s lives have fewer
dental problems up through age five than kids whose moms don’t use any
xylitol products. So the first thing you could do is switch to xylitol toothpaste yourself (there are some great brands online like Squigle and Epic, and I love Tom’s of Maine CinnaMint flavor) or start chewing gum with xylitol.

But even if you don’t use xylitol toothpaste your
kids can. Tom’s of Maine makes a liquid toothpaste  for kids with xylitol that comes in a few flavors (our favorite is grape), and it’s in Gerber baby toothpaste, too. For a 9-month-old you want to use just a teeny bit of the toothpaste with some water. You can use an extremely soft-bristled brush, or one of those things that fits over your index finger with little nubbly parts that lets you brush by sticking your finger inside the baby’s mouth. (Be warned, though, that if your baby has a tooth and chomps down the soft toothbrush will not protect your finger and it will hurt like you didn’t think possible).

If your baby is too young for toothpaste or a brush (gags or won’t open mouth or otherwise resists), you can get Spiffies xylitol wipes to wipe their little baby teeth. They’re individually-packaged wipes (the size of wet wipes) coated in a xylitol solution. They taste like very mild grape, and you just use them to wipe the surfaces of all the teeth and gums.

If you nurse to sleep and can’t imagine waking up your baby to brush, you can still brush or wipe with Spiffies right before you nurse. Some of the xylitol will stay on the teeth, and since the nipple squirts milk in the back of the mouth instead of the front, the milk won’t wash all the xylitol off.

Now for the rougher question. Jennifer writes:

"I just got back from our first trip to the pediatric dentist
with my 17 month old. Peanut has white spots on her teeth, and we’re
told they are early signs of caries forming, eek! (My worst nightmare
realized.) She’s a nursing toddler who is totally attached to Mama’s
boobs during her naps, and she’s an all night nurser. The dentist
recommended brushing her teeth with flouride at least 3 times per day,
using a concentrated flouride gel at night before bed, flossing at
night, and swiping her mouth after each drink besides water. I don’t
know about your toddlers, but mine is pretty typical and eats and drinks all day long!
What a pain in the tookas, not to mention having to pin your child with
the figure four… i never knew i was a natural born wrestler (poor
little Peanut.) 

In case you were
wondering what we feed Peanut, she eats a moderately organic diet,
generally low in sugar, some meat and dairy. No juice, no sweets, but
an occasional Hug A Bear cookie or Graham cracker (whole grain and
organic, of course). She’s been a picky and small eater until most
recently, which I think may have contributed to some potential vitamin
deficiencies. (I read somewhere that deficiencies in calcium, vitamin A
and phosphorus can weaken tooth enamel.)

The
dentist did not say that nursing has damaged her teeth, but certainly
any sugars in her mouth will promote further demineralisation of the
tooth enamel. Daddy-o’s been expressing a desire to put Peanut down
lately so changing our bedtime routine seemed to make sense (even
though I would have nursed her to sleep as long as she wanted.) For the
last 1 1/2 weeks Daddy-o has been putting her to sleep and I’m usually
called into action by about 1-2am when I nurse her back to sleep,
(we’ve all been sick especially my husband, so cutting out all nursing
until early morning has been put on hold.) We are doing our best to try
to keep her mouth as clean as possible while also trying to reverse the
damage to her enamel the acid has done. Boy does this suck!

This
is all very stressful for me as I worry about the prospect of dental
work, and it really bites to have to pin my daughter down to brush her
teeth several times a day… and it’s very likely she’ll still have a
cavity after all is said and done. Has anyone gone through this process
and what was it like for them? What could I expect if she really needs
cavities filled (I can’t even imagine the torture of that day!) We’re
going for a follow up to the dentist in 3 months."

I asked about xylitol to prevent any more damage, and she updated:

"yeah, we’re using spiffies now too… they came in the mail the week we
went to the dentist… my understanding is that xylitol helps to combat
the strep mutans bacteria present in plaque… our daughter already has
damage to her tooth enamel… when this starts to happen it’s called
demineralisation, that’s when the damaging environment has been around
long enough to soften the teeth… you need the nasty bacteria plus
sugars from food to interact in order for the damaging acid to form…
this lovely cocktail eats away at the tooth enamel… they skinny is
that i should have been using the spiffies wipes a long time ago and i
should have been more diligent at "getting in there" and not just have
her chew on a tooth brush before bed… at this point, flouride is
needed to remineralise the tooth enamel, which basically means to make
it strong again so that the white spots don’t turn into irreversible,
decaying holes… in essence, the flouride is the antibiotic and any
other cleaning agents like  xylitol are the band aids protecting from
further damage….

my LLL leader sent me this
link on the subject… i thought you might like to check it out… just
brace yourself for the pics, they are some of the worse cases of Baby
Bottle Mouth (totally freaked me out) anyway, i think we’re doing all
we can but i just wondered how other well-intentioned parents dealt
with this issue… even if the problem was truly genetic…

thanks moxie… "

http://www.brianpalmerdds.com/caries.htm

So once again a reader answers her own question by providing a pertinent link. And, yeah, some gross pictures if you click through from that first page to the PDF presentation (the first page is fine, with no photos).

So it sounds like xylitol is the first line of defense, but once the enamel is damaged, the only help is fluoride. If anyone else can share experiences with this problem, Jen and I would really appreciate it. I have no idea how a 17-month-old will make it through the process of having a cavity filled, but it might not be rough at all. So any stories would be appreciated.

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Q&A: toddler practicing walking can’t nap

Carly writes:

"My 11 month-old daughter just started crawling last week. She has progressed with lightening speed, though, to pulling herself up everywhere and trying to walk.

This is causing immense problems at nap time. We lay her down, she immediately rocks on her knees or sits or pulls up. I end up going in again and again and again resettling her, each time expecting it to be the last because she’s so obviously tired (eye rubbing, yawning, blanket caressing). The past week this has been happening, it sometimes takes more than an hour of resettling before she finally conks out.

I am wound tight as a wire and severely stressed about this, as it tries my patience more than any other issue since she was born. Today I yelled at her for the first time, making her cry. I worry I’m going to snap.

Do I keep going in and resettling? Should I just ignore it and let her tire herself out (if this even happens…)?

I always used to snicker at moms who said their child was beating them, that they let the kid win. But she is totally kicking my ass, and feel beaten and desperate over what to do."

Give in. Surrender, Dorothy. She’s not doing it on purpose, and she has no more control over it than you do. You and she are victims of the same out-of-control roller coaster. So try to cut yourself some slack, and maybe it’ll help you be calmer with her.

Let me repeat: She’s not doing it on purpose. Her body won’t let her rest while it’s doing this new learning-to-walk thing. That’s why she’s screamingly tired, rubbing her eyes, cranky, but still can’t sleep. She’s as upset about it as you are, except that she hasn’t had the misfortune of reading the baby care books that say what she "should" be doing, or listening to advice from mothers-in-law and people at the grocery store saying all kids should be napping on the same schedule all the time by X age, or people telling you that she’s trying to play you and you need to "show her who’s boss." (Trust me–you won’t win. Even if you win now, you won’t win when she’s 16.) No one’s guilting her about this, and no one should be guilting you about it, either. (And she won’t remember that you yelled at her, so just put that behind you.)

The best way to look at this is if you’re partners, she and you, and you’re in this together, and you help each other out. That way you take the power struggle out of the relationship. Because who wants to be struggling for control with a person who can’t even talk yet? It’s a vicious cycle that will only make you feel more frustrated and more disconnected from her, and will leave you both angry.

You’re already saying you feel "beaten and desperate." What an awful feeling! Changing the way you look at it will give you back the confidence and mastery you know you have as her mother. Looking at it as an exercise in detective work or problem-solving will make you feel more connected and better at parenting her. So let’s talk about some ways you can get through this time until she can walk and her body lets her sleep again like she did before.

How could you get her to sleep better during this time? And if there’s nothing you can do about her sleep, how can you help yourself calm down during this time and remember that you’re still a great mother, but now is about movement leaps and not naps?

Well, I’d start by looking at what’s waking her up. It’s the movement her body needs during this time. It might be possible that if you can create the movement externally, she might be able to sleep. You could try putting her in the stroller and walking her around so she can stroller-nap. Or putting her in the car and driving her around so she can sleep in her car seat. Yeah, she might not sleep as long as she usually does in her crib, but it’s bound to be more than she’s getting now. And at least you’ll be out of the house, either getting exercise by walking or listening to CDs in your car.

Whether creating movement for her helps her sleep or not, you definitely need to de-stress. The mantra you should repeat during this time is "It’s not my fault, and it’s not her fault." You two are the innocent victims of a developmental movement spurt. You’ll make it through this one, and then another one will come along, and you’ll make it through that one, too. If you can try to think of it as funny instead of awful, you may be able to keep your calm. Have you taken any photos of her in the crib with her butt stuck up in the air, practicing? Both of mine were so freaked out by that stage. Sometimes they’d be asleep, and then would wake up because they’d be standing and they had no idea how they’d gotten there.

The other thing that may help is to just give up on the nap if it doesn’t work after a set amount of time (my limit would probably be 30 minutes, but my patience seems to be decreasing as I age). Yes, she’ll be extremely cranky by the end of the day, but you won’t be as stressed out from trying so long. Then you can hand her off to your husband as soon as he walks in the door and just go out and do something for yourself. Exercise, or go drink a cup of tea somewhere, or just sit on the front porch by yourself and call a friend. If she’s fussy or cranky because she didn’t nap he can take his turn with her. You can probably bump her bedtime earlier by half an hour or so until this blows over.

And that’s really the take-away from all of this: It is going to blow over. She’ll start walking and then she’ll start sleeping again. You won’t believe how well she’ll sleep, because she’ll be so tired out from running her little legs off all day long. But in the meantime, please don’t think of it as her "beating" you or as a battle of wills between the two of you. That’s a road you don’t want to go down because there’s no possibility of either of you winning.

(If you’re scratching your head about how I can advocate not trying to win against your kids, read the amazing book Between Parent and Child by Haim Ginott. It will change your whole way of looking at yourself as a parent–in a good way–and how you relate to your child.)

Q&A: separation anxiety in 9-month-old

Jessica writes:

"I have a friend with a 9-mon. old baby boy. She can’t
even put him down while she does a pile of dishes or a load of laundry. He is
right by when she tries to do house work but he will not let her put him down
with out crying. What are some suggestions on how to break him of
this?"

It’s going to help your friend to think about why her son wants to be held all the time, instead of as something bad she needs to stop. And I would never try to "break" a baby of anything, because that means
disconnecting his trust, which is bad bad bad for emotional and mental development.

Not wanting to be alone is really common in 9-month-olds, because
they’re going through the "separation anxiety" stage. It’s a
developmental stage when they start to realize that they’re separate
from their parents, and it makes them scared and anxious. For some kids
it’s relatively mild, and they just don’t like to be alone with strangers. For
some kids it’s more severe and they don’t like to be left alone in a
room, even if they can still hear the parent. For some kids, like your
friend’s son, it sounds really severe, since he doesn’t want her to put
him down. But all these degrees are normal. It sounds like your
friend’s son is a little "high-needs" (I guess I’d prefer to think of it as "intense"), and just feels things very
deeply. As an adult that’s going to be really great for him, because
he’ll have extreme focus, loyalty, and determination. It just sucks for her right now,
because she can’t leave him like other people can with more
easygoing babies.

Separation anxiety can be totally confusing for the parents. Maybe they’ve had a baby who was totally content to play alone, sitting on the floor with some toys, babbling away for 15-20 minutes at a time. All of a sudden that same kid wants to be held all! day! long! or screams like she’s being poked with a sharp stick if the mother dares to walk out of the room. It feels like their child is somehow regressing, but in fact, the baby is sort of backing up and revving up to go to the next stage.

Or maybe the parents have a more intense baby who’s wanted to be held all the time from Day One, and they think that finally by now they should be getting some relief. Everyone tells them that if you give the baby enough touch and attention, the baby will eventually separate, so they’ve been dong that all along. But it seems like everyone else’s baby is just crawling away from the parents happily, while their baby is stuck to them more tightly than ever. What are they doing wrong? Well, nothing. Since they have a child who has a more fierce need to be with the parents to begin with, this anxiety stage is probably going to be more severe anyway. The rubber band theory (scroll down to "You’ve probably heard…") still holds true, so things would be even worse if they had tried to force their baby to be more independent before s/he was ready for it. And, yeah, other people have kids who don’t seem to notice where they are, but that’s just not the kind of kid you have. Accepting that the intensity is part of your child’s wonderful personality and not something you’re doing wrong (or, even worse, some flaw in your child) is going to make everything easier for all of you.

So yeah. 9 months can be really rough. Reaally rough. There’s separation anxiety (which hits again in a big way at 2 years), some developmental spurt that causes the 9-month-sleep regression, learning to crawl or cruise, and probably some teething on top of that. They may also be hitting that eating strike in which they only want to eat things they can feed themselves. Oh, and it’s cold and flu season, too. So normally clingy kids are stuck like glue, and even babies who usually don’t care can become velcro (touch tape) babies. Time to haul out the old sling (even if you never used it with a newborn) and do the hip carry (scroll down)–this age loves that–or the backpack (or mei tai, Ergo, Sutemi, etc.) and just strap the kid on and go about your work. It’ll make you feel like a bad-ass Amazon, and maybe the child will just stop fussing.

You know exactly how I’m going to end this: This too shall pass. Hang in there.

Q&A: toddler waking up in the middle of the night

Amy writes:

"Is there such a thing as an insomniac toddler? Twice recently, both on Sunday nights, she woke up a few hours after going to sleep. And would not go back down. Which results in scenarios like a wide-awake two-year-old in bed with us at 3 am (we typically don’t co-sleep but occasionally will bring her into bed when she won’t sleep, in hopes we can) wrapping her arms around us and declaring "Family HUG!!"  Which means NO ONE is sleeping, because really, how cute is that? We explain to her it is sleep time and not play time and don’t engage, hard as it is. Still, she’s ready to rock and we’re half dead.

She’s 26 months old tomorrow, and the only possible consistent thing is that she goes to school on Mondays. She loves school so I don’t think it’s anxiety; we often see my parents on Sunday so maybe overstimulation? But some days things are totally normal and she still has trouble sleeping. Like today (a Thursday), she was up 2 hours earlier than normal and  took a crappy nap and was up for like an hour and half at midnight.

She does have a permacold this winter–we run the humidifier and give her medicine when it’s bad.

We have a pretty consistent bedtime routine and have since she was a newborn. Usually she goes right to sleep. Naps have been bad this whole week, too. It’s not unusual for her to nap badly for a week and then be fine, but the night sleep is unusual. How can I get this girl to sleep? We’re all exhausted when this happens. Poor babe gets dark circles under her eyes and practically falls over from exhaustion.

Help us, Moxie and pals!"

This question piggybacks onto yesterday’s question about the 2-year-old who won’t go to sleep on his own. So let’s repeat some of the stuff from that post, especially the comments: The most common time for parents to co-sleep with their kids is from ages 2-5, because it’s just easier than fighting the wake-up battles all night. And some huge number of kids wakes up at least once in the middle of the night (50%!), even after 2 years old. So your daughter isn’t unusual. For what that’s worth.

Anyway, as to why this is happening, my guess is that it’s a combo of overstimulation from the grandparents, excitement about school the next day (she can wake up because she’s looking forward to going, not just out of dread), and developmental stuff. This age is still jam-packed with development, from verbal to cognitive to physical to emotional. It’s probably like all the developmental spurts you lived through back in the first year, in that whatever’s happening will connect in a week or two, and she’ll go back to sleeping. (Remember how easy it was to know what was going on in that first year with The Wonder Weeks? If only Vanderijt and Plooij would release the guide to developmental spurts for the next, oh, 35 years.)

What leads me also to think that it’s developmental spurts is the idea that she just can’t physically stay asleep. If she’s tired and has circles under her eyes, then she needs to sleep but just can’t. Also, the fact that she’s wide awake ("FAMILY HUG!"?? Hee.) in the middle of the night and not trying to fall back asleep indicates that her body just isn’t letting her sleep then.

So. Where does that leave you? Well, knowing that it’s not going to last forever, but that nothing’s going to definitively fix it right now. So you can decide to do nothing and ride it out, try to enact a plan to get her to sleep through (which will probably not be that successful given the limits of sleep her body’s giving her right now), try to manage her not sleeping so it has an impact on the fewest number of people in your household as possible on any given night, or some combo of all of these.

The one thing that seemed to help us during this phase (the first time through–maybe #2 will be different) was to run him around every morning until he almost dropped. It was tough during the winter (which is why we stuck with the really lame soccer class), but if I could tire out his body physically every day, then at least he could get a decent nap before his brain started waking up his body. And sometimes it seemed to help the nighttime sleep, too.

Readers? Stories of commisseration? Or some magic tricks (and remember that use of opiates doesn’t count) to get a 2-year-old to sleep through the night.

Q&A: pacifier weaning too abruptly and sleeping in big boy bed

Peggy writes:

"I read a some of your advice on pacifier weaning. The problem for us is that we had to pull my son off his paci a little too abruptly. He is 2 1/2 years old and has only switched to a big boy bed in the last 2 months (we are expecting a little girl in a few months). I’d say he’s willingly been using the pacifier for naps and nighttime only for the last 8 months without needing it or asking for it otherwise. However, we had to pull him off of it recently because he had taken to chewing on them and and we were afraid the nipple would break off and choke him. When he got down to his last pacifier, we tried to explain to him that he needed to stop chewing on it otherwise it’ll be broken and we’ll have to throw it away. Well, that time came within a few days. It has been terrible since all his pacifiers are gone. He keeps having these fits in the middle of the night where he is looking for the paci, but he is so out of it, we can’t comfort him enough to calm him down. He eventually falls asleep on his own. This might happen 1-3 times a night. Also, because he is in the big boy bed and isn’t fully adjusted to it yet, he comes running into our bed most nights and we can’t get enough sleep (which I really need with a newborn on the way!) I thought it would be better after a few days, but it’s been over a week.

In a related matter, do you have any suggestions for getting our son to lay down in his bed and stay there on his own? Right now, he only goes to bed if both my husband and I lie down with him until he goes to sleep. We read a few books and turn off the light (same routine every night), but he won’t let us leave. We tried using a gate in his doorway but that was too traumatic for both him and me. We thought we had introduced the notion of a big boy bed as best we could in the first place. He got to help pick it out, and he was really excited about it. He doesn’t seem to want to be back in the crib at all, so I don’t think that is the issue."

Before I really start in on any of the specifics of this question, I want to tell you not to underestimate the effect of having another baby on the way. Even if it’s a few months off, your son is likely to be feeling anxious about it since it’s such an unknown. He can’t verbalize those feelings (even if he understands them, which he doesn’t), so they’re going to come out in other areas of his life, including comfort objects, sleep, and behavior. If you can keep that in mind, it’ll help you get through this stuff more easily because you’ll at least know why some of this is happening and that it’s a time-delineated problem.

I think you’re stuck with the pacifier problem until it works itself
out, which could be a few weeks. In hindsight, you maybe could have
saved yourself a little bit of trouble by having some kind of ritual to
get rid of the pacifiers (giving them away to "someone who needs them"
or burying them in the backyard or sending them to the Pacifer Fairy, or just some kind of ritual to mark
the passage). But I don’t think there’s really any good way to get rid
of pacifiers without any trauma at all, and you clearly had no choice
but to get rid of them ASAP, so all this Monday-morning quarterbacking on my part is just hot air.

The only thing I can think of that might help is to talk
about how he doesn’t use pacifiers anymore during the day at least few times every day,
to rehearse it with him so it’ll stick in his head in the middle of the
night. And make sure you talk about it right before bed, too, so it’s
still in there. It might click at a certain point and he won’t be
looking for one in the middle of the night if he remembers that he
doesn’t have them anymore. And even if it doesn’t help him have an easier night, at least it’ll give you something concrete to do to try to alleviate things until he just moves on on his own.

It sounds like your only problem with staying in his bed is going to bed the first
time, correct? I think that’s really common at that age, to want
someone there while they fall asleep. It’s a normal developmental thing, and doesn’t mean you’ll have to do it forever. Honestly, to me the biggest
problem with the scenario is that he wants both of you there. One of
you is reasonable, but two is excessive.

Personally, I’d vote for your husband to be the one to get him
to bed, because when your daughter gets here you’ll be occupied with
her, and your son will most likely regress for the first few months and
need someone to help him get to sleep (even if he starts going to sleep
completely on his own this week). I guess there could be an argument
made that it should be you for now and then when your daughter arrives
it should switch to your husband, but that’s up to you two to figure
out.

Whichever one of you is not the one getting him to sleep
should arrange to be out of the house at bedtime for a few nights. If
you’re not there, then you can’t be roped into putting him to sleep.
(I’m assuming that there are nights occasionally when either you or
your husband aren’t home at bedtime, so this won’t be a completely new
thing for your son. I can’t emphasize enough the importance of having something even once a month that lets you get out at night to do something adult.) Although this is going to be annoying, I’d also recommend having your husband lie down on the floor next to him, instead of in his bed, because that makes it easier just to roll up and walk out, since it won’t shake the bed and risk waking your son. The first night or two might be a little rough for your husband (depending on how tenacious your son is*) but then they should settle into a good pattern, and you can start being home at bedtime again.

I think you guys should be prepared to have to be in there with him to drift off to sleep until a few months after the baby comes. (I’m being realistic here. It’s not my goal to blow smoke up anyone’s skirts by saying it’ll take a week at this particular point in his life. If the baby wasn’t on the way, it might only be a few weeks, but this is a fragile time. And who knows? Your son might start going to bed just fine on his own after a day or two anyway.) When you feel like he could be loosening up and not really needing your husband anymore, your husband can use the tried-and-true method of saying he has to leave to go to the bathroom but will be back. Then gradually he stays away longer and longer, to see how long it takes your son to fall asleep once he’s out of the room. One day your son will forget to ask for him to stay, and everything will have clicked into place without anyone realizing it.

Good luck. This is such a tough time because of the transitions happening, but it will get easier in a lot of ways once the baby comes.

* Hey, tenacious is a really really good quality in a person. It bodes really well for later success. It’s just a little inconvenient when you’re trying to change that toddler person’s sleep patterns.

Reader call: Negotiating parenting boundaries with your parents

Everyone, please go watch all the muddy fun in the video for "Jump Into The Mud Puddle" by my friend Leo’s Mom, who does real classic rock-y music for kids.

I need to apologize for the sparse posting this week. My mother has been here visiting, and we’ve been so busy I fell way behind on everything I normally do.

Which leads me to my big question: How do you all negotiate parenting boundaries with your own parents or in-laws? My mom and I have never talked about it, but I feel like the way we work together is perfect for us. She’s always let me be the mother, but she does step in when I’m not right there or she notices something I’m missing. And I expect the kids to obey her, especially in her house. She makes the rules there, and I back her up. In my house, the rules are mine, and she enforces them if I’m not already doing it.

My dad has been slowly starting to take more responsibility with and for my kids, as I encourage him to.

Do others of you have the same kind of give-and-take with your parents? Or are you having a harder time negotiating how to relate to each other and the kids? If you feel like you’ve got a handle on it, how did you do it?

With me, I don’t think any of it has been me. I think my parents decided a long time ago that since I was an adult they would just relate to me as an adult, and that’s facilitated the lack of posturing. It’s all been their ability to release control.

Talk to us.