Q1: We’re first time parents. What sorts of things should we look for in a daycare provider?

The biggest question to consider as you are choosing a setting is whether it will be a smaller home-based daycare or a larger center. It’s also a good idea to ask to talk with one or two of the current parents at a facility you are interested in, in order to learn about their experiences with the provider.

In terms of actual expectations, this may seem obvious, but the first priority for all daycare providers is safety—environmental, in the formula and/or food preparation, and in terms of infection control. For example, making sure that all infants under six months of age are sleeping on their backs is a good question to ask. Another may be: “What are the safety measures taken once infants start to get very mobile toward the end of the first year?”

Finally, ask about the type of interaction each of the staff will have with infants and toddlers throughout the day. This will likely increase as infants get older, but from the beginning there should be a certain amount of dedicated time for each in terms of holding, talking, and general nurturing. For example, you could ask how they structure the day—sleep time, play time, meals, reading, teaching sign language, etc.

Q2: Can you help us more effectively deal with our child who may try out for an organized sport but who does not make the team?

A critical question here is why is it important for your child to participate in that sport and make it on the team. The answer to this question will help you decide the most effective approach. For example, is your child feeling pressure to play a certain sport just because mom or dad participated in that sport and did quite well? Is your child a perfectionist and tends to be never satisfied with their performance? Does your child have a role model in that sport that he or she wants to emulate? Are all of his or her friends on the team and now they are left out of an important social activity? Is there community pressure that kids need to be a part of the team to truly be accepted? These questions may be at the heart of this and it may take some time to fully unlock the reasons for the need to be “on the team.”

If and when the disappointment comes, reassurance that he or she still has many great qualities and abilities will be a good strategy. Acknowledging that it is disappointing is important. It hurts not to be chosen, and that those feelings are real. Asking what they want to do about it is a next step. Do they want to work harder to stand a better chance of getting chosen next time? Can they comfortably play at a lower level of competition, i.e., “community” instead of “traveling”? Do they want to redirect their time, energy, and effort toward another activity instead? There are, of course, a number of ways this conversation can go.

In any case, your child will be better off if their identity and sense of importance is not strongly tied to a particular sport—even if they do make the team. Encouraging them to do their best in whatever they do will set them on a good course, as will helping them learn to cope with disappointments that may eventually come their way.

Q3: When is it too late to get a flu shot?

The short answer is that it is never too late to get the vaccine, as long as the flu season is still considered active in the state. But this needs a little more explanation.

Each year there is a different strain of influenza—or the “true flu”—that manifests to make a large number of people very sick and miserable, including our infants, children, and teens. In a typical year the flu season can start as early as the beginning December and can last well into March. There can even be years where there is a kind of “double peak” of flu cases with two different strains of flu affecting a state or even a larger region.

Annual flu vaccinations are important for everyone six months of age and older. For infants under six months of age it is important that everyone else in their family and other caregivers get vaccinated so that the infants are protected. There is the typical injectable flu vaccine as well as a very effective nasal spray. Both of these now contain protection against four different strains of influenza predicted to cause illness for that year. These are available starting at the end of August and continue until influenza activity is considered done for the season. At no time is it too late to get the vaccine as longer as it is still in your area. The only problem may be finding a place to get the vaccine if you have waited too long and supply is limited or depleted.

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to [email protected]. 

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Q: My daughter’s teacher has noticed a pattern of inattentiveness and has mentioned ADHD. What should I do? 

Q1: My child is extremely afraid of the dark and cannot go to sleep unless a light or music is on. What can I do to help him overcome this fear?

Being afraid of the dark is a very common fear for children. Even older teens can retain a fear of the dark for a number of reasons. For children, the “dark” also represents all those things that don’t make sense about the world. Some children have had a fearful experience in the past and still need to emotionally and psychologically work through it, whether the event happened at night or not. Some do not like the separation at night and feel much more vulnerable when alone. These reasons and many more are all variations of being “afraid of the dark.”

While very common, children are generally amenable to interventions by parents. If your child can vocalize what causes the fear, talking through it is a good way to begin. Acknowledging the fear as real in your child’s mind is also important, otherwise he or she may have to “prove” the fear is really there. Spending time at bedtime reading stories and doing a quick room check for “monsters” is frequently a helpful approach. Exposure to disturbing images on the news, in movies, or in video games may need to be minimized to help your child have fewer fears going forward.

Finally, if your child has significant and persistent fears, to the point where it is interfering with sleep and/or otherwise normal functioning, then consulting with your clinician and/or a psychologist may be needed to change their current thought patterns.

Q2: We just had our first child and are concerned that she has colic. She cries for what seems like hours a day, and we’re to the point where we think we are doing something terribly wrong as parents. Can you help?

Crying is a very normal part of an infant’s behavior in the first several months. One of the biggest challenges, especially with first-time parents, is to not think you are doing some thing wrong in the way that you are caring for your baby. The average two month old cries about three hours per day, usually in the evening. Anything above that is typically considered excessive, but is still likely normal for your baby. If it is considerably more than three hours per day, especially if it is all hours of the day or night, then your baby may have a medical condition that needs evaluation.

If you are in the “two to three hours of crying in the evening” phase, there are a number of things you can try to help reduce the amount of time your baby is crying. It is generally helpful to use a sequence of interventions to soothe distress. Try feeding her: even if it was a short time ago, she may still be hungry. If that is not helpful, try walking with your baby, gently patting her on the back and talking softly or singing to her. If she hasn’t settled down after 10 to 15 minutes, it is not likely to help. Next, try sitting in a rocking chair. Lay her tummy-side down on your lap as you gently rock, and rub her on her back. Again, if that has not worked after 10 to 15 minutes, try slowly bicycling her legs while she is on her back—this can be helpful to soothe any intestinal gas issues. Finally, if all else fails, put her in her crib and let her try falling asleep for 10 to 15 minutes. If this is not successful, start the sequence again and you will likely find a way to reduce her crying. This method has actually been confirmed to be helpful in studies on babies and colicky behavior.

If your infant is crying more than what you feel comfortable with, please consult your baby’s clinician. There are situations where crying does indicate a treatable medical condition and needs to be thoroughly assessed.

Q3: With all the talk of obesity, should I be worried that my baby is overweight? Should I restrict his calories to make sure he does not become an overweight preschooler?

While childhood obesity is a major concern and can have significant lifelong implications, this really becomes much more of a concern after age two. Brain growth and overall developmental advances are critical during the first two years and parents should not be concerned with excessive growth during this time. Infants basically triple their weight in the first year of life and you should not try to restrict calories in any way. It is also important that 18- to 24-month olds have a lot of large motor play opportunities and should not be overly restricted in their aerobic activities, such as being stationed in front of a TV for hours each day. They should also have a diet that contains more fruits and vegetables while staying away from sugar sweetened beverages, including many fruit juices.

While it is extremely uncommon, excessive weight gain in the first 12 to 18 months can happen. If it does, there is generally an underlying medical cause. If you are concerned about your infant’s or young toddler’s weight gain, please consult your health care professional. 

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to [email protected]. 

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Q: My daughter’s teacher has noticed a pattern of inattentiveness and has mentioned ADHD. What should I do? 

Q1: My four-year-old is stuttering a lot, and I am worried that he will have problems a year from now when he starts kindergarten. What can I do? 

Stuttering is a very common in preschoolers and is seen in many three- to five-year-olds. Speech and language development is rapidly progressing at this time. The child’s ability to keep up with producing the words that he or she wants to say does not always happen smoothly. This frequently shows itself as stuttering, when a child searches for the right “next word” to use or is trying to say a more complex word than what they have used in the past. It may be helpful to look at stuttering as a kind of brain “software upgrade” as the neural connection continues to evolve and expand.

There are a few things that parents can do while a child is going through a phase of stuttering. Read to your child a lot during this time. This is good for many reasons beyond just stuttering. Try not to correct your child while they are stuttering; it is likely to not help the underlying condition and may actually increase anxiety around speech development. Finally, some parents benefit their child if they start talking a little slower, which will help model that a slower pace of speech is very acceptable.

A small number of children will have speech and language issues at this age that may require intervention by speech therapy. This includes children who have additional “dysfluency” problems such as consistently unclear speech or difficulty forming most words. Hearing problems can show themselves as speech issues at this age. Finally, significant stuttering that persists beyond six years of age will likely benefit from intervention help. 

Q2: My fourth grader seemed to be sick a lot last year, especially during the winter months. What can I do to help her be healthier this year?

Children and teens in school—especially in the first few years—are susceptible to catching many of the illnesses that are present in their classrooms. Unfortunately, there is little that parents can do to prevent most of this from happening. Good hand washing and not sharing utensils or drink cans will help a little, but most viruses and bacteria can live on tables, doors, desks, counters, and other surfaces for several hours. All it takes is your child touching that surface and then rubbing her eye or eating something by hand.

One recommendation that will help prevent one of the more serious viral infections is for your kids to receive the flu vaccine each fall. There is both an injectable form of the vaccine and a nasal spray. People with certain conditions—asthma or suppressed immune systems, for example—cannot get the nasal spray and should definitely get the injectable form of the vaccine. However, the nasal spray tends to be a little more effective, especially when there is not an exact match between the viral strains that are in the vaccine and the flu strain that actually affects the community. This year is the first year there are will be four strains of influenza included instead of three.

For kids and adults that show signs of actually developing the influenza infection, there are a handful of oral medications that can help to reduce the severity of the disease. These generally have to be started within the first 48 hours, so contact your doctor if you or your child starts to develop symptoms of the flu.

Q3: My child just started second grade and is worried about going to school every morning. What can I do to help him have a better attitude?

Worries about going to school—also called school phobia—can happen for three main reasons: 1) what is happening at home; 2) what they think will happen at school; and 3) after a prolonged or serious illness. If there major life events happening at home, younger children will likely be afraid of leaving home because of the uncertainty they feel. Having a talk with them with a heavy dose of reassurance added in will help to ease their fears of leaving for the day.

Fear about what may happen to them at school needs to be addressed with the school. Fear of the consequences of bad behaviors in the classroom and what the teacher is likely to do about it needs to be resolved quickly. Fear of a bully situation at school—or any place between school and home—also needs to addressed as quickly as possible, but will likely be a more complicated situation. 

Finally, if your child has a significant health issue or had a prolonged absence, he may be afraid of what might happen to them outside of their more medically protective home environment. Talking through a plan with your child about his or her health worries is a good start. Reassurance ahead of time that knowledgeable people are close at hand is also part of a good strategy for most children as they transition back to school.

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to [email protected].

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Q: My daughter’s teacher has noticed a pattern of inattentiveness and has mentioned ADHD. What should I do? 

Q1: My kids all have pretty bad allergies beginning in late summer. What can I do to minimize their symptoms of sneezing, runny noses, and itching eyes?

Seasonal allergies are very common in children and teens. They can range from a mild inconvenience to a major disruption in day-to-day life. The symptoms described above are the most common indicators, but they can also include asthma, eczema (drying and redness of the skin), and even recurrent and persistent hives. The allergens most commonly associated with late summer and fall are grass-related pollens (ragweed is one of the most common offenders). Tree-related pollens, on the other hand, are usually more of a problem in spring and early summer, as trees release pollens into the air. Animal dander, mold, and dust mites are year-round causes of allergy irritants and can add to the symptoms caused by these seasonal irritants.

Allergies tend to be an inherited condition, so chances are that one or both parents are at least mildly affected by allergies, as well. The good news is that there are a number of ways to safely and effectively treat the symptoms. Minimize exposure to the allergens if possible, which may include closing the windows and turning on the air conditioner, especially during dry and windy conditions. Showering before bed can work to rinse off adhering pollens. There are a number of over-the-counter oral and eye-related medications available, some of which are much less sedating than the old standby of diphenhydramine (Benadryl, others). Prescription medications are the next level of treatment that can significantly reduce the misery. Finally, allergy shots can be a very effective treatment if nothing else seems to be working.

As always, this is just general information and does not constitute specific medical advice. Please talk to your health care clinician if you have additional questions.

Q2: My sons, ages five and seven are fighting a lot lately. How do I deal with sibling rivalry?

Sibling rivalry—competition between children—is very common and generally cannot be completely prevented, even under the best of circumstances. Children of the same gender and closeness in age seem to be risk factors. 

While not avoidable, there are some interventions that you can use to try to manage and minimize their fighting. One big triggering factor can be trying to get the attention of parents. Ignoring the unwanted behaviors can go a long way to minimize these skirmishes. Separating the children as appropriate can be an effective intervention for some siblings. Consistent imposing of a consequence may be needed for some situations. Rewarding more cooperative behavior—catching them being good—can work to improve cooperation. The rule here is to try a variety of things until you find something helpful.

You will also do well to refrain from any type of comparative statements, such as “if only you were like a good reader like your brother,” or “your sister won first place in track when she was your age; I’m surprised you didn’t even place.” Comparing across a few years is generally unfair to your younger child, regardless of the behavior. In addition, children have different skills, different talents, and different developmental timelines. A comparison of this nature usually does not help your position as a parent and only frustrates your kids.

Finally, if there is a lot of stress or disruption in your family—loss of a grandparent, loss of a job, a new move, and so on—fighting between siblings can reflect that increased stress 

Q3: I have a six-month-old who has begun teething. What do I do to take care of my baby’s teeth, and what age does he need to go to the dentist?

When teeth first come in, simply wiping them off before naps and bedtime is the best way to prevent cavities. Actual brushing of the teeth with a soft tooth brush usually begins when six to eight teeth have erupted—certainly by the time the first molars come in. Fluoride varnishing is something that may be available through your child’s health clinic and does a good job of preventing cavities. Not having your infant or toddler go to bed with a bottle is very essential.

Finally, there are two general opinions regarding when children should first see the dentist. The traditional recommendation has been about three years of age, when the second molars are generally well established, and cooperation with the exam is more likely. More recently the recommended first visit has been changed to one year of age by some professional organizations. Please consult your child’s care professional for a recommendation on that first trip to the dentist’s chair.

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to [email protected].

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Q: We’re past the stage of baby-and-me swimming classes. When is a good time to enroll my twin sons in swimming lessons?

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Q: My daughter’s teacher has noticed a pattern of inattentiveness and has mentioned ADHD. What should I do? 

Q1: My 16 year old is really struggling with acne. Is there anything that can be done to help treat this condition?

Acne is, of course, a very common skin condition, affecting roughly 80 to 85 percent of teenagers.

It is caused by a combination of four processes that affect skin pores causing “pimples,” which are basically an infection in the pores. These processes are 1) a significant increase in the number cells that produce natural skin oils; 2) a notable increase in the growth of skin-pore cells; 3) bacterial presence in the pores; and 4) an inflammatory reaction.

These factors combine to block skin pores, causing whiteheads or blackheads (depending on their size) to form. The bacteria naturally present in these blocked pores then become inflamed. This inflammation causes redness and pus and can be large enough to be almost cyst-like. As these wounds heal, they can leave scarring and/or an increase in pigmentation.

Acne treatments are designed to combat one or more of the four processes. For example, over-the-counter products with benzoyl peroxide work to reduce bacteria and diminish the formation of whiteheads and blackheads. They also have a mild anti-inflammatory effect to decrease redness and pus, helping prevent scarring and hyperpigmentation.

Generally, the method to treat tweens with acne is to use the mildest treatment that treats the skin to an acceptable level. Remember, your child’s skin may not be perfect, but it can be much improved. Gentle washing with an oil-free acne wash two to three times a day with a daily application of benzoyl peroxide may be all that your child needs.

Beyond that, there are various combinations of benzoyl peroxide plus topical antibiotics (medicated skin creams), retinol skin creams, oral antibiotics, and even oral isotretinoin (a medication for severe acne).

If your tween has moderate to severe acne, it is best to work with your primary care provider or dermatologist to develop the most effective treatment plan.

Q2: My daughter complains of severe headaches. She is 10 years old. What can I do to help her?

Headaches are a common childhood occurrence and are usually very treatable. Up to five percent of children will actually have a migraine-type headache, and this is much more common if there is a family history of frequent headaches and/or true migraine headaches.

Stress and muscle tension of head and neck muscle groups are another common cause. Trying to find a trigger for child’s headache is always a good strategy. Anything from being overtired to anxiety due to excess stress can all be triggers. Some kids will have food triggers that cause headaches—tree nuts, chocolate, peanuts, aged foods (e.g., cheese), monosodium glutamate (MSG), and caffeinated items. Also, lack of hydration, especially in the summer, can cause severe headaches.

The treatment for most headaches in this category is adequate rest, reducing stress and anxiety, removing any identified trigger foods, and drinking extra water. Over the counter acetaminophen and ibuprofen in appropriate doses can also be helpful.

Thankfully, the more serious causes of persisting or recurring headaches are uncommon in children. Many children will have headaches with various viral infections and strep throat, but these tend to go away as the infection clears. Head injuries and concussions—even if relatively mild—can cause headaches that persist for quite a while. However, as the head injury resolves, the headaches will eventually clear.

If your son or daughter has a headache condition that seems out of the ordinary or is really interfering with their normal activities, please consult your clinician.

Q3: My two-year-old has frequent temper tantrums. I feel like I’ve tried every trick in the book to manage them. Do you have any tips?

Temper tantrums in toddlers and young children are undoubtedly universal, at least at some level. By 18 months to two years, children have discovered that they are independent persons. At times, they will vigorously assert that mindset.

Being able to control over the world around them is something they are beginning to appreciate. They are also beginning to develop preferences and cannot understand why those preferences are overruled by parents and caregivers. Some personality factors, such as stubbornness, are starting to reveal themselves during this time of rapid cognitive development. Finally, attention of any sort—even if it is “negative attention”—is almost always “good” from a toddler’s perspective.

In terms of reducing the amount of tantrums, here are a few suggestions. First and foremost, ignore the tantrums if at all possible and your child is not in a position of danger. Another important strategy is not to ask “yes” or “no” questions if there is really not a choice. Simply telling your son or daughter, “it is now time to go to the car” is far more effective than asking, “Billy, do you want to go out to the car now?”—especially if that is really not an option. Finally, even young children have very good memories and they will remember what has happened in the immediate past, so consistency on the part of all adults is helpful in reducing tantrums for some toddlers.

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to [email protected].

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Q: We’re past the stage of baby-and-me swimming classes. When is a good time to enroll my twin sons in swimming lessons?

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Potty training isn’t working!

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Q: My daughter’s teacher has noticed a pattern of inattentiveness and has mentioned ADHD. What should I do? 

Q1: Should I apply SPF lotion to my baby and if so, what number should I apply?

Protecting all children and teens from excessive sun exposure and the damaging effects of ultraviolet light is an important effort to make as a parent. Starting early in life and continuing throughout childhood and adolescent years will go a long way to help reduce the rising rates of a number of preventable skin cancers, including the most aggressive cancer—malignant melanoma.

For infants, it is generally recommended to wait until six months of age before applying much sun screen/SPF lotion. This is because infants under six months have more “permeable” skin than older infants and children, allowing for more of the chemical from the lotion to be absorbed through their skin. There are products designed for older infants and toddlers who have more sensitive skin. Generally, a SPF level of 30 or higher is recommended if they are going to have a lot of direct sun exposure. However, it is important for parents to note that keeping children out of direct exposure is always a good idea, even if they have SPF lotion applied.

Q2: How early can I begin swim lessons for my child?

Swimming is a great recreational activity. It is one that you can involve your children in at a very young age, and most generally like the sport. In an area of the country like Minnesota where the outdoor swimming season is fairly limited, anticipation for swimming in the lake or outdoor pool begins to increase as the final snow banks are melting away.

Swim lessons can start at an early age, but it is important to consider what you hope the lessons will do for your child. Parent-infant and parent-toddler classes typically can start at six to nine months. Getting comfortable with being in the water and learning basic swimming strokes can start as early as three years of age. Classes are available through a variety of community groups and are also available through private organizations and fitness clubs.

However, parents should remember this important “heads up” if they choose to put their children in swimming lessons at an early age: this does not replace the basic safety measures you should take with children being around the water. Parents or caregivers should closely supervise children when near water, even if a young child can jump from the side of a pool into the “deep end” or off of a diving board. Also, lake swimming is a different experience from pool swimming and care needs to be exercised with this change. A gradual sloping pool bottom with clear water has few surprises, whereas lakes have cloudier water and frequently have sudden drop offs.

Q3: What can I do with the precious time I have left with my son before he leaves for college?

This transition can be very challenging for parents and students alike. Parents are “sending off” their students to campuses near and far and even if it is only a handful of miles away, a family unit will no longer be as closely connected. You may view this as a transition that only you are feeling at sea about, but this is often a very challenging transition for the student as well, as he or she will have the sudden responsibility to be an independent “adult.” Additionally, the student has to acclimate to a new environment, often with one or more roommates that he or she has never met before. Acknowledging these transitions ahead of time, along with the challenges that they may include, is an excellent first step.

A short list of “lessons that I wish I had shared with you” is an acceptable approach for you to take. Your son may accept it very reluctantly, but will likely appreciate it after he has had some time away from home. Some talk about “keys to success in life” is also a good discussion to have before he leaves for college.

Finally, remember that this is just the start of a new phase in the relationship between you and your son. It will take some learning and some time figuring out how to conduct it, but you both will learn. And, this may surprise you, consider how little your son has probably listened to you over the years: you will always be seen as a source of advice and support regardless of what your son eventually does with his life. Best wishes to the both of you.

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to [email protected].

Recommended for you:

Do temporal thermometers really work?

Potty training isn’t working!

Toddler word count. How many words should a normal 2-year-old be using?

My son seems to have really flat feet. Would special shoes help him?

Screen time truly is a health issue

Facing Cancer Together

Handling the stress of COVID

Q: My daughter’s teacher has noticed a pattern of inattentiveness and has mentioned ADHD. What should I do? 

Q1: I have not vaccinated my son. He’s now two and she’s been just fine. If all of the other children have been vaccinated, why should I concern myself about vaccinating mine?

Unfortunately, there is a lot of misinformation about vaccinations that parents can easily find. There is also an excessive fear by some parents that vaccines will somehow injure or permanently damage their child. The association between vaccines and childhood injury—especially autism—has been extensively studied and shown not to exist. The diseases that these vaccines prevent are very real and with our global society, a case of measles from Russia, Africa, or China can easily be brought home to Minnesota during its incubation phase.

Getting vaccinated is one of the most important steps that parents can take to keep themselves and their children healthy. It is also an important way to not be a source of disease to others in your community, especially who have weakened immune systems from cancer treatments or other medical conditions. You have been fortunate that your child has not had one of these “vaccine-preventable illnesses,” but they do happen. Many children and adults in Minnesota have been ill with infections that could have been otherwise prevented. The reality is that some of these infections have been very severe and the children will never fully recover. Please be sure to discuss this with your pediatrician, who best knows your son. 

Q2: There were some teenagers recently highlighted on the show, Biggest Loser. I am wondering what is safe for dieting for children or teenagers who are overweight?

Having and maintaining a healthy weight is extremely important for children and teens. There are both immediate and long-term medical and psychological implications for kids that are in the “overweight” or in a higher weight category. As a parent, assisting them to get to a healthier point is a great goal, but really needs to be a long-term project; quick weight loss may actually be a bad solution in the long run.

If you have a child or younger teen with a body mass index (BMI) in the 85th percentile or higher, they are likely to be at a point where they can literally grow into their weight if they make behavior changes. A combination of increase in daily physical activity (moderate level or higher), choosing more  healthy food selections, less sugar-sweetened beverages and a decrease in “screen time” will likely be very successful if the change becomes a consistent part of their life. This is part of the “5-2-1-0” strategy, which you may have heard from your clinic or clinician. This stands for 5 servings of fruits and vegetables, no more than 2 hours of screen time, at least 1 hour of physical activity and 0 sugar-sweetened beverages daily.

Children and teens who have higher BMI elevations (above the 97th percentile) may need a weight loss plan incorporated into their goal to achieve a healthier weight. This should ideally be done with informed assistance and supervision because their growth can be affected if their calorie reduction leads to an imbalance in nutritional intake. In this situation, as well, combining dietary changes with an increase in physical activity/exercise levels will be essential in healthy weight reduction. It is the case that some kids have been very successful with primarily increasing their aerobic activity levels with few dietary changes.

Q3: What age is a good age to start reading to my child? What about electronic books for children?

Reading to children should start very young age, even in their first year of life. It is important to remember that for infants and young toddlers reading is very much a multi-sensory experience—seeing the book’s pictures and bright colors, hearing words and speech patterns, touching the book by turning the pages, and so on. The more durable “first-reader” books tend to be the best because they will get handled roughly, usually including a fair amount of chewing.

Electronic books can be started fairly early—as young as toddlers and preschoolers. The only caution here is the potential for damage to the device. Toddlers and preschoolers are terribly curious and do not appreciate that things can easily break, given the right set of circumstances. Some devices designed for preschoolers include interactive components. While the types of devices will be continually changing and evolving, one critical aspect of early childhood reading is in the interaction with parents and other caregivers during reading time.

Ideally, an intentional and interactive reading time should start early and happen on a daily basis. This should continue after your child starts elementary school. This routine will put your child in the best place of school readiness and increase their success in school as they grow up.

Finally, as your child gets older, he or she will be able to handle the electronic book devices quite well. Since many of these have direct access to the Internet, as a parent, you still need to protect your child and teen for age-inappropriate material. Hopefully that is a standard consideration for you because of the prevalence of devices that can easily get information—text, photos and videos—from the Internet.

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to [email protected].

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Q1: Tell me more about the importance of “family meal time.”

Having family meals regularly can have many positive effects that extend far beyond the nutritional advantages. Being able to connect together on a daily basis to hear all about the events of your child’s day—both the good and challenging portions—is essential for emotional health. It can serve as a time to build up your kids and encourage them. This is a good practice to start when your children are young, even though it can be far easier to just have the “drive-thru experience.” It can be a time to add a little needed teaching and perspective into the life experience of your children. It will also provide an opportunity for some real interaction, as the rest of their contacts are becoming increasingly limited to Facebook, Twitter, and texting with their friends.

It is important to emphasize that the television, streaming video, etc., Smart phones, texting, social media sites, etc., should not be invited guests to your family meal time to prevent interference with the person-to-person interactions.

Finally, from a nutritional perspective, everyone tends to eat healthier and in more appropriate portion sizes during family meals. As a parent, it is easier to provide nutritionally balanced selections when everyone is sitting around the table together. Also, research has shown that when people eat while watching television, they tend to eat more calories than they need and also foods that tend to be less healthy than what they would eat if not influenced by the TV.

If you already have a family mealtime established, this will serve you and your family well going forward. If not, it may take a while to change things around. It is worth it though, and the rewards will reach out for years ahead. Remember, even if you cannot do this every night try to make it the majority of evenings with the majority of family members.

Q2: I am really worried that my toddler is not eating enough but meal times are a real struggle. What can I do?

This is a common situation for parents of children between one and three years of age. To answer this concern, it may be helpful to try to “view the world” from your toddler’s perspective. It is also important to make a distinction between calories and nutrition, because it is the latter that is important to focus on and not just the calories that your child is eating on a day-to-day basis.

Rest assured, with rare exception, children do not let themselves starve. They also do not let themselves go thirsty. If they are hungry or thirsty, they will eat and drink what is available for them. On the other hand, if they are “calorie satisfied,” they will not eat or will eat only things they really like.

Another important consideration is that your toddler does not need many calories to supply their energy and growth needs. After the first 12 months of life, a child’s growth rate really slows down, as does their calorie needs to support that growth. Because their bodies are also small (20 to 30 pounds) their calorie needs to supply their daily energy needs are also small. Growth and energy needs together may only require 500 to 600 calories each day for an 18-month-old.

It is very easy for your child to reach that amount. If your toddler really “loves” yogurt, his or her entire calorie needs for  a day can be satisfied through consuming three six-ounce containers of low-fat yogurt—approximately 550 calories. If you add eight ounces of juice—another 100 calories or so—and a small package of French fries—about 230 calories—your toddler isn’t undereating at all, but may actually be overeating. Their nutrition is not great, but they are no longer hungry.

Added to this is the fact that for a toddler, food is much more than just the calorie content. It is an opportunity to explore tastes, shapes, textures, temperatures, and how to handle food. Eating becomes a total body sensory experience. Spreading mashed potatoes with gravy all over may be a new and exciting experience for a toddler, just to see what happens. The same is true with pouring milk out of a cup, or throwing oatmeal to see how far it can go.

Two other important features of toddlers are their desire for attention and their new ability to influence the world around them—both of which can cause challenges at mealtime. If refusing to eat causes a parent to pay more attention, then that is a behavior that is being reinforced from a toddler’s perspective, even if it is negative attention from the parent’s perspective. If the family’s pet dog is a very animated recipient of morsels that come raining down from a toddler’s high chair, then there will likely be food coming down just to see the dog react.

In summary: toddlers will not let themselves starve, so optimize the nutrition of the calories that they do eat. Toddlers are not trying to be “naughty,” but they do love any and all attention, even if it is intended as negative attention from the parent’s perspective. And, if all else fails, vitamin supplements can fill a number of gaps in your child’s nutritional intake.

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to [email protected].

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Q: We’re past the stage of baby-and-me swimming classes. When is a good time to enroll my twin sons in swimming lessons?

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Q1: I have heard a lot about concussions lately. I want my child to participate in sports but now I am very concerned about permanent brain injury. What do I really need to know about concussions?

The term “concussion” can be very concerning for parents, but thankfully very few of them lead to any longer-term problems. On the other hand, it is important to take them seriously. Here are a few general suggestions to consider if your child has sustained a concussion.

Concussion simply implies an injury to brain that is significant enough to cause symptoms after the injury. This can result from a direct hit to the head—from a sporting activity, a fall off a scooter or bike, or even just tripping and hitting the ground. It can also result from an indirect jarring of your child’s brain from an injury elsewhere on his or her body. A child or teen does not need to lose consciousness—dizziness, headache, confusion, blurred or double vision, and loss of memory all signal that a fair amount of force has been delivered to the brain. There does not need to be any physical changes to the brain to be diagnosed with a concussion. It is a “functional” injury related to the neurons (brain cells), which are temporarily not working normally.

One of the biggest advances in the treatment of concussion in the last decade is the determination that the brain must have sufficient time to heal following an injury. This is very different than the previous concept that a quick return to “the game” is perfectly fine. The current recommended steps for “concussion rehabilitation” after a sports-related injury follow these sequential steps:

1. No activity – complete physical and cognitive rest 

2. Light aerobic activity – walking, swimming, stationary bicycle, etc.

3. Sports-specific exercise with no head impact

4. Non-contact training drills

5. Full-contact practice

6. Return to play

Moving from one step to another requires that there are no concussion-related symptoms experienced at that earlier stage of healing before moving upward.

As always, if you believe your child has sustained a concussion, please consult your medical professional.

Q2: With summer coming, I would like my kids to have some sort of camp experience. What should I think about when it comes to camps, and how can I help my child have the best experience possible?

Camps can be a great opportunity for children and teens to experience an entirely different physical environment than what they are used to, from a very primitive setting in the Boundary Waters, to canoeing on one of Minnesota’s 10,000 lakes, to traveling outstate for backpacking in the mountains. At the other end of the spectrum are music, art, debate, theater, and language camps. In addition to the traditional “sport camps,” there are sport-specific camps that can significantly enhance your child’s skills and abilities.

One way to begin considering the best camp for your child is to include him or her in the decision-making process. What type of camp would they like to attend? Then consider if you want a day-based camp—which will generally be more local—or will this be an overnight or extended experience? Camps for teenagers can commonly go for two- to four-week sessions. If this is your child’s first extended time away from home, preparing them in advance by talking through the experience and building up the opportunity will generally be helpful to ease their transition away from home.

Many camps require a number of forms to be completed, including necessary medical information. Your child’s immunizations should be up to date, both for their sake and the sake of the other campers. Making sure the staff is fully aware of any health issues and/or needed medications that your child has is essential. Campers will need to have an adequate supply of routine and urgent medications (like an albuterol inhaler for wheezing)—which can sometimes be overlooked by parents. Knowing what health care resources will be available onsite in case of an urgent need is very important and reassuring to parents as well.

There are a large number of resources and websites that can help you get started in this process with practically an endless number of choices for families. Many colleges and universities will have academically-oriented programs available for younger students. Churches and faith-based organizations typically have many options, including “family camps.” A few websites include: mysummercamps.com; campresource.com; and campchannel.com.

If you get this issue in time to attend, Minnesota Parent holds an annual camp fair at Como Park Zoo and Conservatory. This year it is on February 23 between 10:00 a.m. and 2:00 p.m. Go to mnparent.com for more information.

This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to [email protected].

Recommended for you:

Q: We’re past the stage of baby-and-me swimming classes. When is a good time to enroll my twin sons in swimming lessons?

Do temporal thermometers really work?

Potty training isn’t working!

Toddler word count. How many words should a normal 2-year-old be using?

My son seems to have really flat feet. Would special shoes help him?

Facing Cancer Together

Handling the stress of COVID

Q: My daughter’s teacher has noticed a pattern of inattentiveness and has mentioned ADHD. What should I do?