A Parent Playbook Resource
Live Q & A with Dr. Dina Kulik
Recorded August 4, 2021
ABOUT THE AUTHOR
Dr. Dina Kulik, MD, FRCPC, PEM
Pediatrician, Emergency Doctor
Dr. Dina Kulik is a mother, pediatrician and pediatric emergency medicine physician in Toronto. She is the Founder of Kidcrew, a multidisciplinary clinic for children. She is Canada’s leading child health media expert. Her greatest joy is her family and being the mom of four active, happy boys.
Recorded August 4, 2021
Hi guys. Thanks for joining us for anyone that is here already. Please let me know where you’re from. How many kids you have, how old they are.
I’d love to kind of get a, you know, understanding of who’s with us and you know, what kind of problems you guys might be facing as parents and what topics you might want to hear about.
And then we can get going, certainly like, you know, make yourself comfortable, get yourself some water or a tea or a drink or something. And I’m happy to answer any questions you guys have about kids’ health and BB health and anything you want to know about. I am happy to help. So welcome and nice. I see you guys. Hi Jen.
So Jen has a four-year-old from Mississauga. That’s awesome. And John is asking some questions already. I’ll get to those quite soon.
Jacqueline says hi, Dr. And I live in Toronto and I have an 18-month-old son. So fun. I love 18 months. My favorite age is like 18 months to three years. So they can be challenging, right? They have their meltdowns and their toddler kind of issues, but they’re also so fun. They know they’re learning so much and they’re like starting to talk and become like little people.
And anyway, I just love that 18 months is such a fun age. So welcome. Thank you, Jacqueline. So we ask any questions you guys have, please just throw it down here in the chat area and we’ll work through as many questions as we can get through in the next hour.
And for anyone that you know, isn’t able to stay, or you’re locking in late, you will have access to this webinar afterward. We’ll send it to your email later tomorrow. So if you’re not able to stay the whole time or you’re putting babies to sleep or whatnot, you can definitely take part later. Jennifer says, Jenny and I live in Toronto and I have a three or three and a half-year-old son.
Cool. That’s awesome. That’s a fun age too. My youngest is almost four. So I’m going through the same kind of stages as you as well. Krista says hi, Dr. Dina. I have a 20-month-old, we’re from horseshoe valley. Cool. Very nice. Steph has two kids, a four and a six-year-old from king city and they’re both patients of mine.
Nice to see you guys. Welcome. Welcome.
What else Jen says she has a two-year-old son from north bay. That’s amazing. We’re like all over Ontario right now. That’s very exciting. I love talking to people that are kind of outside, you know, the central core of Toronto, because you know, it’s nice to, if I sit down with people from different areas and different experiences and stuff, so that’s very nice. Perfect.
So we’ll give it a couple more minutes and I will, I’m gonna start to flag some of the questions that you guys have and then we’ll get to it. Tanya has a two-and-a-half-year-old daughter and a four-and-a-half-year-old son. They’re from Peffer Peffer law, Ontario. Cool. I don’t know where that is.
Where’s that Tanya area? Is that, how far is it from where I am in Toronto? I grew up in Ottawa, so I didn’t grow up in Toronto. I moved to Toronto for my undergrad experience. And then since then I’ve been both in Toronto and Hamilton because I did my med school training in Hamilton. So I’ve been in this area since then, but my first 18 years I was in Ottawa and my parents actually only recently moved.
So Ottawa was very much my home until very recently, even though I’ve been here for, I guess 20 years actually. Perfect. Oh, it kind of says in Georgina, you’re just north of Newmarket. We were in Toronto, but we’re in a farm now.
It’s amazing. There were so many families that moved up north and east and west. And I have lots of families. I moved to the US and other places during the pandemic just to get away and have more space and have a backyard and that sort of stuff. So I totally get that. Jody says,
Hey, Dr. Dina, I have an almost three-year-old daughter and a four-and-a-half-month-old son. We’re in Toronto. My daughter’s a patient at kid crew too. Very Cool.
And Jen Has a question for us that I’m going to flag. Okay, perfect. So maybe let’s get going. I’ll start to read out the questions for you guys and then I’ll answer them. And as I mentioned, we’ll try to get through as many as we can.
Okay. So John asks, hi John. Hi, Dr. Dina, thanks for taking the time to answer our questions. My wife and I would like to take on a few things with our five-month-old baby boy, we’re in Markham. One, he’s developed a redness on the inner part of his elbow and behind his knees, is that common for babies to have this? What is it? Any suggestions for melody?
Most likely this is excema. And of course I can’t say for sure whether I’m seeing photos and of course it should be your healthcare provider providing guidance on this by seeing your child. But when we think about areas of rash in babies and older kids too, on what we call Flexeril surfaces. So Flexeril surfaces be where you said bent.
So the elbow crease behind the knees and the ankles, and even like around the neck area or the groin, if it’s red, if it’s rough, if it’s itchy sometimes flaky and dry looking, most of the time that’s Exuma and what Exuma is, is just a dry skin that gets inflamed. And when it gets inflamed, it gets itchy. It’s very common in babies.
Actually eczema is otherwise called the atopic dermatitis and the best management is anything but the lubrication to start. So things like Vaseline, coconut oil, petroleum, free jelly, Shea butter, things like that. I’m actually launching my own line of cosmetics products, including an Exuma line because I see this so frequently, my own kids battle with Exuma and it’s really itchy and uncomfortable.
So actually that will be dropping kind of this, this winter, but in the meantime, anything lubricating, Pasolini greasy. And if it’s for the red inflamed itchy uncomfortable, typically a health care provider will provide something like hydrocortisone, which is a mild steroid, which will decrease the inflammation.
Often we’re looking for appointments versus cream. So the greasy or the better, what you mean is like Vaseline is that like clear sticky, greasy base versus cream. And the reason why I like
So typically I’m looking for greasy stuff as a starting point a few times a day. And then I upgrade to something like hydrocortisone, 1% ointment, which is available over the counter, but you could also ask your doctor about it.
And I always think that, you know, for babies and kids that have rash, it’s best to review with your doctor, just to make sure that is actually the diagnosis, but that is the likely diagnosis based on what you’re saying.
And John goes on to say, initially, we only put on lotion after a bath, but since this development, we try and do it in the morning and after baths. And they also have food sit in age. So food sit in age is an antibiotic who sit into a type of antibiotic like Polysporin. And of course, if there’s an infection on the skin, we want to use something that has integrity in it.
But without, of course seeing the rash, it’s impossible to say whether it’s infected, but the things we think about with infected skin or what we call impetigo or cellulitis is not just broken skin, but typically yellow weeping, crusty liquidity. That’s really the hallmark of cellulitis or a skin infection. If it’s just really red and raw and not really expanding beyond the borders of the rash at the moment, it’s more likely to be something like dermatitis, inflamed skin, like from something like Exuma, but again, always best to touch base with your doctor.
All right, Jacqueline says, hi, Dr. Dina, our 18 year old son has emotion sickness and can’t last more than 30 minutes in the car without committing, what can I do to make him more comfortable?
And assuming Jacqueline, that you’re asking about an 18-month-old son and committing, I think you mean vomiting. So I think Jacqueline, you’re saying you have an 18-month-old son and within a few minutes of being in the car, he is motion sick and motion sickness is actually a really common thing that we see. And it’s such a burden. I actually, personally, as an Emma kind of person that gets motion sick very easily.
I was the kind of person that was sick throughout all four of my pregnancies. I was vomiting quite a lot, dizzy, quite a lot. So I could definitely relate to your child. There’s a few things that you can make easier for your child if they’re emotion sick. So the first thing that’s important is if your child has less than two years of age, they should still rear-facing in the car, meaning their head should be facing the back of the car.
The car seat should be turned backward.
Now a lot of people decide to turn their child forward-facing because they’re car sick, but it’s not safe. Kids should definitely be rear-facing until at least two years of age. So that’s very, very important if they’re rear-facing it’s best.
If they get motion sick to incline them as much as possible. So when you look at the car seat, when it’s installed, there’ll be a little dial on the side, but the little bubble. So it’s a level and you want to make sure that bubble is in the middle of the level to make sure it’s the safe kind of inclined position, but you do want to make sure that they’re inclined straight up and down as possible for the safety of the car seat.
It’ll be possible to recline them a little bit and still have the bubble in the proper place, but you want to incline them as much as possible. Windows open can be really helpful. And I find that the most important trick is actually how much a child eats or drinks before a car ride.
So, you know, if you think about like a movie where like there’s a pregnant person and they’re very motion sick and they have a few crackers by the side of their table or their either bedside table, that sort of the idea around motion sickness, you don’t want to have a too full of a stomach, like having had a big meal or a big glass of milk or bottle of milk before you travel.
But you also don’t want an empty belly cause that can make you more nauseous too. So myself as a nauseous pregnant person back in the day with my four kids, a little bit of carbs could be helpful in settling my stomach, but too much of a meal or an empty stomach could make me feel really sick.
So a little bit of carbs can go a long way, a little snack, but not a full meal or a full bottle, and also not an empty belly.
And you know, some kids do really well with toys and books in front of them, others. It makes them a lot more sick. You know, for me personally, if I’m looking at anything in the car, it makes me much more sick. So, you know, window down, not a full belly belly, not an empty belly, looking at the horizon can be really helpful and distraction.
So I like listening to audio books or music in the car, not looking at a screen in front of us that can also make more motion sickness, but looking or listening to an audio book or music can be really distracting. It can help your child as well. Hopefully that helped Jacqueline.
All right, next question.
So Jen asks looking for advice on how to deal with an almost four year old hitting kicking, spitting her parents. She just went back to daycare recently, and that is when the hitting started. She’d been on her own prior at home for the past 15 months. Not sure how to discipline this behavior.
So Jen, you were having some challenging behaviors. This is really common when kids are going through a transition and it’s actually just really common in general toddlers have what I call big feelings, right?
They get easily frustrated. They get easily tired, they get easily emotional and sometimes, or, you know, they have these big feelings. And so it’s really important at this age to kind of reign that in. And I think to teach them that there’s an appropriate way to express feelings and inappropriate ways.
So when a child is like 15 months old and they get frustrated, they don’t really know how to cycle through that. How to think through that, how to unload those emotions in a safe way, but by four years of age, kids can definitely learn how to do that. So my biggest suggestion is actually about what we give attention for.
So the way I like to think about toddler behaviors and even older kid behaviors too, is I like to put them into two main columns. So one would be what I call the crazy behaviors.
So the hitting and the biting and the fighting and the self-injurious behaviors and the aggressive behaviors or the rude behaviors to parents or caregivers, that’s all what I call crazy. And then there’s all the calm behaviors. So playing independently, eating a nice meal, going to bed at the right time, being pleasant, being, you know, very kind and considerate and patient, all those things to the calm behavior.
And I find a lot of us as parents to give a lot of attention to those crazy behaviors. You know, kids are acting naughty or aggressive and we turn all sorts of attention to them to get them to stop.
We give them a big hug. We tell them it’s okay. We try to appease them. We might say, well, if you calm down, you’ll get X, Y, or Z, but that’s actually giving a lot of attention to the bad or naughty or crazy behaviors. Instead, what I like to do is to turn away attention from those naughty behaviors towards the positive behaviors.
So when a child is being calm and pleasant and you know, thankful and patient, we want to give a lot of attention to that. But I find often we don’t, we kind of creep out of the room like, oh great, they’re playing nicely and independently. We’re just going to back out and not, not get involved, but I want to show my kids how proud I am a fan when they’re being their kind calm selves.
The line that I like to use with toddlers when they’re being naughty is, or, or rude or aggressive, or having a temper tantrum is eyes to eyes. I say eyes to eyes and I make eye contact. I want to make sure they really hear me. And they see me. And we’re really connected on that level, as opposed to, as yelling down the hall or I’m on my phone or whatnot.
So I stop. And I say, when you’re ready to talk, I’m ready to talk. And then I turn my back and I walk away and I’ve done this with all my kids.
And as a result, many temper tantrums have been avoided. And by and large, I get pretty good behavior out of them. Not perfect. No, no kids are perfect, but what I’m telling them, what I’m hoping I’m telling them is you have a right to feel frustrated, mad, angry, sad, angry, you have a right to feel those things.
I, as an adult, feel strong emotions sometimes too. And you have a right to it. And you can, as I say, get your cookies out. You can have your meltdown. You can yell at the wall. You can yell into a pillow. You can go for a run around the backyard. You can get your pickies out, but I’m not going to give you attention at that time.
That is not the best time to be connecting with me or for me to work through things with you just when I’m having a bad day.
It’s not the best time to really work through that with my partner or my friend. I need to calm down, think about it. And then it’s a better time to come forward and talk about it with someone else. So I say, when you’re ready to talk, I’m ready to talk. And I turn my back in a walkaway and I found with my own kids very quickly, they learn, I’m not going to get attention for this aggressive behavior, this temper tantrum, whatnot.
When I calmed down and I come and talk to mommy, that’s when she’s going to give me lots of attention to work things through with me. So when variably within moments of saying, when you’re ready to talk, I’m ready to talk. And I turn my back and walk away.
My kids are chasing me saying, talk, talk, talk, ready to talk. And then we could sit down again. I say, eyes to eyes over. They want to connect and make sure we’re seeing each other. I’m putting away my phone. I’m trying not to deal with my other kids at the moment. If I can avoid it. And I’m really just talking one-on-one with that child to really hear them out in that calm way.
As long as my kid is being aggressive or having a temper tantrum or whatnot, I’m just gonna wait. I’m just gonna wait poker face. I’m not gonna move my emotions into it. Cause I find so often, you know, our kids are having a meltdown and we get really tense and feeling so many of our own big feelings, frustration, irritation, anger, right?
Have we bring that to the table? And now we have a child that’s really stressed out and we’re really stressed out and together, this is not going to make a good conversation. So I walk away, I’m going to, you know, deescalate myself. I’m gonna bring my shoulders down and I’m going to feel confident and controlled. And then I’m going to welcome my child to talk to me about it.
At that point, if a child’s persistently aggressive and doing things like hitting biting, et cetera, I think it has to be the next step that child needs to have it enforced what I call time by yourself. You can’t be with me if you’re hurting me – you can’t be with a sibling if you’re hurting your sibling period. End of story.
I don’t have any patience or tolerance for aggressive behavior because I never want my child to think that that’s an okay way to express themselves ever having a temper tantrum. You’re by yourself. You’re not hurting anybody. It might be annoying, but it’s not dangerous. Hurting me hurting a sibling, hurting another parent, hurting a caregiver or a friend, not acceptable specifically at four or five, six kids know better.
They know how to control themselves better. So for those kids, I often will say, you have a time by yourself. You go to your room and you have time to deescalate on your own. I get, I’m not giving attention. At those times, the child has to learn to settle on their own.
And if it keeps on going and going and going, I’m going to keep on waiting it out again, deescalating my own self, my own emotions until the child calms down. If you need to, if you’re having a child, that’s having so many meltdowns and there’s so many issues.
One strategy I use is instead of taking things away, in other words, punishment, and instead of rewarding a behavior, when they calm down, rather I change the whole system. So I start taking something that they love, that they get on the daily. For example, their favorite TV show. You know, most kids have a favorite show. They want to watch every day.
If you’re having consistent naughty or a poor behavior, I then take it that, that screen away if that’s their favorite thing, right? So instead of you get your favorite show every day, regardless, or instead of I’m going to take away the show when you’re naughty, rather I’m going to reframe it.
So the child feels good about themselves for having positive behavior. The child no longer gets their favorite show at baseline. That’s not on the table. The child now has to earn that show each day.
So with positive behavior, they earn the show versus the show gets taken away for naughty behavior. So the onus is on the child to earn it. Good behavior gets positive consequence. Okay? So it’s not a reward like I’m going to give you a candy bar. I’m going to give you extra special treats. If you’re good. No, they shouldn’t be earning anything for bad to positive behavior, but they can earn what they would normally get at baseline.
And oftentimes that’s enough of a switch for kids to not feel badly about themselves because they’re having punishment, but rather they feel good about themselves about earning that thing that they otherwise love and cherish every day.
Hopefully that would helpful. All right. Let’s see.
Okay. So Jennifer says, my question is about my three-and-a-half-year-old, who naturally likes to sit in the w sets and we are aware that we should correct it, but since she’s in daycare or not with us all the time, it’s quite hard. And I feel like I’m constantly nagging him to correct a sit-in. Is there anything more we can do or advice as how to best deal with this sort of thing?
So actually have a whole article, actually, I think two or three articles about this very topic on drdina.ca, where we have tons of blogs with tons of topics. And we get asked about w sitting all the time. So hence the blog article. So you’re welcome to take a look at that as well.
But in general, we do want to correct a w set. So a w sitting means is that instead of a child sitting with their legs straight and front, or, you know, criss cross applesauce, they sit with their legs behind them. And the w so, you know, legs back like that. And like back laid back, you can picture that with me, right?
And a lot of kids will sit that way because they don’t have strong core muscles. So when we sit upright or their legs, like straight in front, you probably know too, as an adult, a lot of us have kind of weak cores, especially those of us that have had babies. It can be really hard. It’s I feel a lot of work for your core and your back to sit upright.
And with your legs, criss cross applesauce, it supports you more with a wider base of gravity under you, but it is still more challenging than when you put your legs behind you, where you now could picture that you have a very wide base under your body to support yourself. So many kids will sit that way preferentially because they week course.
So, one thing you want to think about is lots of exercise, where you’re building their core, you know, climbing and running.
And, you know, a lot of just normal physical activity will help build their course. Swimming is really great. Anything with a running or jumping, but you do want to replace their feet front because otherwise, again, they’re not supporting their core and they’re not gonna get stronger in that position. And it can lead a lot of kids to be kind of hunched forward.
And more importantly, it puts the hips and external rotation bent outward. Okay. So obviously this is my shoulder, but if you picture your, your knee or your hip, this is internal rotation. The joint is moved forward. If you’re crossing your legs, for example, and this is external rotation.
If your hips are always an external rotation, when you’re sitting, your hips can actually form in a bit of a weird position. And some kids will end up actually walking as if they’re like riding a horse like this wide stance. And we don’t want them having any kind of, you know, you know, bizarre kind of gait or stance. So you do want to keep correcting them and it can be annoying and nagging, but I would continue to do that. And I would enforce that a daycare as well. So, you know, have a conversation with the daycare providers and tell them how important it is that they, you know, start making them have their feet forward, a crisscross applesauce.
And it is just remind, remind, remind, remind, and then as their core gets stronger, it will become easier. And they’ll start direct themselves back into that position on their own.
Christie says, hi, Dr. Dina, I’m struggling with my four year old and her listening skills. She will tune me right out. And it’s often quite scary. The other day, she ran into the street with me, chasing behind her screaming for her to stop. And then she just kept on going, this is the only one example. I’ve tried to explain it to her, the severity of this, but she has just had a tantrum, any help is appreciated.
So I think actually a lot of what we just discussed a couple of minutes ago is going to be very helpful for you for things like this, where it’s just simply dangerous or aggressive.
I would have very, very strict rules about that. If you know that she just had a tantrum and she’s likely to act out in a very kind of aggressive or scary way, I wouldn’t be outside, right. I would move her inside to that safe place, that time by yourself until she deescalates.
If you feel like she’s a flight risk, you just have to know that that’s, you know, risk of your child. And obviously safety comes first, but this me might be the kind of child that would benefit really greatly from having that earned things that they love, like the earn show or the earn treat, or the earned extra special time with mommy or whatnot versus again, that punishment.
And I think really importantly, too, we need to recognize ourselves when our kids most likely to have those meltdowns, when our kids most likely to be aggressive, have a temper tantrum, be hangry, those things. So minimizing them, being really hungry and we’re out and about. And we know we shouldn’t be taking a 10 more minutes without feeding them.
We know they need to get home for nap or bedtime, you know, all those times where like, well, they seem really okay. And you’re thinking in your head, you know, it’s seven. O’clock, you know, normally they’re really tired by now, but they seem okay, we’re having fun at the park. And then you’re just like that suddenly they’re having a total meltdown and it was somewhat predictable. You know, I find that when my kids have meltdowns, probably 95% of the time I could have predicted they would.
And I was hoping against it. You know, I was hoping that things were okay. Cause it was, it was okay. It was okay. It was okay. And that it was not okay. You know, so trying to prevent those times mostly with hunger and mostly with fatigue. And usually we can really prevent some of those meltdowns, but when you need to time by yourself and consequences, that should be really important.
It’s something that we are really consistent and predictable boat kids really like when we’re strict. I know that sounds really crazy to say, but kids like predictability and consistency and the more we can be predictable and consistent.
In other words, a child has a meltdown and we do this and not just me, but my partner, the daycare provider, grandma, grandpa, and nannies, anyone like that, who’s involved in the child’s care.
Ideally they know the child does this and we’re going to do this. And, you know, even making a list of the various behaviors our child might have and what the desired response from the caregiver should be.
So that everyone gets on the same page because very frequently, you know, one caregiver might act this way and another caregiver might react to this way and the child will start to manipulate because they realize that one parents or one caregiver is kind of softer and more lenient and maybe one caregiver gives more attention for naughty behavior.
We’d be really mindful of those things. And that’s true of every single family, right? Every single family has caregivers that are more or less lenient, more or less strict, more or less consistent. Right. You can think about this in your own family. And so coming up with a game plan that you could literally even put on your fridge could be really, really helpful.
So Rihanna and I seem to see you.
So Oriana asks, is it possible for a 24 month old who has not been walking due to fear of a nightmare Sorry, this is weird. Okay. Can you try that again? Sorry.
Anna asks, is it possible? 24 month old toddler has night wakings due to fear or a nightmare. I went 3:00 AM where she just sits up in his bed and cries. So this sounds akin to a night terror.
So a nightmare is in the middle of the night at any point in their sleep where they wake up.
Usually we think because of a bad dream and they’re fearful of something and they’re fully awake. Okay. So a trial may cry for you. Their eyes are awake and they’re awake. They’re fearful. You can, you could see that they are interacting with you. They might call for you. They might want, you know, the sip of milk or water or cuddle or whatnot,
they’re awake. And they remember it. The difference with that and a night terror is a night terror. A child will wake up, seem very fearful. Their eyes may be open and they might be interacting with you, but they’re not actually really awake. So they might not respond to you as you as usual. And they do not remember it the next day.
A lot of kids will have night terrors at consistent times, middle of the night. So I often hear about kids that frequently wake up at 12 o’clock or three o’clock and it happens kind of regularly. And, and the question is, how do you break that cycle? Nightmares though are much more random. It could be at nine o’clock or 12 o’clock or four o’clock and often are attributed to something in particular.
The child’s been experiencing, like they watched a scary movie or read a scary book, or they’ve had some new experiences that are fearful for them. Night. Terrors are a little bit more confusing for people and for parents, but often also related to things that they’re experiencing, whether they’re not getting enough sleep or there’s some new, emotional challenges in their life, like maybe a new daycare or, you know, new fears in life or new anxieties nightmares.
There’s not really magic tricks to preventing them other than making sure kids are getting enough, sleep, avoiding things that are scary for them, like scary books or movies or TV. And you just comfort them and hopefully get them back to sleep as quickly as you can with night terrors, we want to avoid the waking them up.
So again, they may seem awake, but often they’re actually stuck in between two sleep cycles between REM and non REM sleep. They might be looking at you, but a lot of parents will say they just kind of seem vacant, not really acting themselves. You don’t want to turn on the lights. You don’t want to take them out of the room.
You don’t want to break that sleep cycle. Oftentimes even touching a trial, they’re talking to a child can actually make them much more confused and irritated and agitated. So as a parent, I typically just go in the room and I sit with them and I calmly say, it’s okay, you’re sleeping. Don’t worry. Mommy’s here. And I avoid moving them or opening their lights or anything like that.
And hopefully just kind of Sue them back down to sleep for children that are having really frequent night terrors, where they’re waking at pretty predictable times. One strategy to break the cycle has actually to go into the child’s room before they normally have their night terror. So let’s say they normally have their night terror around 12:00 PM or rather 12:00 AM.
One strategy is to go in the room at, let’s say 11:45 lights off, but very gently Rouse them. So you can Cress their hair or say their name or say, mommy’s here or daddy’s here and you’re safe. And it’s okay. Just enough to kind of bring them out of that sleep cycle a little bit, not fully Rouse them, but kind of just like, you know, Jostle them.
And what could happen is it could break that weird pattern of REM to non REM sleep. And some kids will actually stop having night terrors. Even some kids I’ve had patients that had nightmares every night for weeks. And we did that once or twice in a night before their time that we normally wake up had actually broke the cycle for weeks or months afterwards.
So that could be one really powerful strategy for a child’s having consistent and frequent night terrors. Hopefully that was helpful. Ghana.
Tonya says, thanks so much for answering all of our questions. I’m a bit worried about COVID in school. Let a one, we’ll be starting preschool. And then we’ll go, go in person this year into S K, is there anything I could do to help their immune systems, any vitamins I’m gonna recommend a fit for school, but one of the companies, but little one is too little for the fit for school. Thanks so much.
Okay. So immune boosters, this a big thing online, and it’s actually all nonsense. It’s all marketing. So the supplement business is very much alive and well, and it’s worth billions of dollars every year. It is not the case that we can boost our immune systems with supplements. If a child is eating a normal, healthy diet, a varied amount of things, right?
Fruits and veggies and proteins and grains. And they’re getting a supplement of vitamin D that is important because most kids and adults don’t get enough vitamin D in their diets, nor do they get enough sun exposure where they’re not wearing hats or sunscreen or rash guards, et cetera.
We want sun protection, of course, right? So we don’t want our kids’ skin to be, you know, 15 minutes completely exposed to the sun every day. We want some protection, but as a result, a lot of kids don’t get enough vitamin D.
So we do want to supplement our babies less than a year with 400 ICU. That’s the dose of vitamin D a day and children one year and older with 600 IUs of vitamin D a day. That’s really important. Otherwise, unless a child has a very, very poor diet. And if they generally eat a variety of things, there is not a reason to supplement them with anything in particular, particularly vitamins.
I don’t recommend that there’s no particular a brand that I feel compelled to recommend it’s mostly bogus. So the biggest things are healthy living stuff, right? So eating a variety of things, eating the rainbow, really lots of fruits, veg proteins are really important. A lot of people get a lot of carbs and not a lot of proteins and proteins are really, really important, making sure they’re getting vitamin D through a supplement because most kids don’t get enough without a supplement.
And otherwise it’s healthy living stuff. Having heart racing activity, getting your heart rate up at least an hour a day for little kids, having at least 11 to 12 hours of quiet or sleep time every day, minimizing screen time, normal, healthy living stuff is what’s going to help our immune systems.
You know, as kids go back to school, they will get viruses. That’s just how it goes. That’s just how our immune systems go. Our immune systems get stronger by being exposed to things. So unfortunately with back to school, and we’re already seeing this with back to camp and daycares and things, people are getting sick. You’re going to get viruses.
Your kids are going to get viruses, but taking particular supplements, won’t change that at all.
Mia says, hi Mia. Hello, Dr. Dina. My question is about the COVID vaccine. Many European countries are giving one shot of Pfizer vaccine for candidates who got COVID-19 before. What are your thoughts about that?
Mia? It’s interesting. We don’t really have evidence around this stuff. So we don’t really know if having had previous COVID illness is akin to having a first vaccine or whether we should still get two COVID vaccines. If we’ve had COVID-19 before probably the latter, probably if you’ve had the illness or not have the illness, you should probably get two COVID vaccines. I think my, a lot of countries are doing this is because they don’t have enough vaccines.
Not because it’s not more effective. In fact, we probably are looking in a world where we’re going to have to get boosters of the vaccine. I E third doses, fourth doses, et cetera, periodically when that’s going to be, we don’t really know.
Currently in Israel, they are starting to give people that are 60 years and older, a third shot of the COVID-19 Pfizer vaccine in Israel, if you’ve been five months or more post your previous vaccine. And so th these are the first guys doing it in Israel, and they’ve been really the model for vaccine delivery in the world. So we’re all kind of watching to see with bated breath, what’s going to happen there, but there are definitely trying to see some breakthrough in COVID cases, even a double vaccinated people.
So it’s looking like we’ll probably need boosters as we go. What the timing of that will be, whether it should be the same vaccine you previously had or a different one, the same dose, a smaller dose, all these things are still being studied. So as always, I’ll keep updating, you guys know if you don’t already follow me on Instagram, you’ll know that I do give daily updates about what’s happening in the COVID world and on the blog and in my newsletter and on these Q and A’s.
So I’m always hopeful to update you guys, as I know more, and I will certainly let you know what the plan is for boosters, but in the meantime, I would say no, the Canadian recommendation is having had previous COVID illness or not to get two vaccines as though you’ve never had the illness in the first place.
Some people have antibodies from COVID fill MIS for a short term incident takes a long time. I’ve had patients that had confirmed COVID infection and had antibodies and had positive test results and got tested like a month later or two months later because they had a new illness and they did not have a positive test, meaning they didn’t have enough antibodies at that time or enough of the virus at that time from the previous infection even a month ago.
So we don’t really know how long these things last for how frequently we’ll need to get boosters. All right.
So Steph asks, should we be concerned about the potential neurologic complication as a result of COVID infection children also, what are your thoughts about long COVID in children?
So by potential negative COVID side effects, I think you’re probably referring to the fatigue and headache and malaise that some people get as part of what people call a long, long COVID.
So our long callers, so there are some people that have had COVID infection. I think it’s less than 10% that have some kind of symptoms afterwards. And a lot of these times it’s neurologic, headache, fatigue, malaise, people just feel, you know, brain fog and they feel crummy for a bit of time. Now, actually there was a study that was published just today.
That showed about 5% of a study of, I think about 5,000 kids. That 5% of those kids had some kind of symptoms, neurologic symptoms. And they was six weeks later out the review of the study. Again, I was going to present it tomorrow in my it live so about 5%. So it’s not a lot of kids, but it’s enough kids that you don’t want it to be your kid.
I mean, none of us wants our kid to get COVID-19 or for us to get COVID-19. And we certainly don’t want long-term side effects, but it does appear that some people, kids and adults do have some kind of long-term side effects. And as far as we know right now, it is not predictable who that will be. It doesn’t seem to make a difference if you have severe illness or mild illness, or if you have pre-existing conditions, it doesn’t seem to really make a difference.
So at this point, it’s just avoid COVID-19 as much as you can and hope for the best, if you do get exposed and you’ve got the illness.
All right. So Jen asks with these new variants of COVID-19, how can, how concerned should I be, but my two old, so I’ll start with that.
So by new variants, I think what Jen is referring to is the Delta strain. The Delta strain is kind of the new kid on the block in terms of variants of concern. And it is by far and away, the most prevalent variants of COVID-19 I think worldwide, certainly in Canada and the U S and the UK and other places.
And the concern is this particular strain that Delta strain is more contagious and does seem to be causing more significant illness in kids and adults. And unfortunately it does seem to be the case that you can get the Delta strain, even if you’ve been vaccinated, even if you’ve been double vaccinated.
However, the risk of getting severe illness is much, much less.
So most people that have been double vaccinated, they get Delta have very mild illness. And also seems to be the case now that you can even pass on the Delta strain to someone, if you’re a double vaccinated and you’re asymptomatic.
In other words, I’ve had two vaccines. I get exposed to the Delta strain. I am completely well and healthy. I have no idea that I’m sick, but I pass it onto someone that I’ve exposed to. Now that’s concerning because there’s a lot of people out there that are unvaccinated. So we have a lot of unvaccinated people they’re getting COVID-19, they’re passing it to other people. If now they could even pass it to me as a double vaccinated person, and I could pass it on to other people.
I wouldnt get that sick because I’m double Vaxxed.
I will pass it on to other double back to people. They won’t likely get that sick, but I could pass it to them or unvaccinated people and make it get sick. More people need to get vaccines. That’s kind of the bottom line.
All right. Okay.
So Carissa, hi. So Carissa says my 20 month old daughter refuses to drink anything but milk. I’ve tried mixing with breast milk as well as to give her a cup, but she won’t have that. She eats fruits and veggies and proteins, but refuses to drink any dairy milk, including milk and yogurt and cheese. Should I be concerned that she’s eating everything else? Well, I’m still breastfeeding, but wondering what I should do once I wean her.
Okay. So that’s a great question. So a lot of children don’t like the taste of dairy. Other children love dairy, and it can’t seem to get enough dairy, but a lot of kids don’t like the taste of dairy. So the deal with this kiss would have to have dairy at all, right?
There’s a lot of kids that are dairy, allergic and can attack any milk product whatsoever. What’s important is not dairy, but calcium. So as long as kids are getting a good source of calcium every day, that’s all that matters to me. And that can come in the form of other dairy, sorry, non dairy alternatives.
So soy milk, or cashew or flax, or all almond milk, for example, or it could come in the form of seeds and nuts. So flax and chia and all mens and other seeds, and that sometimes have like a source of calcium. It could be in leafy green vegetables or broccoli. There’s a variety of different things that have calcium in them. Salmon is a really great choice.
So for a child that isn’t really into dairy per se, I certainly don’t fuss about it. None of my kids liked milk. Actually, my kids only drank milk and yogurt, sorry, only drink milk in cereal. For example, they really don’t get a lot of milk in their diets.
They certainly don’t drink milk just in a glass nor do I. And so I’m just cognizant to the fact that they need to get calcium in other ways.
So they might get a little bit of yogurt here and there. They might get a bit of milk in their cereal and otherwise I’m just making sure that they’re getting enough calcium in their diets through things like fish, like things like seeds and nuts.
And if you need to supplement because there’s not enough in the diet otherwise, and that’s also an opportunity for you as well, toe foods are really another good source. So it’s, it’s a nice idea to kind of look online. You can go to Dr. dina.ca as well.
We have a blog on this and you can take a look at the tables that you’ll find, you know, how much calcium is in various foods and you can match up, oh yeah, my kid loves salmon.
Okay. I’ll make sure they have salmon twice a week. You know, my kid loves tofu. I’ll make sure they have tofu a couple of times a week. Right? And then you can match, make a match of like, my kid loves this, this particular food has calcium. Great. I’ll make sure they do that a couple of times a week.
It’s really just being a matter of being mindful of it, but you don’t need to stress about milk or dairy per se at all. Some kids just don’t like it. And most kids, once they’re weaned off the breast, they will decide they want to drink something else. Right? A child may just want water. They may not want us to run of milk.
But as long as kids are breastfeeding, they often will be satisfied with the amount of milk they’re getting that way. And of course, there’s calcium in breast milk, but once a woman beans off of breastfeeding, a lot of babies will then decide that they do want another source of milk. And that could be again, a cow’s milk or a goat’s milk or any alternative milk as well.
So hi Caroline. So Caroline says my two-year-old screams at the top of her lungs for anything. If older sister says, no, you are not supposed to use that or ha core have that. And she screams, even if it’s dad or me, she doesn’t cry or get upset. She just screams. We’re unsure how to correct.
So that actually goes back to kind of earlier when we were chatting about the attention. So whether you’re giving a child attention for the crazy, or for the calm for me, if I had a two year old and they screamed to get what they wanted, I would absolutely not give attention for that.
I would actively passive aggressively, turn my attention to that child.
I would not respond to a child that is screaming because it too, they know how to control themselves. They know that there’s a better way to act, but if a two year old had a temper tantrum or a screaming, or is acting aggressively and we give in, or we give the child what they want, because it’s terrible. Like you don’t want to hear that.
You just want to make it go away. So probably for a lot of kids like this, we’re giving into them because we want that terrible sound to go away, but then we’re actually giving attention for it. And it will re reinforce that negative behavior, right? So everything, our kids do, particular toddlers, they’re doing to get something out of us, right?
Every behavior is looking for some reaction. So it’s really important and it can be challenging in the moment, but it’s really important. I think, to think in the moment, is this behavior calm or crazy? And if it’s calm and give tons of attention, shower them with attention, give them a hug, give them high-fives cuddle them. Good job.
You’re being independent. You’re eating nicely. You’re going to bed nicely. You’re leaving the house without a Fise, et cetera. The crazy behavior, turn your back and walk away. And you is that when you’re ready to talk, I’m ready to talk line. If I had a two-year-old, I would do eyes to eyes when you’re ready to talk, I’m ready to talk.
And I would turn my back and walk away. Poker face unemotional. Don’t bring your emotions into it. As much as that might be making you crazy and your child will eventually learn. That’s not how I get attention. That’s not how I get what I’m looking at, you know, looking for for my parents. And I’m gonna stop with the screaming.
All right. So I’ll get to a couple more questions.
So Julia says any tips on potty training. My son is three years old and wants nothing to do with using the washroom. He screams when I try to get him to sit on the toilet.
So actually this is such a common thing that actually, I just wrote a book about this that should be out of the next couple months, called the scoop on poop.
And it’s all of potty training. And actually, I wrote another book about constipation because they tend to go hand in hand. And they’re both very common concerns for parents, but with potty training and particularly potty training toddlers that are not yet interested, I use the strategy of what I call routine and reward. And what I mean by that is a lot of parents,
I think mistakenly choose two methods like these three-day rules or four-day rules of potty training, where parents will strip them down and kids will be without undies, without pants on. And the expectation is that if they’re naked, they will have accidents on the floor and then they’ll realize they shouldn’t have an accident on the floor. They should use the pot. Now for some kids, particularly kids that are really calm, very confident kids, very easygoing kids.
This could be a good strategy because they’re not the kind of kids that would be very upset if they had an accident on the floor, for example, but for other kids, particularly kids that are more cautious, more shy, more behavioral, more challenging, kind of toddlers, this kind of strategy, often backfires where kids will have an accident on the floor and it makes you scared or angry or sad.
And then they may even hold their pee or their stool longer because they’re scared of having an accident. And that can lead to all sorts of problems, including bladder infections and constipation. And once they get constipated, then it hurts them to poo. Then they don’t want to poo because it hurts their bum.
And at least it’s a kind of vicious process. So rather I take a much more kind of cautious and slow approach with what I call routine and reward. And what I mean by that is making a particular routine about your day of potty training, eating and drinking in particular is a very strong time that signals to your body.
We’re putting something in we’re eating or drinking, and we should then evacuate. So it’s a very strong like series of events for your body to stimulate them to empty. Okay. And also stimulate to we called the gastrocolic reflex when we eat it signals to the belly to actually get rid of stool. So after meal times and after snack times is a really good time to start getting a child used to the potty.
So with my own family, I didn’t do these three-day business. I would take them to the washroom after breakfast, after lunch and after dinner to try and the focus isn’t on peeing or pooping, the focus is on trying. And it’s really not even about trying to be your poo. It’s about just letting your body sit on the potty or the toilet.
So the focus goes away from the action and like the, you have to do with this thing, but rather it’s more passive. Let’s just go sit. Okay. And a really good strategy. I find too is by doing something that’s really fun. So I don’t enjoy taking iPads if the washroom or other electronic devices, cause a lot of kids want to sit there and play.
And they’re not in any way thinking about the act of pain or pooing and it could, they could also use it as a delay tactic because if you’re not playing, you’re watching the screen of longer. Whereas once you pee, the screen is done right out of the bathroom. So I don’t like, and I don’t recommend using screens in the bathroom. You could use it as a reward for success or for trying, which we’ll get to in a second.
But what I do is routinizing it after breakfast, lunch, dinner, you could even do it every hour and you could wear a watch and it can ding and you can try every hour if you wanted to, and you can go without pants or undies or not, that’s up to you. You can go without a diaper or not.
A lot of kids that are very fearful of going to the washroom or potty training at the beginning are really scared of going with our, their diaper. That’s their security blanket. That’s their comfort. So for those kids, I totally keep them in diapers or pull-ups, but I get them into this routine. And if you don’t just do it one day or two days, but you becomes part of your everyday life.
You start getting as much pushback because it’s just normal for them. Now we go from the washroom, sorry. We go from the breakfast table to the washroom part of our day. There’s not going to be day that we don’t do that. We’re gonna do it every single day. Right?
You can still wear your pull up or your diaper, but everyday, but going from the breakfast table to the washer and you want them to try it. And then I reward them for trying and I upped the ante for success. So you want them to feel positive for themselves for even trying and for not fighting you on it, for example. So I will give them a high five or sing a song or give a sticker.
That’s what we did with my own kids. Just something that made them feel really special and willing and interested in trying. And then I upped the ante for success.
Now I rarely, in fact, I think only in potty training, do I reward with some kind of snack for success of something, but I do find the potty training when kids are really reluctant or scared of going, it can make the option kind of sweet enough for them to take you no pun intended. So for my own children, we did a sticker for trying, which they didn’t normally get on every day basis.
It was something special for them that was valuable and upped the ante to other one single chocolate chip or one single M and M two. My kids chose chocolate chips to my kids chose m&ms for success.
And then they started to connect the dots. Like first I tried, I got a sticker. Awesome. Then once I had this success and usually it’s an accidental success where they’re sitting there and trying, they’re just kinda sitting there. They, they start to pee and then they, they brighten up, right? They’re like, oh, that’s what happens.
And it looked down or they show you, they’re all excited that accidental success that I reward that with that chocolate chip for the M and M. And then I practiced and I practiced and I practiced and I practiced and then they have more successes. And then they start to realize, oh, that’s how I relax my bladder. That’s how I relax my bond to make it happen.
A lot of kids think, and a lot of parents act as though peanut Poon is an active process. They need to push for squeeze. That’s actually not how it goes at all. We relax our bladder to pee. You relax or
And I don’t think a lot of people know this, but it’s a really great trick. So it’s fun blowing bubbles repeated was actually really fun, but it naturally relaxes your sphincter. So I’ve had a lot of kids that were really fearful of Pima pooping on the potty, and suddenly they were blowing bubbles and they had that accidental success. And then that’s it. And then we practice and practice and practice and practice and practice.
And then they got that, that pattern kind of down pat, but it’s really about making it, not scary, making it fun, rewarding for trying or wanting for success and practicing. And the more times they practice, the more they’re going to get it, but make it part of your routine.
Don’t ask your child that they have to go, okay, don’t fight about whether they’re going to go. We’re just going to make it part of the routine. Just like we brush our teeth every day, too bad. So sad. We’re going to brush our teeth twice a day, you know, too bad. So sad. We’re going to three healthy meals a day, too bad. So sad. We’re going to go to bed at nap, time and bedtime as mommy and daddy decided just like that. We’re going to also go to the washroom.
So you’re going to be confident and we’re going to be assertive, but you’re not going to be fighting or negotiating with your kid. It’s just part of the, okay. All right. So guys, let’s do one more question. And as I mentioned at the outlet outset, we will send out this webinar tomorrow.
So if you didn’t catch it all or you want to replay it for yourself, you certainly can. And we, you know, come back, you know, but once a month, and I do these again, and I actually have a series of these lined up with my team, from the tech, from the membership, the parent playbook was the hair is doing one on sleep.
Next week, we have a dietician doing one on how to, you know, work around picky eaters and those kinds of challenges, starting solid food, all the kind of challenges parents face with diets and nutrition.
One of our parent playbook experts is a pharmacist. And she’s going to talk to you guys about any questions you have around medications and safety and storage of medications and medication attractions and all those kinds of things that parents have questions about.
And so, and then we have a list of nutritionist as well, talking about other diet stuff for parents, as well as for children as well. So you can take a book I’ll, I’ll send her a link in the email with the webinar replay as well, and you can sign up for any or all of those sessions, again, totally free.
Totally Q and a. And you can ask your questions kind of in a variety of different ways to our experts in the parent playbook. Okay. So let’s do one more question and then we’ll call it a day for today.
So Sonya says I saw it. Yeah. My son is 27 months old and we are trying to wean off the pacifier for a while. We’ve successfully cut the pacifier over the weeks until now it’s just a teeny tiny nub, but my son still begs for the pacifier in his mangled form. If we cut any more, it’d be gone. Perhaps you have a better method.
I actually love that method, Sonya. I think that’s great. I often recommend that strategy. So some kids want to suck on something.
So they really want the soother nub that they suck on and other kids where they just want somebody to hold. And some kids want both of course. Right. But a really good strategy is if it’s safe for the actual pacifier, some, you know, if you’ve cut it, cut pieces of it and becomes less safe than there could be choking hazards,
you have to look at your pacifier carefully and even review with your healthcare provider to make sure it’s not a choking hazard, but I often do recommend cutting off the sucky part and the part that looks like a thumb. So that there’s just that kind of base that’s left behind. And some kids will just hold the base or chew the base. Again. You definitely want to make sure it’s not a choking hazard for your child,
depending on the size of it and the shape of it, et cetera. But some kids just really want to hold something and that’s fine. As long as it isn’t a safety hazard for your child, you can also replace it with something different, right? So, you know, a two and a half a child-safe enough to have like a little lovey or a little stuffed animal.
Again, no choking hazard, suffocation risks, et cetera, but maybe it’s time to replace that particular habit with a different habit, like holding a stuffy, which will, you know, limit the, the problems you might have with the oral dentition and, you know, feeding issues and things that you might have with a pacifier. But in general, it too,
I’m not particularly bothered by a child who’s who has a pacifier or sex their thumb. I actually sat my own town until I was seven and my teeth pretty. Okay. So I’m not really bothered by it.
Certainly I would recommend at those ages two years, plus I recommend just keeping the soother for bedtime or for nap time and not having them out and about with it because a couple of things, when they get dirty and then they’re putting dirty things that drop on the floor into their mouth and two, it can actually impair their speech because if you’re always plugged with the soother in your mouth all the time, you may not need to talk as much.
And we want to make sure they’re really practicing that speech skill. So for those reasons, after two, I typically recommend that the Sioux, the remains in their crib and that when kids are sucking their thumb, we try to encourage them to only suck when they’re sleeping. But at each two, for me personally, I’m not so stuck on getting rid of the suitor or a second of their thumb.
But if you’re already at this point and you’re already getting rid of it, I would probably just get rid of that piece of plastic, again, safety, hazard risk, and replace that with something else, like a lovey or A stuffy. Okay. Maybe we’ll do one more question. We’ll get to nine o’clock.
Okay. All right.
So last one, this one is searing. I hope I’m pronouncing your night converting properly. So searing says, hello, Dr. Dina, my baby’s 11 months old. He had green poops a few times when he around two to three months old. And my family doctor told us that he’s growing he’s healthy and happy and that she would not worry about the color. He still has green poop sometimes. Should I be worried, please advise. Thank you.
No problem. So this is a great question and a great one to end on the color of baby’s poos is something that really stresses parents out a lot. I’m asked about this everyday several times a day. I actually have a blog about it on Dr. dina.ca about poop color. I think I have one on kid crew.com actually as well about food color.
Cause it’s really, really common babies. Very commonly have colored poops that are not kind of the typical yellow mustard CD. So for babies, they can have any stool color in the world except for red, essentially. So it could be yellow, it could be brown, it could be orange, it could be green.
It could be chunky CD, mushy, liquid puddle like turning on a faucet. All of those are totally normal unless there’s red blood or truly black, like actually black, not dark purple or dark blue, but truly black. I’m not worried about a baby’s poo and it could be super liquidy like a puddle, or it could be chunky or CD or gritty. All of those things is totally normal.
Once babies are having solid food. So after they started solids between four and six months of age, the poo will totally change again, versus what it was like with breast milk or formula or both, it will often take on the color of what they’re eating.
So just like if we have corn, we often have more yellow pieces in our stool, or if we more blueberries, we’ll have more, you know, purple color in our poo. That’s normal for adults and for kids as well. And green often as a sign that they’re eating something with green stuff in it, but it could also be that they have lots of fiber in their diet and fiber is good.
So a lot of parents think that kids stool should be a formed log in their diaper, for example. But actually that’s not what I want. I want a diaper to be mushy. Okay. So when we put on the diaper, rather when we put in the toilet, we might see a log in the toilet and that’s okay, but I want you to a picture. If we were wearing a diaper, would the Pooh be stuck and squished to the diaper or would it still be hard?
Right. And we don’t ever want it to be hard. So the dog might think about is if you take a diaper that has poop in it from your child and you turn it upside down, we don’t want the poop to fall out. We want the poop to be stuck to the diaper. We want it to be that mushy. It could be mushy.
It could be again soft. It could be wet. I don’t want it to be hard. I want to be mushy and not hard, not falling out of the diaper. Okay. And that’s true for your own poos as well. Obviously you were not wearing diapers, but that same concept applies. If it wasn’t a diaper, it would be mushy stuck to our bottom and to the diaper itself.
Okay. So often it’s from fiber, which is good. And it’s often from food, particularly green foods. And unless your child is having trouble growing or attracting or developing, et cetera, you say your family, doctor’s quite happy with how your child is doing.
Then I reassured by that. And as long as it’s not bloody or hard head, as long as it’s coming out every day, that’s another thing we want our kids and ourselves to pew at least once a day, easy to push out, no struggling, no pain, nothing like that. And that’s all kind of normal poo for kids, for babies and for adults as well.
I hopefully that was helpful for you guys. I’m so glad that you guys came and asked your questions.
Thank you for joining us.
As I mentioned, I will have the playback kind of available. You’ll probably get the link tomorrow. You can listen back to it and watch back to it. And we do have a few webinars coming up. As I mentioned with Rosalee Lahaie Hera our amazing sleep expert with a pharmacist, with a holistic nutritionist, with a dietician, a few others.
And so you’re welcome to join for those totally free Q and A’s. Same thing. If you register, you could watch them back afterwards with our amazing experts within the parent playbook. And hopefully that was so helpful for you guys. Nice to see you. Thank you for joining and have a great rest of the week.