Rewards for Potty Training

Reward Charts can help potty training.

Reward Charts can help potty training.

When starting potty training it’s a good idea to think about how you’ll keep your toddler motivated. Some toddlers will simply want to be ‘just like my big brother/sister’; others will respond to lots of praise; others need something tangible to work towards and that’s where reward charts can be useful.

Potty Training! It’s something that we all experience as parents as we help our children transition out of nappies. I’ve posted previously on:

Reward Charts

Sometimes toddlers need a little extra positive reinforcement to start (or stick with) potty training. Reward charts can be a great way of helping them to see progress, learn about delayed gratification, and learn about working towards achievable goals at a young age.

There are lots of great ideas online for printing out your own reward chart that you can stick on the fridge (like these free to print charts). The important thing is to choose a theme that will tie in with your toddlers interests. I liked this magnetic one from Kmart because I knew Little Miss would like moving the magnets around.

Tip: If you have multiple children, it’s a good idea to instigate reward charts for siblings as well to prevent tantrums, jealousy, and rivalry! If your 2 year old is toilet training, maybe your 5 year old can have a reward chart for homework or chores.

Rewards

These need to be relevant to your child’s interests, realistic for your budget, and appropriate in scale. A trip to the park, a book, a small toy, are more realistic then promising a trip to Disneyland! Also, keep in mind that a reward comes after the action has been successfully taken (and a bribe comes before).

Sit down with your child and be really clear:

  • what they will receive points for (i.e. stickers on their reward chart),
  • what rewards they are working for, and,
  • how many points they need to obtain those rewards.

Encourage your child to brainstorm with you what those rewards are going to be. Possible rewards include:

  • Items (toys / books)
  • Activities (trips to the park, library, the zoo)
  • Food (jellybeans, McDonalds, restaurant)

You may want to start off with reward stickers for:

  1. each wee / poo in the potty (or toilet), and then move towards
  2. stickers for staying dry at home that day,  then,
  3. staying dry at kindy, then,
  4. staying dry overnight.

The important thing is to scaffold your expectations and help your child towards success at a pace that’s realistic to them. Remember that every child is different.

Items

Toys or books can be easily tailored to your child’s interests. It’s a good idea to have a mix of rewards that they can work towards (with larger or more expensive items requiring more points).  If you take them to a store to choose rewards, it’s a good idea to guide their choices by offering them a few options and letting them select one.

It’s also a good idea to guide them towards choosing toys that you were thinking about getting them anyway and which you can afford. Consider items that will encourage open-ended imaginative play and remember that you don’t need to buy ‘branded’ items for your kid to have fun.

We chose a (non-branded) My Little Pony and a wooden pizza – each slice and topping has to be earned so it has a good mix of short and long term gratification.

Activities

Again, these can be easily tailored to your child’s interests. You may want to have activities close to home, or that are free, cost fewer reward points and then have costly activities be something they have to save more points to earn. Not all activities have to be away from home either!

  • At home: build a tent out of sheets & chairs; make a collage; parent play with cars / dolls / animals / trains for 20 mins without distractions; have a tea party with toys; invite a friend over for the afternoon.
  • Free: go to a park; feed ducks; favourite playground; go to a beach; bike ride; art gallery; museum.
  • Paid: go to an indoor attraction (like a playground or trampoline park); go to zoo; go to observatory to see stars; movie.

Food

Food can be a controversial choice because it risks weighting food choices to show that some foods are inherently more desirable than others. In saying that, plenty of parents have chosen to use a jellybean or other small treat as a reward.

For more creative options, why not choose food related activities instead. Reward points could be saved towards things like:

  • doing baking together,
  • helping to make dinner (or choosing from a list of dinner options),
  • buying and planting vegetable seedlings, or micro-greens for the windowsill,
  • going to a cafe for a fluffy or scone,
  • going to a restaurant for lunch / dinner.
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What are turbinates and why do they need surgery to reduce them? (Are you sleeping badly? This may be why!)

What do swollen turbinates look like

What do swollen turbinates look like

If you’ve never heard of turbinates before then you’re not the only one! As long as they’re working well then the subject is unlikely to ever come up; they are also not something that your regular doctor (GP) is able to review – finding out there’s a problem first requires a referral to an Ears Nose Throat (ENT) specialist because of the symptoms you are experiencing.

Your turbinates can have a surprisingly large impact on your quality of sleep; this is especially true in young children and the problems are even more exacerbated if they also have troubles with their ears, adenoids, and tonsils.

What are turbinates?

Turbinates are bony structures (covered in moist tissue called the nasal mucous membrane). Inside your nose there are three sets of turbinates: upper (superior), the middle, and the lower (inferior).

Lateral nasal airway

Lateral Nasal Airway: Turbinates, Adenoids, Eustachian Tube Opening

Why do we need turbinates? What do turbinates do?

The turbinates have several important functions:

  • Help warm and moisturize air as it flows through the nose.
  • Protect the openings into your paranasal sinuses.
  • Help create airflow through your nose (important for your sense of smell!).
  • Trap micro-organisms (like viruses) and pollutants (like pollen).
  • Help the voice to resonate (i.e. they affect how we sound).
  • Produce mucous to help clean out the nose and assist the cilia in their work.
  • Help to regulate pressure in the sinuses.
  • Help the nose and sinus cavities to drain.
  • The turbinates play an important mechanical function when we sleep.  When you sleep on the right side, with the right turbinate down, over time the right turbinate fills up with fluid and expands so that it pushes against the septum; this makes you turn on the left side until that side fills up and turns you again. If the turbinates are not functioning correctly then you may wake up feeling cramped and sore with achey muscles.
Turbinates and sinus cavities

Feeling the pressure? Healthy turbinates help regulate pressure and drainage of the sinus cavities.

What causes turbinates to swell?

One of the most common causes of swollen turbinates (turbinate hypertrophy) are airborne allergies (allergic rhinitis) such as grass or weed pollen, birch tree pollen, or dust mites.

Other causes can include repeat upper respiratory infections, hormones, drugs, medication (i.e. as a complication from long-term nasal spray use).

Healthy inferior turbinate

Healthy inferior turbinate – you can see quite clearly that there is a tunnel for air to flow freely past the turbinates.

Swollen turbinates

Swollen turbinates – you can see how they have swollen and are bulging out across the airway to the nasal septum.

What are the possible side effects of swollen turbinates?

  • Stuffy nose
  • Headache
  • Facial Pain
  • Pressure (often in forehead). In young children this may result in behavioural issues, trouble concentrating, or head banging.
  • Nasal drip
  • Loss of Sense of Taste and/or Smell
  • Mouth breathing, noisy breathing, and/or snoring. This is especially problematic if adenoids and/or tonsils are also swollen and obstructive sleep apnea develops.
  • Fatigue. Children might seem like they’re getting enough hours of sleep but in reality the quality of sleep is poor because their body is struggling to get enough oxygen through the night. It’s a bit like starting each day on a half tank of gas.
  • Sore, cramped, achey muscles in the morning. Healthy turbinates play an important mechanical function when we sleep; they are key to helping us unconsciously change which side we are sleeping on through the night.
  • Developmental delays. Sleep is critical for young children. During those early years, they are rapidly growing and learning. They need sleep to focus during the day; to have time for their brain to make connections between all the things they have learned or experienced; and their brain releases a growth hormone while they sleep. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can make it harder for them to stay on track.
  • Behavioural difficulties. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can result in daily misery that children don’t know how to express.

Why do turbinates need surgery?

An Ears Nose Throat (ENT) specialist will be able to examine the interior of the nose quickly and painlessly during outpatient appointments; they may also opt for imaging scans such as x-ray or CT.

It is likely that they will suggest trying non-invasive means initially to see if this reduces the swelling, This is likely to involve a steroidal nasal spray and anti-histamine medication (in the case of allergic rhinitis). They may also recommend additional saline spray / drops to help keep the nose irrigated, or using a humidifier.

If these options do not work an symptoms have not been alleviated then they are likely to recommend surgery. Note: it is important that turbinates are reduced (not removed) and they will slowly regrow; in order for them not to become swollen again, any other underlying issues must still be addressed.

What does turbinate reduction surgery (turbinoplasty) involve?

Turbinates perform highly important functions and removing them entirely can cause a raft of new issues; surgeons will normally opt to reduce the turbinates. There are different methods that can be used; some remove tissue and others aim to shrink them through other means.

A procedure called submucosal resection is a common technique used to treat enlarged turbinates. With this procedure, the lining of the turbinate is left intact, but the “stuffing” from the inside of the turbinate is removed. As the turbinate heals, it will be much smaller than before surgery. Sometimes, this resection can be performed with a device called a microdebrider. This device allows the surgeon to remove the “stuffing” through a small opening in the turbinate. In some instances, more of the turbinate is removed.

Some of these methods shrink the turbinates without removing the turbinate bone or tissue. These methods include cauterization, coblation, and radiofrequency reduction. In each of these methods, a portion of the turbinate is heated up with a special device. Over time, scar tissue forms in the heated portion of turbinate, causing the turbinate to shrink in size.

Turbinoplasty is generally an outpatient procedure performed under general anaesthetic and patients can go home the same day.

Want to find out more about surgery or risks? The American Rhinologic Society has useful information.

What happens after surgery?

You can expect to have pain, fatigue, nasal stuffiness, and a clear fluid nasal discharge for several days after surgery. If this was the only surgery being performed then pain is generally mild  and typically well controlled with pain medications. A saline spray and/or steroidal nasal spray are likely to be recommended to use for several weeks after the surgery.

Swelling as a result of the procedure means that there may still be snoring for a week or two after the surgery, as well as a general feeling of stuffiness. The fluid discharge will generally begin to improve and crust after the first week.

Patients may be off school or work for a week and are recommended to avoid strenuous activity for two to three weeks afterwards.

 

What are tonsils and why do they need removing? (What is a tonsillectomy or adenotonsillectomy?)

How inflamed tonsils compare with normal tonsils

How inflamed tonsils compare with normal tonsils

What are tonsils?

Tonsils are soft tissue located at the back of your throat; they are part of the body’s lymphatic system (so are adenoids). When they are working properly, they help to recognise bacteria and viruses entering through the mouth and produce white blood cells to fight off infection.

Tonsils are particularly useful during childhood while the body is still encountering new bacteria and viruses for the first time and building up the immune system. Doctors seem to be of differing opinion as to how useful they are as adults; I’ve some that have called them redundant and unnecessary, I’ve also met other doctors who view removing them as an absolute last resort.

Why do tonsils need removing?

Tonsils may temporarily swell while fighting infection, sometimes they become so swollen that they result in a very sore throat and fever (tonsilitis), they may also partially obstruct the airways and not respond to non-invasive treatmeants.

Surgery may be recommended to help treat:

  • Multiple case of tonsillitis (seven cases of tonsillitis or strep in the last year, or five cases or more over each of the last two years).
  • Breathing problems related to swollen tonsils
  • Frequent and loud snoring
  • Periods in which you stop breathing during sleep (sleep apnea)
  • Bleeding of the tonsils
  • Trouble swallowing chewy foods, especially meats
  • Cancer of the tonsils

Back in the 1980s, having your tonsils out was kind of a childhood rite of passage. It was a very common procedure and often parents had already experienced a tonsillectomy in their own childhood. Medical opinion has now swung in a different direction and there is a more stringent list of criteria that often needs to be met (as well as requiring parent consent / advocacy). For a balanced medical opinion, try this post by Christopher Johnson (a pediatric intensive care physician) .

What is tonsil grading?

Surgery is most likely to be recommended if tonsils are consistently swollen at Grade 3 or Grade 4 coupled with other complications (such as snoring and/or sleep apnea).

What are the 4 grades of swollen tonsils

What are the 4 grades of swollen tonsils?

Basically tonsils are graded based on how much of the airway they block.

  • Grade 0 = tonsils are within the the tonsillar fossa
  • Grade 1 = tonsils obstruct 0-25% of oropharyngeal airway
  • Grade 2 = tonsils obstruct 26-50%
  • Grade 3 = tonsils obstruct 51-75%
  • Grade 4 = tonsils obstruct 75%

What are the possible side effects of swollen tonsils?

  • Fever / temperature. Keep in mind that children can react in their own individual ways – they may keep getting low grade temperatures instead of a fever.
  • Runny nose and congestion (as well as the sore throat).
  • Difficult or painful swallowing.
  • Swollen and tender glands (lymph nodes) on the sides of the neck.
  • Bad breath.
  • Fever and chills.
  • Tiredness and headache.
  • Stomach upset or pain.
  • Mouth breathing, noisy breathing, and/or snoring (due to enlarged tonsils blocking the airways). Obstructive sleep apnea. The swollen tonsils and/or adenoids can intermittently block airflow. It sounds like your child is silent and then there’s a big noisy sucking in of air.
    • In Miss 2 it can be so loud that I can hear it through her closed bedroom door and can sound like something’s fallen off a shelf and hit the floor! It’s a crappy and frightening thing as a parent that can result in just sitting with them in the dark either to check that they are breathing or to give them a gentle nudge to help them breathe again. If you’ve spent time with them hooked up to an oxygen saturation monitor then you’ll be familiar with what a stark difference there is between their oxygen levels when alert and upright versus lying prone to sleep.

  • Fatigue. They might seem like they’re getting enough hours of sleep but in reality the quality of sleep is poor because their body is struggling to get enough oxygen through the night. It’s a bit like starting each day on a half tank of gas.
  • Developmental delays. Sleep is critical for young children. During those early years, they are rapidly growing and learning. They need sleep to focus during the day; to have time for their brain to make connections between all the things they have learned or experienced; and their brain releases a growth hormone while they sleep. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can make it harder for them to stay on track.
  • Behavioural difficulties. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can result in daily misery that they don’t know how to express.

Keep in mind that young children (i.e. toddlers) may not be able to describe their symptoms to you and it may not even occur to them to do so (especially if they chronic health issues). They may also be confused by referred pain; the ears and throat share nerves (as well as being linked by eustachian tubes) so they may say their ear is sore when the infection is actually in their throat. Another possibility is if they keep exhibiting teething type behaviour well after all their teeth are in (i.e. chewing on fingers or a dummy constantly, lots of drool) combined with a temperature and bad breath – the cause may actually be their tonsils!

What does surgery (a tonsillectomy) involve?

Surgery will normally take place at a hospital (probably as an outpatient). The doctor will review medical history in advance and make recommendations about pausing medications. You will normally be advised not to take anti-inflammatory medications within 7 days of surgery. They will also discuss post-operative pain medication.

The day of the surgery will involve a period of fasting; food or water won’t be permitted because they can impact the anesthetic. It’s a good idea to have family support and a game plan of how to distract your child; an older child may understand why they can’t eat but a toddler is likely to just focus on the fact that they are off routine and they are HUNGRY!

During surgery, your child will be under a general anesthetic. The surgeon will enter through the mouth and the tonsils will be removed with an electrical cauterizing unit.  You can watch videos of surgery on YouTube but they can be a bit difficult to stomach; I preferred this video of a digital tonsillectomy surgery.

adenotonsillectomy

Adenoids and tonsils

Often the adenoids will be removed at the same time as the tonsils (if they are also swollen); this is termed an adenotonsillectomy. Click here for information about the adenoids.

What happens after surgery?

Depending on the age of your child, they may keep them in the hospital overnight for monitoring or they may go to a recovery room and then go home the same day. You should be given a pamphlet with information about post-op care (i.e. like this tonsillectomy guide).

Your child may feel quite groggy and tired for the next few days and also have some nausea; vomiting once or twice is normal but contact your doctor if vomiting persists.

A light, cool diet for the next few days is generally recommended (avoid hot liquids or spicy food) but doctors will often recommend that children eat whatever they want – the abrasion from bread or crackers will actually help to clean the area. (That’s not to say there won’t sometimes be screaming pain because a sharp cracker edge has just struck the surgical site).

Some doctors will prescribe antibiotics. They will normally be prescribed painkillers (like Pammol and Tramadol) and anti-inflammatories (like Nurofen); if your child won’t take the fully funded options consider buying over-the-counter replacements (for kids) that have been flavoured.  It is important to keep on top of their medication (including waking them up around the clock for a few nights) as the pain is severe; it will often peak somewhere around around Days 5-9 due to the way the membranes heal and can be excruciating.

It’s important to keep them rested and hydrated – even if this means just getting small regular sips of water, lemonade ice-blocks, or melty ice=cream into them; overall, the fluids are more important than food.

Common side effects will include:

  • Swollen tongue
  • Bad breath (like a hyena!)
  • White coating on the tongue
  • White scabs over the tonsils

Your doctor will talk you through potential complications and when to seek immediate medical care – i.e. if bleeding occurs (it can be life threatening); they may be able to resolve with medication or surgery may be required.

They need lots of rest for two weeks to promote healing and will be off school during this time due to the risk of infection.  They will also generally have several weeks off sports, exercise, and swimming.

Keep in mind that removing tonsils may only be one part of a wider treatment plan. If the chronic inflammation was linked to allergies then you will still need to work with a doctor to create an ongoing allergy treatment plan.

How to give your toddler a spa bath in winter!

Spa bath in a flexi bucket

I love flexi buckets! I have two: one big pink one and a small yellow one. They can be used for so many things from hanging out laundry, to clothes hampers, packing stuff to visit relatives, toy storage, and winter spa baths!

Miss 2 loves asking for a bucket bath when the temperatures start dropping. Just sit the bucket in your bath, fill it to a nice warm temperature from the taps, add a gentle-on-the-skin bubble bath, and pop in your toddler.

The Goldilocks principle applies when choosing your flexi bucket: not too big, not too small, but just right. You want your toddler to be able to sit upright comfortably and have water up to their armpits (parental supervision is recommended as per any bath). You’ll find that you use much less water than a normal bath and they’re warmer because more of their body is consistently covered.

The great thing is that this also works in a shower! I’ve also seen friends put multiple buckets in one bath (of assorted sizes) so that siblings can spa together (and without fighting).

You can even do this during summer! Put the empty bucket outside on the lawn (water is heavy) and ferry warm water to it. Presto! An outdoor bath in the sun and a happy excited child!

Tip: These are also great to take to a beach so that you can create a mini pool for younger siblings or wash off sandy feet.

Spa bath fun!

What a nightmare! Getting hospitalised for Mother’s Day at the same time as my toddler!

Hospitalised for gastroenteritis

Hospitalised for gastro

Being a solo mother for a medically fragile child with chronic health issues (including multiple food and airborne allergies) poses a heap of challenges at the best of times. Having us both hospitalised at the same time was incredibly difficult and it frightens me to think what would have happened if my family hadn’t been willing to spend an hour driving in to us and forgoing sleep for about 40 hours.

We actually had quite a pleasant Mother’s Day to begin with. We went to a playgroup for a short time and then went on to a wonderful Solo Mother’s event that was being held.

I’d spent Saturday cleaning like mad (which takes hours because of her dust mite allergies) and then feeling unwell with a nose running like a faucet. I still wasn’t feeling well on Sunday and figured I might have a mild cold.

Things all went downhill at 1am (so, I try to tell myself in an upbeat way that really Mother’s Day had finished) when a loud barking noise coming from my daughter’s room woke me and I found her struggling to breathe. Her story is here.

When the ambulance crew arrived at 1.30am, I was deperately trying to keep my daughter upright (who was determined that she wanted to be alone, prone, and asleep), trying to wake her up to full consciousness, and trying not to throw up.  There’s no time to be sick when your a solo parent with a sick child – I also had a sufficiently high embarassment reflex not to want to hurl in front of the three lovely (male) paramedics; there’s something that’s just easier about vomiting in private.

I spent the ambulance ride sucking on a home-made coconut milk ice-block trying to convince myself not to vomit and looking after Miss 2.

I’m so grateful for all of the lovely staff that helped us at the hospital. A nurse read Miss 2 picture books while I was busy vomiting in the hospital bathroom.  My embarrassment reflex declined as I got sicker; I ended up just drawing the curtain for her room and being grateful for the many vomit buckets the hospital stocks.

My parents spent an hour driving in to us and while Nana stayed with Miss 2, Poppa drove me (in the opposite direction) to collect the car seat and various things from home. This took a long time as the vomiting and diarrhoea kept me in the bathroom a lot and the pain often felt like a thousand glass daggers writhing through my intestines. At times I was crawling through my home on my hands and knees on gritted teeth determined to pack. Poor Poppa! he so wanted to help but couldn’t do more than watch quietly as I assembled everything we needed; it can’t have been easy either having me dry wretch all the way back to the hospital.

We finally got back to the Children’s Hospital and the nurses transferred me to the adult hospital’s Emergency Department. Nana and Poppa stayed with Miss 2 while I got admitted. I was so wracked with constant vomiting that I couldn’t even speak to the doctor unless it was in-between the waves of pain (and more importantly once the anti-emetic had kicked in). They did various tests for infection, a chest x-ray, and were monitoring me in case my appendix burst or my gallbladder (squeezed dry by that point) did anything gnarly. Apparently I was horribly pale, shivering uncontrollably (bless the nurses that brought heated blankets!), and looking pretty crap (aside from the vomiting and hobbling to the adjacent toilet), I went through two IV bags of fluids and a bunch of drugs before I was stabilised enough to sip water. As really awkward timing, Miss 2 got discharged almost 6 hours before me! Thank god Nana + Poppa were with her as I’m not sure what would have happened otherwise – it certainly would have been a far more traumatic experience for both of us!

Overall, they thought I had a severe case of viral gastroenteritis with severe pain from the inflammation + a cold/flu virus, and possibly Miss 2’s croup as well. I was unwell enough that they were considering admitting me into of the other wards but Miss 2 needed me so I got discharged to family care and monitoring instead (as there’s still a risk the appendix could progressively worsen). I’m so grateful that this has happened at a time when my family can help care for us as I can’t walk much without the pain starting and am pretty much living on mum’s Fail-safe Porridge and Rehydration Therapeutic Tonic.

What is croup and how does it effect toddlers?

What does croup look like in toddlers?

What does croup look like in toddlers?

Croup is a viral illness in young children which causes narrowing of the upper airways. Croup is often a mild illness but can quickly become serious, so do not hesitate to get medical help.

The funny thing about croup is that it’s like the vampire of toddler illnesses. During the day it may not have a visible impact beyond your toddler eating little (and lets face it sometimes they do want to live on air and crayons) and sounding hoarse. For Miss 2, it was that she woke up on Mother’s Day having largely lost her voice, was eating little, and had a mild temperature in the afternoon.

Toddlers have softer windpipes than older children so it’s often when they lie down to sleep that the narrowed airways will become more apparent. Their breathing may start to wheeze and become progressively more of a struggle; it can also cause a strange cough (stridor). What does a croup cough sound like in a two year old? It sounds a bit like a lion purring or a seal bark; personally I think stridor sounds most like a lion coughing up a fur ball.  The animal metaphors might sound cute but the cough can be so loud that it’s enough to travel between rooms and wake you up at night; it can also be frightening if it’s the first time you’ve heard it and you have no idea what it means!

For many children, croup will be a mild illness (which can recur) and which can be treated at home. For others, they need to see a doctor or require urgent medical care. In New Zealand there is a registered nurse available 24/7 to provide free health advice on Healthline (0800 611 116); they can help assess your child and advise whether to ring for an ambulance or wait to see a doctor the next morning.

Personally, I think that croup is worse for children that have allergies. In fact, as well as viral croup, there is also a form of spasmodic croup which may be caused by Gastric Reflux Disease (GERDs) or by allergies. I’ve also read blog posts from other allergy families where croup has become a recurrent problem for their toddllers.

For Miss 2, I was woken at 1am by her strange noises (the croup cough) and found her struggling to breathe; she’d also started a mild fever while she was sleeping. She already has enflamed adenoids, turbinates, and tonsils as a result of her airborne allergies (and any undiagnosed food intolerances) so having her airways swell further was frightening.  My gut instinct said she needed immediate help and I rang Heathline to check if I should was right, if I should drive her to the children’s hospital (which would delay things) or ring an ambulance. After listening to her breathe, I was told to ring an ambulance.

She was so sick that she slept most of the night in the Emergency Ward bed; she needed to be kept semi-upright (to help her airways). Her fever worsened, even with parecetamol, and didn’t break until morning. The recommended treatment for croup is oral steroids. This made me nervous as:

  • she’s allergic to topical steroids
  • even temporary steroids can cause massive behavioural changes and tantrums in toddlers.

Her allergy to topical steroids results in awful periorficial dermatitis rather than anaphylaxis and having her airways potentially constrict in life threatening ways – so I opted for the oral steroid.

It definitely helped with her breathing. She still had virtually no voice on Day 2 or 3 (it might take a week to return) and I still had to sit up with her on Night 2 but her breathing was manageable at home and no where near as bad as the night she was hospitalised. Thankfully she also hasn’t had any major tantrums so far; mind you, she’s probably too tired to tantrum yet. She’s eating very little as her throat is so sore and is mainly sticking to formula, sips of water, and the occasional mouthful of soft foods.

NOTE – Thank you to all the readers that have shared their stories with me!

I continue to feel that croup can be a much more serious illness for families with medically fragile children – including food allergies, airborne/environmental allergies, asthma, and reflux. Doctors will most commonly look for croup in babies and very young toddlers but plenty of allergy families have shared that their children have continued to have viral croup up to age 10!

If you’re familiar with what a croup cough sounds like then do advocate on behalf of your child for medical care if it’s needed – you’re the one awake in the wee hours of the night hearing it (and they may not have the cough during the day)!  Don’t hesitate to ring for an ambulance at night if your child is struggling to breathe!

It’s worth investigating what charges there are for your local ambulance service and if they have a subscription service. If you live in New Zealand, it’s around NZD$90 for each medical emergency (non-ACC) call-out of a St John’s ambulance but you can get an annual ambulance subscription for the whole household for NZD$65 per year. I’m so glad that I signed us up for membership after her ambulance trip just before Christmas!

 

What methods can I use for potty training my toddler?

Potty Training

What methods can we use for potty training?

Potty Training! It’s something that we all experience as parents as we help our children transition out of nappies. I’ve posted previously on:

 

Slow

The slow method is great if you’re wanting to stretch toilet training over a number of months.

Maybe it’s winter and you want to wait for warmer weather before fully embracing nuddy time; maybe you have an eldest only child who is showing signs of being ready but isn’t ready to embrace going nappy free; maybe you have a spirited child who responds badly to pressure, or a your family frequently faces change, or your child has health concerns or other stress factors.

I note this is the method I’m using with stubborn and spirited Miss 2!

  1. Regularly embrace talking about bodily functions. Talk about needing to wee or poo. Read stories about potty training.
  2. Storybots have a great video for toddlers about how the human body works, including how food gets turned into energy (and waste products!).
  3. Buy a potty and place it somewhere in the house where it’s easy for your toddler to access.
    • I was resistant at first to having it in the lounge but toddlers really do only think about what’s right in front of them. It’s good to put it next to their picture books, or in front of the tv, or by a window they can look out of. It’s also useful to have a plastic mat under it if you have carpets!
  4. Encourage your child to sit on the potty regularly. It helps if you read them a story to keep them occupied.
    • Try giving them regular naked time. This helps them get accustomed to their body and it also means they don’t have to grapple with clothes when they get to the potty. Watching themselves accidentally wee or poo can also help them form a connection in their mind between how they felt beforehand and what then happened (it’s not like they can see when it’s all conveniently happening in the nappy!).
    • Make a happy fuss about buying them underwear. Keep in mind that although different brands will use the same sizing on their labels, the real size and the way they actually fit will vary hugely. It can also help to buy underwear with decorative bows or buttons at the front so that they can easily see which way to put them on!
  5. See what works for you and your child.
    • If they’re having lots of accidents and you’re getting frustrated cleaning up messes, you may want to have them out of nappies just for a set time each day (i.e.  nappies in the morning and undies in the afternoon).
    • Maybe your child took an interest in potty training for a week or two and then adamantly decided they wanted their nappies back. That’s fine! Keep gently encouraging them to use the potty and offer them the choice each day of whether they want to wear nappies or undies.
    • Have a think about whether you want to use nappies, nappy pants, training pants, undies; or a mix. Some toilet training experts advise against nappy pants and say that they delay things but they are really useful as a parent and if you’re taking the slow approach anyway….
  6. Take time off and try again later.
    • Some toddlers won’t be ready on the first try.  You may need to wait 4-6 weeks and then try again. LOTS of parents find that their eldest will take the longest to potty train and that younger siblings will be much quicker (a big part of that is because they really, really want to be like their big brother or sister!).

Medium

Ideally, this method will allow you to toilet train in the space of 1 – 2 weeks. You do need to plan for it in your schedule but there’s a bit more flexbility in it. Make sure that your child is showing all the signs of readiness and they have good bladder control (1-2 hours).

It’s a good idea to do this during warm weather when your child doesn’t need to wear a lot of clothes. You can even put the potty outside and encourage them to use it while running around the garden naked.

It’s helpful to start this once your child shows clear signs that they are getting ready to do a poo. Some kids might have a ‘poo face’ that they start to make, some kids might have a corner they go and hide in (like in a closet or behind a chair), some might assume a squatting position.

Make sure that you stay at home for the first 3 – 7 days so that your child can relax into the change without the stress of accidents and distractions.

Have a think before you start about whether you want to use rewards as a potty training incentive.

  1. Make sure that you are starting at a settled time when there are no big changes to the family routine (like a new baby, moving house, starting kindy).
  2. Immerse your child in toilet training preparation. Go shopping for a potty and undies. Read potty books. Watch videos about using the potty. Talk about the steps for using the toilet.
    • You can even take photos of them practising each step and print these off. Encourage them to talk about each of the steps they need to take.
  3. Have your child in underwear all the time (except when sleeping). Encourage your child to sit on the potty at regular intervals each day and build these into your routine (i.e. when they wake up, 20 minutes after meals or bottles, before the bath, before bed etc.). Make sure that you stick with these every day so that your child comes to expect the reminder.
  4. Praise them when they’re successful and don’t make a big fuss when there are accidents. There will be accidents at first but these should decrease quickly if they’re ready.

Fast

In theory, this will help your child toilet train in a day or two. It is very reward orientated and won’t suit every child (or parent!)

Make sure that your child is showing all the signs of readiness and they have good bladder control (1-2 hours). Also, make sure that they are confident removing clothing and can easily pull pants up and down.

Decide in advance what rewards you will use.

You will need to be at home for a few days and may want to wait for warm weather so your child doesn’t need to wear lots of clothes.

  1. Make sure that you are starting at a settled time when there are no big changes to the family routine (like a new baby, moving house, starting kindy).
  2. Immerse your child in toilet training preparation. Go shopping for a potty and undies. Read potty books. Watch videos about using the potty. Talk about the steps for using the toilet.
    • You can even take photos of them practising each step and print these off. Encourage them to talk about each of the steps they need to take.
  3. The Day Before: Tell your child that tomorrow will be a special day and that you will be having a toilet training party. Practice the steps of toilet training with a special doll that can pass water. Explain that the aim is to stay clean and dry, and to do all wees/poos in the potty. The night before show them the special treats they will get the next day.
  4. The Big Day: Give them lots of fluids when they wake up and at breakfast. Take off the wet nappy and put on new undies/knickers. Introduce a reward chart and tell them they will get stickers on the chart for keeping their undies/knickers clean and dry by using the potty.
  5. Roleplay with the doll straight after breakfast. Go through the steps of toilet training. Have your child feel inside the doll’s underwear to check if they are clean and dry. Praise the doll and clap. Ask your child if they are clean and dry; check and if dry, praise them and put a sticker on reward chart. Give the doll a drink and then have the doll wee in the potty. Praise the doll and give the doll a treat.
  6. While sitting next to the potty, ask your child if they need to wee or poo. Have your child sit on the potty. You may need to read a story or sing a song to encourage them to stay on. Praise them for practising sitting on the potty. If they do a wee or poo, flush the waste down the toilet, wash hands, and then give them an instant reward.
  7. Set a timer and sit them on the toilet every 30 minutes. Praise them if they have stayed clean and dry, put a sticker on the reward chart. Praise them for sitting on the potty. If they do a wee or poo. give them an instant reward.
  8. Give your child lots of fluids, foods that will make them thirsty, and foods with lots of fibre. Keep practising with the doll. If they accidentally wee or poo in their underwear, don’t make a fuss just quietly clean them up and remind them to do wees/poos in the potty.  Let them associate receiving attention with using the potty.

Highlights for 2016

ALLERGY FRIENDLY COOKING

BAKING & DESSERTS

MEALS

 

PARENTING

PRODUCT REVIEWS

What are adenoids and why do they need removing? (What is an adenoidectomy?)

What are adenoids?

What do swollen adenoids look like?

Miss 2 is now on the waiting list for surgery. She needs her adenoids removed, her turbinates (inside her sinuses) reduced, and her tonsils will continue to be monitored.

What are adenoids?

Adenoids are soft tissue located located behind the sinuses; they are part of the body’s lymphatic system (so are tonsils). When they are working properly, they help to recognise bacteria and viruses entering through the nose and produce white blood cells to fight off infection.

Adenoids are particularly useful during early childhood while the body is still encountering new bacteria and viruses for the first time and building up the immune system. Doctors tend to consider them most useful up to age 7; in adolescence they begin to shrink and by adulthood they can practically disappear.

Why do adenoids needs removing?

Sometimes in childhood the adenoids swell and stay swollen. This can be due to frequent infections, due to a chronically over-active immune system (i.e. in an atopic child there might be ongoing aero-allergens and food allergies), or for reasons unknown.

This swelling is particularly problematic the younger the child is because their airways are so small to begin with! Also, swollen adenoids often aren’t the only problem. Look at the picture above and imagine that there is also swelling in the nasal passage (swollen turbinates) and that there are also swollen tonsils in the throat – that can result in a highly miserable toddler!

What are the possible side effects of swollen adenoids?

  • Obstructive sleep apnea. The swollen adenoids can intermittently block airflow. It sounds like your child is silent and then there’s a big noisy sucking in of air.
    • In Miss 2 it can be so loud that I can hear it through her closed bedroom door and can sound like something’s fallen off a shelf and hit the floor! It’s a crappy and frightening thing as a parent that can result in just sitting with them in the dark either to check that they are breathing or to give them a gentle nudge to help them breathe again.

  • Snoring and heavy mouth breathing.
  • Snotty / blocked nose.
  • Repeated ear infections. The swollen adenoids can block the Eustachian tubes and prevent fluid draining from the ears to the throat.
  • Blocked ears meaning that everything sounds a bit like it’s underwater.
  • Blocked nose meaning a deadened sense of smell. This can also impact their ability to taste foods.
  • Sinus headaches / pressure (in conjunction with blocked nose).
  • Sore throat and/or difficulty swallowing.
  • Fatigue. They might seem like they’re getting enough hours of sleep but in reality the quality of sleep is poor because their body is struggling to get enough oxygen through the night. It’s a bit like starting each day on a half tank of gas.
  • Developmental delays. Sleep is critical for young children. During those early years, they are rapidly growing and learning. They need sleep to focus during the day; to have time for their brain to make connections between all the things they have learned or experienced; and their brain releases a growth hormone while they sleep. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can make it harder for them to stay on track.
  • Behavioural difficulties. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can result in daily misery that they don’t know how to express.

Why didn’t the doctor identify this earlier?

Your normal doctor (a GP) and even a paediatrician can’t see that the adenoids are swollen. You need to be referred to the Ears-Nose-Throat clinic at your local children’s hospital. They will be able to look in their nose and throat during the initial visit and then may request a facial x-ray and/or CT scan for confirmation. They may also monitor the adenoids over a few visits in order to confirm that they are chronically enlarged and not temporarily swollen due to infection; they may also try medications for a few months to see if these help.

It can be a bit like diagnosing the wind – you can’t see the wind but you can see the effects of the wind. You may even have the referral because of something unrelated (like repeated ear infections) and as a result of that find out that the adenoids have been swollen all along.

What does surgery (an adenoidectomy) involve?

Surgery will normally take place at a hospital (probably as an outpatient). The doctor will review medical history in advance and make recommendations about pausing medications. You will normally be advised not to take anti-inflammatory medications within 7 days of surgery. They will also discuss post-operative pain medication.

The day of the surgery will involve a period of fasting; food or water won’t be permitted because they can impact the anesthetic. It’s a good idea to have family support and a game plan of how to distract your child; an older child may understand why they can’t eat but a toddler is likely to just focus on the fact that they are off routine and they are HUNGRY!

During surgery, your child will be under a general anesthetic. The surgeon will enter through the mouth and the adenoids will be removed with an electrical cauterizing unit. You can watch videos of adenoidectomies (like this one); they aren’t pleasant to watch but it can be useful to help you understand what will happen.

What happens after surgery?

Depending on the age of your child, they may keep them in the hospital overnight for monitoring or they may go to a recovery room and then go home the same day.

They may feel quite groggy and tired for the next few days and also have some nausea; vomiting once or twice is normal but contact your doctor if vomiting persists.

A light, cool diet for the next few days is generally recommended (avoid hot liquids).

I’m sure my parents don’t have fond memories of me having my tonsils out when I was 4. I still remember staying overnight in the hospital! Mostly my memories are positive ones due to the fact that I got to spend a week lording it over my baby brother that I got to eat jelly and ice cream. No memory of the pain remains but the joy of those unexpected treats has lasted decades!

They will prescribed antibiotics and some light pain relief. They need lots of rest for 4-5 days to promote healing but the good news is that it is a much faster heal time than for having tonsils removed. They will also generally have 7-10 days off school and 3 weeks off sports, exercise, and swimming.

They will generally have post-surgery check-ups; your doctor will talk you through potential complications and when to seek immediate medical care.

They may have nasal stuffiness for a few months after surgery and may need nasal drops. Snoring may continue for several weeks after surgery (and may temporarily get louder). Their voice may temporarily change for a few weeks to a few months!

Keep in mind that removing the adenoids may only be one part of a wider treatment plan. If the chronic inflammation was linked to allergies then you will still need to work with a doctor to create an ongoing allergy treatment plan.

Looking for more information? I read through a wide number of sites  and this was the one I found most useful.

How can I help prepare my child for potty training?

Potty training

 

You’ve decided that your child is developmentally ready to potty / toilet train and you want to pave the way for starting soon; or, you have a younger sibling who wants to understand what all the fuss is about and be involved (me too!)

Here are some things that you can do to help get them thinking about their body and the potty:

Read books about potty training. Often there are lots of picture books at the library so read a few until you find ones that work for you. Miss 2 is quite fond of Pirate Potty, (the same author also does Princess Potty) and Dinosaur Doo.

Talk to them about their body;  Storybots have a great video for toddlers about how the human body works including how food gets turned into energy (and waste products!). If they have particular ‘tells’ that they are about to do something in their diaper (like squatting, grunting, pulling a face, going to find a quiet place) then call their attention to their body’s signals and the ‘feeling’ that they need to wee or poo. Encourage them to tell you as soon as they have wet or dirtied a nappy so that you can change it straight away.

Get into the habit of talking to them about your own toileting habits; i.e. “I need to stop washing the dishes and go do a wee on the toilet.” It might feel a bit ridiculous at first but no more (hopefully) than pretending to be a monkey, or having your umpteenth imaginary cup of tea, or answering ‘What’ and ‘Why’ over and over and over again. The lesson that your modelling is that your listening to your body, stopping what you are doing, and going to the toilet.

Have an open door policy at home (if you can) and let them come to the toilet with you; let’s face it, most toddlers want to anyway! Talk about needing to go to the toilet and verbalize the steps (like flushing, washing hands etc.).

Get a potty and have it available. For a long time, I had it in the bathroom because I wanted that association of needing to go a particular room to do wee / poo. I’ve learned that it’s far more effective to have it on a plastic mat in the lounge, where she can see it all the time and it’s easy to reach, now that we’re actively potty training.

Ask them each day if they’d like to sit on the potty. Sometimes they might want to just sit on it, fully clothed + a nappy, and roleplay wiping their bum with toilet paper. This is fine! Just keep an eye on the toilet paper because they will happily unwind an entire roll.

Encourage them to roleplay with a doll/teddy. Help them to undress their toy, sit it on the potty, wipe its bottom with a cloth, and praise the toy .

Provide easy access clothes (i.e. no more overalls!). They need to be wearing pants they can pull down easily or a skirt that they can lift. Play games to see who can pull their pants down the fastest when getting changed into pyjamas at the end of the day or encourage them to pull their pants down themselves before each nappy change.

Ask them each day if they’d like a nappy/diaper or undies/knickers. One day they may surprise you and say ‘Undies!’.

Sometimes they will ask for undies before they’re ready to use a potty (because their friends are wearing them). That’s fine! Let them wear underwear over their diapers and get used to the idea. Encourage them to practice putting them on and off themselves. Let them help you choose ones that they like (i.e. they think are pretty / cool / exciting / awesome).