Health Tips

1. How Do I Get My Child to Sleep?
2. Auto Safety 
3. Toilet Training
4. Sunburn Prevention

How Do I Get My Child to Sleep?

Sleep practices of children, both infants and older children, have become one of societies "measures of a good parent." If a child sleeps well, many consider the parent to be a great parent or just lucky. If a child sleeps poorly, the parent is considered by many to be a bad parent, or just unlucky. Neither of those two statements is true. Sleep is based on many factors, including personality, parental attitude, family lifestyle and the sleeping environment itself.

Newborns
Newborns routinely wake one to three times per night, almost always because they are hungry and need to feed. Some infants even sleep well during the day, and are awake frequently at night. This occurs when the commonly called, "nights and days are reversed." Night and Day reversal may be accomplished by stimulating your infant during the day. At night place the baby in his or her own crib in a darkened room.

We recommend placing your baby on his/her back to sleep. Make sure to spread sheets smoothly and tuck them tightly beneath the mattress. You should have a crib mattress that is firm and conforms to safety standards. Check the space between the crib rails - they should be no more than 2 3/8 inches apart. Cribs made prior to 1979 may have wider spacing. Be sure the mattress fits the crib perfectly. If pushed all the way to one corner, there should be no more than 1 1/2 inches between it and the side or the end of the crib.

Do not use any loose fitting plastic mattress covers or waterproof sheets as they may wrap around baby's head or neck and cause suffocation. Do not place pillows or soft stuffed toys in the crib. Baby should not be allowed to sleep on soft surfaces such as waterbeds, beanbags, fluffy blankets or comforters.

Your baby should be dressed in clothing that you would feel comfortable in. The air/room temperature needs to be at a level that would be comfortable for anyone in that room. There is no need to dress baby warmer than you would dress, or give extra blankets. Simply dress according to the temperature. You may also want to accustom baby to sleep through ordinary household sounds. There is no need for silence when a baby is sleeping. Tip-toeing and whispering are not necessary, but do avoid sudden jarring noises and loud commotion.

Many infants have a polyphasic sleep pattern, which means short periods of sleep interspersed with even shorter periods of waking. The ability to sleep for a longer period of time comes with growth and maturity. Some may sleep for extended periods of time as early as 3 to 4 months. Some others may not until 10 to 15 months. Because of immaturity of the nervous system, an infant cannot be trained to sleep longer. Introducing solid foods at bedtime has never been shown to prolong the sleep period.

Have patience, by four months of age, most infants will sleep 8 hours or more and by 6 months almost all infants can sleep through the night.

Children
A structured night time routine and bedtime continues to be important as children grow older. The bedtime routine should be one that helps the child calm from a busy, active day to a restful pace for the evening prior to going to bed.

Play should be at a minimum for the last hour before bedtime and it should be quiet play. Even TV viewing should be calming and video games should be stopped in that last hour. A warm bath may soothe a child, but if the bath is highly active with play, it may serve the opposite purpose and actually invigorate the child to remain awake.

Snacks often help but should be more carbohydrates than sugar sweets such as unsweetened cereal or a bagel with a glass of milk.

Once the child is ready for bed, a story or comforting by the parent can help. Make sure this is done in the childs' own room. If they want to sleep on the floor, with a blanket, a soft animal or favorite doll, or even a night light, that is okay. These items often help the child to accept a parents departure from the room easier. That departure should also be done while the child is still somewhat awake. A child will learn to transition to sleep without their parent in the room by experience. If your child has problems doing this, place a chair next to the bed and comfort the child from the chair with as little stimulation, touching or holding, as possible. Over the next few nights move the chair away from the bed and toward the door. Continue to comfort verbally from the chair. Soon you will be just outside the door and your child will receive comfort by your presence only. This is a part of learning the all important "self-soothing" that will help them transition to sleep without an adult being present.

Remember, you as the parent set the tone for how a child will respond to bedtime. Following these simple steps may take more time to achieve that "good night's sleep," but eventually your child will learn that all important skill that makes day time a much more enjoyable experience.

Auto Safety

Click here for a Car Seat Information Sheet

The major cause of childhood injuries and death in the United States is automobile accidents. By following a few simple rules, you can reduce the risks of an accident significantly.

Which way should my child face?
Infants less than one year of age must ride in a rear facing care seat. First time car seat users should take their car seat to their local fire department station where a certified fire fighter will be more than happy to inspect and help you install your car seat.

Children at one year of age and at least 20 pounds may face forward, but must remain in the rear seat of the car.

Until age 13 years, the child must remain in the rear seat. Children 13 years and older may sit in the front seat

What type of seat should I buy?
When buying any car seat, make sure you know the size and weight limitations of the seat you buy. Babies grow at different rates, so be sure the car seat you use matches your childs' height and weight.

Some seats are "convertible." Again, remember and check the weight and height limitations on this or any seat you purchase.

Children that weigh more than 40 pounds may ride in a booster seat. A booster seat with a high back will help to provide protection from whiplash injuries, especially when a childs' head and ears are higher than the back of the automobile seat.

Virginia law requires that children must be in car seats until they are 80 pounds and 8 years of age. Children under age 8 who are at least 4 feet and 9 inches tall may not need a car seat.

Other Tips
If your automobile has side air bags, they should be deactivated if the car seat is next to a door so equipped.

Never let a child move around or get out of the car seat while the car is in motion. All too frequently, we see children injured or killed in that "moment" to move or adjust, and the child is not in the car seat.

Car seats should be replaced when a child exceeds the weight or height limitations. Exceeding the weight or height limitation destroys any opportunity for the seat to save your child from injury or death. Car seats involved in accidents should be replaced as well as the safety features built into the car seat. They may no longer function after an accident, even though the seat appears to be "intact" and operable.

Safety belts should be worn by all. Setting a good example for children sets them up for lifetime use of the safety belt without question. It becomes a part of the normal routine of riding or driving a car.

Also remember who is "on board" when you drive. A few extra precautions can go a long way in preventing an accident.

What is toilet training?

Toilet-training is teaching your child to recognize his/her body signals for urinating and having a bowel movement and using a potty chair or toilet correctly and at the appropriate times.

When should toilet-training begin?
Toilet-training should begin when the child shows signs that he/she is ready. There is no right age to begin. If you try to toilet train before your child is ready, it can be a battle for both you and your child. The ability to control bowel and bladder muscles comes with proper growth and development.

Children develop at different rates. A child younger than 12 months of age has no control over bladder or bowel movements. There is very little control between 12 to 18 months. Most children are unable to obtain bowel and bladder control until 24 to 30 months. The average age of toilet-training is 27 months.

Learning when my child is ready to begin toilet-training:
The following may be indicators of your child's readiness to begin toilet-training. Your child should be able to:

• walk well in order to get to the potty chair.
• tell you when there is a need to go to the potty.
• control the muscles used for going to the potty.

Signs that your child may be ready for toilet-training include the following:

• asks to have the diaper changed or tells you a bowel movement or urine is coming
• shows discomfort when the diaper is wet or dirty
• enjoys copying what parents or older children do
• follows you into the bathroom and see how the toilet is used
• wants to do things (like going to the potty) to make parents happy or to get praise
• has dry diapers for at least two hours during the day or is dry after naps or overnight

Getting started with toilet-training:
The following tips may help parents get started with toilet-training:

• If there are siblings, ask them to let the younger child see you praising them for using the toilet.
• It is best to use a potty chair on the floor rather than putting the child on the toilet for training. The potty chair is more secure for most children because their feet reach the floor and there is no fear of falling off. If you decide to use a seat that goes over the toilet, use a footrest for your child's feet.
• Children should be allowed to play with the potty: sit on it with clothes on and later with diapers off. This way they can get used to it.
• Never strap your child to the potty chair. Children should be free to get off the potty when they want.
• Your child should not sit on the potty for more than five minutes. Sometimes, children have a bowel movement just after the diaper is back on because the diaper feels normal. Do not get upset or punish your child. You can try taking the dirty diaper off and putting the bowel movement in the potty with your child watching you. This may help your child understand that you want the bowel movement in the potty.
• Children often learn to go to the potty for bowel movements before urine, so you may want to start with bowel training first.
• If your child has a usual time for bowel movements (such as after a meal) you can take your child to the potty at that time of day. If your child acts a certain way when having a bowel movement (such as stooping, getting quiet, going to the corner), you may try taking your child to potty when he/she shows it is time.
• If your child wants to sit on the potty, you may stay next to your child and talk and read a book.
• It is good to use words for what your child is doing ("potty," "pee," or "poop"). Then your child learns the words to tell you. Remember that other people will hear these words. It is best not to use words that will offend, confuse, or embarrass others or your child.
• Avoid using words like "dirty," "naughty," or "stinky" to describe bowel movements and urine. Use a simple, matter-of-fact tone.
• If your child gets off the potty before urinating or passing a bowel movement, be calm; do not scold. Try again later. If your child successfully uses the potty, give plenty of praise (i.e., smile, clap, hug).
• Children learn from copying adults and other children. It may help if your child sits on the potty while you are using the toilet.
• Children often follow parents into the bathroom. This may be one time they are willing to use the potty.
• Initially, teach boys to sit down for passing urine, as, at first, it is difficult to control starting and stopping while standing. Boys will try to stand to urinate when they see other boys standing.
• Some children learn by pretending to teach a doll to go potty. Obtain a doll that has a hole in mouth and diaper area and your child can feed and "teach" the doll to pull down pants and use the potty. Make this teaching fun for your child.
• Make going to the potty a part of your child's daily routine, such as first thing in the morning, after meals and naps, and before going to bed.

After training is started:

• Once children start using the potty and can tell you they need to go, taking them to the potty at regular times or over-reminding them to go to the potty is not necessary.
• You may want to start using training pants. Wearing underpants is a sign of growing up, and most children like being a
• If your child has an accident while in training pants, do not punish. Be calm and clean up without making a fuss about it.
• Keep praising or rewarding your child every step of the way: for pulling down pants, for sitting on the potty, and for using the potty. If parents show that they are pleased when children urinate or have bowel movements in the potty, children are more likely to use the potty next time.
• As children get older, they can learn to wipe themselves and wash hands after going to the bathroom. Girls should be taught to wipe from front to back so that germs from bowel movement are not wiped into the urinary area.
• Remember that every child is different and learns toilet-training at his/her own pace. If things are going poorly with toilet-training, it is better to put diapers back on for a few weeks and try again later. In general, have a calm, unhurried approach to toilet-training.
• Most children have bowel control and daytime urine control by age 3 or 4. Soiling or daytime wetting after this age should be discussed with your child's physician.
• Nighttime control usually comes much later than daytime control. Complete nighttime control may not occur until your child is 4 or 5 years old, or even older. If your child is age 5 or older and does not stay dry at night, you should discuss this with your child's physician.
• Even when children are toilet trained, they may have some normal accidents (when excited or playing a lot), or setbacks due to illness or emotional situations. If accidents or setbacks happen, be patient. Examples of emotional situations include moving to a new house, illness or death in the family, or a new baby in the house. In fact, if you know an emotional situation is going to be happening soon, do not start toilet-training. Wait for a calmer time.

Sunburn Prevention

Children can suffer burns when their unprotected skin is exposed to sunlight. In addition, excessive sunburns can lead to skin cancer later in life. In fact, most people receive 50 percent of their lifetime exposure to the sun by 18 years of age. The following steps have been recommended by the American Academy of Dermatology and the Skin Cancer Foundation to help reduce the risk of sunburn and skin cancer:

• Protect children from excessive sun exposure when the sun is strongest (between 10 a.m. and 3 p.m.), and apply sunscreen liberally and frequently to children 6 months of age and older.
• Apply sunscreen, with at least a (Sun Protection Factor) SPF-15 or higher that protects against both UVA (ultraviolet A) and UVB (ultraviolet B) rays, to all areas of the body that are exposed to the sun.
• Reapply sunscreen every two hours, even on cloudy days. Reapply after swimming or sweating.
• Wear clothing that covers the body and shades the face. Hats should provide shade for both the face and back of the neck. Wearing sunglasses will reduce the amount of rays reaching the eye by filtering as much as 80 percent of the rays, and protecting the lids of the eyes as well as the lens.
• Avoid exposure to UV (ultraviolet) radiation from sunlamps or tanning beds.

Remember, sand and pavement reflect UV rays even under the umbrella. Snow is also a good reflector of UV rays. Reflective surfaces can reflect up to 85 percent of the damaging sun rays.

Consult with your child's physician before applying sunscreen to babies under 6 months old.