Serve and Return Parenting

Serve and return is a term coined by Harvard researchers for the back and forth interactions between a parent and a child. To understand the concept of serve and return, imagine a game of ping pong or tennis. Someone hits the ball, sending it over or serving it to the second player. The second player hits the ball in turn, returning it to the first player. Now substitute a conversation, a smile, or a gesture for the ball, and you’ve got an idea of serve and return.

As parents, we know that when a newborn looks deep into our eyes, he is asking us for some kind of attention. Depending upon the look in his eyes, it could be the baby just wants a smile. Or maybe he wants us to talk to him or play with him. We may not even know exactly what he wants, but we know he wants something. Most of us, as parents, will try hard to figure it out and give him what he wants, even if it takes some trial and error.

That look the baby gives the parent is a “serve.” To respond to it is the “return.”

Serve and Return Builds Brain Architecture

Serve and return interactions like this one have been studied by researchers. Studies show such parent child interactions are critical to brain architecture, or the shaping of the infant’s developing brain. Serve and return parenting is so important that a baby who does not experience this sort of back and forth with caregivers is likely to have stunted development.  According to Harvard:

Because responsive relationships are both expected and essential, their absence is a serious threat to a child’s development and well-being. Healthy brain architecture depends on a sturdy foundation built by appropriate input from a child’s senses and stable, responsive relationships with caring adults. If an adult’s responses to a child are unreliable, inappropriate, or simply absent, the developing architecture of the brain may be disrupted, and subsequent physical, mental, and emotional health may be impaired. The persistent absence of serve and return interaction acts as a “double whammy” for healthy development: not only does the brain not receive the positive stimulation it needs, but the body’s stress response is activated, flooding the developing brain with potentially harmful stress hormones.

Erika Christakis, writing in The Atlantic, speaks about the high-pitched, grammar-simplified, over-enthusiastic baby talk a parent might use in response to a baby’s cooing. This sort of “conversational duet” is a type of serve and return parenting. According to Christakis, one study found that “Infants exposed to this interactive, emotionally responsive speech style at 11 months and 14 months knew twice as many words at age 2 as ones who weren’t exposed to it.”

In other words, if a child lacks serve and return parenting, the child may end up with developmental delays and worse. This would be a tragic outcome. The kind of outcome that happens to kids who are abandoned and end up in the foster care system. Not the kind of outcome we’d expect for our own children.

The only problem with this idea—that it can’t happen to our kids, we’re not those kinds of parents—is that increasingly, that’s not true. The thing that makes this a lie is our smartphones and screens. Our devices have turned us into distracted parents. The kind of parents who all too often miss a baby’s glance in favor of a Facebook PM or Whatsapp message.

Serve and return interaction between mother and baby girl
If your phone were to ping, what would happen to this moment?

Imagine your baby offers you that serve and return glance but at the same time, you hear a “ping” from your phone. How likely is that to happen? And how will that ping affect your serve and return interaction with your baby?

Let’s say you choose to ignore the ping and wait until the serve and return with your infant is complete before checking your phone. As you interact with your baby, the ping of your phone is still on your mind. It’s there in your head in reserve, reminding you it’s waiting for you to pay attention to it instead of to your baby. That’s got to affect the quality of your serve and return interaction with baby.

But what if you attend to the ping first, so you can then give your full attention to the baby? What happens to the serve and return interaction as a result of this delay? Is baby affected by being made to wait a bit longer?

The simple answer is that timing is everything. There’s a rhythm to serve and return interactions. As in tennis or ping pong, miss the moment, miss the serve, and the game could be lost. The baby’s glance or coo, unreturned, may mean baby gives up, acknowledges that a parent’s return just isn’t happening. The baby may look away, or space out, a kind of retreat from the perceived rejection of the parent.

Serve and Return Requires Full Attention

A father and baby serve and return interaction
This father is fully “present” for this serve and return interaction with his child.

There’s another possibility. You multitask! You ignore neither ping nor baby’s serve, dividing your attention between the two. No one gets your full attention. No one wins. Psychologist Kathy Hirsh-Pasek comments that, “Toddlers cannot learn when we break the flow of conversations by picking up our cellphones or looking at the text that whizzes by our screens.”

Baby feels the difference, feels you are distracted, as you switch back and forth between the screen of your smartphone and your baby. Perhaps baby doubles down, tries harder, becoming even more attractive to you by doing something extra cute. Or perhaps the serve and return remains a lackluster failure so that it just sort of peters out. FAIL.

What about children beyond babyhood? Do they still require your full attention? Christakis mentions two studies that illustrate what happens when parents are too distracted by technology to engage in serve and return parenting with their children. In one of these studies, 225 moms and their 6-year-olds were videotaped as the kids were given new foods to try. A quarter of the moms used their phones, which resulted in fewer interactions with their children.

Phone Use and Learning

A second study tested the impact of a parent’s phone use on a child’s ability to learn new words. Moms were told they had to teach their 2-year-olds two new words: blicking, which was supposed to mean “bouncing,” and frepping, which was supposed to mean “shaking.” The researchers rang some of the moms from another room.

When the learning sessions were interrupted by a researcher’s phone call, the children didn’t learn the two new words. When left undisturbed, however, the new words took root. As it turns out, seven mothers were excluded from the analysis of the data, because they didn’t answer the researchers’ phone calls. In other words, they failed to follow the protocol! Christakis says, “Good for them!”

Indeed.

More Time for Children

It’s interesting to note that parents have never been so free to spend so much time with their children. Technology has made chores like cleaning clothes and keeping food fresh so much easier. We can walk into a supermarket to buy food, and clothing is ready-made. No one needs to milk a cow or churn butter. There are no longer accidents of the sort that were commonplace when moms were too busy to give baby much attention.

Those moms had no choice but to leave their babies alone much of the time. But our smartphones make us distracted moms by choice, limiting serve and return interactions with our children, and affecting their brain development. And make no mistake, it is a choice. Because it would be the easiest thing in the world to turn our phones off.

Minimizing Phone Distractions

With this in mind, parents would be well advised to do exactly that: shut off those phones when spending time with children. It’s the only way to be there for those serve and return moments. Here are 3 tips on how to minimize phone distractions:

  1. Put your phone on silent and out of sight in your bag or pocket when spending time with your child
  2. Experiment with shutting your phone off for a fixed time, say two hours in the afternoon, and try to be really present with your child during this time
  3. Stay off your phone while nursing or bottle-feeding your baby and during mealtimes for older children since this is an important time for socialization

That doesn’t mean you have to turn your phone off for your child’s entire waking hours. Nor must parents martyr out and feel deprived. It’s okay to check your voice mail and notifications from time to time. And it’s certainly okay to take time for yourself. It makes you a better parent.

Christakis says it best: “Parents should give themselves permission to back off from the suffocating pressure to be all things to all people. Put your kid in a playpen, already! Ditch that soccer-game appearance if you feel like it. Your kid will be fine. But when you are with your child, put down your damned phone.”

Because the stuff on your phone? It’s just virtual smoke and mirrors. While in the real world, nothing could be more important than those serve and return moments with your child.

How Should Kids Brush Their Teeth?

How should kids brush their teeth and when should they begin? The simple answer is that the minute that first pearly white tooth pops out of your baby’s gums, it’s time to begin brushing. At first, use a very soft brush and some water. Later on, at around 18 months, use a pea-sized glob of fluoride toothpaste. After the age of seven, children can be trusted to brush their own teeth, with a bit of supervision from parents.

No parent can doubt the importance of a child’s teeth. Teeth help children eat and speak and support the bones in their faces so they look nice. But teeth don’t take care of themselves. If children don’t brush their teeth, plaque can form in a thin coating on the teeth. Plaque (PLACK), is a sticky, thin film of bacteria that attaches itself to the teeth.

The preferred food of the bacteria in plaque is sugar. That may be the sugar in a piece of candy or a glass of soda pop, or it may be the sugars that develop from the carbohydrates we eat, for instance noodles, grains, and potatoes. Any time children eat starchy or sweet carbohydrates, they feed the bacteria on their teeth. As bacteria interact with starches and sugars, they turn into acids. These acids burn their way through children’s tooth enamel, making the holes in their teeth that we call cavities.

Mother brushes little girl's teeth

Brush Their Teeth: Gums, Too!

The bacteria in children’s mouths don’t just cause cavities. They also attack children’s gums. If kids don’t brush to remove the bacteria-filled plaque in their mouths, they may end up with gingivitis (jin-ja-VIE-tis), or gum disease. Gum disease not only looks and feels bad, giving children sore, swollen, red gums, but can also cause tooth loss. Gums, after all, are the tissues that hold and support the teeth inside the mouth.

Children should brush their teeth twice a day, after eating breakfast and again before bed. It doesn’t hurt to brush after lunch and after having a snack, too. It is brushing the teeth that removes plaque from children’s teeth, keeping them and their gums, healthy.

Cute little boy brushes his teeth

All of the teeth should be brushed, and not just those in the front. If children can think of their mouths as having four parts or quadrants, it makes it easier to cover all of them. Spend 30 seconds brushing each section of the mouth, beginning at the back and working toward the front, front and back of each section, gums and teeth, for a total of two minutes of brushing altogether.

Angle the brush 45 degree toward the gums from the upper and lower teeth. Move the brush back and forth using short strokes along teeth and gums, making sure to cover all the teeth and gums, front and back. Make sure the tip of the brush is upright when brushing behind the front teeth, both top and bottom.

Don’t forget to brush the tongue, too! Plaque sticks to tongues as well as teeth.

Brush Their Teeth: Two Minutes

It can help to play a 2-minute song as children brush, or to have them sing one in their heads. When the song is over, they’re done brushing! Alternatively, parents can use a two-minute hourglass to help children keep track of how long they should brush their teeth. Some battery-operated or electric toothbrushes have a built-in timer, and will vibrate when it’s time for the child to move along to the next quadrant.

Make sure to use a toothbrush with soft bristles. Get a new one every three months. Some toothbrushes have bristles that turn pale when it’s time to change to a new brush.

If children become sick with a cold or the flu, buy a new toothbrush once the child is recovered. It’s a good idea to have several spare soft-bristled toothbrushes on hand in the home for this purpose. Buy a bunch when they go on sale.

Brush Their Teeth: Floss ‘Em, Too!

Floss your child’s teeth as soon as there are two teeth that touch. Do this once a day. Slip the floss between the teeth to remove food that gets trapped between the teeth, where a toothbrush cannot reach.

To floss, take a strand of floss between thumb and index finger, wrapping the floss around a finger at each end of the strand for good control. Insert the floss gently and curve it around each tooth, sliding it up and down along the insides of the teeth and just below the gum line. Use a new section of the floss for each two teeth, so as not to transfer plaque from one tooth to the next.

Even when children do a great job brushing and flossing, it’s important to have their teeth cleaned by a dental hygienist (hi-JEN- 7i ist) or dentist twice a year. A professional cleaning gets the plaque we might miss, even with the best of efforts. The dentist or hygienist can also give children tips on better techniques to use when they brush their teeth.

Red-headed brothers get a lesson in tooth brushing from bearded dentist

Limit sweets and starches to starve plaque of its favorite source of nourishment!

Brush Their Teeth: Water or Toothpaste?

You can begin using fluoride toothpaste for a child of 18 months, using a pea-sized dab on a water-dampened soft-bristled toothbrush. Children should be cautioned not to swallow toothpaste when brushing. Make sure that children spit the foamy mess of toothpaste and loosened plaque out into the sink.

Children can rinse their mouths out with water, after they brush0 their teeth. This gives them more practice at spitting!

Brush Their Teeth: Infants

An infant’s teeth should be brushed with a soft-bristled toothbrush moistened with water.

For an infant or very young child, hold the child in your lap, facing away from you, or stand behind a young child. The head should be tilted back so you can see the teeth. Brush their teeth gently with a circular motion, angling the bristles toward the gums.

Infant has his teeth brushed

It’s important to make tooth-brushing a fun time for parent and child, in order to avoid a situation where the child fusses and fights when it comes time to brush their teeth. You want the child to develop good dental hygiene habits right from the beginning. That’s the best way to prevent painful cavities and expensive dental work.

Let your child see you brushing your own teeth, night and day. Doing so sends a message to your child that this is something that everyone does and that it’s important.

Brush Their Teeth: Make it Fun!

Make tooth-brushing a fun time by gargling noisily or trying to sing songs as children brush their teeth. Roll your eyes and make faces at your child as the two of you brush your teeth together! Tell jokes. Do whatever you can to reinforce the idea that brushing teeth is fun and represents quality parent-child time.

Think of keeping your child’s teeth clean as having the same importance as wearing a seat belt in a car, or putting on sunscreen. If you feel this way, your child will come to feel this way, too.

If you can’t find a toothpaste your child likes, have children brush their teeth with plain water. Your child will still get the benefits of brushing.

How do you make brushing fun?

How do you keep kids from fussing at tooth-brushing time?

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Not All Babies Are Forgotten

Infant and toddler hot car deaths which we have, in the past, called “Forgotten Baby Syndrome,” is a topic that isn’t going away anytime soon. We’ve tried to raise awareness of these tragedies here at Kars4Kids with postings (here, here, here, here, and here) on the Kars4Kids educational blog for parents. We also created a free downloadable app, Kars4Kids Safety, to alert parents to the presence of a baby in the backseat of the car.

Our favorite resource for these efforts has, without a doubt, been Jan Null’s website, noheatstroke.org. That’s why it knocked us for a loop when Null reached out to us with a comment on one of these blog pieces, as follows:

“I am the creator and author of all of the material on http://noheatstroke.org.  First and foremost, all of the cases cited would not [be] due to infants and children being forgotten in vehicles. Only 54%* are forgotten. Secondly, while Forgotten Baby Syndrome is catchy, I have yet to find it documented as something unique in any peer-reviewed literature. It’s like saying Forgotten Car Key Syndrome is something unique when I’m stressed about going to an appointment! Yes, people do forget things and reminders are a great idea, but only for the just over half the cases where they are forgotten.”

Here’s where I’m going to drop the collective “we” and ‘fess up. I serve as contributing editor of the Kars4Kids educational blog for parents. I saw the phrase “Forgotten Baby Syndrome” some years back and thought: “I need to be using that phrase on the blog to help popularize it and raise awareness.”

To my mind, the biggest obstacle to raising awareness of babies dying in hot cars, is the knee-jerk response of parents who say “I’d never forget my baby,” because they think only bad parents forget their babies.

Parents who don’t understand or recognize the cognitive process behind memory failure don’t take precautions to protect their children from this eventuality, with often dire results. To my mind, branding the phenomenon was critical. It had to have a name for parents to latch onto, one that sums things up neatly.

So there I was, confronted with Null’s comment. “If I post it,” I thought, “that will only exacerbate the problem of parents thinking: this can’t happen to me. On the other hand, If I don’t post it, I’m being dishonest.”

I decided I’d write Null and tell him that. I wanted to see what he’d say. Besides, I wanted to know about the other 46% of babies who die in hot cars, but aren’t forgotten.

I wrote to Mr. Null explaining my conundrum about posting his comment and asking about that other 46 percent. He wrote:

“The other 46% are broken down into two categories, but neither of them are the result of forgetting.

  • 28% happen when children get into a vehicle on their own, typically when a car is left unlocked in the driveway or other nearby location.  This is why parents should be urged to lock cars, keep keys and fob out of reach and if a child is missing to always check cars (including the trunk).
  • 17% are when a parent or other caregiver makes a conscious decision to leave a child in a vehicle when they go do some other activity.  These have included getting their hair done, going to a bar, casino or racetrack, having a romantic rendezvous or going to work.

Null added, “I don’t doubt that 54% are forgotten, just that it is nothing unique.  We all have busy multitasking lives and parents do indeed have additional stresses but other than the tragic consequences is it any different than spacing out and forgetting our freeway exit?

“Finally, I really appreciate your efforts to raise awareness about this issue and for every baby’s life that might get saved is important. I have been involved in the issue, primarily pro bono, since 2001 and obviously feel it is an important one.”

“Forgotten Baby Syndrome” An Inaccurate Catchphrase

I saw Null was right: lots of babies who die in hot cars aren’t forgotten, so it’s inaccurate to say they died of “Forgotten Baby Syndrome.” The cognitive process that makes memory fail isn’t unique to parents, so it’s not correct to call it a “syndrome.”

“So where do I go from here?” I thought. “What are we going to call this thing?”

I decided to ask Dr. David Diamond what he thought. Considered the expert on forgotten babies, Diamond speaks and writes extensively on the subject, and has testified in trials of parents whose babies died in hot cars.

“I’m reluctant to post Null’s comment,” I wrote to Diamond, “for fear that parents will continue to believe that only bad parents forget their babies, and won’t take precautionary steps to avoid leaving their own babies behind in their cars.”

Diamond, incredibly, responded, suggesting that since the catchphrase is not always well-received and since, “leaving a child in a car is not an act of brain damage or pathology,” he no longer uses the phrase  Forgotten Baby Syndrome.

“I wrote an article here about the phenomenon and I didn’t mention FBS at all,” said Diamond. “There is no need for a peer-reviewed publication on the topic. Forgetting kids in cars is, in theory, the same brain processes involved in any other type of memory failure when the habit memory system outcompetes the conscious fact-based memory system.

“As to the 54% figure – sometimes kids play in cars and get themselves locked in, and other times parents forget kids. I don’t see why it matters. Both types of child deaths are preventable.  There are documented times when parents intentionally leave children in cars because they think the children will be safe. This clearly is poor judgment and is in a different category from forgetting kids in cars. I don’t see why 54% of the deaths caused by memory failures should be trivialized.

“Bottom line – memory is flawed, whether it’s remembering that our headlights are on or that our child’s in the car – being aware it happens to attentive loving parents is necessary to appreciate that we need technology to help us so that kids don’t die in cars and parents aren’t traumatized and incarcerated.”

“Good points all,” I responded in my next missive, “but it does seem like we need a name for this, even if we don’t call it a ‘syndrome.'”

Dr. Diamond heard me.

“I understand the need to have a catchphrase for this phenomenon, that’s why FBS was so appealing. But to have a phrase for it is flawed, first, because the word ‘syndrome’ medicalizes it as a form of brain abnormality, and second, FBS opens it up to ridicule, such as to compare it to ‘forgotten phone syndrome’, etc. It also makes it appear that parents don’t take responsibility for forgetting their kids by blaming it on FBS.

“Bottom line: it is in the general category of a failure of prospective memory, in which we plan to do something in the future, but we forget to do what we planned to do, which is the most common form of memory failure. The reason is not because we don’t care, it’s because we lose awareness of the plan. The insidious aspect of forgetting children is that our brain creates the false memory that we did complete the plan, that we did take the child to daycare. This is why parents go about their normal routine as the child dies in the hot car.

“At a neural level, forgetting a child in a car involves the same brain structures as forgetting to stop at the store on the way home (information is held in temporary memory to be used at a later time while the brain engages in habitual activity). The comparison may offend some, but only the magnitude of the consequences of the memory failures in the two examples is different – the brain structures involved are the same.

Forgotten? Time for a Phone Call

I returned to Null to get his take on Diamond’s position. We decided we had to speak on the phone. My transcript of that call:

Jan Null: If you look at my website, I’ve made a plea not to trivialize forgotten babies. But we have to be careful not to emphasize one factor at the expense of others. We can’t be looking only at that 54% and not be looking at the others.

By the same token, we shouldn’t think that if we have technology to prevent us from forgetting babies in cars, that this alone will solve the problem. It’s like advertising a fat-reducing pill and saying, “Take this, and you won’t be fat anymore,” it’s dishonest.

Every step along the way saves lives, but when one aspect of it is made to be the chief component the other half gets left out of the discussion. When we do that we’re trivializing and saying once we take care of the 54% we’ll only have to worry about the next 46%, as if that’s minor.

Null continued: Take technology and the new legislation: these laws and devices will take some amount of time to make their way to the entire population. It’s not instantly you’re going to have these devices in even 50% of these cars.

Once you have the technology, it’s got a limited application. I’ve written about this on my website: “It is especially important to note that these types of sensors/devices are aimed at the segment of the cases where a child is accidently forgotten (54%), but not the other half of the cases where children gain access on their own or are intentionally left in vehicles.”

The amount of penetration of this technology even within 10 years, well, half the cars on the road are 7 years old, so you’ll be siphoning new technology into maybe half the cars, at best. Even with your technology being put in cars you’re going to have underserved populations who are going to get it last. In areas where people can’t afford to buy cars every year? That’s where you’ll get the technology last. The distribution of technology is going to be skewed to the higher socioeconomic groups.

Null: The Guy Bringing Tools and Trends

As for finding a good term to describe forgotten babies, well, that’s not my specialty. I’m the guy bringing tools and trends. I’ve spent 17 years of my service as a weather forecaster and meteorologist looking at this issue. But that term “Forgotten Baby Syndrome” is misleading. It made people think it was something specific to parents and babies.

I think it was Weingarten who used “forgotten baby syndrome” first, but that’s branding. I’m the one presenting the data for the people who are in the sphere of heatstroke death, people going to congress, people running heatstroke prevention campaigns. Trends and patterns, that’s my part.

I develop trend lines.  If we’re looking at weather and heat patterns, the trend line is going up. The total number of deaths, on the other hand, has been flat for 17 years. The numbers have stayed at 37 or 38 average heatstroke deaths per year.* But it’s pretty much been a flat trend all the way back to 1998. That’s discouraging.

Me: Discouraging? I would have thought encouraging. That the number of deaths isn’t rising. That the trend line is flat rather than going up.

Jan: It shows we’re not doing a good job with awareness, of making parents aware of the problem. Things haven’t changed.

Me: Well, that’s why I say you have to have a name. If not Forgotten Baby Syndrome then something else. But you need to have a name.

Jan: But we have the words. We have campaigns. Phrases like “Look before you lock.”

Me: And the parents say, “I’d never leave my baby so I don’t have to look before I lock.”

Jan: It’s definitely a problem to make parents understand it could happen to them. There’s an urban myth, a story, don’t know if it’s true, that a spouse saw a device and bought two of them, one for the other spouse. The other spouse made the first one take his back. Because he’d never leave the baby in a car. You know where this is going, right?

But again, the branding of it, that’s not for me. What is important is we continue to educate people with statistics and blogs like yours. It’s not going to be a short process or a single device.

Me: How do kids get into cars on their own? They take the keys and find their way in?

Jan: Sometimes. Sometimes the car doors aren’t even locked. They just go into the car.

Me: And then can’t get out? Is that because of child locks?

Jan: Sometimes. They climb over into the backseat and then can’t get out. They don’t know they can get out of the car from the front seat at any time. And sometimes they just don’t make it out.

Me: They’re overcome?

Jan: Overcome by the heat, yes. Sometimes they want to get hold of the key fob and click. Was it Volkswagen that had the Darth Vader commercial of the kid with the key fob, who kept clicking [yes. V.E.]?

Sometimes the kid is looking for a quiet place. Or the parent has an appointment and can’t get childcare, so leaves the child in the car. Sometimes parents are going to a bar or a casino—they think they’re leaving the kids in a “safe” place. It’s intentional. There was a story of someone who had a court appearance, couldn’t get childcare, and left the child in the car.

Me: And when a child dies due to a parent leaving him a car, you never get over it. How can you live with yourself after that?

Jan: There’s a whole sociology to this. For instance it was a spouse or a childcare provider who left the child in the car. Whether or not the childcare provider was paid or just doing a favor.

There’s the crime and punishment issue. Allen Breed looked at this 10 years ago. How are these cases prosecuted? Do you say that causing the inadvertent death of a child is punishment enough? Or do you look at it like a murder? There’s a whole discontinuity in the way these cases are prosecuted. One court calls it a crime and another says it’s a memory failure.

“Forgotten Baby Syndrome” Officially Discarded

I thanked Jan Null for the generosity of his time. Essentially, both Null and Diamond agreed with each other. Forgotten Baby Syndrome was a catchphrase to be discarded. It’s inaccurate. And trivializes the other 46 percent of babies who die in hot cars for other reasons.

It seems we may never find the perfect catchphrase for this terrible thing. But raising awareness, now that’s a goal we can hold onto. We need to make Null’s trend line go down. Way down.

Starting now.

Found what you just read useful? Why not consider sending a donation to our Kars4Kids youth and educational programs. Or help us just by sharing!

*Source: Jan Null, CCM, Department of Meteorology and Climate Science, San Jose State University, http://noheatstroke.org

Choking Hazards for Toddlers

Choking is the fourth leading cause of accidental death in children under the age of 5. Choking occurs when children swallow something large enough to block their airways. When a child’s airways are blocked, the child will either find it difficult or impossible to breathe.

Choking may seem a simple problem for parents to understand and deal with. Parents know, for instance, that hotdogs pose a choking hazard to children. But how many parents think they solve the problem by slicing a hotdog into thin rounds?

The diameter of a child’s airway is around the same size as the child’s pinky finger. A thin round of hotdog could most definitely block that child’s airway, if swallowed whole. That is because the shape and texture of that slice of hotdog can make it act like a cork in a bottle, closing the child’s airway completely.

Cutting a hotdog can make it safe. But you have to understand the shape and size of your child’s airway to understand how to cut that hotdog. The smart way to do it is to slice the hotdog into four, lengthwise, and then into shorter pieces crosswise. These chunkier pieces, angled at the top, will make it past a child’s airway, even if the child doesn’t properly chew his food.

Food isn’t the only choking hazard for a young child, but it is a big one. That’s because most small children don’t do a good job of chewing their food. This means that any round, firm food is going to pose a choking hazard.

A parent might think that a grape, for instance, is a soft fun fruit that perfectly fits a child’s small hand and mouth. Grapes are so easy to pop into the mouth! But grapes are actually the perfect size and texture to block a child’s airway, if swallowed whole. An x-ray posted to Facebook by an Australian blogger illustrated this point better than any words might do.

Another food that could prove deadly to small children is nut butter. We all know how peanut butter sticks in our throats. A child’s throat is so slender that eating a spoonful of nut butter could seal it shut. For this reason, it is recommended to spread a thin layer of nut butter on a slice of bread or a cracker for the child, rather than offer up a spoonful of the stuff.

Foods to Avoid

Here is a list of foods that can be dangerous for children under the age of 4 years:

  • Thin, circular slices of hotdog
  • Whole grapes
  • Popcorn
  • A gob of peanut butter, for instance on a spoon
  • Hard candy
  • Gooey candy
  • Sticky candy
  • Marshmallows
  • Chewing gum
  • Nuts
  • Seeds (these can pass through the airway and into the lungs)
  • Raisins
  • Hunks of meat or cheese
  • Raw vegetables

Cutting Food

Because children tend not to chew their food very well, it’s important to cut food down to a size that won’t block their airways if swallowed whole. Pieces of food should be cut no larger than one half inch. Conversely, seeds and other very small items also pose a danger. “If the food item is small enough, and passes through the windpipe, it can settle in the lung, leading to lung collapse and pneumonia,” says Akram Alashari, a trauma surgeon and critical care physician.

If your child is teething and you use a topical anesthetic to numb the gums, don’t give food or drink for an hour or so. The numbing effect can interfere with the child’s ability to swallow and present a choking hazard.

Choking: Location, Location, Location

It’s tempting to let children walk around with food in their hands. It’s best, however, to make sure your child eats only at the table. When your child eats at table, she’s in an upright position. She’s also focused solely on the twin tasks of chewing and swallowing.

Another tempting place to give kids snacks is in the car. The problem with this is that if you are the driver, you may not notice if your child chokes while noshing on a snack in the backseat of the car.

Parents should always watch their small children when they are eating. A piece of food could block the child’s airway and you might not know about it if you’re in the next room, for instance. A child who is choking may not be able to speak or call out. Here it’s important to note that choking means that less oxygen is getting to the brain. It only takes four minutes of serious choking to cause permanent brain damage or even death.

Choking and Crawling

When babies begin to crawl, it’s time for parents to baby proof the home. Baby proofing is about seeing things from the baby’s perspective. Parents should be on the watch for small objects a baby might find while crawling and attempt to put in the mouth (and babies try to put everything into their mouths—it’s how they explore the world). Such objects should be placed far out of reach of babies since they pose a choking hazard.

Examples of small objects that pose a choking hazard include:

  • Toys with small parts that can break off or come apart
  • Toys that can be compacted to fit inside the child’s mouth whole
  • Coins
  • Marbles
  • Latex balloons
  • Caps from pens or markers
  • Small balls
  • Small, round batteries
  • Hair clips and barrettes
  • Beads and strings of beads
  • Medicine syringes
  • Buttons

Choking and Latex Balloons

It seems like the most natural thing in the world to give a child a balloon. That is until you learn that latex balloons are the leading cause of death by choking in children 8 years and under. Children have been known to inhale balloons while trying to inflate them. Children have also choked on pieces of broken balloons.

A child may chew on a balloon, causing it to burst, and pieces of latex might then be inhaled by the child. Because latex has a smooth surface, it can mold itself to a child’s throat, blocking the child’s airway so completely that the child cannot breathe.

The worst part about latex balloons and choking is that a Heimlich Maneuver won’t help the child in such a case and may even make the problem worse. That’s because any air that comes through is going to expand the pieces of latex so that they further cover the throat and airway. And of course, if you try to stick your fingers into the child’s throat to get that piece of latex out of there, you can end up pushing it farther in, still.

Now that you know how dangerous latex balloons can be for small children, be smart and buy Mylar balloons, the ones made out of shiny foil, instead. They’re easier to inflate and just as fun. The main difference is that the foil balloons aren’t dangerous to small children.

Toy Safety and Choking

Always make sure your child plays with toys that are appropriate for his age. Most parents read the package before buying a toy. But parents may not take into account age warnings when receiving hand-me-down toys. Secondhand toys may have been deemed safe for young children when they were first manufactured, but safety standards may have been changed or upgraded. Older toys may be damaged with pieces that can break off and pose a choking hazard.

If you have more than one child, it’s important to make sure that young children don’t have access to the older child’s toys. These may not be age appropriate and may pose a choking hazard to your younger child. A Lego piece, for instance, can be deadly to a small child, if a single piece is left on the floor or under a sofa cushion for the smaller child to find and swallow.

Toys that are small or have small parts can be tested with a small parts tester for suitability. A small parts tester is a tube. If the toy fits into the tube, the toy is too small to give to a small child and presents a choking hazard. Most fine toy stores carry small parts testers. Also watch recall lists to make sure that your child’s toys haven’t been deemed choking hazards since they were manufactured and purchased.

Parents and prospective parents would be wise to learn how to perform child CPR in case of emergency. It’s something you hope you’ll never need to use. But CPR can save lives, if not your child’s life, perhaps the life of a neighbor’s child.

Keep emergency numbers posted where you can easily find them. In case of choking, make sure to call 911 right away. Don’t wait for the situation to resolve on its own.

Found what you just read useful? Why not consider sending a donation to our Kars4Kids youth and educational programs. Or help us just by sharing!

Youngest. Donor. Ever. Teaching Kids Kindness

Modeling kindness to others may be a great way to teach kids empathy and how to do good deeds. But there’s modeling and modeling. Five year-old Anikan just got the lesson of his young life on going out of your way to do a kindness. Here’s the deal:

Anikan fell in love with the Kars4Kids jingle. He’d sing it all the time, his family would sing it with him. Kids are curious, and Anikan is no exception. He started asking questions:

What does donate mean?

Do they give those cars to the kids?

Anikan’s family understood that each of these questions and the boy’s interest in the subject in general, represented teachable moments. His family explained that Kars4Kids helps take used and unwanted cars from people, using the proceeds to help children. Anikan loved the way that sounded. He asked his mom if they could donate a car to Kars4Kids.

His mom said no.

But Anikan’s Aunt Lisa hated to see this impulse for kindness go to waste. She thought, “What if Anikan could raise the money to purchase a used car to donate to Kars4Kids? Now, that would be some lesson in charity and kindness.”

Anikan’s aunt decided she’d help the boy create a crowdfunding page. Lisa set the fundraising goal at $350. But she decided that if Anikan managed to raise that sum, she’d match it, penny for penny. Surely $700 would buy a decent used car, good enough to donate to Kars4Kids?

Kindness: Anikan Exceeded His Goal!

Naturally, the people at Kars4Kids got wind of this wonderful exercise in teaching a small child about kindness and we wanted to get involved. If you look at the crowdfunding page, you can see that Kars4Kids employees began chipping in, five dollars here, ten dollars there, and soon enough, Anikan had exceeded his goal.

We felt it important that he succeed, that he feel the feeling you get when you do something good for others, expecting nothing in return. So we helped. We also created a special version of the jingle, just for him, as you can hear here:

In the end, everything we do at Kars4Kids is about the kids. And we hope Anikan will, having gotten this amazing, young start at doing good, continue to do good all the days of his life, may they be long and productive.

If we can learn anything from this true-life tale of giving it’s that we must always be on the lookout for teachable moments where we can show by example, how to be kind to others. Sometimes we need to be creative to make the lesson stick. Sometimes we need to go the extra mile or spend some hard-earned money to get there.

We’re pretty sure Anikan will always remember his impulse to donate a car, how Aunt Lisa responded (we love that she spelled “kar” with a “K” on the crowdfunding page) and how the Kars4Kids people responded in turn. It seems that one good deed begets another.

Anikan? We’re proud of you. We’re expecting great things from you. We think you’re the luckiest little guy in the world to have a role model like your Aunt Lisa in your life.

She’s a keeper and so are you!

What are some of the ways you’ve demonstrated acts of kindness for your children?

Does Anikan’s story inspire you to do something similar with your child? Any ideas come to mind?

Found what you just read useful? Why not consider sending a donation to our Kars4Kids youth and educational programs. Or help us just by sharing!

Separation Anxiety: How to Cope

Separation anxiety describes the feelings and behavior of babies when parents leave them with caregivers. The baby experiencing separation anxiety may scream and cry as the parent tries to leave. This is normal behavior for babies around the age of one year.

Even though the behavior of a baby with separation anxiety is normal, it can be quite upsetting to parents to see a baby get so upset. It can help parents to know what causes the anxiety. It also helps both parents and baby to know how you can head off some of the stress and how you can lessen the baby’s trauma.

A young baby does great when left with a caregiver. Parents are more upset about the separation than the infant. As long as babies are kept dry, fed, and cuddled, however, they mostly adapt well to being cared for by others.

Things change somewhere between the ages of 4-7 months. This is when babies begin to understand the concept of object permanence. Until this point, when mom or dad leave the room, baby doesn’t understand that they still exist. If baby can’t see mom or dad, it’s as if they are gone for good. For this reason, baby may cry when mom goes into the kitchen, continuing to cry until she returns. Peekaboo is a good game for teaching object permanence.

Somewhere at around the age of 8 months to one year, however, the baby learns that Mom and Dad still exist even when they aren’t in the room. Even so, a toddler can feel afraid when a parent leaves. The parent is the center of the child’s universe. The one who helps the baby manage his life. It feels uncomfortable and scary when mom and dad aren’t around. This is true separation anxiety.

Now the baby will cling to you or cry even if you just leave the room for a minute to get something. If you try to leave the baby with a babysitter or drop her off at daycare, she’s liable to screech and give you a hard time, crying, “No, no, no,” and grabbing your clothes or your hand. She won’t look at the caregiver and will try not to accept her friendship or help.

Toddlers can experience separation anxiety at different ages. Some children may not experience separation anxiety until they are from 18 months to 2 ½ years old. Others may never experience separation anxiety. For some children, it’s not age but a new situation that triggers separation anxiety, such as moving to a new home; the divorce of the toddler’s parents and the accompanying tension in the home; a new baby sister or brother; or a new babysitter, daycare center, or caregiver.

How Long Does Separation Anxiety Last?

Separation anxiety can be short-lived or last for a very long time. A great deal depends on the child’s personality and how the parents handles the anxiety. An especially sensitive child may even experience separation anxiety all the way through the elementary school years.

If separation anxiety is still affecting your older child, consult your physician. It could be the separation anxiety is a symptom of an anxiety disorder. If the older child suddenly develops separation anxiety, this could signal that the child has a deeper issue, for instance, the child may be the victim of bullying or abuse.

Kids generally don’t like to see their parents leaving. This isn’t the same thing as separation anxiety. You can distract the child who doesn’t want you to leave by showing him a new toy, for instance, or telling him to look at the enormous bird that just flew by the window. The child with separation anxiety is much more difficult to calm and help. Still, it is crucial that parents don’t give in to children with separation anxiety by giving up plans, lest children learn to cry and freak out to keep parents from leaving.

It can be nice to see how much your little one loves and is attached to you. But it can make you feel guilty to leave her to go to work or out for fun. Don’t let this stop you from carrying out your plans, be they work or play. It is healthy for parents to have a life outside of home and family. It is healthy for babies to learn to cope as individuals, without their parents. It’s good for toddlers to learn to socialize with caregivers and people other than their parents.

After a time, your child will begin to feel more secure and understand that while you sometimes leave, you always return. This knowledge offers the comfort your child needs to help her conquer her separation anxiety. Also, every time you leave, your child is learning more about how to cope in your absence, and about how to be an independent being.

Here are some tips that can help ease your child’s separation anxiety:

Consider the Timing—Don’t start your child in daycare or with a new caregiver at the time your child is most likely to experience separation anxiety, between the ages of 8 months to one year. When you have to go somewhere and leave your child with someone else, try not to do it when your child is likely to be hungry, tired, or cranky. In fact, if you can, time your goodbyes for right after a nap or mealtime.

Do Things Gradually—Invite the babysitter over to meet your child and play with her while you’re in the house. This helps your child get to know the new person without separation anxiety. Next, plan a short trip to do an errand while your child stays with the sitter. That serves as practice for when you must go out for several hours. If your child will be starting at a new daycare center or school, bring her for a visit, and play with her there. That helps make everything more familiar for when you have to leave her there for the day.

Be Firm, Be Calm—Develop a ritual that you always use when you say goodbye. For instance, “See ya later, Alligator,” and “After a while, Crocodile.” Rituals make partings seem less sudden and new. Remind your child you’re going to come back, tell her when in terms she understands, for instance, “After naptime.” Be calm, but firm in your goodbye. This is reassuring. It shows your child you’re in control. If you appear guilty, on the other hand, your child is likely to feel even more nervous about parting from you, since you seem unsure about whether you’re doing the right thing to leave her.

Don’t Sneak Away—Make sure you say goodbye to your child, rather than sneak away. It’s important that your child sees you leave and also sees you come back. It’s important that she doesn’t think you’ll try to trick her if she isn’t watching carefully. It is hard to watch your child cry, but it’s critical she learn how to cope with goodbyes.

Do As You Say—Did you promise your child you’d be back before supper? Make sure you keep that promise. It is through keeping your word that your child learns to feel confident that when you leave, you’ll also come back. This teaches your child she can make it when you’re not around, that she can be just fine without you.

It’s no small thing to leave a child who is kicking and screaming and crying for you. That’s why you want to make sure you leave your child with a sitter or caregiver you trust—one who can handle anything. If it makes you feel better, have the sitter or caregiver call you when the child has calmed down. This will give you some idea of how long your child’s separation anxiety tantrums last. You can tell if the behavior is getting better or worse by the lengthening or shortening of the tantrums each time you go, over time. For the most part, the child will already be happily playing with the sitter by the time you’re starting your car.

Are you caring for a child with separation anxiety? See if you can distract the child with an unusual toy, or by playing a game. Try singing a song or making funny faces. Just keep trying new things until something works.

If the child you’re caring for struggles with separation anxiety, it’s best not to talk about mommy and daddy. If the child asks you when they’ll be home, you should answer her question. Then you can try to distract her. “Daddy will be home at 10. Who wants to draw a picture?”

If you feel unsure, remind yourself that like all phases of childhood, your child will outgrow her separation anxiety. Remember too, that separation anxiety is normal. Consider your child’s temperament and the specifics of the situation: is she shy?  Is she used to being cared for by others?  It may take your child a little bit longer to get over her separation anxiety. Even if the neighbor’s kid is already past that stage. And that is perfectly fine, perfectly normal.

Does your child reacts more strongly with a specific babysitter or caregiver or seems troubled even after your return? Does she refuse to eat, or find it difficult to fall asleep? There may be something wrong with the caregiver. Don’t be afraid to investigate the matter. You are your child’s only and best advocate. Sometimes it really IS the sitter.

If your child’s separation anxiety goes on way into the elementary school years or beyond, or it gets in the way of daily life, it may be time to talk things over with your child’s doctor. There is a mental health disorder called separation anxiety disorder that isn’t just a normal phase. Separation anxiety disorder is a rare condition in which children are afraid of getting lost and separated from their families for good. Someone with this disorder may have extreme fear that something terrible will happen to them and to their families. Signs of separation anxiety disorder include:

  • Panicky behavior (shortness of breath, nausea and vomiting) or having panic attacks when a parent is about to leave.
  • Having bad dreams about being separated from family
  • Being afraid to sleep alone
  • Being excessively worried about becoming lost or being kidnapped
  • Being afraid to go anywhere without parents

Most children learn to be without their parents without a freak-out and without need for a doctor’s visit. If you aren’t sure about your child’s behavior, it’s always a good thing to talk to a caring doctor. It’s more than likely your child’s doctor will tell you that your child’s separation anxiety and behavior are completely normal. Separation anxiety is your child learning how to be independent. It’s part of the process of growing up.

Pacifier Pros and Cons From a Mother of 12

Pacifiers may be a good or bad thing, depending on what expert is weighing in at the moment. Which is the problem with a lot of parenting advice. But as a mother of 12 babies who cried more often than not, I can tell you that pacifiers were a lifesaver for me.

Pacifiers gave my babies the extra sucking they needed for comfort when their bellies were already full. A longer feeding would have meant more milk. More milk would have meant more gas. More gas would lead to even more crying. Besides, I had (and still have) a rather low tolerance for crying. The pacifier stopped the crying. That meant for a much less stressed mom (me).

In addition to the gas factor from too much milk, breastfeeding for me meant soreness and even breast infections in the early postpartum days. I needed to give myself a break here and there for air and healing. The pacifier gave me that bit of a break from breastfeeding.

The experts would tell me that longer suckling didn’t mean more milk, since most of the milk comes in the first several minutes of nursing and after that, it’s not a significant enough amount to be causing my baby gas. They would tell me that soreness came from poor positioning. But let me tell you, I nursed all 12 of my children, and nursing longer did upset their tummies. Also I worked hard at positioning, and nothing I did ever made a difference. I’m fair-skinned, and cracked nipples due to nursing were unavoidable.

Then there was the myth that pacifiers cause nipple confusion. If I gave my baby a pacifier, this would make it difficult for the baby to nurse, since these were two differently shaped objects and the baby wouldn’t be able to adapt. Nonsense. All my babies adapted just fine to having both.

Finally, I had a nursing expert insist to me that pacifiers were deadly. That several babies had arrived at the emergency room, dead on arrival, with pacifiers down their throats. I searched in vain for such an occurrence. The fact is, it never happened. (Old wives tale #162. Apparently.)

I learned with my first that you had to find a pacifier that was small enough that it wouldn’t set off the baby’s gag reflex. I also found you had to give the pacifier very early on, or the baby wouldn’t take to it. I’d buy and sterilize  a few pacifiers and stow them in a clean baggie in my hospital bag, giving it to the baby between feedings, and that worked very well for me.

I spent some time researching current thought on pacifier use just now and saw that while some of the advice fits with my experience as laid out above, some of it definitely does not. My advice is to do what feels best to you as a mom. Listen to what your heart tells you and you won’t go wrong. With that said, here is a list of pros and cons regarding today’s view of pacifiers:

Pacifier Pros

  • A pacifier may calm a crying baby. Some babies are only happy when they are sucking. Yet they can’t be eating all the time! The pacifier offers extra sucking without causing infants to eat beyond what their immature little tummies can handle.
  • A pacifier can serve as a distraction. The baby has just had a vaccine or a blood test and is crying. Stick the pacifier in the baby’s mouth and voila! The baby has already forgotten all about the discomfort from the medical procedure and is quiet once more.
  • A pacifier can help your baby fall asleep. Some babies fall asleep at the breast and as you try to ease them into their cribs, they awaken. If you can slip the pacifier into the baby’s mouth, you may just be able to get that baby into bed without him waking up. Also, if the baby awakens, sometimes putting the pacifier in the baby’s mouth will help the baby fall back asleep.
  • A pacifier can keep the baby’s ears “open” while flying. An adult can chew gum or hold his nose while swallowing, but a baby can’t do anything intentional to ease the ear pain that comes with pressure changes. Sucking a pacifier can help prevent the ear pain associated with air travel.
  • A pacifier may cut your baby’s risk for sudden infant death syndrome (SIDS). Research suggests that babies who use pacifiers when napping and sleeping have a lower risk for SIDS.
  • The pacifier habit is easier to break than the thumb habit. Some say that it’s easier to stop sucking a pacifier because it’s not a part of the baby’s body, unlike the thumb. You can just throw it away and then it’s not always “there.” Others say that with thumb-sucking, there is sensation experienced in both thumb and mouth, making it a more difficult habit to break than the pacifier which gives sensation only in the mouth. Probably both these ideas are true, making it easier to surrender the pacifier than the thumb.

Pacifier Cons

  • A pacifier can cause nipple confusion in the early days after birth. The shape of a pacifier is different than the shape of the nipple. Offering both before nursing is well-established can confuse a very sensitive baby and interfere with the baby’s nursing. Anything that complicates breastfeeding in the first few weeks and months can make developing a steady milk supply difficult.
  • A baby can become dependent on the pacifier. If your baby becomes used to sleeping with the pacifier, you may find he awakens every time the pacifier falls out of his mouth. That means you may find yourself running to the baby in the middle of the night, every time he loses the pacifier, to put the durned thing back in the baby’s mouth. That kind of defeats your purpose, since the idea of the pacifier is to help the baby be calm and sleep, and not for the pacifier to become something else that makes the baby cry (when he loses it). Not to mention, the pacifier is supposed to give you more sleep by giving the baby more sleep. Getting up every five minutes to stick the binky in the baby’s mouth just isn’t going to cut it.
  • Pacifiers may increase your baby’s risk for middle ear infections. The pacifier may cause middle ear infections. Middle ear infections, on the other hand, tend to be lowest during the baby’s first 6 months—the time when your baby is liable to need the most sucking. Also, the risk for SIDS is at its highest during this time period, when the pacifier may actually cut the baby’s risk for this deadly syndrome. If after 6 months, the baby seems to be prone to middle ear infections, that can be a good time to wean baby from the pacifier.
  • Long-term pacifier use can lead to problems with a child’s bite. Bite problems, yes. But we’re talking years here. If you can get your baby to give up the pacifier by even the very late age of three years, there shouldn’t be any dental problems at all.

Pacifier Tips

If you decide to give your baby a pacifier, remember to:

  • Opt for a pacifier that is one-piece and made of silicone. A one-piece pacifier is less likely to pose a choking hazard in the event there is breakage. Silicone pacifiers are dishwasher safe and easier to keep clean and sterile.
  • Keep several, identical back-up pacifiers. Pacifiers get lost. If your baby is dependent on the pacifier, you’ll want to make sure you have a spare on hand—or even two or three!
  • Sterilize pacifiers in the early months. Wash pacifiers with soap and water and then boil for five minutes in a pot of water or run through the dishwasher—even when they’re new and never been used. When your baby is older, soap and hot water will be enough to keep the pacifier clean. Wiping a pacifier on your shirt tail or licking it “clean” are definite no-no’s.
  • Don’t dip the pacifier in honey or other sugary substance. Honey isn’t safe for babies and anyway, the extra sugar is bad for their developing teeth and tummies. It’s just a bad habit, period. You don’t want them addicted to both the pacifier and some sugary sweet dip.
  • Watch the pacifier for signs it needs replacement. Pacifiers can deteriorate which makes them dangerous. Also, babies age out of pacifiers, needing larger ones as they grow.
  • If you use a pacifier clip, make sure the chain or strap isn’t long enough to become wrapped around the baby’s neck. Don’t improvise a pacifier clip with a string and pin, because it isn’t safe!

Helping the Baby Transition to Life Without Pacifier

Some babies are kind enough to give up the pacifier on their own somewhere between the ages of 2 and 4. Other babies need a bit of help from their parents to stop the pacifier habit. How you help them depends on their age:

Infants. Try rocking or singing to the baby. Swaddling the baby in a blanket can help calm a crying baby. Infant massage can also relax a stressed-out infant.

Older babies and toddlers. A “lovey” or a toy or blanket that the baby loves to hold and cuddle can serve as a substitute for the pacifier, acting as a distraction when the baby is needy.

Older toddlers and children. You might devise a ceremony to say goodbye to the toddler. Perhaps you might wrap it in a special box, sing a goodbye song, and put it on a high shelf. You might offer to exchange the pacifier for a special gift your child wants, for instance a tricycle. It can also be helpful for the dentist to have a talk with the older child. At this point, the pacifier can cause real damage to the child’s teeth and bite. Sometimes, the explanation is more readily accepted from the dentist than from the parent—coming from the parent, the child can see it as a power struggle, not so from the dentist.

Still can’t get the child to give up the pacifier? Speak with your child’s doctor for advice.

Found what you just read useful? Why not consider sending a donation to our Kars4Kids youth and educational programs. Or help us just by sharing!

Forgotten Baby Syndrome Statistics 2016

The year 2016 is coming to a close and we’re no closer to solving the problem of Forgotten Baby Syndrome (FBS). We know this because as the year comes to a close we find that the total number of U.S. heatstroke deaths of children left in cars in 2016 is actually higher than average. That number would be a very shocking 39 deaths, when the average is 37 deaths in one year.

Yes. A full 39 infant deaths have occurred in 2016 (as of this writing) due to these babies having been left behind in cars. That’s in spite of all the articles written to raise awareness of the subject. It’s also in spite of all the organizations and experts devoting their time to the problem of FBS.

The phenomenon of Forgotten Baby Syndrome came into its own in 1998. That is when we began to sit up and take note that babies were dying of heatstroke after being left behind in cars. It was happening often enough that the problem needed to be addressed. Since that time, 700 babies have died of heatstroke after being left behind in cars.

In 2013, there was a spike of 44 infant deaths from FBS, which was followed by a slew of articles on the subject. That information campaign seemed to make a difference. The following year, 31 babies died from Forgotten Baby Syndrome, and the year after that, “just” 24.

It looked like we were getting somewhere.

But now the number of mortalities has jumped again. This suggests that parents are still in denial about the roots of Forgotten Baby Syndrome. They don’t believe that the cognitive process that causes Forgotten Baby Syndrome is involuntary. They don’t think it can happen to them.

Therefore, they refuse to take precautions against Forgotten Baby Syndrome. Those precautions run the gamut from leaving a cell phone in the backseat of the car, to free apps, such as Kars4Kids Safety. It’s actually predictable: parents will read this paragraph and think, “Why would I remember my cell phone but not my baby? I would never forget my baby and leave him/her behind in my car.”

They don’t get it. They don’t understand, or perhaps they don’t believe the cognitive process, as outlined by Prof. David Diamond, that is the root cause of Forgotten Baby Syndrome, exists:

“The quality of prior parental care seems to be irrelevant. The important factors that keep showing up involve a combination of stress, emotion, lack of sleep and change in routine, where the basal ganglia is trying to do what it’s supposed to do, and the conscious mind is too weakened to resist. What happens is that the memory circuits in a vulnerable hippocampus literally get overwritten, like with a computer program. Unless the memory circuit is rebooted—such as if the child cries, or, you know, if the wife mentions the child in the back—it can entirely disappear.

“Memory is a machine,” says Diamond, “and it is not flawless. Our conscious mind prioritizes things by importance, but on a cellular level, our memory does not. If you’re capable of forgetting your cell phone, you are potentially capable of forgetting your child.”

Diamond is speaking of executive function. This is the brain on autopilot doing the myriad things we do in our day that we barely think about. Things like getting up, taking a shower, driving to work, doing errands, and so forth. Now throw in something extra, like dropping off the baby at daycare, the one day in the week you do it instead of your spouse, and add in some stress, poor weather conditions for driving, and sleep deprivation and you’ve got a recipe made in hell. A recipe for Forgotten Baby Syndrome, that is, in which the working memory is overwritten by an automatic brain process that is not something we, as human beings, can consciously fight. It happens without our knowledge, consent, or awareness.

As long as we don’t believe that and don’t take precautions to protect our babies in the event it happens to us, it, Forgotten Baby Syndrome, will keep happening to our precious babies, Heaven forfend.

Some stark facts and figures:

Forgotten Baby Syndrome Death Statistics

  • Total number of U.S. heatstroke deaths of children left in cars, 2016: 39
  • Total number of U.S. heatstroke deaths of children left in cars, 2015: 24
  • Total number of U.S. heatstroke deaths of children left in cars, 1998-present:  700
  • Average number of U.S. child heatstroke fatalities per year since 1998: 37

Forgotten Baby Syndrome Circumstances of Death

Examination of media reports on 700 Forgotten Baby Syndrome deaths in the 19-year period of 1998 through October 2016 suggest the following circumstances:

  • 54% – child “forgotten” by caregiver (376 Children)
  • 28% – child playing in unattended vehicle (198)
  • 17% – child intentionally left in vehicle by adult (120)
  • 1% – circumstances unknown (6)

Forgotten Baby Syndrome Ages of Victims

Babies who died from vehicular heatstroke in the United States from 1998 to October 2016 range in age from 5 days to 14 years.  Over half these deaths are for children under the age of 2 years.

  • < 1-year old = 32% (225)
  • 1-year old = 22% (154)
  • 2-years old = 20% (136)
  • 3-years old = 13% (92)
  • 4-years old = 6% (42)
  • 5-years old = 3% (23)
  • 6-years old = 1% (9)
  • 7-years old = < 1% (3)
  • 8-years old = < 1% (3)
  • 9-years old = < 1% (2)
  • 10-years old = < 1% (3)
  • 11-years old = < 1% (2)
  • 12-years old = < 1% (1)
  • 13-years old = < 1% (1)
  • 14-years old = < 1% (3)
  • Unknown = < 1% (1)

Forgotten Baby Syndrome Preventive Laws

  • 20 states now haveUnattended Child Laws that specifically address the issue of leaving a child in a vehicle, unattended.
  • The remaining 30 states have not yet created specific laws to address the problem of leaving a child in a vehicle, unattended.
  • 14 states have proposed to adopt unattended child laws.
  • 10 states now have “Good Samaritan Laws” that make use of specific language to protect anyone who sees a child in a car and subsequently attempts a rescue.

Forgotten Baby Syndrome Charges and Convictions

A 2005 Associated Press (AP) study looked at the frequency of prosecutions and length of sentences in infant hyperthermia deaths and found that:

  • Charges were filed in 49% of Forgotten Baby Syndrome deaths with 81% of them resulting in convictions.
  • In cases involving paid caregivers such as childcare workers and babysitters, 84% were charged with 96% resulting in convictions.
  • Only 7% of all cases of Forgotten Baby Syndrome involved drugs or alcohol.

Forgotten Baby Syndrome Heatstroke Facts

Heatstroke occurs when body temperature rises above 104 degrees Fahrenheit. At this temperature, the body can no longer regulate its own temperature.

Symptoms of heatstroke:

  • Dizziness
  • Disorientation
  • Agitation
  • Confusion
  • Sluggishness
  • Seizure
  • Hot dry skin (skin flushed red, not sweaty, hot to the touch)
  • loss of consciousness
  • rapid heartbeat
  • hallucinations

When the core body temperature reaches 107 degrees Fahrenheit or higher, the body’s cells will become damaged and the body’s internal organs will stop working. Once this happens, death comes quickly.

Children’s bodies are not as efficient as adults at regulating body temperature. A child’s body temperature rises at a rate that is 3-5 times faster than an adult’s.

Forgotten Baby Syndrome: How Closed Cars Heat Up

From a 2002 heat study, the average elapsed time and resulting temperature rise inside closed cars:

  • After 10 minutes ~ 19 deg F
  • After 20 minutes  ~ 29 deg F
  • After 30 minutes ~ 34 deg F
  • After 60 minutes ~ 43 deg F
  • From 1 to 2 hours ~ 45-50 deg F
  • From 2 to 4 hours ~ 50-55 deg F

Summary:

  • Two-thirds of the heating of a closed car occurs within the first 20 minutes
  • “Cracking” the windows had little effect (lowered the heat rise by fewer than 3 degrees)
  • The color of the closed car’s interior has a significant effect on how high the temperature rises

Don’t be in denial. Take simple steps to prevent Forgotten Baby Syndrome, even if you don’t believe it could happen to you, or to your baby! Put your wallet, cell phone, or purse in the backseat of your car. It’s an extra step that will make you stupid, but keep your baby alive, when your brain is overwhelmed and goes on autopilot. You don’t have to believe it. You just have to do it.

So do it, and save a life.

(Source for cited statistics: Jan Null, CCM, Department of Meteorology and Climate Science, San Jose State University, http://noheatstroke.org)

How to Stop Thumb Sucking In Older Children

Thumb sucking is a problem in the older child. Parents know that their children need to stop once they get to a certain age. But parents may not know an effective way to make help their children break the habit. After all, it isn’t easy to stop thumb sucking when a child has been doing it for years, ever since he or she was a baby. You may well wonder: why do babies suck their thumbs, anyway? And why is thumb sucking so addictive?

Thumb sucking is a wonderful comfort to babies who need more sucking than they can get from their feedings. It’s also resourceful. A baby doesn’t need an adult to show him how to suck his thumb. It’s something he can figure out on his own. And it’s something he can do to make himself feel better, no adults needed, thank you very much.

Babies do need lots of sucking. But a baby can only suck so much, drink so much milk, from the bottle or breast. When baby’s full, he has to stop feeding or he’ll get a tummy ache.

Thumb sucking, on the other hand, won’t give baby a tummy ache. That’s even if he sucks his thumb for hours on end. Also, unlike say, the pacifier, the thumb is always around. It can’t get dropped or lost. (Maybe that’s why some babies suck on their fingers or thumbs even before they are born.)

That’s all well and good, but at a certain point, kids become too old for the comfort of the thumb. Thumb sucking is literally for babies. Taken too far, the habit can affect a child’s bite (and his social life). The American Academy of Pediatrics says that treatment for dental problems caused by thumb sucking is generally needed only in children who continue to suck their thumbs past the fifth birthday.

The question is: how do you make them stop? How do you get your kid to break the habit and stop sucking his thumb? That is before he wrecks his teeth (and loses all his friends)?

Thumb Sucking and Peer Pressure

First of all, take heart: a lot of children stop sucking their thumbs between the ages of 2-4 just on their own, with no prompting. Past that age, an older child is going to hear about it if he is still sucking his thumb. The other children his age may even refuse to play with him, because his thumb sucking makes him a “baby.” It may seem harsh to us adults, but this is how children learn the social code of their society. They learn how to act around kids their own age through the teasing and insults of their peers.

Such peer pressure should make the older child stop sucking his thumb soon enough. At least during the day when the child is in school or on the playground. The older child may however, still continue to suck his thumb in his sleep, just as he did when  he was a baby. Some older children may manage to stop sucking their thumbs most of the time, but resume the habit when they are under stress.

As the child begins to put limits on his thumb sucking, parents can begin to take heart. The child is gradually moving away from thumb sucking altogether. During this time he will find new ways  to comfort himself.

The Teeth

Thumb sucking usually doesn’t cause problems with a child’s bite until the permanent teeth are in. At this point, thumb sucking can change the shape of the roof of the mouth (the palate). Thumb sucking after the permanent teeth are in can also affect the way the teeth line up inside the mouth (alignment). It should be noted that very vigorous thumb sucking can also affect a child’s baby teeth. A child who is still sucking his thumb at age 5 should be seen by the dentist.

Here are some tips to help the child over four years of age break the thumb sucking habit:

Have a conversation about thumb sucking. . . Explain to your child that thumb sucking can affect the bite and may also cause the kids to make fun of him. Ask your child how he feels about that. Does he want to stop sucking his thumb? What can he do instead of thumb sucking, when the urge to put his thumb in his mouth comes on?

. . .then ignore it. Some kids suck their thumbs to get attention. They want to see what you will do. They want to see if you’ll get angry at them. Or if you’ll sit down and have a nice long chat about thumb sucking, which is also a form of attention.

Arrange a chat with the dentist. Having the dentist talk to your child about how thumb sucking can hurt his bite may have more of an impact on your child than a talk with you. The dentist wears a white coat and seems important. Your child may accept the advice he stop thumb sucking from the dentist. The dentist may also be able to fit your child for a mouth guard to help prevent thumb sucking.

Do something nice when they try hard. If your child takes steps to stop the thumb sucking, show your child you’ve noticed. Take your child for a walk, or read his favorite book to him in the middle of the day (instead of waiting for bedtime). Let your child mark each day he succeeds in not sucking his thumb on a calendar you provide for this purpose.

Offer a substitute for times of stress. Does your child sucks his thumb when he’s upset or stressed out? Try a cuddle or comforting words. You can bring your child a stuffed animal or a pillow and suggest he give it a squeeze.

Remind him oh-so-gently. If your child forgets and begins to suck his thumb, suggest he stop in as gentle a tone and words as you can muster. Don’t insult him or make him feel bad about this lapse. If it happens in public, wait until you get home to say something. At home, you can suggest the two of you have a special signal for when that happens (for instance: blink three times, tug on an ear, touch the tip of your nose).

Make thumb sucking unpleasant. Remember Violet from the Peanuts cartoons? Her Italian grandma put chili pepper on the children’s thumbs to get them to stop their thumb sucking. You can try applying vinegar, which makes the thumb taste different without being too spicy. Or you can try putting a bandage on the thumb.

Patience is a virtue. Finally, remember that thumb sucking is a habit and a hard one to break. It’s more difficult to stop thumb sucking than to stop using a pacifier. With the pacifier there is only oral sensation. With thumb sucking there are two sensations: the feeling in the mouth and the feeling in the thumb. That makes a thumb sucking habit doubly difficult to break.

When you feel like nothing is going to make your child quit sucking his thumb, take a deep breath and compose yourself. Getting upset and putting pressure on your child is not going to get him to stop sucking his thumb. In fact, such behavior may even delay your child’s progress. Besides, once your child goes to school, it’s almost certain peer pressure will do what you could not. The other kids will, with their teasing, get him to stop the thumb sucking, for good.

Sensory Play: It’s Summer!

Sensory play is about playing games that stimulate the senses. Children use their senses to understand the world they live in. Sight, smell, hearing, touch, and taste offer different ways for children to experience their surroundings.

Sensory play is also important for developing the senses themselves. As children use their senses, they learn how to make sense of the various stimuli that come at them from different directions. A child who plays sensory games that involve sense of smell, for instance, will develop his sense of smell. The child will learn that some smells are pleasing (flowers, fruit) while other smells may signal danger (cooking gas). The child will also sharpen his senses so that eventually, he can tell the difference between grape and lemon scents.

That’s just sense of smell, but the same is true of all the senses. If you think of a baby who puts everything in her mouth, you understand this immediately. The child must be given things that are safe to put in the mouth, because at that stage, everything is going to end up in her mouth. You wouldn’t, for instance, put a baby of that age in the sandbox, because she’s going to put sand in her mouth. This is how, at this age, she learns about her environment. She learns, for instance, that some things don’t taste very good!

Using the senses, develops the senses. This is true for all children. Some children, however, have issues with sensory integration. These children may have autism or sensory integration dysfunction disorder. The disorders may make it difficult for children to understand and organize the stimuli that come at them by way of the five senses. Think of how some people can’t stand the sensation of a wool sweater against their skin. Children with sensory integration difficulties may need labels cut out of their clothing, and may only be able to tolerate certain fabrics.

Sensory Play Offers Extra Practice

That’s just a single example of a sensory issue relating to sense of touch. A child may find certain sounds too stimulating and may need to wear earphones to block out the background noise in his environment. For these children, too, sensory play offers extra practice in sorting out the senses.

During the summer, children can lose ground in their learning. This is a good time to offer them sensory play time. Sensory play doesn’t feel like learning. It feels like fun. It is fun.

Meantime, sensory play can help build your child’s vocabulary by adding words like sour, salty, bitter, and sweet. Water can be cold, hot, wet, frozen, blue, still, or move in waves. A tree’s bark may be smooth or rough.

Sensory play can also help your child develop fine motor skills. Playing with sand, clay, or a bowl of noodles can help develop these senses as kids pinch clay, pour sand, or pick up a noodle, for instance. This sort of play readies a child for tasks like writing, tying shoes, zipping zippers, and buttoning buttons.

Sensory Play Helps Calm

Sensory play also has a calming effect on children. This is the reason your child is calmer after a bath, or after hard outdoor play, or jumping on his bed. Working the senses is known to help children cope with the discomfort of fatigue, restlessness or boredom, for instance.

Create An Edible Sensory Experience

Here is a recipe for Edible Sensory Playballs, from Emma and Trish over at the Mud Kitchen. These playballs are awesome because they stimulate all five senses: taste, touch, smell, sight, and hearing. Most of all, kids have a blast learning while they play.

Prepare the playballs a day before you plan to use them, as they need time to set.

You’ll need:

  • Jello in assorted flavors
  • Ice ball molds in two different sizes
  • A large tray or tub
  • Bowls (for half spheres)

Mix jello in separate batches to keep colors and flavors separated, and using slightly less water than called for for a firmer consistency. Pour the jello mixture into ice ball molds and/or bowls.

When jello is set, empty the molds and bowls onto a large tray and let the kids at ’em. They are irresistible. In fact, you’ll want to get in on the fun along with them, and so will all the other adults in your home!

There will be all these awesome fruity smells and colors and textures. Kids will dive right in to smash the balls flat or squish them between their fingers. They’ll want to do a taste-test, too, which is all part of the fun.

Note that jello also makes funny, delightful sounds as you mess with it on the tray.

Yellow Babies? What’s Up With That??

Yellow babies are babies with jaundice. Jaundice occurs when a baby has too much bilirubin. As bilirubin builds up inside the baby’s body, the baby’s skin and even the whites of his or her eyes may turn yellow. A new mother may notice her baby’s skin is yellow in color around two or three days after the birth.

Yellow babies are common, as jaundice affects around 60% of full term newborns. Babies born early are even more likely to get jaundice as are babies who are sick. Most of the time, yellow babies are healthy and the jaundice goes away after a week or so.

Unless the level of bilirubin is very high, the yellow color is normal and the baby will be just fine. Some yellow babies will need treatment. The main treatment for jaundice is phototherapy (light therapy), in which the baby is placed under bright lights.

Yellow Babies: How It Happens

Our bodies are making and breaking down red blood cells all the time. This happens in babies, too. The hemoglobin in red blood cells, for instance, is broken down into different waste chemicals. One of those chemicals is bilirubin.

Before the baby is born, the placenta carries the bilirubin out of the baby’s body and into the mother’s blood. The mother’s body handles the more difficult task of filtering this waste product and getting rid of it. But after the baby is born, the newborn’s liver must suddenly take on this task. The baby’s liver may not be quite mature enough to handle all that tough work.

As a result, it takes more time to flush out the waste, and the bilirubin levels build up in the baby’s body. That is what causes the yellowing of the skin and eyes. In fact, all babies have a higher than usual bilirubin level for some days after birth. In a normal healthy baby, this is not cause for concern, and there may not be any noticeable change in color. Even where there is yellowing of the skin/eyes, the level of bilirubin may not be high enough to worry about.

If the baby has a lot of bruising, from a rough birth, for instance, there may be a high number of damaged red blood cells. These blood cells need to be broken down in order to clear the way for new red blood cells. As the blood cells are broken down, the baby’s bilirubin levels can climb.

Yellow Babies And Breastfeeding

Some yellow babies, around 5% of them, are breastfed babies. These babies can have a mild jaundice that is persistent, and takes a few weeks to clear up. It is thought that a protein in breast milk may cause bilirubin levels to remain high, though not so high as to harm the baby.  Also, a mother’s milk takes a few days come in. During this time, the baby may not be getting enough calories and fluid to flush out the bilirubin as quickly as usual. This too, can cause bilirubin levels to stay high, though not high enough for concern.

Other Causes Of Jaundice

Premature babies and babies sick for one reason or another, for instance, infection, may also have higher than usual levels of bilirubin. Yellow babies may also be the result of babies with different blood groups than their mothers. The level of bilirubin is less important than the general health of the baby. A healthy, fully mature baby with a higher level of bilirubin may do just fine, while an early or ill baby may develop further health issues.

In addition to the yellow coloring of their skin and sometimes eyes, yellow babies may seem sleepier than usual and they may not want to feed much. Getting babies to feed often and long is important. Lots of liquid nutrition can often do the trick of bringing down the bilirubin levels with no need for any other treatment.

The bilirubin levels have to rise quite high to cause damage. But unchecked, very high bilirubin levels can affect the parts of the brain that control vision, hearing and movement (kernicterus).

Now that babies are sent home a day or two after birth, mothers need to be on the watch for jaundice. The yellowing first appears on the baby’s face and head. If the level of bilirubin rises, the yellowing will then show on the baby’s body. At very high levels, there will be yellowing on the baby’s palms and on the soles of his or her feet.

If you’re not sure your newborn baby is yellow, there’s an easy way to tell. Simply press the tip of your finger (gently!) on the tip of the baby’s nose or forehead. Watch as you lift your fingertip away. If the baby’s skin looks white, the baby is fine. If the skin appears yellow, call your baby’s doctor.

If the doctor agrees your baby may be jaundiced, a blood test will be done to see the level of bilirubin in the baby’s body. The doctor will decide whether the baby needs treatment depending on the level of bilirubin and the baby’s health. If the baby is full term and healthy, the doctor may decide to keep a watch on the baby and the baby’s bilirubin levels.

Most yellow babies won’t need treatment. Their livers will mature and learn to break up the bilirubin so it can be broken down and flushed out of the system through the gut. But in the event that the baby’s bilirubin levels continue to climb, phototherapy is an effective treatment.

In jaundice, some bilirubin is just beneath the skin. In response to light, the bilirubin can turn into a different chemical that is easier to clear out of the baby’s body. A baby may need phototherapy for a number of days. This type of therapy works well and is quite safe.

During phototherapy, the nude baby is placed in a bassinette under lights. The baby’s eyes are covered so the light won’t be uncomfortable. Nursing or feeding often is to be encouraged during this time. If you’re breastfeeding, aim to feed the baby between 8 and 12 times a day for several days.

Yellow babies will receive blood tests daily to measure bilirubin levels. This will tell the doctor when the baby can stop phototherapy, assuming the baby responds well and levels of bilirubin are falling. If bilirubin levels become very high, the baby may need a blood transfusion, perhaps from the mother. This almost never happens.

Doctors used to recommend that yellow babies spend time in the sun. Today, this is no longer done. Sun exposure can burn the baby’s delicate skin and the sun may overheat the baby. Phototherapy is much safer, more controlled.

Did you have a newborn with jaundice? What was your first thought when you saw the baby becoming yellow?