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Growing Concerns (11/28/2004)
By Dr. Martha Erickson

A question-and-answer column with Dr. Martha Erickson of the University of Minnesota

Question: I'm trying to potty train my 2-1/2-year-old son. He has used the toilet a few times, sometimes by surprise. He has woken up a few times dry and won't use the potty. He waits for a diaper to be put on him. Recently, when he woke up dry, I told him I'd buy him a donut if he'd use the potty today. He did! Am I about to set a bad precedent by bribing or rewarding him in this manner?

Answer: I understand your concern about setting a precedent of bribery; children should not expect a tangible reward every time they do what you want them to. However, there is a time and place for rewards, and potty training often is one of those.

As hard as it is for adults to imagine, there seems to be little natural incentive for young children to use the potty. Especially with today's super-absorbent disposable diapers, which leave children feeling dry and comfortable even after they've wet them, toddlers often see no good reason to use the toilet. Many toddlers are even a little bit fearful of using the potty, so diapers feel like a safe, familiar alternative. Add to that the fact that 2-year-olds are in a developmental stage in which they are trying to establish some arena of power and control. It's a time when they are reluctantly learning that adults control much of their life, so potty training often becomes the focus of a battle of wills.

With that in mind, I see no problem with using a special treat as a reward for your son's first few successful efforts to use the potty when he gets up in the morning. At the same time, give him a smile and a hug and tell him you're proud that he doesn't need diapers any more. Maybe even celebrate with a new package of big-boy underwear. Soon using the potty will be a habit, and the rewards won't be necessary.

But if your son does occasionally slip, as most children do, don't panic. Wet pants or an occasional wet bed are common when young children are still learning how to read their bodies' signals. If accidents happen, just be matter-of-fact, start the laundry and move on. By keeping a positive focus and avoiding shame, you can keep potty training from becoming an emotional battleground.

Question: My mom is worried about my baby because she says he's too skinny. I say he's just fine, but she has this idea that a baby isn't healthy unless he's chubby. How can I know for sure, and what can I tell my mom?

Answer: It used to be that people thought "healthy baby" and "chubby baby" were synonymous, but now we know that's not the case. In fact, with childhood obesity at epidemic levels in the United States (and Type II diabetes increasingly common at young ages), raising "chubby" kids is not desirable. That said, babies vary greatly in size and body type, and there's a wide range of normal. Up to the age of two years, a baby's weight is not very predictive of size or weight later in childhood or adulthood.

There are two situations in which a baby's low weight may be cause for concern. First of all, a baby weighing less than 5.5 pounds at birth is considered a "low-birth-weight baby" and may have a higher risk of developmental problems than a normal-sized baby. Low birth weight is sometimes a result of maternal smoking or poor nutrition during pregnancy. A second scenario involves a baby whose growth proceeds at a slower rate than normal. This may indicate a physical problem or, in rare and serious circumstances, a condition called "failure to thrive," which may result from extreme emotional neglect or hard-to-diagnose medical problems in the child.

Chances are your baby is just fine. Your pediatrician can show you exactly where your baby falls on the normal growth curve for both height and weight and can track his growth over time, reassuring you and your mother that he's on track despite his slender body type. Beyond looking at his growth patterns as compared to others his age, it's also important to pay attention to other indicators of your baby's health and well-being--for example, skin tone, muscle tone, energy level and his achievement of major developmental milestones such as rolling, sitting, pulling up and grasping.

As for what to say to your mother, it's important to let her know that you appreciate her concern about your baby's health. Then let her know what your doctor says about your baby's growth, perhaps showing her where he falls on the growth chart or even inviting her to go along for a well child visit. No doubt, your mother has much to teach you, and you will have things to teach her, as well. Knowledge about child development, nutrition and parenting is changing all the time, so welcome your mother to be your partner in learning all you can about what's most important for your child. 


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