"If you hit your little sister one more time, I will slap you!"
Okay. You said it. Now what? If you follow through on the threat, you engage in exactly the same behavior you're trying to stop, and you will hurt your child.
What can you do if your toddler can't seem to stop hitting, jabbing, pushing or poking a younger sibling?
Monitoring whereabouts
A baby should never be left alone in any area where other young children - or pets - have unrestricted access to him or her.
Many parents choose to wear a sling that holds the baby close to them. The sling gives parents the freedom to move their arms and perform multiple tasks while still holding the baby. It also makes it difficult for a toddler to reach up and poke or prod.
Teaching appropriate touch
Help your child understand that babies need to be handled with care. You can teach your toddler gentle touch using a "pretend baby," such as a doll.
Teaching your toddler how to act around the baby may take several weeks. It is not a "one-and-done" learning experience. Use the doll to demonstrate good touching and playing behaviors. Practice with your toddler. When he or she consistently displays good behavior with the doll, reward your toddler with more supervised time with the baby.
Catch 'em being good
"Baby bucks" can be a reward system for your toddler's good behavior. Each buck a child earns for good behavior can be turned in for a reward or treat, such as watching a video, getting a special snack, reading an extra bedtime story or spending more time with you and the baby.
The rewards should be directly linked to your toddler's behavior with the baby. Rewards and consequences (for bad behavior) should be significant and important to your child. As your toddler's behavior improves, you can reduce the rewards and focus on other behaviors he or she struggles with.
Intensive Toilet Training
Sometimes the 7 P plan is not enough. This often happens when continence is needed now or at least in the next week or two. Reasons for this range from parents simply being fed up with poopy pants and icky Pampers to ultimatums from day cares or preschools. Here’s an example of what I mean. Years ago when I left the University of Nebraska, I turned my incontinence clinic over to another professor. He then became Dr. Poop and Pee instead of me. One day, he received a call from his 3-year-old daughter’s preschool informing him that she was being expelled because she was having too many toileting accidents. This would be bad news for any parent, but it was particularly bad for Dr. Poop and Pee, if you catch my drift. He swiftly followed guidelines similar to those below and she was fully trained in four days. So if you are willing to spend a lot of your time toilet training and be consistent about following the guidelines, your child can be toilet trained in a few days.
A good time to begin intensive toilet training is a weekend when you are free from work and other chores. Okay, I know you are never free from work and chores. Just pick a time when all the things you have to do can be set aside for a while without too much of a penalty.
1. Increase fluids. Toilet training is really a form of plumbing, and to do it well, we need something to plumb. Said differently, good training requires multiple toileting opportunities, and the best way to achieve this goal is to have your child drink a lot. So let them drink as much of their favorite beverages as they want; you can even encourage them to drink more. And before I forget, stay home. Filling them full of fluid creates multiple urinations, and thus, multiple training opportunities – if you are home. If you are out and about, it creates either a big mess and large headache, or a lot of little messes and small headaches. Neither option is fun for Mommy and Daddy.
2. Give frequent prompts. Watch them carefully. When they begin to show signs of having to go, tell (don’t ask) them to go to the bathroom and then take them there. When they really have to go, the signs are obvious (e.g., they grab themselves, cross their legs, and wince). If they have their shirt off, you will be able to see more subtle signs (e.g., minor to major movements of their lower abdomen). In a sense, this is like bombardier training – you need to get them over the target before they release their payload. Keeping a close eye on them reveals when the payload is near the bomb bay doors. A more structured way to do this is to merely tell your child to use the potty every 30 to 45 minutes.
3. Do dry pants checks. Every 15 minutes or so, check your child's pants to see if they are dry. If they are, praise your little trainee (see P #6 from earlier). Because this is intensive training, I recommend having a system for rewarding your child for dry pants. For example, you could make a chart where you record each pants check and give a star each time you find dry pants. Then, you can reward your child for, say, every 10 stars he or she earns. Or, you can arrange to spend “Special Time” with your child in the evening after a day of dry pants. Special Time means one parent spends 15 to 20 minutes with the child doing an activity the child particularly enjoys. Always follow through on promised rewards (“Give it up!”).
4. Praise. You should abundantly praise and appreciate all toileting successes (once again see P #6). And if your child happens to go to the toilet unprompted, something big should happen. Have the glitter dome descend, the mayor call, and confetti spill from the ceiling. Or, if you are on a budget, a big hug will probably do.
5. Use positive practice for wetting accidents. Positive practice is an intensive practice of what should have been done instead of the accident. It can take various forms, but it generally involves multiple practice trips to the bathroom after an accident. (Because this practice can generate opposition from the child, I will cover it in another article. In the meantime, you can ask your health care provider to give you the guidelines on toileting accidents that explain positive practice.)
6. The cleaning bill. There will be accidents in the house – which is a nice way of saying there’s a good chance your child will poop or pee on your floors and carpets. So set aside about $60 for the cleaning bill when you are all done.
A good time to begin intensive toilet training is a weekend when you are free from work and other chores. Okay, I know you are never free from work and chores. Just pick a time when all the things you have to do can be set aside for a while without too much of a penalty.
1. Increase fluids. Toilet training is really a form of plumbing, and to do it well, we need something to plumb. Said differently, good training requires multiple toileting opportunities, and the best way to achieve this goal is to have your child drink a lot. So let them drink as much of their favorite beverages as they want; you can even encourage them to drink more. And before I forget, stay home. Filling them full of fluid creates multiple urinations, and thus, multiple training opportunities – if you are home. If you are out and about, it creates either a big mess and large headache, or a lot of little messes and small headaches. Neither option is fun for Mommy and Daddy.
2. Give frequent prompts. Watch them carefully. When they begin to show signs of having to go, tell (don’t ask) them to go to the bathroom and then take them there. When they really have to go, the signs are obvious (e.g., they grab themselves, cross their legs, and wince). If they have their shirt off, you will be able to see more subtle signs (e.g., minor to major movements of their lower abdomen). In a sense, this is like bombardier training – you need to get them over the target before they release their payload. Keeping a close eye on them reveals when the payload is near the bomb bay doors. A more structured way to do this is to merely tell your child to use the potty every 30 to 45 minutes.
3. Do dry pants checks. Every 15 minutes or so, check your child's pants to see if they are dry. If they are, praise your little trainee (see P #6 from earlier). Because this is intensive training, I recommend having a system for rewarding your child for dry pants. For example, you could make a chart where you record each pants check and give a star each time you find dry pants. Then, you can reward your child for, say, every 10 stars he or she earns. Or, you can arrange to spend “Special Time” with your child in the evening after a day of dry pants. Special Time means one parent spends 15 to 20 minutes with the child doing an activity the child particularly enjoys. Always follow through on promised rewards (“Give it up!”).
4. Praise. You should abundantly praise and appreciate all toileting successes (once again see P #6). And if your child happens to go to the toilet unprompted, something big should happen. Have the glitter dome descend, the mayor call, and confetti spill from the ceiling. Or, if you are on a budget, a big hug will probably do.
5. Use positive practice for wetting accidents. Positive practice is an intensive practice of what should have been done instead of the accident. It can take various forms, but it generally involves multiple practice trips to the bathroom after an accident. (Because this practice can generate opposition from the child, I will cover it in another article. In the meantime, you can ask your health care provider to give you the guidelines on toileting accidents that explain positive practice.)
6. The cleaning bill. There will be accidents in the house – which is a nice way of saying there’s a good chance your child will poop or pee on your floors and carpets. So set aside about $60 for the cleaning bill when you are all done.
Acne Treatment Guide
Pimples are a common problem that affects most teenagers at one time or another. It is caused by oil clogging the pores in your skin. The buildup of more oil and bacteria can then cause your skin to become red and inflamed. It commonly begins during puberty, because this is a time when many hormones increase and it is these hormones that cause your skin to produce more oil.
Pimples are not caused by the foods that you eat (such as chocolate, soft drinks or greasy foods) or by dirt (blackheads are caused by a pigment, not dirt), and you can't catch it from someone else. It can be made worse by pinching pimples, harsh scrubbing which irritates the skin, certain cosmetics which can further block oil ducts, and emotional stress.
Acne can also be commonly found in young infants in the first one to two months of life. This form of acne, called neonatal acne, is thought to be caused by a temporary increase in hormone levels just before and after birth. Neonatal acne usually goes away on its own without treatment. Infantile acne occurs in older infants after the firs two to three months of life and may last until they are 2-3 years old. Drug induced acne occurs in children taking certain medications, including oral and topical steroids, methotrexate and some anti-seizure medications.
The two main types of acne are comedonal acne, consisting of whiteheads and blackheads, and inflammatory acne, with red and sometimes tender papules, pustules and cysts. Also, many children have a combination of both comedonal and inflammatory acne.
Pimples usually improve by the time you are twenty – twenty five years old, but can be brought under control sooner with the proper treatments.
Preventing Pimples
Wash (but don't scrub) your skin twice a day with a mild soap. Avoid harsh cleansers or scrubs, as they can irritate your skin, and lead to more pimples.
Don't pop or pinch pimples, as this can lead to scarring.
Use noncomedogenic cosmetics and moisturizers and don't put oily or greasy substances on your face or hair.
Avoid 'stripping' of blackheads, as this can also lead to scarring.
Avoid touching your face a lot, as your hands have oil on them and this can make acne worse.
Avoid wearing hats or headbands that rub on your forehead, since this can also make acne worse.
Acne Medications
The medications most commonly used to treat acne contain benzoyl peroxide. Other medications include antibiotics (such as minocycline), retinoid creams , combinations of these products, and Accutane, which is usually only prescribed by a dermatologist for more severe or hard to treat cases.
Benzoyl Peroxide 2.5% 5% 10%
The different forms of benzoyl peroxide are the most effective medications available OTC (such as PersaGel or Clearasel) and helps to kill bacteria, unplug oil ducts and heal pimples. You should start with a low strength once a day and work up to 10% twice a day. Apply it to all areas where pimples occur, and not just on your current pimples.
Benzoyl Peroxide is also available in a number of prescription strength forms, including topical washes and cleansers (like Triaz and Brevoxyl).
If you do not see improvement in 4-6 weeks using OTC medications with benzoyl peroxide or if your child just has comedonal acne (whiteheads and blackheads), then you should see your Pediatrician about using a prescription medication used to treat acne, or see a dermatologist if your Pediatrician is not comfortable treating kids with acne:
Benzamycin Topical Gel
This is a combination of 5% Benzoyl Peroxide and Erythromycin (an antibiotic) and is very effective for treatment of inflammatory acne. It must be kept in the refrigerator and may bleach clothing. Apply a thin layer of it to affected areas after washing once or twice a day. Use it in the morning only if you are also using Retin A or other medications at night.
New! Benzaclin Topical Gel
Another combination of 5% Benzoyl Peroxide and an antibiotic, this time Clindamycin and it should also be effective for inflammatory acne. It has the added benefit that it doesn't need to be kept in the refrigerator. It should be applied to skin that has been washed, rinsed and patted dry.
New! Duac Gel
Another combination of 5% Benzoyl Peroxide and Clindamycin that is used to treat acne. Like Benzaclin, it doesn't need to be kept in the refrigerator. It should be applied to skin that has been washed, rinsed and patted dry.
Retin A 0.025% 0.05% 0.1% cream
Retin A cream helps unplug oil ducts and should be applied to the affected areas at least 20-30 minutes after washing (applying it to wet skin may cause irritation). Use a small amount (one pea-sized dose is enough for your entire face) every third night, and if tolerated, increase to every other night and then every night. It is especially effective for comedonal acne (whiteheads and blackheads) and is often used with Benzoyl Peroxide or a topical antibiotic cream for inflammatory acne.
If your skin can't tolerate Retin A cream, there is a Retin A Microsphere gel that is less irritating, or you can try some of the newer medicines, including Azelex, Tazorac or Differin gel.
Oral antibiotics such as Tetracycline or Minocin (minocycline) are sometimes used if topical therapy with a combination of benzoyl peroxide with a topical antibiotic and Retin A doesn't clear up your skin. They are used twice a day until your pimples have cleared up (usually 4-5 months), and then are slowly weaned off.
Irritated Skin
It is not uncommon for the skin to become red, dry and irritated when beginning to use new acne medications. This usually improves with time, but here are some suggestions to minimize irritation:
Use noncomedogenic moisturizers if your skin is becoming dry.
If starting more than one new medicine, consider starting with just one and then waiting two or three weeks before beginning the other one.
You can also begin a new medicine by applying it every third night, and then gradually increasing it to every other night and then every night.
Another alternative is washing the medicine off after about five minutes. Each night, you can then leave it on for longer periods of time before washing it off.
In general liquid and solution forms of medications are less irritating than creams and gels, so you can try using a different form of the medication if you can't tolerate it well.
Seeing a Dermatologist
While most primary care physicians can treat mild and moderate skin problems, you should consider seeing a specialist if you have severe cystic acne that may lead to scarring, if you are not improving with your current regimen (especially if you are already on a combination of medicines, including benzoyl peroxide with a topical antibiotic, RetinA, and minocycline (or other oral antibiotic), if you have very sensitive skin and can't tolerate topical medicines, or if your doctor is not comfortable treating children with pimples. A Dermatologist may be able to use different combinations of the above medicines or may put you on Accutane, an oral retinoic acid that you take daily for three to four months.
You may also need to see a Dermatologist if you already have scarring. Treatments for scarring include using chemical peels, dermabrasion and laser therapy.
Important Reminders
Be patient. It can take 3-6 weeks to see improvement and your skin may get worse before it starts getting better.
Use your medicines every day. If your skin is getting too irritated, red or dry, then start using them every other day. It takes time for your skin to adapt to your new medicines.
Accutane can cause severe birth defects, and should never be taken by someone who may become pregnant.
Don't overdo it! Scrubbing your skin or using too much of these medicines can irritate and dry out your skin and won't make your pimples go away any quicker.
Protect your skin from the sun. These medicines will make your skin more sensitive to the effects of the sun.
Call your physician if you haven't improved in 4-6 weeks with your current regimen.
Pimples are not caused by the foods that you eat (such as chocolate, soft drinks or greasy foods) or by dirt (blackheads are caused by a pigment, not dirt), and you can't catch it from someone else. It can be made worse by pinching pimples, harsh scrubbing which irritates the skin, certain cosmetics which can further block oil ducts, and emotional stress.
Acne can also be commonly found in young infants in the first one to two months of life. This form of acne, called neonatal acne, is thought to be caused by a temporary increase in hormone levels just before and after birth. Neonatal acne usually goes away on its own without treatment. Infantile acne occurs in older infants after the firs two to three months of life and may last until they are 2-3 years old. Drug induced acne occurs in children taking certain medications, including oral and topical steroids, methotrexate and some anti-seizure medications.
The two main types of acne are comedonal acne, consisting of whiteheads and blackheads, and inflammatory acne, with red and sometimes tender papules, pustules and cysts. Also, many children have a combination of both comedonal and inflammatory acne.
Pimples usually improve by the time you are twenty – twenty five years old, but can be brought under control sooner with the proper treatments.
Preventing Pimples
Wash (but don't scrub) your skin twice a day with a mild soap. Avoid harsh cleansers or scrubs, as they can irritate your skin, and lead to more pimples.
Don't pop or pinch pimples, as this can lead to scarring.
Use noncomedogenic cosmetics and moisturizers and don't put oily or greasy substances on your face or hair.
Avoid 'stripping' of blackheads, as this can also lead to scarring.
Avoid touching your face a lot, as your hands have oil on them and this can make acne worse.
Avoid wearing hats or headbands that rub on your forehead, since this can also make acne worse.
Acne Medications
The medications most commonly used to treat acne contain benzoyl peroxide. Other medications include antibiotics (such as minocycline), retinoid creams , combinations of these products, and Accutane, which is usually only prescribed by a dermatologist for more severe or hard to treat cases.
Benzoyl Peroxide 2.5% 5% 10%
The different forms of benzoyl peroxide are the most effective medications available OTC (such as PersaGel or Clearasel) and helps to kill bacteria, unplug oil ducts and heal pimples. You should start with a low strength once a day and work up to 10% twice a day. Apply it to all areas where pimples occur, and not just on your current pimples.
Benzoyl Peroxide is also available in a number of prescription strength forms, including topical washes and cleansers (like Triaz and Brevoxyl).
If you do not see improvement in 4-6 weeks using OTC medications with benzoyl peroxide or if your child just has comedonal acne (whiteheads and blackheads), then you should see your Pediatrician about using a prescription medication used to treat acne, or see a dermatologist if your Pediatrician is not comfortable treating kids with acne:
Benzamycin Topical Gel
This is a combination of 5% Benzoyl Peroxide and Erythromycin (an antibiotic) and is very effective for treatment of inflammatory acne. It must be kept in the refrigerator and may bleach clothing. Apply a thin layer of it to affected areas after washing once or twice a day. Use it in the morning only if you are also using Retin A or other medications at night.
New! Benzaclin Topical Gel
Another combination of 5% Benzoyl Peroxide and an antibiotic, this time Clindamycin and it should also be effective for inflammatory acne. It has the added benefit that it doesn't need to be kept in the refrigerator. It should be applied to skin that has been washed, rinsed and patted dry.
New! Duac Gel
Another combination of 5% Benzoyl Peroxide and Clindamycin that is used to treat acne. Like Benzaclin, it doesn't need to be kept in the refrigerator. It should be applied to skin that has been washed, rinsed and patted dry.
Retin A 0.025% 0.05% 0.1% cream
Retin A cream helps unplug oil ducts and should be applied to the affected areas at least 20-30 minutes after washing (applying it to wet skin may cause irritation). Use a small amount (one pea-sized dose is enough for your entire face) every third night, and if tolerated, increase to every other night and then every night. It is especially effective for comedonal acne (whiteheads and blackheads) and is often used with Benzoyl Peroxide or a topical antibiotic cream for inflammatory acne.
If your skin can't tolerate Retin A cream, there is a Retin A Microsphere gel that is less irritating, or you can try some of the newer medicines, including Azelex, Tazorac or Differin gel.
Oral antibiotics such as Tetracycline or Minocin (minocycline) are sometimes used if topical therapy with a combination of benzoyl peroxide with a topical antibiotic and Retin A doesn't clear up your skin. They are used twice a day until your pimples have cleared up (usually 4-5 months), and then are slowly weaned off.
Irritated Skin
It is not uncommon for the skin to become red, dry and irritated when beginning to use new acne medications. This usually improves with time, but here are some suggestions to minimize irritation:
Use noncomedogenic moisturizers if your skin is becoming dry.
If starting more than one new medicine, consider starting with just one and then waiting two or three weeks before beginning the other one.
You can also begin a new medicine by applying it every third night, and then gradually increasing it to every other night and then every night.
Another alternative is washing the medicine off after about five minutes. Each night, you can then leave it on for longer periods of time before washing it off.
In general liquid and solution forms of medications are less irritating than creams and gels, so you can try using a different form of the medication if you can't tolerate it well.
Seeing a Dermatologist
While most primary care physicians can treat mild and moderate skin problems, you should consider seeing a specialist if you have severe cystic acne that may lead to scarring, if you are not improving with your current regimen (especially if you are already on a combination of medicines, including benzoyl peroxide with a topical antibiotic, RetinA, and minocycline (or other oral antibiotic), if you have very sensitive skin and can't tolerate topical medicines, or if your doctor is not comfortable treating children with pimples. A Dermatologist may be able to use different combinations of the above medicines or may put you on Accutane, an oral retinoic acid that you take daily for three to four months.
You may also need to see a Dermatologist if you already have scarring. Treatments for scarring include using chemical peels, dermabrasion and laser therapy.
Important Reminders
Be patient. It can take 3-6 weeks to see improvement and your skin may get worse before it starts getting better.
Use your medicines every day. If your skin is getting too irritated, red or dry, then start using them every other day. It takes time for your skin to adapt to your new medicines.
Accutane can cause severe birth defects, and should never be taken by someone who may become pregnant.
Don't overdo it! Scrubbing your skin or using too much of these medicines can irritate and dry out your skin and won't make your pimples go away any quicker.
Protect your skin from the sun. These medicines will make your skin more sensitive to the effects of the sun.
Call your physician if you haven't improved in 4-6 weeks with your current regimen.
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