Qn of the Month: Do Kids Have Stress?

A: Apparently! This as an issue that never crossed my radar until I recently received some resources from a community liaison on this topic. One of the sentences on the website I was pointed to was this “The signs and symptoms of stress can often be seen in challenging behaviours. Children may be reprimanded for actions that are really stress reactions, rather than intentional misbehavior or poor cognitive ability. Lantieri, L. 2008.”  Suddenly it clicked. Sure my child has had a pretty vivid “terrible 3s” phase, so much so I was happy to celebrate her fourth birthday and leave the “3’s” year behind. But reflecting on my child’s behavior made me realize there were many times when she would stop cooperating and start fussing when she got frustrated at something, or when we were stressed ourselves as parents.

In the Kids Have Stress Too! Booklet targeted for parents of preschoolers, it was stated that “Children can experience stress at home, in child care settings, or even in play with

others. In the course of an average day, preschool children experience stress when they have to wait, when they want something they can’t have, or when they lose or break one of their toys.” The following were listed in the booklet as examples of common sources of preschool stress:

  • Early or rushed mornings, being hurried
  • Exposure to new situations
  • Too many expectations or demands
  • Separation from parents
  • Difficulties with peer friendships
  • Fights or disagreements with siblings
  • Transitioning from one activity or place to another
  • New beginnings such as starting kindergarten or child care
  • Frequent change of caregivers

Hmm, rushed mornings, feeling hurried, too many expectations? Sounds a lot like our household. This information has caused me to re-evaluate the way our household is run, and whether my child is expressing some unneeded stress with having a busy daily schedule – something that may not be totally necessary for a 4 year old.

And what can be done if a child is stressed? Apparently one simply measure is just to allow the child to have some more down time. According to one resource handout “Kids also need time to themselves – just to relax and do nothing! Sometimes the best cure for stress is just to have some quiet time. Kids need some time on their own. Listening to music, reading or playing quietly may help them feel better. Doing nothing is fine too!” Hmm, sounds like this advice is applicable to adults too. Don’t we all wish we had more down time to relax and unwind in the midst of our busy and hectic schedules? I know I do!

For this and other great resources on how to help preschoolers and kindergarteners cope and deal with stress, see this link: KHST Preschool and Kindergarten


  1. Kids Have Stress Too! KHST! The Psychology Foundation of Canada. https://psychologyfoundation.org/Public/Public/Programs/Kids_Have_Stress_Too/Kids_Have_Stress_Too_.aspx. Accessed February 22, 2017.
  1. Kids Have Stress Too! KHST Preschool and Kindergarten. Psychology Foundation of Canada. https://www.psychologyfoundation.org/Public/Resources/KHST_Download_Resources/Copy_of_Download_Resources.aspx?WebsiteKey=7ec8b7ce-729b-4aff-acd8-2f6b59cd21ab&hkey=0e18b555-9114-49b4-9838-084fab967f0e. Accessed February 22, 2017.)

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.


  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.)

A Physical to Emotional Transition

Take Time to Peel - Dietitianmom.com

Take Time to Peel – Dietitianmom.com

My father recently remarked, “You are good at taking care of your daughter’s physical needs, but have neglected her emotional needs.” He was saying this on the back of witnessing a series of big tantrums my nearly 3 ½ year old started having. Reflecting on this, I realize there is truth to his statement. All my mothering energies up till now from infancy to toddlerhood had been focused on three main things: that my daughter had enough to eat, enough to sleep and adequate physical ca

re in terms of bathing, clothing and diaper changing. Up till young toddlerhood, my child was also quite transparent emotionally and honest. She would usually let us know quickly if she was unhappy, tired or hurt with a physical ailment and you could then take action to alleviate it. So in a sense I never had or felt I needed to properly consider my daughter’s emotional needs.

Now that she is over 3 years of age though, it seems that my toddler girl is no longer as ‘simple’ and easy to figure out anymore. For one, she is telling lies more frequently, so it is more difficult to take her at her word. She is also throwing more tantrums and having more BIG serious meltdowns (sometimes lasting 1-2 hours at a stretch). While I attributed the big meltdowns initially to her growing independence and the ‘terrible twos’ and ‘horrible threes’ period, a few recent experiences showed me that more was lying beneath the surface.

This transition from needing to shift attention from physical to emotional care sort of snuck up on us as an unexpected revelation with her recent change to a different preschool. In the week leading up to her first day of school, we not only experienced one or two night wakings, but also huge tantrums and crying fits. It was over very simple things like her not wanting to change out of her pajamas in the morning, having the window blinds opened or refusing to pull up her pants after going to the potty. Once (this may have been the day before her first day of school), she got upset that the blinds were opened and the night light turned off in the morning. However, the moment I tried to close the window blinds again and turn the nightlight back on, she seemed to get more upset and demand that the blinds be opened again. Neither action pleased her. As she descended into a meltdown, we attempted to calm her down and then closed the bedroom door to let her have time to “cry it out.” However she continued to scream and scream. The most incredible thing is that the moment I left the room and closed the door, she would beseech me loudly to come back in. But once I came in she would push at me and scream demanding that I leave the room. My husband said that she was demonstrating something called “ambivalent attachment” where she was both needing but also angry at the caregiver. On one occasion, after an hour or two of such a tantrum, my husband managed to calm her down and distract her with toys and a stuffed animal. On another occasion, I managed to get her to calm down by counting out loud to a hundred with me using my fingers. My father, who witnessed all this, was just as befuddled by her behavior, but suggested that the child might be afraid of school, especially since the month prior she had been behaving pretty much like a ”little angel”.

So a day or two prior to her big day at school, I asked her during bedtime if she was afraid of school. She said, “Yes!” Her school jitters was something that never occurred to us, as she had always seemed to show that she was excited about beginning school again (after a 2 month break) and taking the school bus to and fro. Prior to this, she had been in another preschool for 2 years and dearly loved her teachers, the friends and the environment. I guess we just didn’t realize that she was not as brave or fearless as we thought, and that she needed more emotional support to get through this. So then I decided to take the following steps: I prayed with her regarding her fears of school, and then told her that I would be there at the school when she arrived in the school bus, to speak to the teacher and see her for a little bit before heading home. On the morning of the ‘big’ day, I gave her a special morning snack and presented her with a pre-prepared small bible verse card as a gift. I had decorated it with small red construction paper hearts (each heart representing someone in the family who loved her very much) and inside wrote the Bible verse about perfect love (i.e., God’s love) casting out all fear. She was delighted to have that card as a gift and held onto it the whole 3 hours of preschool that first day. Then I made sure that I was at home when the school bus came around, so that I could greet her when she got off the bus. The next day, she still kept the little white card near her in a pocket, but did not feel she needed to hold on to it tightly. By the 3rd day, she felt she could leave the card at home. However, after the following weekend and subsequent long holiday break that followed, she again threw a tantrum or two, and protested about going to school in the morning when we tried to get her ready. It was not until about 3 weeks later, that she really began to feel more comfortable in school and had started to make some friends. Now when I ask her if she is afraid of school, she would tell me she was only a little bit afraid or no longer afraid of it. The tantrums and meltdowns have obviously not disappeared, but they have substantially decreased…subsiding just as mysteriously as they came.

My conclusion? A three year old is more sensitive and emotional than you think! Perhaps like an onion, they grow developmental ‘layers’ over time, so more time is needed to peel back and figure out the source or cause of the emotions and tantrums. I know of another friend sharing about her son (who was 3 or 4 years old at the time) becoming very upset one afternoon and refusing to take a nap. Then after the son had calmed down, and was able to articulate his emotions, it turned out he was upset they were going on a family trip and leaving the family cat at home. It appears that part of the reason for tantrums and meltdowns may be that older toddlers are experiencing more complex emotions, have difficulty in controlling their emotions and may feel frustration at not being able to articulate themselves clearly.

On the one hand, it is definitely easier now physically as my daughter has learnt many aspects of self-care, such as brushing her own teeth, putting on her clothes, buttoning jackets, and going to the potty by herself. But emotionally it is more challenging for both her and us as parents. In some sense, the journey of motherhood has gotten that much harder, as it’s much easier and simpler to only focus on potty training, skills like shoe lace tying and preventing the child from falling sick, rather than on lying and emotional outbursts. In your case, this shift in focus may need to come earlier than at 3 years of age, depending on the emotional and developmental stage of your child, but one worth being aware of that this may happen!

Qn of the Month: Are there Physical Activity Guidelines for Post-Pregnancy?

MH900427748A: Yes! In the United States, postpartum physical activity recommendations come from two main sources: the American Congress of Obstetricians and Gynecologists (ACOG) and the U.S. Department of Health and Human Services 2008 Physical Activity Guidelines for Americans. In the United Kingdom, recommendations come from a 2006 statement issued by the Royal College of Obstetricians and Gynaecologists. Guidelines from the 2008 U.S. Physical Activity Guidelines for Americans are to aim for a minimum of 30 minutes of physical activity most days of the week (so at least 150 minutes a week) of at least moderate intensity. The good news is that this amount can be spread out into 10 minute blocks of moderate intensity activity throughout the day. Much more manageable if you’re handling a young infant!

A recent study reviewed the physical activity guidelines similarities and differences among 5 countries (Australia, Canada, Norway, United Kingdom, and United States).  Although there are quite a few variations between the country-specific guidelines, one thing is clear: physical activity is good post-pregnancy and brings a host of benefits! Advantages for mothers can include an improved mood, improved weight control, increased weight loss, maintenance of cardiorespiratory fitness, reduced depression and anxiety. Recommended types of physical activities from these different country guidelines are aerobic, pelvic floor exercises, strengthening, stretching and walking. Overall, it may be best to build up the intensity of exercise gradually in the postpartum period depending on your body. If you’ve had a cesarean birth, it is likely best to speak with a health care provider first, before resuming previous physical activity levels.

Hopefully in the future, there can be more consistency across countries and more specifics provided within each guideline to help postpartum women.

(Sources: ACOG. Exercise during pregnancy and the postpartum period. ACOG Committee Opinion No. 267. Obstet Gynecol. 2002; 99(1):171–3. [PubMed: 11777528]

U.S. Department of Health and Human Services. 2008 Physical Activity Guidelines for Americans.Washington, D.C.: 2008. ODPHP Publication No. U0036. http://health.gov/paguidelines/. Accessed September 25, 2015.

Evenson KR, Mottola MF, Owe KM, Rousham EK, Brown WJ. Summary of International Guidelines for Physical Activity Following Pregnancy Obstet Gynecol Surv. Obstet Gynecol Surv. 2014 Jul; 69(7): 407–414. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4134098/pdf/nihms-616584.pdf. Accessed September 19, 2015.)

On Toddler Time

Is all the stress worth it? - dietitianmom.com

Is all the stress worth it? – dietitianmom.com

I have heard from 2 to 3 mothers now and we are all experiencing the same thing: stress from trying to get us and our children on time to places like schools, play dates, lunch dates, bookstore and library story times… you name it. We get frustrated and end up being short with our children, often resulting in unhappy children and unhappy moms.

A friend’s experience recently was a good example of this. They were trying to get out the door to go somewhere, and the mom ended up being short with her daughter, a 2-year-old toddler. The child didn’t say much but her expression and subsequent reaction told it all. The mom could clearly tell that the child ended up not really enjoying herself at the story-time activity they were trying so hard to get to on time.

It is really amazing how much our children pick up on our vibes and stress levels, often even without us saying anything. One of my toddler’s first words was “hurry up”, probably because I said it so much (and continue to). I often find myself hurrying her to get ready to get out the door when she is content playing with a particular toy, or on to bed when she is happily chatting with me instead of brushing her teeth. Now that she’s older, she picks up on these vibes and asks,” Are you angry?” because my voice changes as she refuses to obey me for the 3rd time. Another friend’s older child asked her, “Are you frustrated?” when they were having trouble getting out the door for school one morning.

I don’t know what gets us so stressed. Is it our self image and desire to maintain a façade of competence? Perhaps there’s a pressure to appear “with it”, that is, an ability to handle multiple children and get to activities on time (or close to it), all the while maintaining perfect manicures and hairstyles. As another friend once put it, it’s like trying to be a duck: appearing calm and unruffled on the outside but paddling “like the dickens” underneath the water.  Maybe it’s altruistic: we want our child to be exposed to as many activities as possible to discover and develop their blossoming talents in art, music, and sports. Perhaps it’s a selfish motivation; we really want the child out of the house, so that we can have a break, some time to ourselves and do the things that we really want to do. Maybe there is an unconscious, subtle fear and anxiousness in us, thinking that if we don’t make it to the activity, then we will be stuck at home with the bored toddler or child, who will then look to us to entertain them and help them expend their energy, all of which wears our energy and patience down even more and gives us less time to ourselves. Don’t get me wrong; some self-preservation and self-care is a must and healthy, because it enables us to recharge and be better moms. But on the other hand, it can be taken to the extreme and our children wind up in so many activities during the week, that it has an ultimate negative impact on the child and parent. Perhaps it’s a pride issue; we expect our children to fall in line like good little soldiers and conform to everything we say or ask them to do, so they should conform to our timeline and sequence of events for the day. After all, our way is the best, right?

I know I’m guilty of many of these above-mentioned motivations. But whatever our underlying motives, one question remains: is all this stress and frustration worth it? I think the answer is a clear, “No.” So what can we do about it? Perhaps some activities need to be phased out of the weekly schedule, allowing less rushing about to get from one activity to another. Maybe we need to start earlier and allow a longer “get ready” time before going out the door. Or, we can start to make adjustments to our own expectations to accommodate to our child’s/toddler’s timeline.  I’m trying to adjust now to a bit more of ‘Flexi-Time’. It’s difficult! Let’s face it – kids operate on their own sense of time. They really don’t operate according to ours. But maybe that’s a really good thing in the end.

In the Trenches: 2 Year Old Tantrums

little boy cryingOver these last few weeks, around the time our toddler turned 2, we have noticed progressively more tantrums and ‘meltdowns’, sometimes up to 2 or more in a day. These crying bouts are noticeably different from the ones in earlier toddlerhood. Back then, whenever our little one cried, we knew it was usually due to a physical reason (e.g., real discomfort with teething, or a bump on the head). At such times, our toddler’s attention could be still relatively easily diverted with a toy or a book. Even if there was a day or two of prolonged fussiness and whining from a cold/flu or teething bout, our toddler would usually revert back to her happy-go-lucky self once she was feeling better physically. Then the Sunday morning of the daylight savings time change (‘fall back’ in the United States was on November 2, 2014 so an hour was gained), I blamed myself for the hour long meltdown during breakfast to the fact that she was overly hungry because I did not get her up earlier to help with the time transition. However, when she subsequently melted down again for another 45 minute screaming fit after a good afternoon nap, I started to question if the daylight savings time change had anything to do with it!

As I pondered on this, I began to see a pattern of meltdowns more related to the stage my toddler currently is at, rather than external or physical causes. Why? Because there are marked differences between her crying bouts now and her crying bouts in early toddlerhood.  Now, the tantrums seem to start from something very simple such as a refused request (in terms of what she wants to eat or drink or a specific toy) or her not getting something she wanted quickly enough. Something could suddenly set her off, and then she goes into a downward spiral. The meltdowns are extreme in nature, with high pitched screaming and crying lasting 30 minutes to an hour. It’s like a boiling kettle suddenly going into a full steam siren-like wail with no one to turn off the heat and move it away from the hot burner. She is difficult to console, may become violent (wanting to throw something or push things, scratch her face in frustration, or throw herself to the ground). She keeps screaming a request but then pushes it away when it”s given to her, and even when we are near her she is not consoled easily with a hug. Sigh.

During one of these episodes, my husband remarked, “She doesn’t know how to calm herself.” I think that is probably very true. There is the new frustration too of being able to communicate in some sense what she wants, but not very well, especially when she is upset. As parents, I think there is not much we can do at this stage…except to support her and sit with her patiently until her tantrums subside, to be consistent in our disciplining and to calmly help our toddler talk through it afterwards when she is calm again.

If you have suggestions or similar experiences, feel free to share them! Hope you are having an easier time in these ‘Toddler Trenches’!

Qn of the Month: Does My Breastfeeding Baby Need Iron Supplements?

Infant Grasping Mother's FingerA: This is another ‘yes’ and ‘no’ answer. Whether a breastfeeding baby needs iron supplementation is dependent on many factors such as whether the child was born full term or premature, fully breastfed or not, amount of iron-fortified infant formula consumed, the age of introduction of solids, what those complementary solids are and also country specific recommendations.

In the United States, the American Academy of Pediatrics (AAP) revised its recommendations in 2010 to better meet the iron needs of infants to prevent iron deficiency. For infants who are exclusively breastfeeding, the AAP currently recommends an oral iron supplement of 1 milligram iron per kilogram per day (1mg/kg/day) starting when the baby is 4 months of age. This should be continued until the baby is well established on iron-containing complementary foods to provide the same level of iron. This also applies to partially breastfed infants, who receive more than half of their daily feedings as breast milk. Some examples of iron-containing complementary foods would be iron fortified infant cereals and puréed meats.

All preterm infants should have an iron intake of a minimum of 2 mg/kg/day up until 12 months of age. For preterm infants fed breast milk, the AAP recommends 2 milligrams of iron per kilogram per day to be started at one month of age. This supplementation should be continued until the infant is transitioned over to an iron fortified formula and/or the diet includes complementary foods supplying 2 mg/kg per day of iron.

What about babies who are not breastfed? Fully formula fed term infants would likely have their iron needs met during the first 12 months of life from standard infant formulas alongside iron-containing complementary foods introduced after 4-6 months of age. For premature fully formula fed infants, the standard preterm or term infant iron fortified formula would generally be a sufficient source of iron, though some formula fed preterm infants may need additional iron supplementation. The exception to the need for supplementation is if the preterm infant was provided blood transfusions and is at risk for iron overload.

(Source: Baker RD, Greer FR, Committee  on Nutrition. Diagnosis and prevention of iron deficiency and iron-deficiency anemia in infants and young children 0 through 3 years. Pediatrics. November 2010. 126(5):1-11. http://pediatrics.aappublications.org/content/early/2010/10/05/peds.2010-2576.abstract. Accessed October 27, 2014.)