Child Development: 24 Months 09-P

ChildChild DevelopmentDevelopment 2424 MonthsMonths My name is . The date is .

I weigh pounds, and I am inches long.

I like to think I am a pretty independent person at this age. I like to do what I want, when I want to do it. I tend to rebel at any attempt to lead me.

I can feed myself with utensils and drink well from a cup or glass now. I don’t need my bottle anymore.

I can speak in short phrases and sentences, and this helps me express some of my needs and frustrations. I am learning to control my bladder and bowel function during the day, though I may not want to and can forget.

Please remember to:

Use my car seat in the backseat of the car, but you can now turn me to face forward. Limit my screen time (TV, computer, Smartphone, video games, etc.). Save time for quiet reading and game activities. Watch me and my toys near sidewalks and street corners. Do not get trapped into arguing with me. Teach me about discipline in a loving but firm, consistent way.

Revised 5-21-2013 Discipline: Time-out Technique 40-P

Discipline: Time-Out Technique

Definition Time-out is a form of discipline used to interrupt unacceptable behavior by isolating a child in a chair or room for a brief period of time. Time-out has the advantage of providing a cooling-off period for both the child and the parent. It gives a child over two or three years old a chance to think about his misbehavior and feel a little guilty about it. When a child is less than two years old, Rooms time-out mainly establishes who is in charge. with the door open. Many Misbehaviors that respond best to time-out are parents prefer a aggressive, harmful, or disruptive behaviors room for time-out that cannot be ignored. Time-out is much more because it offers more confinement than a effective than spanking, threatening, or shouting chair. The most convenient and safest room at your child. Time-out is the best form of for time-out is the child’s bedroom, though discipline for many of the irrational behaviors making the bedroom a place of punishment of toddlers. As a child grows older, use of can cause sleep issues. Until two years of time-outs can gradually be replaced with logical age, most children become frightened if they consequences. are put in a room with a closed door. Other ways to confine your child in a room without completely closing him off are a gate or a Choosing a Place for Time-Out piece of plywood that covers the bottom half of Playpens. Playpens are a convenient place for the door. time-out for older infants. A playpen near a Rooms with the door closed. Some parent is preferable to isolation in another room children will come out of the room just as soon because most infants are frightened if they are as they are put in. If you cannot devise a not in the same room as their parent. Cribs are barricade, then the door must be closed. You not an ideal location for time-out because this can hold the door closed for the three to five can lead to sleep problems. minutes it takes to complete the time-out period. If you don’t want to hold the door, you Chairs or corners. An older child can be told to can put a latch on the door that allows it to be sit in a chair. The chair can be placed facing a temporarily locked. Be sure not to forget your corner. Some parents prefer to have their child child. The time-out should not last longer than stand facing the corner. a few minutes (one minute per year of age).

Revised 5-21-2013 How to Administer Time-Out need to hold him in the chair with one hand on his shoulder for the entire two minutes. Don’t Deciding the length of time-out. The time-out be discouraged; this does teach him that you should be long enough for your child to think mean what you say. If your child yells or cries about his misbehavior and learn the acceptable during time-out, ignore it. The important thing behavior. A good rule of thumb is one minute is that he remain in time-out for a certain per year of the child’s age, with a maximum of amount of time. Your child will not be able to five minutes. A kitchen timer can be set for the understand the need for quietness during required number of minutes. If your child leaves time-out until at least three years of age, so time-out early (“escapes”), he should be don’t expect this of him before then. returned to time-out and the timer should be reset. By the age of six years, most children can Ending the time-out. Make it clear that you be sent to their room and asked to stay there are in charge of when time-out ends. When until they feel ready to behave. the time is up, go to your child and state, “Time-out is over. You can get up (or come Putting your child in time-out. If your child out) now.” Then treat your child normally. Don’t misbehaves, briefly explain the rule she has review the rule your child broke. Try to notice broken and send her to the time-out chair or when your child does something that pleases room. If your child doesn’t go immediately, you and praise her for it as soon as possible. lead or carry her there. Expect your child to cry, protest, or have a tantrum on the way to Practicing time-out with your child. If you time-out. Don’t lecture or spank her on the way. have not used time-out before, explain it to your child in advance. Tell him it will replace Keeping your child in time-out. Once spanking, yelling, and other such forms of children understand time-out, most of them will discipline. Talk to him about the misbehaviors stay in their chair, corner, or room until the time that will lead to time-outs. Also discuss with is up. However, you will have to keep an eye on him the good behavior that you would prefer to your child. If he gets up from a chair, put him see. Then pretend with your child that he has back gently but quickly without spanking him broken one of the rules. Take him through the and reset the timer. If your child comes out of steps of time-out so that he will understand the room, direct him back into the room and your directions when you send him to time-out reset the timer. Threaten to close the door if he in the future. Also teach your baby-sitter about comes out a second time. If your child is a time-outs. strong-willed two- or three-year-old and you are just beginning to use time-outs, you may initially

Instructions for Pediatric Patients by Barton D. Schmitt, M. D., Pediatrician. Adapted from Your Child’s Health, Copyright © 1991 by Barton D. Schmitt, M.D.. Reprinted by permission of Bantam Books. Toilet Training Basics 76-P Toilet-TrainingToilet-Training BasicsBasics

• Your child prefers Definition dry, clean diapers. Your child is toilet-trained when, without any (Change your reminders, your child walks to the potty, undresses, child frequently to urinates or has a bowel movement, and pulls up his encourage this preference.) pants. Some children will learn to control their bladders first; others will start with bowel control. • Your child likes to be changed. (As soon Both kinds of control through the night normally as she is able to walk, teach her to come happens several years later than daytime control. to you immediately whenever she is wet The gradual type of toilet training discussed here or dirty. Praise her for coming to you for can usually be completed in two weeks to two a change.) months. • Your child understands the connection Toilet-Training Readiness between dry pants and using the potty. Don’t begin training until your child is clearly • Your child can recognize the ready. Readiness doesn’t just happen; it involves feeling of a full bladder and concepts and skills you can begin teaching your the urge to have a bowel child at 12 months of age. Reading some of the movement; that is, he special toilet-learning books to your child can help. paces, jumps up and Most children can be made ready for toilet training down, holds his genitals, by 24 months of age and some even by 18 months. pulls at his pants, squats If you don't actively try to toilet train your child, by the down, or tells you. time she is three years old, she will probably have (Clarify for him: “The trained herself, and this is a perfectly fine approach. poop [or pee] wants to The following signs indicate that your child is ready: come out. It needs your help.”) • Your child understands what “pee,” “poop,” “dry,” “wet,” “clean,” “messy,” and “potty” • Your child has the ability to mean. (Teach these words.) briefly postpone urinating or having a bowel movement. • Your child understands what the potty is for. She may go off by herself and (Teach this by having your child watch come back wet or soiled, or she parents, older siblings, and children near may wake up from naps dry. his age use the toilet correctly.)

Revised 5-21-2013

1 Method for Toilet Training story. If your child wants to get up after one minute Method for Toilet Training of encouragement, let him get up. Never force The way to train your child is to offer encourage- your child to sit there. Never physically hold your ment and praise, be patient, and make the process child there or strap him in. Even if your child fun. Avoid any pressure or punishment. Your child seems to be enjoying it, end each session after must feel in control of the process. five minutes unless something is happening.

Buy supplies. Praise or reward your child for cooperation or any success. All cooperation with these • Potty chair (floor-level type). If your child’s practice sessions should be praised. For feet can reach the floor while he sits on the example, you might say, “You are sitting on the potty, he has leverage for pushing and a potty just like Mommy,” or “You’re trying real hard sense of security. He also can get on and off to put the pee-pee in the potty.” If your child whenever he wants to. urinates into the potty, she can be rewarded with • Stickers or stars for rewards. small presents or stickers, as well as praise and hugs. Although a sense of accomplishment is Make the potty chair one of your child’s enough for some children, others need rewards to favorite possessions. Several weeks before you stay focused. Big rewards (such as going to the plan to begin toilet training, take your child with you ice cream store) should be reserved for when to buy a potty chair. Have your child help you put her your child walks over to the potty on her own and name on it. Allow your child to decorate it or even uses it, or when your child asks to go there with paint it a different color. Then have your child sit on you and then uses it. Once your child uses the it as a chair. Have your child use it while watching potty by herself two or more times, you can stop TV, eating snacks, playing games, or looking at the practice runs. For the following week, con- books. Keep it in the room in which your child tinue to praise your child frequently for dryness usually plays. Encourage your child to sit on the and using the potty. (Note: Practice runs and potty after bathing, while being dried off or getting reminders should not be necessary for more than hair combed. Only after your child clearly has good one or two months.) feelings toward the potty chair (after at least one Change your child after accidents. Change week), proceed to actual toilet training. your child as soon as it’s convenient, and respond sympathetically. Say something like, Encourage practice runs on the potty. Do “You wanted to go pee-pee in the potty, but you a practice run whenever your child gives a signal went pee-pee in your pants. I know that makes that looks promising, such as a certain facial you sad. You like to be dry. You’ll get better at expression, grunting, holding the genital area, this.” If you feel a need to be critical, keep to mild pulling at his pants, pacing, squatting, squirming, verbal disapproval and use it rarely (for example, or passing gas. Other good times are after naps “Big boys don’t go pee-pee in their pants,” or or 20 minutes after meals. Say encouragingly, mention the name of another child he likes who “The poop (or pee) wants to come out. Let’s use is trained); then change your child into a dry the potty.” Encourage your child to walk to the potty diaper or training pants in as pleasant and and sit there with his diapers or pants off. Your non-angry a way as possible. Never use physical child can then be told, “Try to go pee-pee in the punishment, yelling, or scolding. Using pressure potty.” If your child is reluctant to cooperate, he or force can make a two year old child completely can be encouraged to sit on the potty by doing uncooperative. Do not keep your child in wet or something fun _ for example, you might read a messy pants for punishment.

2 Introduce training pants after your child starts using the potty. Switch from diapers to training Recommended Reading pants after your child is cooperative about sitting Joanna Cole: The Parents’ Book of Toilet on the potty chair and passes about half of her urine Teaching, Ballantine Books, N.Y., 1983. and bowel movements there. She definitely needs training pants if she comes to you to help her take Vicki Lansky: Koko Bear’s New Potty, Bantam off her diaper so she can use the potty. Take your Books, N.Y., 1986. child with you to buy the underwear and make it a reward for her success. Buy loose-fitting ones that Alison Mack: Toilet Learning, Little, Brown, she can easily lower and pull up by herself. Once Boston, 1978. you start using training pants, use diapers only for naps and nighttime.

Instructions for Pediatric Patients by Barton D. Schmitt, M. D., Talk WIth Your Child's Doctor If: Pediatrician. Adapted from Your Child’s Health , Copyright © 1991 by Barton D. Schmitt, M.D.. Reprinted by permission of • Your child won’t sit on the potty or toilet. Bantam Books. • Your two-and-a-half year old child is negative about toilet training. • You begin to use force or punishment. • Your child is over three years old and not daytime toilet trained. • The approach described here isn’t working after two months. • You have any other questions or concerns.

3 TV: Reducing the Negative Impact 69-P Television: Reducing the Negative Impact

Television has a tremendous influence on how children view our world. Many youngsters spend more hours watching television from birth to 18 years of age than they spend in the classroom. The positive aspects of television viewing include seeing different lifestyles and cultures. Children today are entering school more knowledgeable than children before the era of television. In addition, television has great entertainment value. Although television can be a good teacher, many children watch it excessively and, therefore, experience some of the negative consequences described below.

Harmful Aspects of Television Heavy television viewing (more than 4 hours per day) definitely reduces school Television displaces active types of performance. This much television interferes recreation. It decreases time spent playing with study, reading, and thinking time. If with peers. A child has less time for self- children do not get enough sleep because directed daydreaming and thinking. It takes they are watching television, they will not be away time for participating in sports, music, alert enough to learn well on the following day. art, or other activities that require practice to achieve competence. Television discourages exercise. An inactive lifestyle leads to poor physical Television interferes with conversation and fitness. If accompanied by frequent snacking, discussion time. It reduces social interaction watching television may contribute to weight with family and friends. problems.

Television discourages reading. Reading Television advertising encourages a requires much more thinking than television. demand for material possessions. Young Reading improves a youngster’s vocabulary. children will pressure their parents to buy the A decrease in reading scores may be related to toys they see advertised. Television portrays too much time in front of the television. materialism as the “American way.”

Revised 5-21-2013

1 Television violence can affect how a child If your child is doing poorly in school, limit feels toward life and other people. Viewing television time to one half hour each day. excessive violence may cause a child to be Make a rule that homework and chores must overly fearful about personal safety and the be finished before television is watched. If your future. Television violence may numb the child’s favorite show is on before he can sympathy a child normally feels toward victims watch, try to record it for later viewing. of human suffering. Children may be more aggressive in their play after seeing violent Set a bedtime for your child that is not television shows. altered by television shows that interest your child. Children who are allowed to stay Tips For Healthy Television up late to watch television are usually too tired Viewing the following day to remember what they are taught in school. By all means, don’t permit Encourage active recreation. Help your child your child to have a television in her bedroom become interested in sports, games, hobbies, because this eliminates your control over and music. Occasionally turn off the television television viewing. and take a walk or play a game with your child. Read to your children. Begin reading together Turn off the television during meals. when yor child is an infant and encourage him Family time is too precious to be squandered to read on his own as he becomes older. Some on television shows. In addition, don’t have the parents help children earn television or video television always on as a background sound in game time by spending an equivalent time your house. If you don’t like a quiet house, try reading. Help your child improve his to listen to music. conversational skills by spending more of your time talking with him. Teach critical viewing. Turn the television on only for specific programs. Don’t turn it on at Limit screen time (TV, video games, random and scan for something interesting. computer, Smartphone apps, etc) to two Teach your child to look first in the program hours per day or less. An alternative is to guide. limit screen time to one hour on school nights and two to three hours per day on weekends. Teach your child to turn off the television You occasionally may want to allow extra at the end of a show. If the television stays viewing time for special educational programs. on, your child will probably become interested Computer use for school work does not count in the following show and then it will be more toward this screen time limit. difficult for your child to stop watching. Don’t use television as a distraction or a baby-sitter for preschool children. Encourage your child to watch some Preschoolers’ viewing should be limited to shows that are educational or teach special television shows and videotapes that human values. Encourage watching are produced for young children. Because the documentaries or real-life dramas. Use difference between fantasy and reality is not programs about love, sex, family disputes, clear for this age group, regular television drinking, and drugs as a way to begin family shows may cause fears. discussions on these difficult topics.

2 TV: Reducing the Negative Impact 69-P

Forbid violent television shows. This means Discuss the differences between reality you have to know what your child is watching and make-believe. This type of clarification and turn off the television set when you don’t can help your child enjoy a show and yet realize approve of the program. Develop separate that what is happening may not happen in real lists of programs that are acceptable for older life. and younger kids to watch. Make your older children responsible for keeping the younger Set a good example. If you watch a lot of ones out of the television room at these times. television, you can be sure your child will also. If not, the show is turned off. The availability of The types of programs you watch also send a cable television and recording devices means clear message to your child. that any child of any age has access to the uncut versions of R-rated films. Many children under 13 years of age develop daytime fears For More Information and nightmares because they have been allowed to watch such movies. For more information or if you have particular questions about media exposure in children, Discuss the consequences of violence if consider looking at Children's Hospital you allow your older child to watch violent Boston's website "Ask the Mediatrician" at shows. Point out how violence hurts both the http://cmch.typepad.com/mediatrician/. victim and the victim’s family. Be sure to discuss any program that upsets your child.

Discuss commercials with your children. Instructions for Pediatric Patients by Barton D. Schmitt, M. D., Help them identify high-pressure selling and Pediatrician. Adapted from Your Child’s Health , Copyright © exaggerated claims. If your child wants a toy 1991 by Barton D. Schmitt, M.D.. Reprinted by permission of that is a lookalike version of a television char- Bantam Books. acter, ask how he or she would use the toy at home. The response will probably convince you that the toy will be added to a collection rather than become a catalyst for active play.

3 Car Safety Seats 30-P (Rev. 5-21-13) CARCAR SAFETYSAFETY SEATSSEATS The major killer and crippler of children in the United States is motor vehicle crashes. Improper use of child safety seats causes death or injury in thousands of children each year. Seven out of ten children in child safety seats are not properly buckled in. Important safety rules  Always use a car safety seat, starting with your baby's first ride home from the hospital.  Never place a child in a rear-facing car safety seat in the front seat of a vehicle that has an airbag.  The safest place for all small children to ride is in the back seat.  Set a good example: always wear your seat belt. Help your child form a lifelong habit of buckling up.  Remember that each car safety seat is different. Read and keep the instructions that came with your seat.  Read the owner's manual that came with your car on how to correctly install car safety seats.

CHOOSING A CAR SEAT Choose a car safety seat that is right for your child’s age and size.

AGE GROUP TYPE OF SEAT GENERAL GUIDELINES

Infants/Toddlers Rear-facing only All infants and toddlers should ride in a Rear-Facing seats and rear-facing Car Seat until they are 2 years of age or until they convertible seats reach the highest weight or height allowed by their car safety seat's manufacturer. Toddlers/ Convertible seats and All children 2 years or older, or those younger than 2 Preschoolers forward-facing seats years who have outgrown the rear-facing weight or with harness height limit for their car seat, should use a Forward- Facing Car Seat with a harness for as long as pos- sible, up to the highest weight or height allowed by their car seat's manufacturer. School-Aged Booster seats All children whose weight or height is above the Children forward-facing limit for their car seat should use a Belt-Positioning Booster Seat until the vehicle seat belt fits properly across their shoulder, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age. Older Children Seat belts When children are old enough and large enough to use the vehicle seat belt alone, they should always use Lap and Shoulder Seat Belts for optimal protection. All children younger than 13 years should be restrained in the rear seats of vehicles for optimal protection.

Information obtained from AAP, http://www.healthychildren.org/English/safety-prevention/on-the-go/pages/Car-Safety- Seats-Information-for-families.aspx Infant-Only Seats  These are small and portable (sometimes come as part of a stroller system).  These have a 3-point or 5-point harness.  They can only be used for infants up to 20 - 35 pounds, depending on the model.  Many come with detachable base, which can be left in the car. The seat clicks in and out of the base, which means you don’t have to install it each time you use it.  Most have carrying handles.

Convertible Seats  These are bigger than infant-only seats.  These can also be used forward-facing for older and larger children, therefore these seats can be used longer.  Many have higher rear-facing weight limits than infant-only seats. These are ideal for bigger babies.  They may have the following types of harnesses:

5-Point Harness T-Shield Overhead Shield 5 Straps: A padded T-shaped A padded tray-like 2 at the shoulders or triangle-shaped shield that swings. 2 at the hips shield attached to the 1 at the crotch shoulder straps.

Booster Seats Your child should stay in a car seat with a harness as long as possible (i.e. as long as they fit the weight and height limits of the car seat) and then ride in a belt-positioning booster seat. You can tell when your child is ready for a booster seat when one of the following is true:

 He reaches the top weight or height allowed for the seat.

 His shoulders are above the harness slots.

 His ears have reached the top of the seat.

Booster seats are designed to raise your child so that the lap/shoulder belt fits properly. This means the lap belt is across your child’s pelvis and the shoulder belt crosses the middle of your child’s chest and shoulder. Correct belt fit helps protect the stomach, spine, and head from injury. Both high-backed and backless models are available. Booster seats should be used until your child can correctly fit in a lap/shoulder belt, which is typically when a child is at least 4’9” and 8-12 years old. Government safety standards Since January 1981, all manufacturers of child safety seats have been required to meet stringent government safety standards, including crash-testing. Choose a seat that has met Federal Motor Vehicle Safety Standard 213, with 1981 or later as the year of manufacture. When in doubt or if you have questions about installing your car safety seat, Child Passenger Safety (CPS) Technicians can help you. A list of inspection stations is available at www.seatcheck.org. You can also get this information by calling the National Highway Traffic Safety Administration (NHTSA) Auto Safety Hot Line at 888-327-4236. The American Academy of Pediatrics also publishes a list of infant/child safety seats that is updated yearly. To obtain this list, go to http://www.healthychildren.org/English/safety-prevention/on-the-go/pages/ Car-Safety-Seats-Product-Listing.aspx.

California Law California law (as of 1/1/2012) states that each child must be properly restrained in a child safety seat or booster seat in the back seat of the car until the child is 8 years old or at least 4’9” in height. The law specifically states that:  Children under the age of 8 must be secured in a car seat or booster seat in the back seat.  Children under the age of 8 who are 4’9” or taller may be secured by a safety belt in the back seat.  Children who are 8 years and over shall be properly secured in an appropriate child passenger restraint system or safety belt.  Passengers who are 16 years of age and over are subject to California’s Mandatory Seat Belt law. Exceptions to the law are: A. There is no rear seat. B. The rear seats are side-facing jump seats. C. The Child Passenger Restraint System cannot be installed properly in the rear seat. D. All rear seats are already occupied by children under the age of 7 years. E. Medical reasons necessitate that the child or ward not ride in the rear seat. The court may require satisfactory proof of the child's medical condition. A child may NOT ride in the front seat with an active passenger airbag if: A. The child is under one year of age, B. The child weighs less than 20 pounds, or C. The child is riding in a rear-facing Child Passenger Restraint System. Sun Protection Protect Your Child From The Number One Cause of Cancer: The Sun!

Did You Know?  Skin cancer is the most common type of cancer.  Many skin cancers can be prevented.  Ultraviolet (UV) radiation, which causes skin cancer, is present even in the shade, on cloudy days, or in the winter months when the sun isn't as strong as a bright summer day.  Childhood sun exposure is especially important in terms of cancer. A child or adolescent who has had 5 or more sunburns is twice as likely to get melanoma.  UV exposure is especially high in locations like San Diego, which are nearer to the equator.

Sunburn Sunburn is caused by overexposure of the skin to the ultraviolet (UVA/UVB) rays of the sun or a sun lamp. Minor sunburn is a first degree burn which turns the skin pink or red with swelling and pain. Prolonged sun exposure can cause blistering and a second degree burn. Sunburn does not cause third degree burns or scarring. Blistering sunburns, especially in childhood, significantly increase the risk for future skin cancers including malignant melanoma.

Tips For Enjoying The Sun Safely  Apply sunscreen to your baby or child anytime she will be outdoors for more than a few minutes at a time, even in the winter or if you plan to stay in the shade. If you have a family rule that everyone wears sunscreen before going outside and you start at an early age, your child is more likely to cooperate when she's older. Apply sunscreen 30 minutes before going outdoors for best absorption.  Pick the right sunscreen. The higher the SPF, the more protective the sunscreen is. Sunscreen with titanium or zinc in it provides a physical as well as chemical barrier, and protects better than other sunscreen. Waterproof sunscreen is helpful, but even waterproof sunscreen needs to be reapplied after water exposure. Spray-on sunscreen is less effective than traditional lotion. Suntan lotion or oils are mainly lubricants and do not block the sun's burning rays, and may even cause more burning.

6 Months SHC-PE-3671-NS UPDATED 5-21-13  Reapply sunscreen every 2 hours (even on cloudy days) and after swimming or sweating.  Put on a hat. If you insist that your child wears a hat from the time she is a young infant, she is more likely to keep hats on when she is older.  Cover up. Whenever possible, keep your child covered with long sleeves, long pants, a wide brimmed hat, and sunglasses with plastic lenses with UVA/UVB protection. Darker clothes block more sun than light clothes. Tightly woven fabric is more protective than looser weaves. UPF clothes are specially designed clothing that are more effective at blocking the sun than regular clothing.  Avoid being out in the sun between 10:00 am and 4:00 pm if possible. Stay in the shade when possible.

 Be careful at high altitude and near reflective surfaces. Sun exposure increases at higher altitudes. Water, sand, and snow increase sun exposure through reflected rays.

 Avoid tanning, either in the sun or in a tanning booth.

When Sunburn Happens Acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) can be used to reduce discomfort. Cool baths and/or wearing cool wet clothes on burned areas can be more comfortable. Drink plenty of water and keep well hydrated.

Moisturizing or aloe creams applied several times a day may reduce swelling and pain. Do not use petroleum jelly or other ointments that inhibit heat and sweat from escaping because these prolong healing. First aid creams or sprays for burns often contain benzocaine, which can cause an allergic reaction.

Call Our Office Immediately If:

 Your child becomes unable to look at lights because of eye pain.

 An unexpected fever over 102°F (38.9°C) occurs along with a sunburn.

 The sunburn becomes infected.

 An infant less than one year old sustains a second degree burn.

Call Our Office During Office Hours If:

 Several blisters break open.

 You have other questions or concerns. Keep On Smiling! Tooth-Brushing Recommendations from the American Academy of Pediatricsics and the American Dental Associationn

When To Brush and Floss As soon as your baby has teeth, make sure to brush them twice a day (morning and night). You can start off using a soft infant toothbrush. Parents should assist young children with tooth brushing. Start fl ossing daily when at least 2 teeth are touching.

Fluoride Toothpaste To prevent cavities in children, the American Dental Association and the American Academy of Pediatrics now recommend that caregivers brush infants’ and children’s teeth with fl uoride toothpaste as soon as the fi rst tooth comes in. For children under 3 years old who have not learned to spit yet, just use a smear of fl uoride toothpaste (or an amount about the size of a grain of rice). This small amount of fl uoride toothpaste is safe to swallow (swallowing larger amounts of fl uoride toothpaste can cause tooth discoloration, which is a cosmetic issue that can be avoided). For children older than 3 years who have learned to spit out the extra toothpaste after brushing, you can use a pea-sized amount of fl uoride toothpaste.

Bottle Use Don’t let your baby go to bed with a bottle, because this leads to cavities. Try to switch your baby from a bottle to a sippy cup at 1 year of age to prevent dental problems later.

Pacifi ers Pacifi ers given at the time of sleep can decrease the risk of SIDS (crib death), and they are often very soothing to babies. After your baby reaches 6 months of age, you may want to start decreasing pacifi er use to decrease the chance of ear infections. Pacifi ers can also cause dental problems after 2 years of age, but usually dental problems do not occur until after 4 years of age. Most toddlers gradually stop using pacifi ers on their own.

Dentist Appointments The American Dental Association and the American Academy of Pediatrics recommend the fi rst dentist visit by one year of age. If your family dentist does not see children that young, there are many pediatric dentists available in the area.

For More Information http://www.ada.org/~/media/ADA/Publications/Files/ForthePatient-0514.ashx http://www.ada.org/en/press-room/news-releases/2014-archive/february/ada-uses-fl uoride-toothpaste https://www.healthychildren.org/English/healthy-living/oral-health/Pages/FAQ-Fluoride-and-Children.aspx

SHC-PE-3920 (7-21-15)