Qn of the Month: What Are The New Sleep Guidelines for Children?

A: In June 2016, the American Academy of Sleep Medicine released new guidelines to guide parents and health care professionals on the recommended amount of sleep that infants, children and teenagers need to receive for optimal health. This came after a 10 month process of an extensive scientific literature review, and multiple rounds of voting amongst a Pediatric Consensus Panel of 13 experts. The findings from the literature research found that those who followed the recommended daily sleep hours regularly tended to have overall better health outcomes such as improved attention spans, as well as better behavior, learning, memory, emotional regulation, quality of life, and mental and physical health. However, sleeping more or less than the recommended hours on a regular basis tended to be associated with adverse health consequences.

Supported by the American Academy of Pediatrics, here are the recommended sleep hours by age in the consensus statement:

  • Infants four to 12 months should sleep 12 to 16 hours per 24 hours (including naps) on a regular basis to promote optimal health.
  • Children one to two years of age should sleep 11 to 14 hours per 24 hours (including naps) on a regular basis to promote optimal health.
  • Children three to five years of age should sleep 10 to 13 hours per 24 hours (including naps) on a regular basis to promote optimal health.
  • Children six to 12 years of age should sleep nine to 12 hours per 24 hours on a regular basis to promote optimal health.
  • Teenagers 13 to 18 years of age should sleep eight to 10 hours per 24 hours on a regular basis to promote optimal health.

According to the experts, besides having enough total hours of sleep regularly, reaping the benefits of healthy sleep also require having appropriate timing, daily regularity, good sleep quality and the absence of sleep disorders.

(Sources:

  1. Recharge With Sleep: Pediatric Sleep Recommendations Promoting Optimal Health. American Academy of Sleep Medicine. http://www.aasmnet.org/articles.aspx?id=6326. June 13, 2016. Accessed September 30, 2016.
  1. HealthDay. “How much sleep children need by age.” Chicago Tribune. June 13, 2016. http://www.chicagotribune.com/lifestyles/health/ct-child-sleep-recommendations-health-0613-20160613-story.html. Accessed September 30, 2016.)

Constipation Matters (Part 2): Prevention Tips for Toddlers

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Constipation Prevention Tips – Dietitianmom.com

To prevent constipation in adults, the 3 ‘Fs’ are usually recommended: Fluids, Fiber and Frequent Exercise/Activity. Well, it’s the same for babies and toddlers as well. Some time ago, I had posted an entry on some tips for combating constipation in babies (see post Constipation Matters (Part 1): Prevention Tips for Babies). Here is the follow on post with more tips for toddlers:

Fluids
Even if a toddler is already established and used to drinking water, as a parent you can still encourage frequent water intake by offering fluids at meals, water with snacks and making sure water is readily accessible with a water bottle or cup at hand in the play area at all times. The toddler will then know that there is always water available when she wants or needs it, and can regulate his/her own intake. Some days I go into the play area and see the water cup untouched and other days a third or more of the water in the sippy cup (non-spill of course) gone within a few hours! So it is really difficult to predict when or how much your toddler will want to drink on any given day. But reminders to drink water throughout the day and role modeling lots of water drinking yourself definitely helps! Sometimes I also have little water drinking competitions with my daughter, to see who can finish a cup of water faster. She enjoys this but of course you need to make sure she doesn’t drink so fast she chokes on the water!

Fiber
Some recommend not giving a toddler too much bran and bran containing foods as the high fiber content may possibly fill the child up more and make the child less hungry for other foods, compromising his/her nutritional intake. Personally I don’t think this is true. When my toddler was 17 month old, she ate Shredded Wheat squares, Total Cereal flakes, brown rice, whole wheat pasta and whole wheat bread, and still had room for foods like milk, fruits and vegetables. So I think it is safe to switch completely to whole grain products and breakfast cereals. The key I find is to watch the amount of crackers and Cheerios a child can get at snacks as well as his/her overall milk intake during the day, as these have a greater likelihood of filling the child up and making him/her less hungry to eat properly at meals. In fact, at around 15 months of age, I cut out giving milk at snacks (but I still give 3-4 ounces at meals) as I found that it was affecting her intake at lunch and dinner. Don’t forget that fiber comes from providing lots of fruits and vegetables into the diet too. These can be fresh, frozen or dried (examples are dried figs, raisins and apricots). Just ensure your toddler has a higher fiber intake with an intake of plenty of water!

Frequent Movement/Activity
I don’t think parents need to worry about this one! It’s probably more about how to restrain excessive activity and movement…Toddlers with their newfound freedom and independence love to move and explore on two feet the surrounding environment, not to mention climb, crawl, dance and play. So let them!

Qn of the Month: How Can I Tell My Baby Is Full?

A: An age old question is, “How can I tell my baby is full?” Just as important as the previous post (How Can I Tell My Baby is Hungry?) is being able to tell when your baby is full, so that baby gets just the amount of intake he/she needs for optimum growth and development.

Some signs to watch out for in the infant include:

  • Falling asleep after emptying or softening at least one breast
  • Infant pushing away from the breast or fussing with back arching
  • Reduced sucking
  • Infant drawing head away from the nipple
  • Infant’s body relaxes with extended and relaxed hands/arms

Young babies under 3 months of age may not give clear signs of hunger and fullness, but these cues are usually clear by 3 to 6 months of age. For optimal health and growth, parents should check to see if their baby is still hungry after a pause in feeding by looking for satiety cues. This is important before continuing forward in the feeding, especially in babies that are bottle fed. Parents are often eager to have a baby finish an entire bottle of expressed breast milk or formula, simply because they see the contents in the bottle, instead of letting the baby decide when or how much to take at a feeding.

Fresh Raspberry Yogurt Cake

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Raspberry Yogurt Cake – Dietitianmom.com

This was a recipe that I obtained from the book “Bringing Up Bébé” by Pamela Druckerman, in which I jazzed up with some fresh raspberries. I had recently read this book during the spring, and was highly entertained by its witty and informative content. It certainly caused me to ponder many cultural norms and child-raising habits often observed in the United States!

This recipe below was so easy that I was able to make it with my nearly 4 year old this past week. It was her first time in the kitchen and she loved it! The key is to obtain at least one 6 oz  plain yogurt container (or equivalent container) which your child can then use as a ‘measuring cup’.

Ingredients
2 (6 oz) containers of whole or reduced fat plain yogurt
½ to ¾ cup of vegetable oil
2 eggs
1 teaspoon vanilla
4 containers of all-purpose flour
1 ½ teaspoon of baking powder
1 cup fresh (or frozen but thawed out and drained) raspberries

Directions

  1. Preheat the oven to 375 degrees F (190 degrees C). Grease a 9 inch cake or loaf pan.
  2. Gently combine the wet ingredients (yogurt, sugar eggs, vanilla and oil) into one bowl.
  3. Combine the flour and baking powder into a different bowl.
  4. Add the dry ingredients gradually into the wet ingredients, mixing gently until just combined
  5. Add in the frozen or fresh raspberries (or other fruit).
  6. Bake 35 minutes to an hour, until a knife inserted comes out clean. Let cool then serve!

Although the original recipe called for using whole milk yogurt, I found that the reduced fat yogurt I used worked fine as an alternative. Also while combining the dry into the wet ingredients the mixture became quite thick and difficult to stir. But using a wooden spoon, and consistent mixing, the mixture ended up softening down and became more malleable. I used olive oil as the oil in the recipe which worked but you could discern the olive oil taste. Hence, you may want to use a different vegetable oil like sunflower oil or canola oil in this recipe instead. I also found that using about 1/2 to 2/3 a cup of oil was adequate. The first time I made this recipe, I became concerned that the batter was too thick so added a little bit more oil (about 3/4 cup). However, it ended up taking a long time for the batter to cook through. So do not worry if the batter appears too thick. If you end up with the same problem as I did, you can cover the top of the loaf pan with some aluminum foil halfway through the baking process, to prevent the top from becoming overly brown and hard. Enjoy!

 

Saying Goodbye to that Last Overnight Diaper (Part 3) – The Experience

Having described my background fears and the process of weaning off that last nighttime diaper (see previous posts 1 and 2 in this series), what was my experience? Not knowing what would happen, I decided to try just one potty waking at night first, before adding in a second one. The initial goal I had was really just to get her used to getting up 1-2 times at night to pee and then to learn to put herself back to sleep. It was not so much to achieve a dry diaper every night. Here’s my experience:

First Potty Waking (each night I put my toddler to bed before 9pm):
Night 1
I went in about 6 hours after her bedtime. This was too late as her diaper was already wet. I woke her up gently, but she told me she didn’t need to go. I still carried her and put her on the potty briefly.

Night 2
I went in 3 ½ hours after she was put to bed, and found her diaper already a little bit wet. She let me pull her pants and diaper down, but I had to carry her to the potty. Once there though, she sat down and automatically took a piece of toilet paper and wiped herself. I asked her in a whisper, “Did you go?” (as I didn’t hear anything). She whispered back,” Yes.” Then she let me pull her pants/diaper back up and walk her back to bed. I gave her a kiss and left the room quickly!

Night 3
I went into her room at about 2 ¾ hours after she was put to bed. Her diaper was already wet and she didn’t have anything on the potty.

Night 4 & 5
I went in each of these nights at 2 ½ hours after her bedtime and found her diaper still dry! Each time I carried her to the potty (after pulling her pants/diaper down), helped her pee, and then helped her back to bed. She almost immediately went back to sleep!

After a few successful nights of waking her up at night about 1.5- 2.5 hours after her final potty break before bed, I decided to add in a 2nd potty waking. Here is what happened the first few nights:

Second Potty Waking
Night 1
I tried the first night to go in about 5 hours after the 1st potty waking. Her diaper was still dry! So I quickly pulled down her diaper and pants and carried her to the potty. She went, but I had to help her pull up her pants and get her back to bed. The next morning though, she had a REALLY hard time getting up (even though she awoke at a usual time), and didn’t want to get out of bed though she was awake, saying she was tired… Her diaper was still dry in the morning, and she didn’t feel the need to go to the potty until much later after she woke up!

Night 2
I went in again about 4-5 hours after the 1st potty waking, but I made the mistake of not taking away her security pillow from her hand, before waking her up and pulling the diaper/pants down. So when I carried her to the potty, she yelped as she was afraid her security pillow would get wet! Although I quickly took the pillow away, she had woken up a bit more by this point. So after I got her back to bed (after having her pull up her own diaper and pants), she didn’t want me to leave the room. I told her I would stay with her for ‘2 minutes’ and did this, and then she let me leave the room. The next morning, she was again didn’t want to leave her bed and lay in it for half an hour more, despite having woken up already!

Night 3
I went in for the first potty waking and while she went on the potty, I could tell she was EXTREMELY tired, and so I had to pull up her diaper/pants and help her back to bed. I decided to let her stay asleep the rest of the night and not wake her up for the 2nd potty waking.

After a few more nights of trying this method, I found that really only one potty waking a night was needed to maintain a dry diaper throughout the night, especially if the first potty waking was timed right at about 1.5-2 hours after her last potty break before bed. The key was to make sure my toddler went quickly to the potty the moment she woke up in the morning. Within a few weeks, my toddler started to wake up with a dry diaper consistently, and she also became more adept at going to the potty at night if she needed to and going back to sleep afterwards. In fact, after about 2 months of this process, she only had 1-2 nighttime accidents in terms of wetting her bed, and I even stopped having to go in to wake her up for the first potty waking at night!

So at the end of this process, I am glad to say, my worst fears were unfounded! I was so afraid my toddler would be screaming at being woken up, and would be extra clingy to me, take forever to put back to sleep, and no longer sleep well at night…but thankfully none of that happened. I was actually very surprised how smooth the process was, and how quickly my toddler got the concept of going to the potty herself at night!

Qn of the Month: What are Early and Mid Hunger Cues?

A: Instead of waiting till your baby starts bawling from hunger, look out for these signs (early and mid cues) that baby needs a feed…before he/she starts kicking and screaming in a fit of frenzy. Most people are not aware that crying is actually a late hunger cue. Early cues help signal that the baby is getting hungry, while mid cues signal that baby is REALLY hungry.

Early Cues:

  • Stirring in the sleep
  • Mouth opening as if he or she is nursing
  • Turning head from side to side
  • Seeking/Rooting

Mid Cues:

  • Stretching
  • Increased physical movement
  • Hand to mouth activity
  • Sucking on hands or clothing

Saying Goodbye to that Last Overnight Diaper  (Part 2) – The Process

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Welcome back to the world of potty training! In the first part of this post series, we looked at the background behind this whole rather ‘potty’ process of weaning off the last nighttime diaper and the fears I had (See post titled “Saying Goodbye to that Last Overnight Diaper (Part 1) – Background”). Here, in part 2 of this post series, I would like to describe the successful process I undertook. These are the main steps involved:

  • Have a small potty in her bedroom at ALL times, so that she gets used to using that during the day.
  • Install a small dim nightlight in toddler’s room, bright enough so that she can still see and use the potty.
  • Get toddler up earlier in the morning and earlier to bed in the evening. That way, you will have a chance to go in and do the first ‘potty run’ at night before you head to bed.
  • Give your toddler the last chance to drink water about 1-2 hours before bedtime.
  • Prepare the bed: have spare bedsheets and place disposable mattress pads underneath the fitted sheet. Some even wrap the entire mattress in plastic before attempting night time potty training!
  • As part of the bedtime routine, the last step is to have your toddler pee before being tucked into bed.
  • Do some initial investigating: the key is to know your toddler’s night time pattern: how often does he/she tend to pee in the diaper at night? Is it usually about 2-3 hours after he/she falls asleep? If so, you can time the first ‘potty run’ at that time to keep the diaper dry. Then once or twice at night, you can go in to check the toddler’s diaper to see if it is wet to gauge roughly when the next ‘potty run’ needs to be timed.
  • You can initially start with one ‘potty run’ a night first, to get you and your toddler used to the idea of waking up and getting back to sleep quickly. Then gradually add in the 2nd
  • First thing in the morning, when the toddler wakes, you need to get the toddler used to using the potty immediately (if she/he feels the need to). This may mean you waking up first earlier prior to the toddler waking up, until the toddler is used to going to the potty automatically after waking up.
  • Praise the toddler and give a big reward (e.g., she can sleep with a stuffed toy of her choosing, and/or a small surprise toy or roll of stickers) if the diaper stays dry for a few days in a row. Then when the child’s diaper stays dry for a week or more in a row, he/she can move on to a trial of regular underwear (with/without an outer pair of plastic pants) at night!

Note that this entire process may take slightly longer than the ‘cold turkey’ method, since it is a graduated approach, and involves some trial and error. Your toddler will also continue to use the diaper for a while.

An alternative method is to buy a pair of plastic training pull up shorts or pants, and to put on the underwear inside. Then if the child wets himself or herself, he or she will feel naturally uncomfortable and wake up. This will prevent much urine getting on the bedsheets, but may help the child get more used to waking up on his/her own to pee. The plastic training shorts apparently aren’t too expensive, and usually come in a set of 2-4 pairs. If you prefer this method, it may be worth a try with your toddler!