The Cribsiders podcast

#99: Parenting for the Pediatrician Part 1: Infant Sleep, Picky Eating, & Potty Training

December 7, 2023 | By

Audio

Summary:

Get ready for a Nap-tastic episode that will feed your parenting knowledge and potty humor! Join us and expert guest Dr. Tanya Altmann (@DrTanyaAltmann) as we unravel the secrets of infant sleep, tackle the picky eating habits of little ones, and flush out the best tips for stress-free potty training. It’s a diaper-changing experience you won’t want to miss!


Parenting Pearls

  1. Be flexible! Development is a process and varies from child to child. It’s ok if some things take a little longer as long as the child is moving in the right direction with a goal of health and wellness.  
  2. Help prolong infant sleep stretches by teaching them skills for independent sleep. Once they are around three months, start switching away from nursing to sleep. 
  3. When it comes to healthy eating, the foods a child is exposed to matter! Even if they don’t eat everything right away, focus on the child having regular interactions with healthy foods.
  4. Management of constipation is essential to successful potty training. In older children, potty training can be a relatively short process if families choose to invest the time and energy.


Parenting Show Notes

Infant Sleep

“Normal” Sleep Patterns

  • Newborns need to feed about every two hours overnight; as infants get older, the time between feeds can be stretched out
  • Most babies become able to sleep through the night (6-8 hours without waking) between 4-8 months of age
  • Sleep regressions do happen, but also  assess for signs of illness, reflux, and constipation. During these phases help families reinforce goals of self-soothing (see below)
  • Naps: Good nap routines often starts around 4 months – most babies take 3 naps per day at this age. Around 6 months babies will go to 2 naps/day and sleep for around 11 hours at night. Toddlers typically drop to one nap between 1-2 years – a good sign for when to do this is when bedtime is getting pushed later as a result of the second nap. Children will drop naps altogether anywhere between ages 2-5. 

Promoting Sleep Independence

  • Find out what parents are doing to put their baby to sleep. If caregivers are rocking or feeding the baby to sleep, the baby will often need these same things to fall back to sleep
  • By 3 months switch up the bedtime routine such that nursing isn’t the last thing before bed (e.g., end with a book or song). This helps them learn self-soothing skills and not need to rely on nursing to fall back to sleep. 
  • Sleep training: There are MANY different techniques for this. Several methods rely on having the baby “cry it out” (e.g., the Ferber method) for varying amounts of time. In studies, these methods do help babies sleep through the night, and are reasonable to try as long as the baby is growing and developing normally. There are no known long-term adverse outcomes related to this. 

Safe Sleep

  • Infants should sleep on their backs in a  crib, cosleeper, or bassinet. 
  • Avoid loose blankets – a sleep sack or wearable blanket is great
  • Avoid crib wedges and bumpers 
  • Expert tip: If you decide to start a “security blanket” earlier than 12 months (as recommended by AAP),  knotting it in the middle helps to prevent suffocation risk.  
  • AAP recommends that infants sleep in their parents room through 12 months to reduce risk for SIDS. That said, if a baby is waking frequently overnight AND has met the milestone of being able to raise his/her head independently (which is associated with a lower risk for SIDS), Dr. Altmann may recommend moving the baby to a separate room, if feasible.
  • See AAP guidelines for more details and additional recommendations

Picky Eating

Expectations & Anticipatory Guidance

  • Picky eating is most common around age 2 and age 5.
  • The first foods a child is exposed to affects their expectations for food – try to expose them to a variety of healthy things early on and avoid artificial/processed foods. 
  • Remind parents that even if a child goes through a “picky phase,” he/she will often go back to what they’re used to eating.
  • When a family presents with a picky eater, start with learning what others in the house are eating – it is not reasonable to expect a child to eat differently from the family. 

Tips for Picky Eaters

  • Involve the child in food experiences – shopping, cooking, creating menu – even if don’t eat the healthy foods right away, exposure matters. Can slowly progress from cooking a vegetable, to it being on the table, to it being on parent’s plate, to touching it, to “kissing” it, to trying a bit
  • Try to make healthy food fun! Serve vegetables with dips, and try presenting them in different forms. 
  • It’s ok to “hide” the vegetables! The nutrition is there whether or not the child knows that he/she is eating them. Smoothies are great for this. 
  • No matter what, don’t stop buying and making healthy foods! Set the stage for kids to return to eating healthy foods. With enough exposure, kids will eventually get curious and try things. 
  • Have some item that parent and child agree on (ideally something with some nutritional value) that is an acceptable “back up” (e.g., nut butter on whole wheat bread). 
  • Bring the child into discussions about how to approach unknown foods. 
  • Expert tip: If the child doesn’t want to eat something, eat it off of their plate! This helps to build interest and normalize the food. 
  • Encourage families to eat together as much as possible – ideally at least a few meals a week

Guidance for Clinicians

  • As a clinician, always assess for an underlying medical issue (e.g., signs such as abdominal pain or loose stool)
  • If there is a concern for inadequate dietary nutrition, consider starting a multivitamin (at an extreme end, scurvy is rare but can happen in the pickiest of eaters!)
  • Expert tip: Supplementation with omega fatty acids and other nutrients from fruits & vegetables seems to “jump-start” cravings for healthier foods
  • Dr. Altmann prefers to increase the caloric density of healthy foods (e.g., adding olive oil or nut butter to snacks and meals) rather than using appetite stimulants (e.g., cyproheptadine) as much as possible.

Potty Training

Expectations & Anticipatory Guidance

  • Constipation “derails” potty training – early on make sure stool is soft. 
  • Expert tip: Start prunes early (often as one of the first foods) because liking prunes makes it easier to manage constipation as it arises. 
  • Look for signs like being able to indicate when the diaper is wet

Tips for Potty Training

  • Keep it exciting and fun! Encourage families to celebrate wins, such as getting excited about the “poop party” under the house
  • For an older child families can do an “abrupt switch.” This involves leaving the child naked or in underwear and making sure the potty is always nearby. When the child starts to wiggle or squirm, encourage him/her to sit on the toilet, and follow up with praise and celebration for any successes (pay little attention to accidents and restart right away). This method usually works by day 5-6.

Bedwetting

  • There may be a hereditary component to this. About half of kids can stay dry at night within a few months of potty training, others takes much longer. 
  • Tips include: 1) Assess for and manage constipation. 2) Increase daytime/decrease evening fluids. 3) Role play getting up and using the potty in the night. 4) Praise children for dry nights. 
  • Bedwetting alarms can be helpful for older child but are rarely necessary (the other steps are usually sufficient). 

Resources

Books

HealthyChildren.Org Resources


Goal

Listeners will explain strategies to address common parenting challenges related to infant sleep, picky eating in toddlers and young children, and toilet training.

Learning Objectives

After listening to this episode listeners will…  

  1. Explain the common sleep patterns and needs of infants and toddlers
  2. Identify strategies to address barriers to infant sleep
  3. Describe techniques help toddlers gain toileting independence
  4. Recognize common medical diagnoses that can contribute to issues with sleep, potty training, and picky eating
  5. Counsel families on strategies to support healthy eating habits in the context of selective eating behaviors.

Disclosures

Dr. Altmann reports no relevant financial disclosures. The Cribsiders report no relevant financial disclosures. 

Citation

Engel S, Altmann T, Masur S, Chiu C, Berk J. “#99: Parenting for the Pediatrician Part 1: Infant Sleep, Picky Eating, & Potty Training”. The Cribsiders Pediatric Podcast. https:/www.thecribsiders.com/ December 6, 2023.


 

Episode Sponsors

Uncommon Goods

Uncommon Goods is offering all Cribsiders listeners 15% off at uncommongoods.com/cribsiders

Episode Credits

Producer, Writer, & Infographic: Sydney Engel FNP
Showrunner: Sam Masur MD
Cover Art: Chris Chiu MD
Hosts: Justin Berk MD, Chris Chiu MD & Sydney Engel FNP
Editor: Clair Morgan of nodderly.com
Guest: Tanya Altmann MD, FAAP

CME Partner

vcuhealth

The Cribsiders are partnering with VCU Health Continuing Education to offer FREE continuing education credits for physicians and other healthcare professionals. Visit cribsiders.vcuhealth.org and search for this episode to claim credit.

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