What to Expect the Toddler Years (150 page)

An assessment of your child’s risk for anemia (done annually from age 12 months to 4 years), and, if needed, a finger-stick blood test to screen for the condition.

A blood test to screen for lead, which may be done yearly depending on where you live.

A urinalysis, usually done annually.

A Mantoux tuberculin test for children at high risk.

Other need-to-know advice:
The doctor or nurse-practitioner may also discuss such topics as good parenting practices; injury prevention; appropriate toys and play activities; nutrition; discipline; dental care; and toilet learning; day care or preschool; and other issues that will be important in the year ahead.

Immunizations.
None, if immunizations are up-to-date.

The next checkup.
If your toddler is in good health, and there are no problems, the next scheduled checkup will be at four years. Between visits, be sure to call the doctor or nurse-practitioner if your child shows any signs of illness (see page 569) or if you have any questions that aren’t answered in this book.

“Our daughter has given up her afternoon nap, and I’m worried she isn’t getting enough sleep.”

Sleep needs vary widely from child to child, and even from day to day in the same child. Toddlers sleep an average of twelve hours a day in the third year, but that’s an average that takes into account those who sleep only ten hours and those who sleep fourteen, those who nap and those who don’t.

If your toddler’s recently given up her afternoon nap, you can expect her to be sleepier and crankier than usual until her body adjusts to her new shut-eye schedule. But as long as she’s able to function well on the sleep she’s getting, you can rest assured she’s getting enough. If she isn’t functioning up to par, continues to be tired and cranky, consider moving bedtime ahead a bit to compensate for the nap she’s nixed.

“Our son never had a going-to-bed problem, but now he tells us that he’s afraid to go to bed in the dark. What can I do?”

Your impulse may be to try to tease (“Silly, there’s nothing to be afraid of”) or shame (“Only babies are afraid of the dark”) your child out of his fear; to force him to face it (“Now, I want you to be brave and stay in your dark room”); or even to use logic (“See, there’s nothing in your room that’s scary, even when we turn off the lights”). But such approaches almost never help a child overcome fear. If anything, they make him more fearful. And by belittling his fears, they can also wound his self-esteem.

Instead, to help your toddler come to terms with his fear of the dark, and ultimately, to conquer it:

Let there be empathy.
It’s often hard for a parent to relate to a fear of the dark—or any other seemingly irrational fear. But it’s important to acknowledge and accept your child’s fears. When a child feels his fears are given credence, it makes it easier to confront them. Instead of saying, “You’re a big boy—big boys aren’t afraid of the dark,” say, “Sometimes the dark does seem scary.” Get him to talk about his feelings about the dark, and listen without judging.

Let there be light.
For a fearful child, a night-light or a ceiling light on a dimmer switch, is a welcome compromise between a pitch-black bedroom, which can be scary, and one that’s lit up as bright as day and difficult to sleep in. A night-light is particularly appealing when it’s in the shape of a favorite animal or character. But be sure that it’s UL (Underwriter’s Laboratory) approved and is plugged into an outlet away from bedcoverings, clothing, or other flammable materials. And only use bulbs with the wattage specifically recommended by the light’s manufacturer.

In the dim light, the shapes of toys and furniture often appear familiarly comforting instead of menacing—as they might if the toddler were left to his imagination in the dark. Many children no longer need the light by the time they reach five or six, when they begin to realize that there’s nothing lurking in the closets and dark shadows. Some, however, need that extra touch of reassurance
throughout childhood. And that’s okay—as crutches go, a night-light is a pretty harmless one.

Let there be a search.
Imagination is going full steam at this age. If your toddler keeps talking about the dragons under the bed or the monster in the closet, doing a thorough search before bedtime may help. Or it may not. The imagination is often more powerful than reason, especially in young children. You can also try banishing monsters loudly and dramatically (“Any monsters thinking of coming into this house, STAY AWAY. We will not let you come in.”). This will, hopefully, demonstrate to your toddler that you are in control of the house, even when everyone’s asleep.

Let there be a sentry to stand guard.
You can’t—and shouldn’t—always be there when fear of the dark strikes. So appoint a sentry to stand in for you—a courageous teddy bear or doll, for instance. Make much of this sentry’s ability to protect little children (“I know there are no monsters in this room, but if there were, Teddy would take care of you”). Some children are helped by reciting a “magical” sentence or rhyme (“Monsters, monsters go away; don’t come back another day”) and keeping a flashlight, “lucky charm,” and/or a special toy at bedside.

Let there be comfort . . .
From time to time, every fearful child needs a mommy or daddy to hide behind. In the right doses, comfort makes children stronger, not weaker. When your child is afraid, provide some extra reassurance—as well as some cuddling and a hug or two. When you leave the room, stay within earshot if possible (the dark is less frightening to young children if they hear their parents puttering around) until your toddler is asleep.

Daytime stress can lead to nighttime fears. If your toddler is going through a difficult time (with a new baby-sitter, a new baby, or some other upheaval), giving him extra time and attention, and helping him to deal with the problem, may reduce nighttime fears.

. . . but don’t overdo it.
Making too much of the fear can have a negative effect. It can lead a child to believe that there really is something to worry about, or teach him to use his fears to pull your strings (“If you read me one more story, I won’t be scared of the dark”). Who would want to give up a behavior that nets a lot of attention and extra privileges? Comment little on his fears, but when he shows a bit of bravery, make much of it.

Put on a brave show.
Children “catch” attitudes from their parents. When their parents seem comfortable in the dark, children usually learn to be comfortable, too. So while you should acknowledge your child’s fears, don’t feed them. Talk about the dark as a nice, comforting place. Explain to him that his room is just the same in the dark as it is with the light on.

Let there be pleasant experiences.
Help your toddler to think of his room as a safe haven—never banish him there for time-outs or as a punishment. Also help him to associate the dark with good feelings. When you respond to his calls in the middle of the night, comfort him without turning the light on. In the evening, try turning off the lights in the living room while everyone is holding hands and singing happy songs or listening to a tape. Or lying in his bed in the dark with your toddler, take turns closing your eyes and trying to imagine favorite things (an ice cream cone, the beach, Grandma’s hug). Or roll a glow-in-the-dark ball (or one marked with fluorescent tape) into your child’s darkened room and have each family member take a turn at chasing after and retrieving it.
(Be sure there is ample room to prevent collisions.) Don’t force your toddler to participate in any of these activities, but if you make it fun he may just want to. It may also help to talk about your child’s fear of the dark in the light and to read books about children who overcome such a fear.

Don’t let there be frightening experiences.
Scary movies, violent television shows, spooky books can all fire up a child’s imagination once he’s under the covers. Ban those that you fear can stimulate fear. Also avoid such threats as, “If you’re not good, the monster will get you,” and harsh punishments or the threat of them. Of course, sometimes children are exposed to scary incidents in real life—as observers or participants—so we can’t banish all frightening experiences. But we can minimize them and, afterwards, try to be reassuring.

“The last couple of days our son has had accidents with bowel movements at preschool. He’s been potty-trained for almost a year; why would he regress now?”

Even the toddler who’s been using the toilet for a year is entitled to an accident now and then. But when such accidents happen regularly, there’s usually a good reason, such as:
Stress
. A new baby-sitter, a new sibling, a new school (or a new teacher), a trip away from home, or another anxiety-provoking change in a child’s life can disrupt his internal timetable and lead to toileting accidents.
A new routine.
Often, a child who’s just begun attending preschool has trouble adapting his toileting habits to the new schedule and structure. Some children are also uncomfortable using a toilet that’s different from the one they have at home, are uncomfortable asking to use it, or are uncomfortable using it without a parent present.
Anger
. A toddler upset with his parents for any reason may decide to strike back by doing something he knows will really upset them, such as soiling his pants.
Concentration on play.
Toddlers often get so involved in their activities that they ignore their bodily urges until it’s too late. This is especially likely at school, where there are so many diversions competing for their attention.
Loose stools.
Softer movements usually give less notice and are tougher for toddlers to contain. These may be due to a change in diet (more fiber than he’s used to, or excessive quantities of fruit juice, which children are often served up at preschool), or an intestinal virus (if you suspect the latter, see page 603).
Constipation.
When a young child has had a bout of constipation (see page 600) with painful bowel movements, he sometimes becomes fearful of going to the toilet. In an effort to dodge the pain, he consciously begins withholding his movements, refusing to go when the urge first strikes. And then, all of a sudden—during story time or in the middle of a finger-painting session or halfway down the slide—the bowel movement can wait no more. And out it comes, right into his pants.