How do doctors determine if a child is growing normally?

It is often hard to resist comparing our children to others about many things and growth is no exception. However, what is normal growth for one child may not be normal for another. Multiple factors come into play including age, sex and especially genetics. That is why with each wellness assessment, your pediatrician measures height, weight and if applicable, head circumference, and plots these values on a growth chart.

Growth charts are standards of growth that take into account age, including gestational age if your baby was premature and sex of the child. Also, recently developed growth charts take into account variability seen among some ethnic groups because they were developed using a good cross section of children to determine normals. Growth charts are used to determine how a child is growing compared to same sex/age peers and allows your pediatrician to see the pattern of growth. Since there is lots of variability in growth, your child’s position on the chart means very little. What does matter is the trend. There will be variability from checkup to checkup, but dramatic changes may be a red flag to your pediatrician to consider an evaluation or to watch your child closely. So, bring up any concerns with your doctor, but remember not every child is the same

How can I get my infant to sleep through the night?

Sleep worries haunt some parents even before their babies are born, because friends share their woes of sleeplessness as soon as they find out about the pregnancy, leading to the belief that sleep as you have known it will never happen again. The truth about babies and sleep is that there is a huge range of what is considered normal. Newborns, for example, sleep 16 or more hours a day, but it is fragmented due to the need for frequent eating. The good news is that as your baby grows a more consistent sleep schedule develops and babies can go longer periods without needing to feed, hopefully allowing longer stretches of sleep. On average, 3 month olds are sleeping a stretch of about 6 hours; by 6 to 9 months of age babies are sleeping an average of 8-10 hours at night; and 9-12 months olds, 10-12 hours.

Although the age at which a baby sleeps through the night can vary, there are things parents can do to encourage good sleep habits, which may give everyone a better night’s sleep. For example, swaddling in the first couple of months may help calm a fussy baby therefore promoting sleep. A pacifier (used after the first month of life once breastfeeding is established) may also be soothing and has been shown to help reduce incidences of SIDS. Additionally, a bedtime routine with consistency of time and activities in a quiet and calm manner helps baby settle and reminds her it is bedtime. Putting baby down drowsy but awake also helps him to learn self-calming skills. The room should be calm and dim to lower stimulation. Also, avoid middle of the night diaper changes which can stimulate the baby to be more awake and aren’t usually needed unless baby has stooled. Avoid cereal in bottles unless instructed by your pediatrician; this may actually upset baby’s stomach and make sleep worse. Finally, encourage activity during the day when baby is awake which will help promote better sleep.

Above all, regarding babies and sleep, safety comes first. Babies should be put on their backs to sleep in a crib or bassinet that has a firm surface, no soft objects like pillows, stuffed animals or bumpers should be present. Positioners and wedges should not be used. And no bed sharing, which increases the risk of SIDS dramatically.

In summary, a few techniques done in a safe manner with a little time and patience and everyone should be getting a great night’s sleep!

What are night terrors and are they normal?

Night terrors are sleep disturbances, similar to nightmares but much more frightening to the observer. They usually happen after the child has been asleep 2-3 hours and is in the deep, non-REM stage of sleep. During an episode which usually lasts from 10-20 minutes, a child may scream, cry, shake or hyperventilate. He or she may be confused or disoriented and may not respond to efforts to comfort or awaken. In the morning the parents are usually more upset than the child, who likely remembers little if anything about the event.

Night terrors are common, affecting approximately 10% of children in the 3-10 year old age group and are NOT usually a sign of an underlying problem. Although the cause is not known for certain, it is thought they may occur due to disruptions in the normal transition between sleep stages. Night terrors seem to happen more frequently when a child is tired, ill, or stressed. During an episode it is best to just observe the child to ensure their safety and avoid attempts to awaken. Keeping a child from becoming too tired by establishing good sleep practices with consistent routines and times may help to prevent or decrease the number of episodes. Stress reduction may also help. The good news is these events, although scary to observe, are usually benign and self limited; so try to relax, they will be over soon.

When should I talk to my child about puberty?

Thinking about the timing of this important discussion brings to mind the children’s book Parts, by Tedd Arnold in which a little boy is frightened by the things he is experiencing with his body like loose teeth (“how am I going to eat?”), ear wax (“this yellow goo in my ear”) and belly button fuzz (“my stuffing?”), because no one told him to expect these things. Kids should really know about expected life changes, especially puberty, before they happen. For puberty, that could be as early as 8 years old for girls and 9 years old for boys. Add to that the exposure of today’s children to the internet and media, and it’s even more important to have timely conversations with accurate information about the physical and emotion changes that are going to happen.

Although not easy, parents may need to initiate these conversations, since some kids may be too uncomfortable to bring up their questions on such a sensitive subject. However, your child might start asking questions about friends or relatives who are going through pubetal changes themselves. Be honest and relaxed, but be careful not to overwhelm your child with too much information early on. This process should entail a series of conversations; not just a onetime “lecture.” Be sure to reassure your child the changes are very normal and that everyone goes through this process. There will be as to when your child’s peers start puberty, but everyone ends up in the same place in their own time. Most importantly, let your child know you are always available to answer any questions at anytime. Hopefully, getting the information to your child early and establishing good communication will keep everyone from thinking their “stuffing is falling out”.