LIVE Q & A  with  Dr. Dina Kulik

Recorded February 25 2021


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. 

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Full Transcript

Recorded February 25 2021

Wow. Welcome. Welcome. Welcome to the Q and a. You guys will get an opportunity to ask whatever questions you want. Just us hanging out tonight for the next hour. So kind of, lots of you have questions about kids’ health and parenting and wellness and whatever other things you have questions about. I’m here. Please let us all know how many kids you have and how old they are and where you live.

Cause I’m curious where you guys are all at, and maybe you can give me like a thumbs up or happy face or something. If you can hear me, if you can see me, I want to make sure that it’s working. Okay. And you can use the chat function on the right to say, Hey, hi, Erin. Nice to see you guys have.

I’m glad it’s working and you can start at any point, you know, in the next couple of minutes, throwing questions in the chat box and I will get to answering some of your questions. Hi everyone. Hi to Anna<inaudible>. Her son is three and a half and her daughter is one such a fun, crazy age, crazy times for sure.

Jacqueline’s expecting her first baby in April. And it’s amazing congratulate Chaplin. And my Elena says, hello? All is good. Perfect. Sharon gives me the thumbs up. Jacqueline’s in Toronto to send 13 months of wild. Amazing lots of little ones so far. So yeah, I mean welcome. Welcome. We’re expecting quite a few people and I hope to get to as many questions and answers as we can in the next hour or so.

I’m happy to jump in once you guys are settled and yeah. Grab yourself a drink, grab, you know, pencil and paper or your phone or whatnot. Cause we’ll just kind of rapid fire answer questions tonight. As you guys seem to like, when we do this, each time actually says he’s from Barry and his son is seven months old, so fun.

It’s a fun age. They’re like starting to move around and starting to communicate more, but they still asleep a lot hopefully. And that’s, that’s always really fun. Perfect. My Elena has a, five-year-old a four-year-old and a three-year-old that’s hard. I feel for you when I had my last kid, because I have four children. My kids at the time were seven, five, three, and a newborn.

So not quite back to back to back as you, but young and it’s busy. It’s like having, you know, three toddlers at home, right. Justin and Becky has a 15 day old baby a week have some fun and then also overwhelming, but so fun. Congrats does amazing. Sharon has a, four-year-old a two-year-old and she’s almost doing two weeks.

That’s amazing. Congrats. Hopefully you’re feeling okay. It’s a loss that a four year old and a two year old at home done that. Yes. Woodwinds is yeah. Super busy for sure. For sure. It goes really fast though. Like my youngest now is three and I like almost like yearning for the baby stage again, like I’m good. I’ve done after the four and it’s COVID, which is crazy.

But, but I miss that like little baby stage. I didn’t love the baby stage while I was in the baby stage. Cause it was overwhelming and tiring and stressful, but I do love those little cuddly delicious moments, but I don’t miss the sleep deprivation when it says was a 15 week old fraternal twin girls. That’s so fun.

I always wanted and didn’t want twins. If that makes sense. Like I know from doing this kind of work for a long time, how crazy it is, twin life, you know, from the baby age and the feeding and the waking and just getting on the same schedule and then 15 weeks, like that’s a lot, hopefully things are going okay with you for sleep and everything, but it’s a lot.

And then like the toddler age is crazy. Cause there’s two of them at the same time, but it’s also so fascinating and I wish I was a twin. You know, like the idea of growing up with someone at the exact same time as me, I just thought that’d be the coolest thing ever. So twins are fascinating to me.

I’m a big fan. Glad in a way I don’t have twins, but also I wish I did have twins. One of those things, you know, you know, catch 22. Perfect, cool. So there’s lots of things here. Welcome. Make yourself comfy. And at any point you guys can start sharing questions with me and we’ll just go through as many as we can.

We will post this Q and a afterwards. So if there’s anything you missed or you wanted to go back and see certain questions again or whatnot, I think I will for you. So, and your friends or whoever weren’t able to come to the Q and a. So, all right, so they’re coming in. Let’s go, go in. Okay.

So Joanna says:

My three and a half year old son sleeps very well from 6:30 PM to 6:30 AM. Perfect. I loved while that hurts with a two hour daytime rest time, he started taking, talking in his sleep and sometimes he’ll sit up when I go, when I just tuck him in and give him a hug and he goes back to sleep. Is this normal? Is there anything I should be doing? (04:48)

Well, it is very common for toddlers anywhere between two and five years of age to wake up or sort of wake up in their sleep. So some kids and adults too will have periods of rousing when they’re sleeping. And typically it’s like in the middle of the night between sleep cycles of REM sleep and non REM sleep and some adults and some kids will, will wake up or seem to wake up.

Some kids even cry out or have almost like mini meltdowns at night. We call those night terrors, but some kids will get up. They might stand up. Sometimes they leave their bed or their crib. They might sit up, they might talk to themselves, they might laugh. They might cry all sorts of different things.

And sometimes they’re awake and that would be like more like a nightmare or, you know, fragmented sleep. Or it could be just a break in their sleeping between sleep cycles regardless. I actually leave them alone. So you want to avoid intervening because when we intervene in those times to get actually wake them up and they’re actually sleeping, like they are still in sleeping.

If their eyes are open, even if they’re talking to you, even if they’re crying in general, would going in, unless your child’s very distressed or truly awake, or you think they’re sick or something’s going on in general, I would avoid going in. So, you know, at this age I still had monitors in my kids’ rooms. I still do have monitors in my kids’ rooms, even my older kids.

And so I’ll kind of look and make sure they kind of go back down and if they sit we’re in, but they stand, ideally, if they’re good at self soothing with your child probably is given that they’re sleeping so well at night and nap time, I would typically avoid going in and I, I basically would not intervene.

And, and often times they’ll go right back to sleep and this can happen during periods of time, you know, for a week or a month or intermittently for a few weeks or months and then use it off. It just kind of goes away. It’s just part of development and, and that’s that part of the waking oftentimes just self Results. So I basically avoid going in.

Alright, Joyce. Hello. So Joyce says:

Hi to Dina. I have a 13 month old who can say a few words and likes to mimic sound and words, but has been unable to say anything with an M sound like a mom or my mom or my two questions. At what point should I be concerned? And to what speech milestones should I be mindful of between 12 and 18 months? (07:08)

That’s a great question. Okay. So between 12 and 15 months of age, the kind of speech milestones I’m looking for typically is somewhere between one and five words and they don’t have to be real words per se. I say they have to be things that parents understand. Okay. So for example, a 13 month old might say Bubba, and that child might be referring to their bottle and a parent or a caregiver understands.

Baba means bottle to that child. That to me is like, tick. That’s a word. However, if they just make nonsense about GABA, but it means nothing to you. It’s not quite a word to me of those one to five words by 15 months, I’m looking for at least five words. Most kids have 15 words and they should again mean something.

They don’t have to be the exact word. So it’s an example. So CA could be car and you know that every time your child says CA they mean car, but it’s still difficult have that gauge to enunciate the R sound. So by 15 months, I’m looking typically for about 15 words, but some kids have less, as long as they’re also doing other appropriate detrimental actions, we’ll come back to that in a second.

And then at 18 months, I’m looking for at least 20 words that you understand they should be enunciating quite well, not perfectly but better such that I would, those words that they’re saying as an outsider. Okay. So 12 months to 15 months, we’re looking for one to five words or so that you understand is caregivers at 15 months, usually at least five, but closer, usually to 15 words that you understand, and 18 months class where you should looking for 20 plus words.

Many kids have dozens of words at 18 months. Some children are even putting together two words into a sentence at that point, but we don’t need that to happen until two years of age. So the average two-year-old is having has in their vocabulary, dozens of words, sometimes even more.

And my expectation is that we’re putting two words together. So for example, let’s go mama up, come on, simple things. But two words, sentences when I’m also looking for at 15 months is not just the expressive language, but also the receptive language, or are they starting to follow simple commands, right?

Can they point out body parts for example, or can you ask a toddler to grab their shoes and will they, you know, know to do that without just showing them, but saying like, Johnny, go grab your shoes right at 18 months. And for sure, by two years, my expectation is at least to, to park commands. So Johnny go upstairs and grab your shoes.

So that’s a two-step command. Some kids at 18 months can do that. All kids should be able to do that by age two. Okay. So expressive language, number of words I mentioned and receptive language able to follow commands. Also most kids at 15 months and all kids by 18 months are pointing at things. They’re, they should have what we call shared attention, which means they are demonstrating things to you that excited them.

So does a child bring you a book and they’re excited about it. Do they point out a plane in the sky? For example, they’re interested and they’re having social reciprocity with that caregiver. Also by 15 months, most kids are becoming more interested in playing with other kids. They don’t necessarily have to be playing like really playing together, but they’re usually more interested.

And by 18 months, my expectation is that they’re playing much more consistently with other kids, not just next to them or what we call parallel play, but much more with them, like really truly playing, passing balls back and forth, you know, playing with trains together, that sort of kind of activity. So that’s, that’s basically what I’m looking for from a language and socialization perspective.

Hopefully that’s helpful. Let me know Joyce, if there’s any kind of other followup piece to that, but you know, to say a few words and mimic sounds at 13 months is quite appropriate. Some syllables are more difficult for some children and some not. So though, a lot of babies will say mama or dada that early on most typically can say dada before mama, which by way has nothing to do with the, the people in their lives that caregivers in our lives.

Some kids say data months before they say mama and don’t have a father present in their lives, or they say mama, and it’s two or one male caregiver. So they’re not directed when kids first see them. They’re more directed after 15 months. So I expect because a baby is saying, mama, they’re referring to whoever that person is that they call mama at 15 months, not necessarily at 12.

All right. So Sherly, hi, so Sherly asks:

What’s the best time to sleep train. (12:25)

And there’s not really a one size fits all of course. And there’s no real best answer. You know, myself and most of the Hara who is with me in the parent playbook, we’re one of the, you’re the two co-founders of this particular membership sites that we work in and Rosalie is my partner in crime.

And she is a, a sleep experts. She spends her career coaching families on getting the best sleep possible. She and I, and many others would recommend, you know, setting the, the setting us up for success for sleep hygiene as early as possible, even in the first few months of life.

So there’s lots we can do even before we formally sleep train, if you will, or coach towards independent sleep, there’s many things we can do very early on even the first few months. So for example, you’re trying to encourage your child to sleep independently, putting baby down, not necessarily fast asleep when that’s possible.

Some babies will consistently fall asleep on the breast or the bottle, and that’s fine, but the more we can practice, practice, practice, practice, falling asleep independently, even from a very young age, even in the first few months of life that is going to set the stage for more independence in terms of sleeping. We both like, and many others, like eight pitch, a room. I’m a big fan of that.

So that the child is very aware that when they’re in the light, this is a wake time. And when they’re in the dark, this is sleep time. And that’s true for nighttime and for rest periods or nap time, I’m a big fan of white noise. No more than 50 decibels, no closer than six feet from baby’s face or baby’s head.

I’m a big fan of white noise because it emulates what it’s like or what it was like when babies were in utero, because it’s quite noisy inside the uterus. There’s an aorta or big, huge blood vessel, the biggest blood vessel in our bodies, right by their ear. So kids are basically listening to vacuum cleaners when they’re sleeping or all day long when they are still within us.

And so when they come out, we often say, okay, everyone quiet the baby sleeping, but it can be really helpful for them actually to have that constant ongoing white noise. So I like a pitch black room. I like white noise. I like to encourage babies to sleep in a consistent place, whether that’s the best Annette or their crib or whatnot as early as you can.

But I guess what I’m getting at is very early on. I like being consistent and being mindful of setting the stage for those independent sleep skills. And then personally, I recommend starting to think about training towards independent sleep around four to six months of age. That’s what I did with my own children. That’s when I encourage them to sleep on their own.

And even to fuss it out a bit, if they needed to do that, which my kids all needed to do that they had to fuss it out until they found their thumbs and then were able to self-soothe I chose four months of age for that. Others chose to have six months and it’s always going to be what’s up. What’s the best thing for you and your family and your choices.

But even before you’re been doing those kinds of training methods, I’m all about early introduction of proper sleep habits. And those will take you a long way. You know, it’s really all about practice. So the more you often you can try to put baby down independently, it’d be far easier when you go to actually do any training methods. If you choose to do that.

All right, Jacqueline says:

I’m in a home with my son. Who’s 13 months and he’s gotten sick five times. How is that? How is it? He is still getting sick, but we are socially distanced and not going to daycare. (15:57)

I don’t really know the answer to your question. Really. It’s far easier to get certain viruses than others.

And sometimes kids need very minimal exposure to get something right. Their immune systems have been to yet to been exposed as much as ours, of course. And so some kids, they get exposed to any virus and they Mount an immune response and they show illness, which is why kids that do start daycare often gets sick on average 13 times in the first year, if your child’s home and it’s still getting colds, there is likely some kind of exposure.

Maybe that’s another caregiver that is working outside the home. Maybe that’s, I don’t know, grandparents that might be coming and spending time with the child. I’m not sure, but if a child’s getting virus viral illnesses or fevers or whatnot, it is because they’re getting exposed to things except for the very small number of kids that get illnesses.

And they’re not related to viruses and there’s some other medical condition happening, which is much, much, much less typical. So certainly somebody to review with your doctor, if your child’s getting sick, but it’s pretty remarkable how easy it is, get some viruses. And we’re seeing that with the, with the pandemic, right? I mean, there’s many people that say they have no exposures and they, they really weren’t around other people or they spent very little time or they were distanced or they were masked or both around other people and yet did to get infected.

So I think it goes to show how easy it is to get things. And young people put things in their mouths and young people obviously don’t have good high-end hygiene. Like we might, if we’re being very mindful of it.

So it’s easy, right? It could be as simple as going to the playground. And someone else was recently at the playground with not perfectly clean hands and the child puts their fingers in their mouth. You know, it could be from, again, another caregiver leaving the home or someone that you saw outside, and you didn’t recognize the risk that was present even with some distance.

So we don’t know what all, you know, with regard to viruses, but if a child truly has no exposures and they’re getting sick, they’re getting illnesses. That’s for sure. A reason to talk to your doctor to want to say, thank you incredibly helpful. No problem. Happy to help.

All right. So Aaron says:

My five-year-old has a bit of a picky eater. We all eat the same meals. And, and our only rule is that he tried everything on his plate. Sometimes this means very few vegetables. One is, are there rule appropriate for this age? And two is a few veggies, a problem. And three, when you kids get less picky. (18:25)

Okay. So let’s kind of unpack a bit of a picky eater.

I am a big fan of one plate for every one of the family. And so what I mean by that is all of us in our family. There’s six of us. My youngest is three. Then I have six year-old, eight year-old and 10 year-old. And my husband, we all share the same food, the same food, you know, the same plate of food and our personal rule.

Of course, everyone could choose their own for their family. My kids have to eat a variety of the things on the plate. They don’t have to finish it all, but they eat a reasonable amount of it in order to move on to the next phase, which for us, again, our family, this is our choice is some, some type of fruit.

And our kids often have a choice of kind of whatever’s around. They might pick berries or an Apple or pear or a banana whatever’s kind of available. And they have a choice in that. And then they, if they’ve had a good day, good behavior, all the rest of them, and then they can have a treat of their choosing. Again, this is just our rules.

Everyone has their own rules, but for us, if a child, one of my kids has a bite of broccoli. That for me wouldn’t feel enough. So when we say to our kids, you just try it. A lot of kids will try it, but it’s like so minimal that doesn’t really help anything. So I like not being forceful about it.

And I, and I really try not to encourage any negotiating and bribery and battling at the meal table. I always say to families, I want you to fake it till you make it. Like almost like poker face, be happy, go lucky is all good. And I basically don’t give attention for the negative behaviors, like the pickiness, or they’re throwing food on the floor or whatnot, but I also won’t give them more of what they want if they don’t eat a variety of things.

All right. So here’s a good example. So a lot of times modelers prefer carbs. Things like pasta, rice bread. And to be honest, that’s what a lot of us prefer. Right. I would really be happy living my life, getting past that in bagels and muffins.

Like a lot of us would gravitate towards carbs cause they’re yummy and they’re sugar right at the base of it. And they taste really good. However, obviously that’s not a perfectly balanced diet. And in particular, a lot of kids don’t like eating protein, filled foods, like, you know, the meats or eggs or like goons or tofu or things like that.

So if left to their own devices, I find a lot of kids will have, let’s say the past data have almost no or no meatballs. And they’ll have like a bite of the broccoli if that’s your meal, right? So if you offer those three things and your kid has all the past data has none or almost none of the meatballs. And again, a bite of the broccoli.

Next time I would offer less of the past stuff, ensuring that they eat those other two ingredients and then I would offer more pasta. Right? So I think you have to know what your kid is into. And again, the vast majority of our children would prefer carbs and dairy as well. Kids love cheese and yogurt and milk, and it would also be mindful of how many snacks a child is eating in a day.

Because a lot of kids, we have this like dogma. I don’t know why eating many times throughout the day. You know, a lot of people think it’s healthier for us. It’s good for metabolism. It’s not actually, that’s, that’s a lot of rubbish, but also a lot of kids will have a snack.

You know, whether it’s at school or daycare or buy us at like four o’clock let’s say, and then we expect them to have a full or rather an empty belly for dinner time, like an hour and hour and a half later. But they just had crackers and cheese an hour ago or whatnot.

And kids by and large don’t snack on like a chicken breast or like tofu cubes, right? They’re snacking on carbs and dairy. So I’m always very mindful to suggest to pay attention. You know, I say to families, I want them to earn their snacks. Okay. Not to say it’s reward, but rather if your child can’t eat three great meals a day with protein and healthy fats and fruits and badge, and it’s varied and you’re satisfied and they’re satisfied and they’re growing well and all is good.

Then you can experiment with putting snacks into the mix, but I wouldn’t necessarily offer snacks every day. If your child has difficulty with meal times, because there’ll be much more likely to eat those meals that you provide, again, with a variety of things that are in meals.

Again, the healthy fats, the proteins hits they’re hungry. And if they just had a snack an hour ago, they might not be hungry. In which case you’re going to be much more likely to have a battle. Okay. So basically come to the table, hungry. He is a family and eat one plate of food that everyone has the same food.

Don’t negotiate, don’t bribe and be mindful not to give them all the things that they want. If those things don’t make up a varied balanced diet cut back on the things that they really would like. And they might eat more of in favor of eating the things they don’t want first, and then give them maybe seconds of the past stuff or the rice or whatnot, if that’s what they’re looking for.

And when did kids get less? (23:43)

Well, some kids continue to be picky actually, when we battle and we negotiate and have these fights at mealtimes, it’s a lot of it is attention seeking behavior. Kids are getting a lot of attention for it and also important. We developed taste buds and tastes according to what we eat.

So if a child continues to eat tons of carbs and tons of lactose and a lot of sugary type of things, or tens of salty type of things like snack foods often can be like ships, et cetera. We then have more difficulty accepting and liking the taste of things that might be more sour or more bitter or more tart. So the more we expose our kids to foods when they’re younger that have these varied, you know, kinds of tastes, the more likely they are to actually like those foods.

Right? So a good example of this would be beer or alcohol, very rarely does someone try some kind of alcoholic beverage when they’re younger and they love it. Right. So if you think about your own selves, if you ever drank alcohol, which probably most of you have the first time, no one is like, wow, this is delicious.

This beer is amazing. Like, I definitely did not have that experience, but you’re trying it again and again, in some cases, and then people start to like it, but the first time you drank beer was probably quite gross to me. It is still quite gross, but I guess if I tried it again and again, and again, if I was motivated to do that, I might develop a taste for it and actually like it.

So it’s that same kind of idea with food for kids. So they have to experiment with things, try things again and again, it was very good evidence that kids need to be exposed to foods anywhere between 10 and 20 times to accept it more readily.

So if your kid hasn’t liked broccoli the first twice, like two times or five times or 10 times, you’ve offered it, keep on trying. You can, you know, mix it with foods that they do like, right. You could put melted cheese on that broccoli. You could put some butter or some seasoning on that broccoli or some healthy oils.

You know, you can mix things with other things that make it more palatable for them, but I wouldn’t give up because I don’t like it on the first go or the 10th go, but I also wouldn’t fight it. Okay. I think that’s really, really, really important. I hear from families every day, many times a day, parents that are battling with their kids about mealtimes.

And that is something I would absolutely recommend. You don’t do it. Doesn’t help. It tends to make more pressure. It tends to ruin the entire night for people everyone’s that hour or longer everyone’s bedtime. Then kids are saying that they’re still hungry and then bedtime gets delayed. And it’s just, it’s a bit of a mess. And a lot of parents think all day about that dreaded dinner time coming up.

And quite frankly, it makes me really sad, right? I don’t want this for families. I want it to be a social time. I want it to be an enjoyable time. You know, I want to sit down and talk to my kids about their day. I want to, you know, hear about what happened in the, of the day without battling and trying to get them to eat X, Y, or Z.

So easier said than done in some cases, especially if you’ve been battling for a long time, but I would take it back, relax your shoulders, fake it till you make it. If you have to, but stop with negotiating the battling, here’s the plate of food. This is the offering. And if they don’t want it poker face, okay. No big deal, but this is the meal.

The next time we’re going to get to eat this breakfast. And if you’re getting hungry, hungry in an hour, either, there’s no more offer the dinner. You know, the dinner services over. Or if you really want, you could offer that dinner again. You can keep that plate out for your child, but I would fight or negotiate or top up with other food.

You know what they want because you feel badly that they’re hungry because they need to learn. You know, they don’t know what’s healthy for their bodies and just not, you know, the idea that they’re hungry, making us relax, audit and say, okay, whatever you see whatever you want.

That’s not teaching them anything. And it’s not filling them up with the variety of things that we know they need. Right. They can, many of us adults will eat salads, you know, salads, not the most delicious thing, but we eat them and we learned to enjoy them because they’re good for us. Can we know that? But they don’t know that.

Right. So that’s why we have to many coach them and practice practice. Yes. All right, Darren. Hopefully it was helpful if there’s any other follow-ups please let me know. All right. Can we get this guys? There’s so many questions. We have half an hour left. Let’s let’s see we do this. Okay.

So Sharon says:

Sunnybrook stopped during circumcisions. I know I can book an appointment at sick kids, but I was wondering if there are other places that you trust where we can do a circumcision. (28:01)

So I guess this is Toronto specific Sharon’s asking of hospital does do circumcisions. The wait time is over a year and it costs three to $5,000. If children are less than three months of age, there are plenty of options in the city, actually, for people that do it in hospital, people that do it in clinics, people that come to your home.

And instead of mentioning on here, I think it’s best to discuss it with your physician, but there’s definitely options. But the important part to know is that if the children are three months and older and you’re looking for a circumcision that has to be done in hospital hamper than that, it’s hospital-based community-based options.

Madelina Says:

My pal does not speak until she was three and a half. My youngest just turned three. He understands absolutely everything and says a few words, but doesn’t make sentences. (28:50)

So I always recommend if your child has any kind of developmental delay to follow up with your own doctor, get a full assessment. Obviously this is, you know, just the Q and a session, but we do know that a family history of delayed expressive language is pretty common.

I’ve met many families over the years where a parent or a sibling had delayed expressive language and then caught up and is doing just fine. And siblings have the same, but it is really important to get a formal assessment. Cause there’s many reasons why kids have to leave language, including, you know, developmental challenges like autism and other developmental and behavioral challenges.

Hearing could be an issue. So there’s lot of things to kind of work through here. So I would follow up with your doctor about that.

Justin and Becky:

We’re currently exclusively breastfeeding, our 15 year old daughter, two questions. She’s getting a second blister in the middle of her top lip. Is this more normal? Now? What can we do to prevent it. (29:47)

Very easy actually. So a lot of babies will even be born with sucking blusters and that’s because a lot of babies, even in utero will suck for own lips or they suck their hand. And what’s happening causing that second blister is the lip is rubbing against whether it’s the breast or the bottle, the nipple of the bottle or their hand.

And it’s just friction. It’s just rubbing. So if a baby comes out like that, I’m not going to do yes, resolves on its own. They don’t hurt. I don’t get the sense that they’re uncomfortable in any way, and they don’t get infected or anything like that. But the important thing would be whether it’s breastfeeding or bottle feeding, to make sure that the lips are Fallon. Okay.

So some babies will take their lips and kind of pucker them. And then that rubs on the breast for the nipple of the bottle. When you want always is basically being duck-billed right? So you want the lips to be open like this, like a duck and sucking like this again, breast or bottle, doesn’t make a difference.

You just don’t want the lip to begin and then rubbing on the breast or the nipple of the bottle. So you want to kind of balance the lips. That’s how you prevent it. That’s how you fix it.

And the second question at one point is the breast pain or sensitivity go away completely. (31:02)

This is another thing I think we should, you know, work through with, with your physician or midwife or lactation consultant.

I’m actually a big fan and a big advocates that new parents work with lactation consultants. If they’re breastfeeding after birth, not just, you know, the day after delivery, when the milk isn’t even in yet. And we don’t even know if a baby is transferring milk yet because rarely does mom actually have real milk yet.

Maybe just claustrum or that early thicker cream kind of milk. I really think that all moms, when possible should follow up with a lactation consultant after day three or four. So when milk is really in, because that’s really, when we see, you know, trouble, you know, start to begin where moms might be feeling any red or raw or uncomfortable, and babies may not be getting as much milk out as they can, but it is really common for breastfeeding women to experience some discomfort on their breasts or their nipples after delivery and during breastfeeding.

But typically after a few days of age, moms will start to feel less discomfort. If the mom is still feeling uncomfortable, ongoing with feeding, particularly if it hurts kind of throughout the feed and not just with the initial latch, this tells me that there is some concern that the latch there’s some imperfections to that latch because breastfeeding should not ongoingly hurt.

Okay. Nipples should not hurt. They should not be chapped. They should not be cut up. They should not be bleeding. A lot of women kind of like, you know, data, take it and like, okay, it’s okay, this is what’s supposed to happen like this.

And it’s not okay. Breastfeeding is not supposed to hurt. Okay. Some women feel uncomfortable the first couple of days that should resolve. Okay. So I would encourage you to follow up with a lactation consultant or your doctor to make sure that the latch is as perfect as it could be.

All right. Luna says:

It’s my twins are battling GERD. They’re on a hypoallergenic formula and medicated with compounded laptop resolve and stoppers all is a proton pump inhibitor. And it’s an antacid at first in responding to the meds and food combo. But after three weeks, things got worse and it doesn’t look like the meds were food is working anymore. Should I look into allergy testing for them? The reflux issues are affecting their sleep. And baby B screams in their state for hours for at night. Baby A is congested with trouble breathing at night. Are these related to GERD? (33:00)

I think this is one of those things that it’s best to follow up with your doctor because there’s so many pieces to this. You know, there’s so many reasons why kids can have trouble sleeping or pain or discomfort.

But I think it’s important to mention that hypoallergenic formula. What that means is that it’s not there’s no, the dairy protein has been broken down. And so essentially babies are not ingesting. Dairy. Dairy has nothing to do with guard. Okay. So a GERD is, is gastroesophageal reflux disease. When babies feed milk goes from the mouth to the esophagus, into the stomach at the bottom of the esophagus and the top of the stomach, there is a sphincter or a muscle.

Okay. It’s the same as like, if you tighten your bum cheeks, you’re tightening the sphincter that allows poo to leave your rectum. You have a sphincter that you cannot control up here at the top of the stomach, the bottom of the feeding tube or the esophagus.

Okay. That is basically open and relaxed when babies are babies because their muscles are relaxed. Okay. So picture like a relaxed rubber band. Okay. Milk goes in, it fills up the stomach and the point of least resistance might actually be up and not down because that’s Victor to the intestines can actually be tighter over time. Those muscles get stronger and tighter and it’s become more upright, right? So like you have a four months or six months, they’re more upright.

Their muscles are stronger and tighter. So reflex or the splashing pop of milk or food starts to lessen when milk is splashing up, whether kids are spitting up or burping up, or it kind of goes to the back of their throat, they may think they make that kind of face.

That’s GERD, gastroesophageal reflux. It just means the milk is coming up to the back of the throat or leaving them out. GERD, gastroesophageal reflux disease means the milk is coming up and there are comfortable by it. Okay? So most babies have GERD and they spit up or goes to the back of their throat or, you know, milk comes out their nose and they’re not bothered because those happy spinners they’re unbothered.

We don’t do anything about it. And it goes away by itself. Some babies are more uncomfortable wide. So those babies might be more fussy. Those babies might be arching back. They might be refusing the breast or refusing the bottle that is reflux disease. And by and large, this goes away on its own. Again, as those muscles get stronger and tighter, and as they start to take more solid food, which has more weight to, it has more gravity to it, which leads to less spinning up.

But it’s, there’s many things that can cause babies to be fussy or have poor sleep and that sort of thing. And so again, it’s worth reviewing with the doctor, what these antacid medicine is do is they do not prevent the milk from coming up, right?

Because that’s just an anatomic thing. The muscles are relaxed and milk comes upward. What they do is they make that stomach acid less acidic. So when it does come up, it doesn’t burn as much. So babies will still spit up. Babies will still have that gurgling and gagging kind of thing in the back of the throat, but it shouldn’t hurt so much.

And so that’s why some people will use as medicines, which eventually in my experience, usually by four to six months, babies don’t need them anymore. Again, because their reflux has already been improving on its own hypoallergenic formula is not, it has nothing to do with reflex, right? Whether you have this type of formula or this type of formula or breast milk makes no difference, it’s still milk.

It’s still going to the stomach and it’s still going to come up if it wants to. So hypoallergenic formula is not a useful thing. In the case of reflux, some babies have trouble digesting milk, protein, or soy protein. And that is again, not related to reflux. So I think about reflux like reflux is here and how is milk, protein intolerance or a difficulty digesting cow’s milk, or sometimes soy protein is more of an intestinal thing.

And that’s like below the belly button, if you will, or below the rib cage, those kids also sometimes have discomfort with feeding or afterwards. They might have really gurgly bellies. They might have really particularly wet or mucousy pu though, both wet and mucusy.

Poo is normal in many babies too, or they might have blood in their stool. Again, not related to the upper staff, which is the reflux. This is more abdominal stuff. And in those cases, that’s when we consider using hypoallergenic formula, because the challenge there is it reflux, it’s digesting, dairy protein, so unique things, and always again, best to discuss with your doctor because there’s so many pieces involved and we want to make sure that the weight is good and your kids are growing well and they’re interacting well and developing well.

And there’s so many pieces to it, but that’s kind of how you tease apart. What is a protein and tolerance, which again, kids grow over time versus reflex.

At the end of the day, the vast majority of kids benefit the most. If they have spinning up or discomfort with really. So you can imagine if you’re lying down your esophagus and your stomach are going to be at the same level, but the more upright you are, you soft against is above the level of the stomach. So that’s why we often will like hold the babies up right after a feed or, you know, put down.

But sometimes that an ankle or some parents will wear their babies after feeding for a period of time. And that’s to allow the milk kind of to pass through to the intestine instead of coming up as much as otherwise it might, Right?

Jennifer says:

Three-year-old, who’s super active. Daycare teacher says he doesn’t waste a moment of the day, but we are struggling to get rest time in the day on the weekends when he’s home, because he doesn’t get to this at school. I know you’re a big advocate for rest time. I absolutely added get ready for your first time. So how do we introduce this as a, too late in the game? He dropped his nap about six months ago. (39:05)

I don’t ever think it’s too late to bring back rest time, actually at all. I’m a big fan of siesta or rest time or nap time or whatnot. And my focus in the toddler is isn’t on sleep per se, especially if they’re not used to sleeping some kids, they just need just quiet time. For me, it’s like a reset. It’s, you know, it’s like a push pause because I find that when kids have some rest time and to be honest, where we have some rest time, it can, you know, kind of reset the day and it’s not.

So just straight, you know, I find if we’re with our kids, you know, for those 12 hours, when they were awake, there’s no time to chill. There’s no downtime.

There’s no kind of relaxation for the brain. They’re just go, go, go, go, go is, as you mentioned with your child. So I wouldn’t say you have to go for sleep, you have to go for nap. I would more encourage it to be independent play or quiet time. So I really talk about it.

And it’s this amazing thing, you know, mommy is going to have such a nice rest time now where daddy’s gonna have such a nice rest time now. And it’d be really good for you to rest time. Now, you know, you could talk about your child’s favorite stuffed animal or, you know, stuffy or pet or whatnot also needing rest time.

Right? So what I would say to my own three-year-old would be your stuffy bunny really needs to rest. And we have to be really quiet. Cause bunny really is tired and we need to make sure bunny feels really good, right? They understand the love they have for their things and especially their stuffed animals. So if you put it on to them, bunny really needs that rest.

Mommy really needs that rest. You really need that rest too. And again, I wouldn’t negotiate and I wouldn’t battle it. I would just make it as this is now the part of your day, right? Just like when you start daycare for the first time your child is now getting used to all sorts of new routines and new structure in the day.

And we expect that’s going to happen just like when they start school for the verse, I’m going to start a nursery or daycare for the first time. So two, you can change up your routine and your structure just because you haven’t done it before. Doesn’t mean you can’t do it again. Right. Also I would really suggest making sure your child’s as tired as possible.

So they do want that rest. And again, really important. Don’t focus on them needing to sleep. They need to have quiet restful time. So I don’t care if they want to talk to their stuffies or sing to their stuffies. I don’t care if the kids want to do Lego quietly in their bed or at their desk. I don’t care if kids want to read.

I love all of those quiet activities, but I’m not going to be present for it. So point is your sweet, independent, quiet time. And I don’t want to hear you essentially. So sometimes like, you’re my three-year-old like, Oh, happy. He’s like saying this stuff. These I’m okay with like quiet, you know? And then he’ll often sleep.

To be honest, my three-year-old will fact my six-year-old sleep still sometimes during quiet time, but all my kids, including my eight year old and 10 year old have quiet time every single day after their school day and on the weekend for actually two and a half hours on the weekend. And most days a week, an hour to two hours before dinner time, again, it’s that reset button.

Nothing makes dinner time better than having had that siesta arrest time. It’s that, that refresh that reset. It makes everyone much more calm. So basically you want to make it sound fun and awesome. You want it to say, I’m doing it, Bunny’s doing it. Or whoever else, you know, your child likes take the pressure off of sleep, focus on something quiet they need to do.

And I think it’s really, really important for kids to know and learn how to be bored. Okay. This is, I think I feel like old saying this, but I really feel like this is like a problem for our generation or a kid’s generation. I really do. And I’m really worried about it.

We are so used to being constantly stimulated all the time with, you know, you know, our phones and kids have tablets and TV and video games and smart watches. And they’re just so much happening all the time that many people are incapable of being alone and quiet and bored. So I see a lot of kids that need their screen all the time.

I’m really worried about two, three and four year olds that have their own tablets that they can just access whenever they want. This is not normal for kids’ brains. It just isn’t. And it’s very much just kind of this generation that has access to these things. Right. You know, some parents will tell me, you know, I always watch TV all the time when I was a kid.

Yeah. You might have. I watched TV a lot when I was a kid in my parent’s family room and that was my screen. I didn’t have a smart watch and an iPhone and a tablet or a gaming system in my bedroom because no one had those things. They didn’t exist. So it’s very different how much tax to screens our kids have now, compared to when we were growing up.

Even if you watch screens all day, it wasn’t in your bedroom when you’re trying to go to bed because it didn’t exist. Right. So that’s the part that I think, you know, is, is worrisome kind of as this, this generation of kids grows up, but I want kids and adults, to be honest, to know how to be bored and like think and like read and be creative independently. Right.

I really think that’s a really important skill. I think a lot of kids are very used to being entertained or played with by parents. And I think part of the siesta for me is them learning that they could be alone and still have a great time and not be bored even though they’re by themselves.

All right. Jacqueline says:

Would you recommend restore ALEKS for constipation, toddlers, we’d fry prunes, but that doesn’t seem to help. (44:48)

So lots of old constipation, I’m actually writing a book about potty training and constipation. Yeah. Because it is very common and probably the most common thing I get asked on a daily basis, actually, other than sleep training, kind of related stuff and other behavioral stuff, constipation essentially is when children or adults have harder poos or difficult to push out poos or infrequent pools.

So the goal for kids and adults is to have at least one soft food a day, easy to push out, no straining and no pain, no blood, it shouldn’t hurt. You shouldn’t take more than five minutes and it should be basically easy to do.

Okay. No belly pain, no rectal pain. None of that. My goal is that all kids from the time that they’re starting to have solid food and older, or having at least one soft, easy to push out per day, ideally kids get enough fiber and fluids, water in particular, in their diet to have that soft poo every day. And lots of kids don’t.

As I mentioned before, a lot of kids have a ton of carbs in their diet and a ton of lactose or dairy in their diet, both of which can be very binding. So the first step for me is always going to be to look at their diet, making sure kids are drinking, lots of water, not drinking too much milk. So not more than 16 ounces of milk a day.

Again, we’re talking about older kids that are having solid food. Now, not baby. He’s going to obviously have more milk than that. And that they’re getting a good amount of soluble fiber in their diet. My favorite foods are mango berries like goom so beans and lentils, dried fruits. So things like prunes, as you mentioned, apricots, et cetera, which are always best to rehydrate. So they’re really wet though.

You could, I guess, munch on prunes as well, but make sure you’re going to get Navigant off of water to push all that fiber through and berries. Those are my favorite, any kind of berries. Great. And also Apple and pear are particularly good, but I like to keep the peel or the skin on a lot of people don’t know that a lot of the fiber in a fruit or veggie is actually in the peel.

So what I recommend is children should, again, after they’re trying to have solid food start having the peel of fruits or veg that you would eat as well. Right? So I wouldn’t eat a banana peel, so I’m not going to make my child eat a banana peel. I wouldn’t eat a mango peel. So I would peel that for my children, but I would bite into a payer after it’s been cleaned.

And I would not peel that for myself. Therefore my children would eat it cleaned with appeal as well. Okay. So pear Apple, mangoes berries, dried fruit, like booms mango. Those are my top things. And then lots and lots of water when children have a great diet and they’re still having a predisposition to constipation, which is very common, even in some kids that haven’t beautiful diets.

Oftentimes I find it, a family history to that where one of the parents will say, Oh yeah, I always get constipated. Constipation is by thing. I’ll be constipated for years, et cetera, restore lax or peg 33 50 is the medicine or the laxative of choice. Pretty much around the world by pediatricians and family doctors, gastroenterologists.

What it is is an inert fiber that acts like a sponge. So what it does is it brings water into the poop to make the poo softer, with easier to push out and then you exclude it. So your body doesn’t absorb it. You don’t get addicted to it or tolerance to it. It leaves your body. And so what we often do with, depending on the age of the child, again, always ask your doctor about your child because there’s other reasons for constipation as well.

But if you’ve ruled out other things that are causing constipation, what we suggest is to use restore, relax, depending on the age of the child and the size of the child. Sometimes half the capita, sometimes full capita or 17 grams is a cap full of this medicine with the goal of again, one soft, mushy, easy to push out poo every day.

And then once you get to that point, we start to slowly wean down off of the medicine. We don’t just go on and then stop it because every kid will get constipated again. But rather it’s a very slow ween. So again, they’re having that soft, easy to push out who every day, the way I think about constipation is similar to pregnancy. Okay.

So when you’re pregnant, your uterus is stretching and growing and then you deliver and your intestine, isn’t sorry, your uterus has to go right back to the, it was, it takes some time, you know, the muscles have to get stronger. Again, we, you know, it takes time,  you know, nine months plus to make it maybe nine months plus to go back to it was.

And sometimes we’re never back the way we were. There’s some stretched out kind of, there’s some stretch from having our uterus stretched out. And so that’s the same way with the intestine, right? You know, your intestine, it’s stretching out accommodating more and more poop that isn’t leaving the body.

So we can’t expect just because we pooed just like, just like we had a baby that is going to go right back the way it was it’s muscle and it’s stretched now. So it does take some time to slowly go back to the way that it was. So it’s not a quick fix using peg or getting on a diet where they’re putting every day does not make constipation go away.

Okay. So it’s always a slow kind of wean off of those medicines. And ideally, you’re able to find what I call the kids, magic food, my own kids. It’s blueberries. If they eat blueberries every day, their view, their poos are beautiful and easy to push out and soft. And if they don’t have berries every day, their poos tend to run more, more firm.

So my kids blueberries every day, hopefully you can find out what your kid’s magic food is and they don’t have to use the medicine in the first place. All right, guys, we’re ready to be. It was a lot of questions, But we’ll do it again. We’ll do it again soon. Okay.

Archie says:

My seven month old is, is popping his teeth. Now he’s having fever for the last three days, going up to 38.5. Is this because of teething? (50:55)

Nope. So I know you have more questions, but teething does not cause fever. Okay. Teething can cause elevated temperature. So the child’s temperature is normally, let’s say 37. We sometimes see like 37, five or something like that with teething, but true fever over 38 degrees is not from teething.

If it’s three days a fever, the child might be teething, but they probably also have something else going on like a virus. So I would touch base with your doctor about that.

How long before the fever goes away? (51:35)

I don’t know. I don’t know the cause of the fever, but it’s not from teething.

You’re making enough white diapers. No diarrhea gets quite cranky, but controllable somehow, when should I be worried? Right now I’m giving a tempra, every 16 hours. (52:41)

So, you know, tempras fine, you know, for fever all we check with your doctor to make sure that that’s an okay medicine for your child, but typically is. And I would touch base with your doctor because I don’t believe that a fever of 35, three days in a row in a seven month old is related to fever.

Sorry, limited to teething. I would touch base with the doctor to make sure there’s no other infection happening.

Aaron says:

What’s the latest on accurate COVID testing and small kids. My son who’s five years of age had the brain scratcher, I guess the nasal PCRs swab once this fall. And it did not go well, he’s back in school. So I assume at some point we’ll need to go again or the oral or lower nasal swabs accurate. (52:10)

We don’t really know, basically. So currently what’s happening still is the brain scratcher as you call it the PCR nasal swab test. And it does have to be going, it does have to be deep into the nostrils, you know, as close to the back of the throat, actually as possible from the nose.

So that is currently the test that is being performed by public health. There is some research going on into the saliva tests and oral tests and other kinds of tests. But so far they haven’t been validated or rolled out as a proper and as accurate screening tool for kids and adults with presumed or possible.

COVID certainly around the world. There’s doing other types of testing, including melt swabs and rectal swabs and urine tests and other things, but not quite in Canada yet. Right?

Flaviana says:

My son and 11 month old is frequently constipated. He’s still breastfeeding, but I also give them food. How long is it normal for a kid at this age to go without pooping, which I worry about? (53:22)

I think I answered most of this earlier breastfed babies before they have solids do not need to poo every day. Okay. I think that’s really important to mention there’s a huge variety of normalcy in babies that are breastfeeding in particular, even if it’s not exclusive breastfeeding, even if it’s only partial breastfeeding babies that are breastfeeding could poo 30 times a day or even every 30 days.

Okay. Say it again. Some breastfed babies poo once a month. And that’s normal for that baby. If that baby’s otherwise normal and has had normal poos, et cetera, but there’s huge variety. Some babies don’t poo every day when they’re breastfeeding. However, once we start solid food, I would like them to have enough fiber foods. As I mentioned before, those things may go as berries, et cetera, that they are coming every single day.

And even if the baby’s exclusively breastfeeding still, I would also be offering water after four months of age, once they start solid food to help push all that fiber through, even if they’re still breastfeeding, a lot, water is very helpful with meals and I would continue to offer it.

All right. Let’s do two more. Carrie says:

Is it usual for toddlers to develop a tick with shoulder shrugging? Should I be concerned and see her doctor? (54:40)

I always think if you have concerns, you should see your doctor. I mean, that’s, that’s what we do, right? I think if you’re concerned, yes, you just, your doctor.

However, I would say that takes are very common. When it take beans, it’s a motor or something physical or a vocal, something that you hear movement or habits. So some kids will blink or some kids will, or, or some kids will move their head or move their shoulder. Some people bite or pick their nails. You know, some kids twirl their hair.

These are all different types of ticks. And it’s basically a habit or a child or an adult. A lot of adults have ticks as well. You feel like you need to do something to feel better, right? So kids will tell me, they feel like they need to sniff to make the thoughts about sniffing go away. So sort of like OCD, it’s not OCD, but it’s that concept where I feel like I need to do something to make that feeling go away.

And they’re very, very common. They’re not very common in toddlers, but I have never seen more ticks in my life than during the pandemic. I think for a number of reasons, I think screen time, excessive screen time contributes.

I think poor sleep and stress and all this emotional kind of turmoil can certainly contribute. And just the overall stress and overwhelm. I think if some families, so I think it’s always best to talk with your doctor and make sure it’s not something medical, but ticks are very common. And the natural history of them is that they wax and wane and they change.

They get better. They morph, it could be blinking. Now in four months from now, it might be throat clearing and then it might be a shoulder shrug. They kind of change over time. And family history also plays a role. There’s a lot of people, a lot of kids that have ticks have parents that also have, or have ticks now not a hundred percent, but many people do.

A lot of parents will tell me, Oh yeah, I had a tick when I was young and now my child has one. That’s just super common. Right? Last question. I’ll try to get to one person who hasn’t asked one yet. So Carla says, last question guys, but we’ll do this. We’ll do this once a month.

Okay. Well, we’ll get on it also. I should mention that. Like, if you have lots of questions like this, please do ask your doctor, but this is actually exactly why he has the membership. So the parent playbook, which you can see the icon here, it’s a membership site and it’s dedicated to helping parents work through all these challenging things that we all face.

So challenges around feeding or starting solids or picky eating behavioral issues like temper tantrums or, you know, meal time drama, all of these issues and sleep related stuff too. This exactly what we do. So we have a team of experts. There’s 12 of us, different people like pediatricians and sleep experts and psychologists and behavioral therapists and speech therapists and dieticians.

We’re all these group of experts that are here to answer your question. So if you find yourselves having tons of questions and you don’t have access to your doctor, or you want more resources, that’s exactly what we do within the membership. So I see there’s lots of you have many questions and we’re really happy to help you out. And you’re welcome to check us out.

Our memberships are currently open. Actually it’s a closed membership. We opened only a few times a year, but if you want to learn more information, you can certainly check us out and we will open again, probably in April and may to new members. So in the meantime, we’ll keep on doing these for free and I’m happy to answer your questions, but if you’re dying to learn more and learn from more of our experts and you always feel like you have these questions, this is a great resource for you guys, for sure. Okay.

So Carla says:

Hi, Dr. Dina warning, if you can share when it’s safe to wean off formula to a regular milk and any tips on how to do so, Carla has a nine month old. (58:24)

Fun time of those fun. They’re like moving and they’re trying to talk. And they’re like little people. It’s really, really a age. So to answer your question, babies can start having homo milk anytime after nine months of age. So many people choose 12 months or older, but most children can tolerate cows milk or homo milk.

At nine months of age, plus formula is made with cows milk. Most kids are getting housed milk based formula. So the transition to milk should not be a significant one. So after nine months, babies can have homo milk. We do want to use homo milk, high fat milk, whole milk, or 3% milk is what homo milk is. And the goal would be by 12 months of age, I’m looking for no more than 16 ounces of milk drinking a day.

What happens usually between six and nine months is that babies start taking a lot more food and a lot less milk. So if you think about like babies, they’re having milk and no food. And at four months, usually four to six months, we start having more and more food and milk starts to come down.

And between six and nine months, you know, milk is going down. Food is going off Chrysler foods here and milk starts to go down. So by nine months, most kids are getting a lot of their calories from food, much less from milk and homo milk is something that you could offer. Head of babies are less interested, whether they’re pushing away, you know, you, if you’re breastfeeding or pushing away the bottle, that’s fine.

My expectation is that they’re taking more food and less milk after nine months of age. Perfect. Awesome guys. I think there’s a lot more questions. I’m sorry. I can only do as much as we can do in the hour, but I will be back in a few weeks.

We’ll do this again, please, you know, ask your, ask your pediatrician or healthcare provider. If you have any questions about your kids, you know, follow me on, on social media, in the YVC, I’m happy to answer things there in some capacity, knowing of course that I’m not your pediatrician and you know, the whole kind of comprehensive part of your kid’s health is important to review with them.

And we do share free resources within the parent playbook. And we will open to new members in the next couple of months. And in the meantime, you’re welcome to get our updates on our waiting list and things like that. If you’re interested and yeah, we’ll probably be back in a few weeks. We’ll do this again. I hope you guys are healthy and safe and are having a great winter and I’ll see you back in a few weeks.

Bye everyone. Thanks for joining us.


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