Monday, December 03, 2007

Children, Blankies and Thumb Sucking

All three of my children have a special blankie, two are thumb suckers and one is a nail biter. I’m not surprised, these are typical coping mechanisms children use for stressful situations. I not only allow, but encourage children to develop what coping mechanism works for them …and is socially and developmentally appropriate.

As a busy mom and wife and pediatrician, I have had to learn over and over again how to cope. Our parental responsibility is to help our children foster appropriate coping skills. One of the best ways we can do this is by simply teaching them to communicate. They can then carry this skill into the world to manage other stressful situations. It can help them deal with hurt feelings, loneliness and fear.

We all need coping mechanisms. We just need to encourage ourselves and our children to develop ones that are healthy. Writing has been a big stress reliever for me. Just getting my thoughts down on paper actually helps me clarify what I need. Two glasses of wine and some ibuprofen might be more fun but not as effective. So as I hone my coping skills, I’ll let them hone theirs. If I start to see them dragging their blanket around Linus-like, or if they are still sucking their thumb… in public… at fourteen, I’ll have to set some limits. Until then I’ll keep waiting and watching.

Sheila Cason, MD

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Monday, November 26, 2007

Teach Your Child the Right Way to Tie their Shoelaces

Did you know there are 17 ways to tie a shoelace? Me neither. But I was fascinated by this little bit of information. I’ve been trying to teach my 5 year old the “standard shoelace method” but I’ve decided to change to the "bunny ear method” because it’s easier. In my quest for more information, I stumbled across Ian’s Shoelace Site and was fascinated to learn there is an entire website designated to shoelaces! As I was perusing the site this little piece of information popped out and changed my whole world.

Kids find it easier to learn this "Two Loop Shoelace Knot"(aka Bunny Ear method) because it's really the same as tying the starting knot except that the ends are formed into loops. However, if the loops are tied into a bow in exactly the same way as the loose ends were tied into a starting knot, the result will be an un-balanced "Granny Knot", which comes undone more easily. In other words, if you tie your starting knot by wrapping the left end over the right end and through, then tie this finishing bow by also wrapping the left loop over the right loop and through, you'll invariably find that your shoelaces keep coming undone.

He goes on to say more about the “Granny Knot”

1. It's caused when the starting knot & finishing bow don't "balance" each other.

2. It can be spotted by the tendency of the bow to sit crooked (ie. heel to toe).

3. It's fixed by reversing one stage of the knot, most easily the starting knot.


Now I don’t do the bunny ear method, I just do the standard shoelace knot BUT my shoelaces are always coming undone! Even with double knotting. So I thought to myself, “Have I been tying my shoes wrong my entire life?” Sure enough, I glanced back at my running shoe sitting on the floor and plain as day was my abnormal knot. It was sweetly pointing north and south instead of east and west.

It seems that “Shoelace knots are usually tied in two stages: A Starting Knot followed by a Finishing Bow. Each of these stages "twists" the shoelaces slightly, so it's important that the two stages be tied in opposite directions in order to cancel out each other's twists.

If you’ve been tying your shoelaces wrong, just remember you were either taught wrong or you interpreted it wrongly at the tender age of 5 or 6. Now that you know better, you can teach your child the correct way! This little rhyme should help.

Right over left, left over right,
Makes a knot both tidy and tight.

Now having said that, I did succeed in teaching my girl how to tie her shoelaces but she wouldn’t reverse the way in which she did the starting knot or the finishing knot. All her knots were “Granny Knots”! When I mentioned this, she fell out laughing and giggled for a good fifteen minutes. Every time she got quiet it just bubbled up out of her. “Granny knot! Ha ha ha!” It seems that it doesn’t bother her as much as it did me!

Sheila Cason, MD


Friday, November 16, 2007

The Three Year Old Blues

“Three-year-olds can better manage their emotions, but may still fall apart under stress.”

This said so eloquently by PBS Parents.
That’s my girl all right. She’s a bundle of light and energy. At times it is all I can do to stop myself from hugging and kissing her but when she’s upset and whiny - which is a lot of the time, it can get a little much. The slightest insult whether it be a teeny scrape or baby push by her brother is enough to send her over the edge. I don’t know who is having a harder time with it, me or her.

She’s willful and determined, sensitive and engaging. We were on our way to swim lessons when she wiped out on the slick sidewalk. Poor thing just lay there on the concrete drowning in tears. After that she refused to go in the pool. I tried the soft- “Come on honey. It’ll be okay”- approach. Didn’t work. I tried the hard – “You better get yourself over to the pool”- approach. No surprise that didn’t work either. Finally I just let her wait it out and she was coaxed in – by the swim teacher. Drove me crazy.

Just when I think she’s a big girl and ought to know better, she reminds me otherwise. I have been known to find her crawled up in bed, clutching her blankie and sucking her thumb. My heart goes all soft and reminds me that there is no one else like her. I need to cut her some slack.

Sheila Cason, MD


Tuesday, October 30, 2007


Do you see my toddler looking at the snail? How cute is he? All crouched down and inspecting the little wonders of the earth. He calls it a “nay”. Everyday we walk my daughter to her bus stop. When he sees one, he starts to trot along eager to reach it.

I try to allow plenty of time to wander in the morning so he can explore some of his favorite things, including snails. Just the other day he crouched down and blew on one. The snail’s head retracted into its shell. He was thrilled! He’s similarly fascinated with light switches. Off. On. Off. On. He’ll poke me and says “Liiii!” he’s so excited to share his discoveries!

I have to admit that I spend a lot of my time squelching and redirecting my child’s curiosity. “What are you doing? Don’t touch that! Get down!” When I ask my older kids just what do they think they are doing they often say, “But I wanted to see what would happen!” I can’t argue with that. I just need to keep them safe while they are exploring!

I know that curiosity is key to their learning. Right now blowing on little snails and playing with light switches are pretty harmless, but the other day I turned around the corner and saw my toddler teetering at the edge of the dining room table. I carefully led him down to safety…kids!

Sheila Cason, MD


Wednesday, October 24, 2007

The Long Hug

It seems that when the kids start to get past the little baby stage that any embrace gets shorter and shorter. There was a time when all my precious children slept soundly and preferably in my arms. I could hold them all day long if I so desired. Now the cuddles come in the morning and while reading books. The days of the prolonged hold is starting to wan…unless they are sick.

When they kids are sick their regression comes quickly, and I latch onto it knowing that this moment of stillness is something I might not get for a while. Yesterday, my 17 month old, still trying to kick his cold, fell back asleep in my arms after waking from his nap. I was talking to my husband and rocking my little boy when my husband whispered, “He’s asleep.”

I froze. It was too good and I was afraid of spoiling the moment. This hadn’t happened since I stopped breastfeeding 2 months ago. I settled back in my chair gazed at his little face. He was a bigger version of his baby self but just as vulnerable looking. He slept there for a long while, enough for dusk to settle over the house and for me to wonder if he’d be there all night. While I felt terrible that he was sick I was also grateful for the long hug.

Sheila Cason, MD

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Thursday, October 04, 2007

Making Friends

This is my conversation with my kindergartner a couple of nights ago.

“I saw Timmy today.”, she whispered

“Oh… where?”, I replied

“In the cafeteria.”

“Is he in your class?”

“No… he’s older. Not little like me. He’s in 3rd grade.”, she said.


“He sat next to me in the bus.”

“When? Today?”

“I don’t know” …pause… “He makes me laugh”, and she erupted into giggles.

“I saw him in the cafeteria today. He did this…” – she smiled the tiniest of smiles. I almost missed it. “And I did this…”- she again smiled the tiniest of smiles.

Throughout her conversation I was trying to follow what happened and then slowly it started to make sense. Near as I can figure, she met a boy on the bus and then recognized him in the cafeteria amongst all the other kids. He recognized her too. He smiled in acknowledgement, and she smiled in acknowledgement back.

Isn’t that amazing? She’s making friends all on her own. I don’t know about you but it’s hard for me to watch my kids make friends. I have to fight the urge to “manage” her relationships at such a young age. Say hello. Be polite. Don’t be rude. Every time I even begin to worry or start to say something, I am reminded that she’s okay and somehow it all worked out.

Sheila Cason, MD


Tuesday, October 02, 2007

TV and Children Under the Age of Two: Part Two

As we saw in yesterday’s article there is evidence that allowing your baby to watch TV may hinder their language. Our cheapest babysitter may be our most expensive. It’s funny now that I’m researching TV and children, I certainly have been more aware of its use in my house. But what about the parents who don’t know? If you thought that TV was giving your kids a head start wouldn’t you want to know if research found it to be otherwise? Should Baby Einstein have a label on its videos warning parents that the American Academy of Pediatrics recommends no TV under the age of two? The Campaign for a Commercial-Free Childhood says yes.

The Campaign for a Commercial-Free Childhood (CCFC) made up of health professionals, educators, advocacy groups and concerned parents filed a complaint with the Federal Trade Commission in 2006 against Baby Einstein, Brainy Baby and BabyFirstTV. They state that these companies make false and deceptive claims that they cannot substantiate.

“They are likely to deceive a consumer acting reasonably under the circumstances.” “The number one reason parents allow babies to watch television and DVDs is the belief that the programming is educational and/or good for brain development.”

After the latest study regarding delayed language in children who watched TV for an hour was published in August 2007 the CCFC issued a press release reaffirming their stance. “This important study is the clearest indication yet of potential harm caused by the false and deceptive marketing of television programming and DVDs that target babies. Previous research suggests that television is not a good medium for teaching language to babies. Now we see that infants (ages 8-16 months) who watch baby videos have a slower rate of language acquisition than infants who do not. Not only is there no evidence that baby videos do any of the things the baby video industry claims they do, but these media may actually be undermining the development of the very skills they claim to foster.”

But maybe Baby Einstein, Brainy Baby and BabyFirstTV isn’t all to blame. I have a feeling that with or without a label on the video or websites, babies under two will still watch TV. The Kaiser Family Foundation in their 2005 study stated that “…it appears that the primary reason many parents choose to bring media into their children’s lives is not because of the educational benefits it offers kids, but because of the practical benefits it offers parents: uninterrupted times for chores, some peace and quiet, or even just an opportunity to watch their favorite shows.”

If it’s true that our primary reason to allow babies to watch TV is for our convenience, then maybe we need to develop some strategies for how we’re going to get that shower in or dinner cooked. But remember you don’t have to parent perfectly. Even if you tried you wouldn’t get it all right. But as long as you’re trying it won’t be all wrong either. I tell parents what the AAP recommendations are so they can make an “educated” decision. So now you know and the decision is yours. As for me? For now my older kids can watch some TV. But none for the baby. He has a whole lifetime to develop a taste for television.

Sheila Cason, MD


Sunday, September 30, 2007

TV Under the Age of Two

Dr. Cason:

I know the AAP recommends no screen/TV time before the age of 2. My question is, if the AAP recommends that, how come there are so many videos for children under 2? (Baby Einstein) I don't allow my daughter to watch a video or TV (Sesame Street) unless I'm desperate to have her entertained while I'm getting ready to leave in the morning. I feel guilty and I feel that I'm somehow ruining my child!


Dear Anonymous,

Don’t feel too bad, a lot of parents are not only allowing their children to watch TV but actually encouraging it. TV is the babysitter that gives parents a break and lets them get dinner made or a shower completed. I admit it. I’ve done it at times. In fact the picture is of my oldest when she was only 18 months old! I too have been worried about what TV does to kids so I did some research and this is what I found.

Gradually since the introduction of television there has been debate whether TV is harmful to our kids. In 1999 the American Academy of Pediatrics - AAP- released a policy statement recommending no television programs for children under the age of two. They stated that “research on early brain development shows that babies and toddlers have a critical need for direct interactions with parents and other significant care givers for healthy brain growth and the development of appropriate social, emotional, and cognitive skills.”

Recommendations are one thing but reality is another. The reality is that kids all over America are still watching TV… A lot of TV. Most people aren’t aware of the AAP’s recommendation. The Kaiser Family Foundation in a 2003 study researched America’s media habits. They found that 49% of parents thought educational videos were "very important" in the intellectual development of children and only 6% of parents were aware of the AAP’s recommendation of no TV under two years of age. When the study was repeated in 2005, there was a slight improvement in perception. Now only 38% thought that videos were very helpful. But despite this, they still found that 61% of children under the age of two, watch TV, a video, or a DVD for 1 hr and 19 minutes per day.

Until recently we didn’t know a lot about TV and its effect on our children under the age of two. Recent studies found that it might not be all that harmful for a child over the age of two. In fact a study in the November 2006 issue of Pediatrics, A Systematic Review for the Effects of Television Viewing by Infants and Preschoolers found that educational TV may have a positive effects on toddlers and preschoolers. Researchers conducted a literature search and found 376 articles dealing with children and television. Of these, 12 met the criteria of being a controlled trial. They were conducted between 1973 and 2000 and focused specifically on television content viewed by children under age 6 and its impact on learning, racial preference, aggression, pro-social behavior, self-regulation and imagination. It was concluded that there is evidence to suggest that educational television programs, such as Sesame Street and Mister Rogers, can help in the acquisition of general knowledge plus improve overall cognitive knowledge among young children. It can also improve their imaginative play and racial attitudes. However “there is evidence that television viewing can increase a child's display of aggression. Children who watch aggressive programs and cartoons with lots of violence can be more likely to engage in aggressive behavior than those that do not.”

None of these previous studies looked at infant television viewing or examined the content of videos designed for children. Not until recently that is. A new study was published in the Journal of Pediatrics titled Associations between Media Viewing and Language Development in Children Under Age 2 Years It appears it is the very young baby who is affected most by these videos. Researchers found that for every hour per day spent watching baby DVDs and videos, infants 8-16 months understood an average of six to eight fewer words than infants who did not watch them. For toddlers 17-24 months of age, Baby DVDs and videos had no positive or negative effect on the vocabularies.

Now that recent studies show that TV under the age of 16 month may be linked to impaired language development, the question remains: How does this affect the “Baby Media” market. Are they responsible for informing their consumers of these findings? The Campaign for a Commercial free Childhood thinks so. I’ll talk more about that tomorrow.

Sheila Cason, MD


Friday, September 21, 2007

Fear in Toddlers

Oh it was pitiful. Just two days ago I was putting my kids to bed and my baby – 16 months old- started to point at the bookshelf and say:
"Duuu! Duuu! Duuu!." His little brow was all crinkled up.
Something was definitely wrong. So I peered around at the book case, and there innocently perched was the “I’m a little giraffe book” by Tim Weare. Now I love this book. All my children have loved it too including the baby a while ago. But the way it was sitting in the bookshelf, the little giraffe face must have looked a little menacing.

“This?” I asked.

I slowly picked it up and put my index finger in the plastic giraffe head and wiggled it.

“See, it’s okay.”

His eyes widened, and he turned and ran in the other direction.

I couldn’t help but laugh a little - not in front of him of course. Poor baby! I’d never seen him like that! He’s such a rough and tumble boy. And it is such a cute giraffe. We can never fully predict what it is that will be scary to a child. And we can’t rush them to get over it. We can just be there with them and provide some security. Soon he forgot about it and was playing with another book. Later my husband tried to show it to him again. Nope- that little giraffe was still scary. He ran off.

Today his sister was playing with the book and he watched her quietly… and I watched them even more quietly. Soon he picked the book up and tried to explore the giraffe head with his finger. I guess his curiosity was piqued, and it was not so scary anymore.
For more information regarding toddlers and fear, has a great article!

Sheila Cason, MD


Wednesday, September 05, 2007

Speech Delay - Question for Dr. Sheila Cason

Dear Dr. Cason,

My 15 month old hasn’t started to talk. Is this something that we should be worried about or just watch closely? I have read many books about it and most of them say that by 15 months they should be saying a hand-full of words by now. I was just wondering what your advice is.


Dear Anonymous,

I get this question a lot!! Parents look around, compare their child to others and then start to ask the question, “Does my child have a speech delay?” When a parent comes in my office and is concerned about a speech delay. I listen pretty carefully. It’s stressful to think there might be something going on. I first ask if the child points and if they make eye contact. I want to immediately assess if there are deeper developmental issues. At 1-2 years of age language should really start to take off. Because language is a highly complex task, speech delay can be an early presenting problem of a child who has other developmental disorders. After talking with them about their concerns, I then get a piece of paper, write everything down and really count up the words. Does he say up, down, mama, dada, papa, more, dog? Don’t worry about articulation issues at this young of an age. Sometimes I have noticed that parents will think their 16 month old isn’t speaking. But if you really break it down, it turns out they say one particular mumble every time for water. This is their word for it! Then I look at the other mumbles!

A 1 year old should have between 3-5 words and by the time they are 18 months then they will have between 10-20 words. Don’t get stuck on the number though! But I have to admit I’m a little stuck on the number and have written all of my boy’s words down!! He’s 16 months old has taken his time acquiring language; he’s much different than my girls were. Remember that the norms are guidelines and all children will have their own rate of language acquisition. When I finally couldn’t take him screaming duuuuhhh for everything I got very aggressive about teaching him American Sign Language. This is a great way to tap into the language capacity of the child. He now signs more: please, thank you, want, food and water and milk and his favorite “all done”. Speech is a good user friendly site to get some basic ASL and tips how to use the signs.

If you suspect your child has a speech delay, the best thing you can do is check with your pediatrician. They are trained to evaluate your child and refer you if there is a concern. But, having said that, many people – including friends, family and even your child’s doctor- will say don’t worry let’s wait and see. You don’t have to do that. If you really want an expert opinion then ask to see a speech-language pathologist certified by the American Speech-Language-Hearing Association for a professional evaluation. You can check your child’s milestones yourself by looking at the website of the American Speech- Language- Hearing Association. They have great articles and detailed explanations regarding speech delay. Good luck and don’t forget to read everyday and talk, talk, talk!! These two are the best things you can do for your child regardless of whether they have a speech delay or not.

Sheila Cason, MD


Tuesday, September 04, 2007

First Day of School

Oh my gosh! There she went! She climbed aboard – with trepidation – that big yellow school bus and headed off to kindergarten. I cried and I’m still crying now. How did the time go by? I remember when she was born. How can that be? When she was a baby I had to work 36 hours at a time. I would pump my breast milk all day and night long, and I ached to hold her. I used to take her blankie to work with me and sleep with it. For every day of her almost 5 years of life I have fretted and worried. Even when I’ve had to go to work, I always knew exactly where she was. She doesn’t ever get more than 3 feet away from me. She holds my hand. She brushes my hair away from my face. She says, “Thank you mommy for making me dinner” and at random unexpected times she signs “I Love You” with her hand. And I’m supposed to just watch her climb onto a bus and hope that somehow it all works out? I’m supposed to hand her over to strangers and trust that the two of them will work it out?

Yes, I guess I am. It was harder than I thought it would be. I tried not to let her see me scared and nervous and teary. How do I tell her all the things I need to tell her? I want to warn her and keep her safe and innocent. I want her to explore but I want her to stay with me. She looked at me yesterday, with her bright blue eyes and asked, “What if the other girls don’t want to play with me?” And my heart broke because I know it’ll happen. Someone will do it to her. And as much as I don’t want it to happen she might do that to someone else.

I can’t stop her from making mistakes. I cannot protect her from feeling pain. It’s a very real and necessary thing about growing up. We cannot make some of the hard experiences easier. It’s just not within our power. We can be there for them, but we cannot do it for them. I would have gone in her place if I could. I love her that much that I’d endure a thousand “first day of school” days. But it’s her school, and it’s her life. Okay, okay I know she’s only in kindergarten but today it felt real to me. Today I saw a little person who will only get bigger and wiser and there’s nothing I can do to slow that down. I just have to wipe the tears away and enjoy her at each step.

Sheila Cason, MD