Family Matters Newsletter by Pediatric Therapies
Family Matters Taking care of the ones who matter most.
The Scoop On Poop | Potty Training | Busy Bag Activities | Superstar Award
THE SCOOP ON POOP: WHAT'S NORMAL, WHAT'S NOT
Color. Stool ismade up of broken-down food, bacteria, cells that shed from the intestines, and bile. Bile is a waste product that is excreted from your liver; it dumps into your intestines and accounts for the majority of poop's color. At birth, babies' intestines are sterile, but in a matter of weeks their intestines (and poop) are full of a huge variety of healthy, diverse bacteria. Exclusively breastfed infants ingest different proteins every day, depending on what Mom eats, which causes color variations. And while formula-fed infants will get the same food daily, their variations in bacteria can also alter the color of BMs. So poop on Monday may look really different from poop on Tuesday. Consistency. Baby and toddler poop can be as thick as peanut butter or mushier, like cottage cheese or yogurt. Breast-milk poop usually looks like fancy mustard: yellow, seedy, or curdy. Formula poop tends to resemble beat-up flan or pudding. If your child, regardless of her age, passes anything that looks like cat poop (loglike) or rabbit poop (a pebble), she's probably constipated. Rule of, um, thumb: If the poop can roll, it's too hard. Timing. Howoften your baby or toddler poops isn't all that important, but it seems to be a big deal to new parents. After about 6months of age, more than four BMs a day are toomany, and less than one a week for a breastfed infant or less than one a day for children over
age 2 is too few. That's because we want poop to move through gradually and steadily. If it moves too quickly, the body absorbs less food and nutrition. If it moves too slowly, it can cause constipation. Yet what the poop looks likemattersmore than howoften you see it. Odor. The scent is most often a reflection of how long the poop was in the intestines -- the longer it sits in bacteria, the more it'll smell. However, some babies with very sour- or foul-smelling poop may have an intolerance or allergy. In general, breastfed baby poop doesn't stink at all, while that from formula-fed infants is just lightly odorous. Those early poopy diapers really shouldn't clear the room. However, once you add baby food, and then various protein sources, it's another story. If you think your baby's BMs are exceptionally smelly, talk with your pediatrician. WHEN TO WORRY: CONSTIPATION BMs: A Timeline. Poop will evolve dramatically as your baby ages and expands his diet. In utero. Bet you didn't know that stool was forming in your baby's intestines far before birth. It's full of meconium, a sterile, sticky, brownish-green substance made up of swallowed amniotic fluid, hair, bile, and body cells. Most babies wait until birth to pass meconium.
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THE SCOOP ON POOP: WHAT'S NORMAL, WHAT'S NOT Continued
1 to 4months. When your baby is 3 or 4 days old, his stool changes from tarry meconium to a watery consistency. Babies usually make up to ten dirty diapers a day for the first one or twomonths and then go two to four times a day until around 4 months. This is thanks to the gastrocolic reflex, which occurs as the stomach stretches with food and the colon is automatically signaled to empty andmake room for more. In babies, the gastrocolic reflex is immature, so each time they feed they usually squirt out a little poop. Over time, some babies' intestines absorb so much breast milk that they create extremely small amounts of waste and their colon doesn't emptymore than once daily, or even once weekly in some cases. Formula-fed babies typically poop less frequently than breast-milk eaters because their stool moves through the intestines more slowly. Meanwhile, babies on both formula and breast milk go somewhere between multiple times a day and once a week. 5 to 12 months. Once a baby starts eating pureed foods and cereals, between 4 and 6months, her stool will change. A breastfed baby's poop often thickens with the addition of solids, whereas a formula-fed baby's usually softens. If your breastfed baby used to go only every five days or so, you'll see it becomes more of a daily event. 1 to 3 years. As you transition from breast milk or formula to wholemilk and amore solid diet, the stool will continue to change. For most babies, it gets thicker and harder. Between 12 and 18 months, you'll probably also notice what I call the "salad diaper," filledwith larger pieces of veggies that aremore difficult to digest. This can make your effort to offer a diverse range of foods feel like a huge waste of time! But it's not, insists Evelyn Hsu, M.D., a gastroenterologist at Children's Hospital of Seattle. "Your toddler's colon is just learning how to process whole veggies," Dr. Hsu explains. (Not tomention that kids aren't necessarily chewingwell at this stage.) Over time you'll see the food get more digested. Research shows that the perfect time to begin potty training is between 27 and 32 months of age. When we talk about potty training, though, we usually mean learning to pee. Pooping in the potty often comes later; most kids are able to do it by 3 or 4 years of age. 3 to 5 years. By now, kids ideally poop once a day. And when they do, it should be soft and pain-free. However, constipation is common around this age. I often ask older children if their stool looks like a bowl of chunky soup, a snake, a log, or a bunch of pebbles. The answer I'm looking for: a long snake. Kids who are constipated often have trouble toilet training because they'll avoid pooping if they're afraid it will hurt. To treat constipation, I suggest that 50 percent of a child's calories come from fresh fruit and veggies and that she should have no more than 2 or 3 cups of milk per day. Parents should also have their child try to sit on the potty after every meal. If those methods don't work, we prescribe stool softeners such as Miralax. Have patience and stay positive! With that, I wish you well in the diaper years. We all want an end to the potty patrol, but the exact timing
is ultimately up to your child. Do your best to provide support for your child. And then know this: Although pooping on the potty may seem like the finish line, many of us can be found wiping bottoms for a few more years to come. POOP PROBLEMS: WHEN TO CALL THE DOCTOR • If it's white (a sign your baby isn't producing enough bile), black (which signals blood digested from the stomach or small intestine), or contains streaks of red (it could mean blood from the colon or rectum) • If your child screams out in pain or bleeds while pooping • If you see mucus, which can be a sign of an infection or intolerance • If your child's stool changes dramatically after you introduce a new food; this may signal an allergy • If your child's poop is still a very runny consistency by age 1 (if your child has diarrhea -- watery stools more than five times a day -- mention this to your doc too) 3 THINGS THAT CAN ALTER YOUR CHILD'S BMS Antibiotics. If your child takes them, hemay experience diarrhea, gassiness, stomach upset, or more frequent poops. So use antibiotics for your child only when you have to. Or ask your pediatrician about giving your child probiotics daily while taking an antibiotic. Research shows that probiotics can shorten bouts of diarrhea in children who are taking antibiotics. Gastroenteritis. Children with a stomach virus often vomit for about 24 hours, but they may need up to two weeks for their stools to get back to normal. When a virus sets up camp in the intestines, it takes time for the good bacteria to re-populate and allow your child's stools to get back to the way they were. Travel. Being on the road can make it tricky to stay hydrated, leading to harder BMs. When you're drinking water from new places, the normal bacteria living in the gut can change and may also lead to runnier stools. Try to eat culture-rich yogurt daily and use probiotics the week before you travel.
Written by: Wendy Sue Swanson, M.D. from Parents Magazine
Success Stories "Wen we first started Caleb on this journey, he wasn't really using any words. Nothing but a whole lot of crying if his needs weren't met. Emily came into our lives and has oversaw the SLP development of this little boy in ways I couldn't fathom, and man has it been quick. Hearing him at home coming towards me to say: 'Daddy, juice please!' in roughly six months blows me away. Everyday this kid does things that relate directly back to the therapy sessions. Whether he's saying his ABC's, singing 'Wheels On The Bus', 'Rocky Top' or identifying needs and asking me for them, it's amazing what' he's doing at two years old. He has exceeded everything I could imagine. I have to say this; if my beloved Tennessee Volunteers could hire athletic directors and coaches at the success rate that you guys do, I'd wear orange year round!" -S.L.
Meet Our NEW Physical Therapist!
Superstar Award Our Superstar Award this month goes to Caleb L.
Working with Caleb over the last 8 months has given me immeasurable joy. When he first began therapy, he would scream and cry when it came time to leave his dad in the waiting room. Now, when I come out to get him, he smirks and runs over to his dad for LOTS of big hugs before eagerly coming back to play. His mischievous, little smirk and constant giggling
Callie Fold, DPT g r adua t ed f r om Belmont University’s Physical Therapy Program in 2011. She felt a calling to work with children while in school and pursued pediatric wor k expe r i ence following graduation. She worked for the Children’s Hospital in
CONTACT US TODAY FOR A FREE PEDIATRIC CONSULTATION TO FURTHER ASSESS YOUR CHILD'S NEEDS (615) 377-1623 | info@pediatrictherapies.com Knoxville for 4 years as a home health therapist. In May of 2016 she returned to Middle Tennessee with her husband and two children. Callie began working for Pediatric Therapies in January, 2017. She has expertise working with premature infants, developmental delay, oncology patients and orthopedic injuries. She is passionate about the importance of play in childhood and seeks to provide opportunities for children of every ability level to be able to play and have fun!
warm my heart. It has been a pleasure to watch his language and play skills bloom, and to see his personality shine brighter with each passing week. He continues to showme new things and keeps my days full of love, fun, and silliness. I am so proud of him and all the wonderful progress he has made. I feel honored to work with Caleb and his supportive and loving family. They are truly a family of superstars!
Do You Notice Your Child Struggling With... • Speech or language delays? • Gross or fine motor or other physical challenges? • Social skills, play and interaction? • Sensory or self regulation challenges? • Self care difficulties such as feeding or dressing?
Activities
PAPER PLATE EASTER BIRDS
What you’ll need: • Paper Plates • Sticky Tape
• Scissors • Paint • Pipe Cleaners
What to do: 1. Cut the Paper Plate in half creating a ying-yang shape. Use one-half for the body and use the remainder to create a large heart shaped wing, a triangular beak and big circle for the eye. 2. Next, paint the bird – get creative use lots of colors and make a pretty pattern. 3. Using glue, attach the wing and beak. If you have pipe cleaners in hand, excellent!
4. You will need one pipe cleaner cut in two. Bend one piece into a V shape and leave the other slightly longer piece straight. 5. Simply place the long pipe cleaner into the center of the V, align and twist in the middle. 6. Using some sticky tape, attach the legs to the back of the paper plate.
Source: http://onelittleproject.com/how-to-make-puffy-paint/2/
POTTY BOARD BOOK by Leslie Patricelli
A new toddler title charts a crucial achievement. There comes a point in a toddler’s life when going in one’s diaper is only one possible option, and the question must be raised: "Should I go in my potty?" With pitch-perfect humor and pacing, Leslie Patricelli follows the inner dialogue (sure to have little ones shouting responses) and hilarious actions of everyone’s favorite Baby, winding up with an over-the-top look of surprise and delight that will have both parents and offspring laughing out loud--"I did it!"
WIN A $30 GIFT CERTIFICATE! Families that have perfect attendance for the month of March will be entered into a drawing for a $30 gift certificate at the end of the month. If you attend multiple therapies, you will have multiple chances to win! Get more details from our front desk.
POTTY TRAINING: How To Get The Job Done
Potty training is a big step for kids and parents alike. The secret to success? Timing and patience. Is it time? Potty-training success hinges on physical and emotional readiness, not a specific age. Many kids show interest in potty training by age 2, but others might not be ready until age 2 1/2 or even older and there's no rush. If you start potty training too early, it might take longer to train your child. Is your child ready? Ask yourself these questions: • Does your child seem interested in the potty chair or toilet, or in wearing underwear? • Can your child understand and follow basic directions? • Does your child tell you through words, facial expressions or posture when he or she needs to go? • Does your child stay dry for periods of two hours or longer during the day? • Does your child complain about wet or dirty diapers? • Can your child pull down his or her pants and pull them up again? • Can your child sit on and rise from a potty chair? If you answeredmostly yes, your childmight be ready for potty training. If you answered mostly no, you might want to wait, especially if your child has recently faced or is about to face a major change, such as a move or the arrival of a new sibling. Ready, set, go! When you decide it's time to begin potty training, set your child up for success. Start by maintaining a positive attitude — and recruiting all of your child's caregivers to do the same. Then follow these steps. Pull out the equipment. Place a potty chair in the bathroom or, initially, wherever your child is spending most of his or her time. Encourage your child to sit on the potty chair with or without a diaper. Make sure your child's feet rest firmly on the floor or a stool. Schedule potty breaks. If your child is interested, have him or her sit on the potty chair or toilet without a diaper for a few minutes several times a day. For boys, it's often best to master urination sitting down, and thenmove to standing up after bowel training is complete. Read a potty-training book or give your child a toy to use while sitting on the potty chair or toilet. Stay with your child when he or she is in the bathroom. Even if your child simply sits there, offer praise for trying — and remind your child that he or she can try again later. To maintain consistency, try to bring the potty chair or a portable potty with you when you're away from home with your child. Get there, Fast! When you notice signs that your child might need to use the toilet such as squirming, squatting or holding the genital area, respond quickly. Help your child become familiar
with these signals, stop what he or she is doing, and head to the toilet. Praise your child for telling you when he or she has to go. Teach girls to wipe carefully from front to back to prevent bringing germs from the rectum to the vagina or bladder. When it's time to flush, let your child do the honors. Make sure your child washes his or her hands afterward. Consider incentives. Reinforce your child's effort with verbal praise, such as, "How exciting! You're learning to use the toilet just like big kids do!" Be positive even if a trip to the toilet isn't successful. Ditch the diapers. After several weeks of successful potty breaks, your child might be ready to trade diapers for training pants or underwear. Once your child is wearing training pants or regular underwear, avoid overalls, belts, leotards or other items that could hinder undressing. Sleep soundly. Most children master daytime bladder control first, often within about two to three months of consistent toilet training. In the meantime, use disposable training pants or mattress covers when your child sleeps. Know when to call it quits. If your child resists using the potty chair or toilet or isn't getting the hang of it within a few weeks, take a break. Try again in a few months. Accidents will happen. Youmight breathe easier once your child figures out how to use the toilet, but expect occasional accidents and near misses. Here's help preventing — and handling —wet pants: • Offer reminders. Accidents often happen when kids are absorbed in activities that — for the moment — are more interesting than using the toilet. To fight this phenomenon, suggest regular bathroomtrips, such as first thing in themorning, after eachmeal and snack, and before getting in the car or going to bed. Point out telltale signs of holding it, such as holding the genital area. • Stay calm. Kids don't have accidents to irritate their parents. If your child has an accident, don't scold, discipline or shame your child. Youmight say, "You forgot this time. Next time you'll get to the bathroom sooner." • Be prepared. If your child has frequent accidents, absorbent underwear might be best. When to seek help Occasional accidents are harmless, but they can lead to teasing, embarrassment and alienation frompeers. If your potty-trained child reverts or loses ground — especially at age 4 or older — or you're concerned about your child's accidents, contact his or her doctor. Sometimes wetting problems indicate an underlying physical condition, such as a urinary tract infection or an overactive bladder. Prompt treatment can help your child become accident- free.
Written by: Mayo Clinic Staff
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HOW CAN I ENCOURAGE MY CHILD TO USE THE POTTY PROPERLY?
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