Time-Out: When It Doesn’t Seem to Be Working

Some parents become discouraged with time-out.  Their child repeats misbehavior immediately after release from time-out.  Other children seem to improve temporarily but by the next day are repeating the behavior the parent is trying to stop.  Some children refuse to go to time-out or won’t stay there.  None of these examples means that time-out should be abandoned.  It remains the best discipline technique for 2- to 5-year-old children.  If you use time-out repeatedly, consistently, and correctly, your child will eventually improve.  The following recommendations may help you fine-tune how you are using time-out.

1. Give your child more physical affection each day. Be sure your child receives two time-ins for every time-out each day.  A time-in is a positive, close, brief human interaction.  Try to restore the positive side of your relationship with your child.  Catch him being good.  Try to hold your child for 1 or 2 minutes every 15 minutes when he’s not in time-out or misbehaving.  Play with your child more.  Children who feel neglected or overly criticized don’t want to please their parents.
2. Use time-out every time your child engages in the behavior you are trying to change (target behavior). Use time-out more frequently.  For the first 2 or 3 days you may need to use time-outs 20 or more times a day to gain a defiant toddler’s attention.  Brief time-outs are harmless and there is no upper limit on how many times you can use them as long as you off-set them with positive interactions.
3. Use time-out. Don’t just threaten to use time-out.  For aggressive behaviors, give no warnings, just put your child in time-out.  Better yet, intercept your child when you see her starting to raise her arm or clench her fist and before she makes others cry.  For other behaviors, remind your child of the rule, count to three, and if she doesn’t stop immediately, put her in time-out.
4. Put your child in time-out earlier. Put your child in time-out before his behavior worsens.  Your child is more likely to accept a time-out calmly if he’s put in early rather than if he’s put in late (and screaming).  Also, putting him in early means you will be more in control of your emotions.  Try to put your child in time-out before you become angry.  If you are still yelling when you put your child in time-out, it will not work.
5. Put your child in time-out quickly. Don’t talk about it first.  When your child breaks a rule, have her in time-out within 10 seconds.
6. Don’t talk to your child during time-out. Don’t answer his questions or complaints.  Don’t try to lecture your child.
7. Ignore tantrums in time-out. Don’t insist on quietness during time-out because it makes it harder to finish the time-out.
8. Return your child to time-out if he escapes. Have a back-up plan for further discipline; for example, holding a young child in the time-out chair, or grounding an older child.
9. Consider increasing the length of time-out. If your child is over 3 years old and needs to be placed in time-out more than 10 times each day, a longer time-out may be needed to get her attention.  A preschooler with a strong-willed temperament may temporarily need a time-out that lasts 2 or 3 minutes per year of her age.  Children younger than 3 years should receive only brief time-outs (1 minute per year of age) because it is difficult for them to stay in time-out any longer.
10. Make the time-out place more boring. If your child doesn’t seem to mind the time-outs, eliminate sources of entertainment.  Move the time-out chair to a more boring location.  If you use your child’s bedroom, close the blinds or shades.  Make sure that siblings or pets aren’t visiting.  Temporarily remove all toys and games from the bedroom and store them elsewhere.
11. Use a portable timer for keeping track of the time. Your child is more likely to obey a timer than to obey you.
12. Be kinder in your delivery of time-out. This will help reduce your child’s anger.  Say you’re sorry he needs a time-out, but be firm about it.  Try to handle your child gently when you take him to time-out.
13. Praise your child for taking a good time-out. Forgive your child completely when you release her from time-out.  Don’t give lectures or ask for an apology.  Give your child a clean slate and don’t tell her father or relatives how many time-outs she needed that day.
14. Don’t punish your child for the normal expression of anger, such as saying angry things or looking angry. Don’t try to control your child too much.
15. Give your child more choices about how he takes his time-out.  Ask, “Do you want to take a time-out by yourself or do you want me to hold you in your chair?  It doesn’t matter to me.”  (For older children, the choice can be, “By yourself or do you want to be grounded?”)
16. Give your child the option of coming out of time-out as soon as she is under control rather than taking the specified number of minutes.  Some children feel overly controlled.
17. Use a variety of consequences for misbehavior. Ignore harmless behaviors.  Also use distraction for bad habits.  Use logical consequences–such as removal of toys, other possessions, or privileges–for some misbehavior.
18. Clarify with your child what you want him to do. Also clarify the house rules.  Review this at a time when your child is in a good mood.  This will help him be more successful.
19. Use time-out with siblings when appropriate. Be sure that one sibling isn’t being treated preferentially.  If siblings touch the timer or tease the child in time-out, they should also be placed in time-out.
20. Teach all caretakers to use time-out correctly and consistently.

Written by B.D. Schmitt, M.D., author of “Your Child’s Health,” Bantam Books.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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Toilet Training Your Child: The Basics

What is toilet training?
Your child is toilet trained when, without any reminders, he walks to the potty, pulls down his pants, urinates or passes a bowel movement (BM), and pulls up his pants.  Some children will learn to control their bladders first.  Others will start with bowel control.  Both kinds of control can be worked on simultaneously.  Bladder control through the night normally happens several years later than daytime control.  The gradual type of toilet training discussed here can usually be completed in 1 to 3 months, if your child is ready.

How can I help my child get ready for toilet training?
Don’t begin training until your child is clearly ready.  Readiness doesn’t just happen.  It involves concepts and skills you can begin teaching your child at 18 months of age or earlier.  All children can be made ready for toilet training by 3 years, most by 2 1/2 years, many by 2 years and some earlier.  Ways to help a child become ready include the following:

18 months: Begin teaching about pee, poop and how the body works.

• Teach the vocabulary (pee, poop, potty, etc.).
• Clarify that everyone makes pee and poop.
• Point out when dogs or other animals are going pee or poop.
• Clarify the body’s signals when you observe them: “Your body wants to make some pee or poop.”
• Praise your child for passing poop in the diaper.
• Do not refer to poop as dirty or yucky stuff.
• Make changing diapers pleasant for the child so he will come to you.
• Change your child frequently so he will prefer dry diapers.
• Teach your child to come to a parent whenever he is wet or soiled.

21 months: Begin teaching about the potty and toilet.

• Teach what the toilet and potty chair are for (“the pee or poop goes in this special place”).  Demonstrate by dumping poop from diapers into the toilet.
• Portray using the toilet and potty chair as a privilege.
• Have him observe toilet-trained children use the toilet or potty chair (having an older toilet-trained sibling can be very helpful).
• Buy a floor-level type potty chair.  You want your child’s feet to touch the floor when he sits on the potty.  This provides leverage for pushing and a sense of security.  He also can get on and off whenever he wants to.  Take your child with you to buy the potty chair.  Make it clear that this is your child’s own special chair.  Have your child help you put his name on it.  Allow your child to decorate it or even paint it a different color.
• Have your child sit on the potty chair for fun.  Have your child sit on it fully clothed until he is comfortable with using it as a chair.  Have your child use it while eating snacks, playing games, or looking at books.  Keep it in the room in which your child usually plays.  Never start actual toilet training unless your child clearly has good feelings toward the potty chair.  Help the child develop a sense of ownership (“my chair”).
• Then, bring his potty chair in the bathroom and have him sit on it (bare-bottom) when you sit on the toilet.  Don’t allow diapers or pull-ups in the bathroom.

2 years: Begin using teaching aids.

• Read toilet learning books and watch toilet learning videos.
• Help your child pretend she’s training a doll or stuffed animal on the potty chair.
• Present underwear as a privilege.  Buy special underwear and keep it in a place where the child can see it.

How do I toilet train my child?

1. Encourage practice runs to the potty. A practice run (potty sit) is encouraging your child to walk to the potty and sit there with his diapers or pants off.  Your child can then be told, “Try to go pee-pee in the potty.”  Only do practice runs when your child gives a signal that looks promising, such as a certain facial expression, grunting, holding the genital area, pulling at his pants, pacing, squatting, squirming, etc.  Other good times are after naps, 2 hours without urinating, or 20 minutes after meals.  Say encouragingly, “The poop or pee wants to come out.  Let’s use the potty.”  If your child is reluctant to sit on the potty, you may want to read him a story.  If your child wants to get up after 1 minute of encouragement, let him get up.  Never force your child to sit there.  Never physically hold your child there.  Even if your child seems to be enjoying it, end each session after 5 minutes unless something is happening.  Initially, keep the potty chair in the room your child usually plays in.  This easy access greatly increases the chances that he will use it without your asking him.  Consider owning 2 potty chairs.  During toilet training, children need to wear clothing that’s conducive to using the potty.  That means one layer, usually the diaper.  Avoid shoes and pants.  (In the wintertime, turning up the heat is helpful.)  Another option (though less effective) is loose sweatpants with an elastic waistband.  Avoid pants with zippers, buttons, snaps, or a belt.
2. Praise or reward your child for cooperation or any success. All cooperation with these practice sessions should be praised.  For example, you might say, “You are sitting on the potty just like Mommy,” or “You’re trying real hard to go pee-pee in the potty.”  If your child urinates into the potty, he can be rewarded with treats such as, animal cookies or stickers, as well as praise and hugs.  Although a sense of accomplishment is enough for some children, many need treats to stay focused.  Big rewards (such as going to the toy store) should be reserved for when your child walks over to the potty on his own and uses it or asks to go there with you and then uses it.  Once your child uses the potty by himself two or more times, you can stop the practice runs.  For the following week, continue to praise your child frequently for using the potty.  Practice runs and reminders should not be necessary for more than 1 or 2 months.
3. Change your child after accidents. Change your child as soon as it’s convenient, but respond sympathetically.  Say something like, “You wanted to go pee-pee in the potty, but you went pee-pee in your pants.  I know that makes you sad.  You like to be dry.  You’ll get better at this.”  If you feel a need to be critical, keep it to mild verbal disapproval and use it rarely (for example, “Big boys don’t go pee-pee in their pants,” or mention the name of another child whom he likes and who is trained).  Then change your child into a dry diaper or training pants in as pleasant and nonangry a way as possible.  Avoid physical punishment, yelling, or scolding.  Pressure or force can make a child completely uncooperative.
4. Introduce underpants after your child starts using the potty. Regular underwear can spark motivation.  Switch from diapers to underpants after your child is cooperative about sitting on the potty chair and passes urine into the toilet spontaneously 10 or more times.  Take your child with you to buy the underwear and make it a reward for his success.  Buy loose-fitting ones that he can easily lower and pull up by himself.  Once you start using underpants, use diapers only for naps, bedtime and travel outside the home.
5. Plan a bare bottom weekend.  If your child is older than 30 months and has successfully used the potty a few times with your help and clearly understands the process, commit 6 hours or a weekend exclusively to toilet training.  This can usually lead to a breakthrough.  Avoid interruptions or distractions during this time.  Younger siblings must spend the day elsewhere.  Turn off the TV and do not answer the phone.  Success requires monitoring your child during these hours of training.

The bare bottom technique means not wearing any diapers, pull-ups, underwear or any clothing below the waist.  This causes most children to become acutely aware of their body’s plumbing.  Children innately dislike pee or poop running down their legs.  You and your child should stay in the vicinity of the potty chair.  This can be in the kitchen or other room without a carpet.  A gate may help your child stay on task.  During bare bottom times, supervise your child but refrain from all practice runs and most reminders, allowing the child to learn by trial and error with your support.

Create a frequent need to urinate by offering your child lots of her favorite fluids.  Have just enough toys and books handy to keep your child playing near the potty chair.  Keep the process upbeat with hugs, smiles and good cheer.  You are your child’s coach and ally.

What if toilet training isn’t working?
There are some children who are resistant to toilet training.  Your child is considered resistant if after trying to toilet train your child using the method described above:

• Your child is over 2 1/2 years old and has a negative attitude about toilet training.
• Your child is over 3 years old and not daytime toilet trained.
• Your child won’t sit on the potty or toilet.
• Your child holds back bowel movements.
• The approach described here isn’t working after 6 months.

If your child is resistant to toilet training, ask your healthcare provider for ideas and information about toilet training resistance.

Written by B.D. Schmitt, M.D., author of “Your Child’s Health,” Bantam Books.

This content is reviewed periodically and is subject to change as new health information becomes available. The information is intended to inform and educate and is not a replacement for medical evaluation, advice, diagnosis or treatment by a healthcare professional.

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Engorgement

Your breasts will typically begin to feel full between the second and fourth day after delivery, with this fullness lasting three to five days. Increased nursing at least 8 to 12 times a day can help minimize this sensation. If you are having excessive discomfort, or if the infant is having trouble latching due to your engorgement you can try some comfort measures. Take a warm shower and massage the breasts gently. Ice packs may also be used for approximately twenty minutes to the breasts. Be sure to pump if the breasts are so full that your infant refuses to breastfeed, or is unable to latch because the breasts are too full. Make certain to nurse frequently, at least every 2 to 2 ½ hours around the clock while engorgement is present.

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Sore Nipples

Correct positioning during breastfeeding is the most important factor in preventing sore nipples. Tenderness experienced with latching is common during the first week or two; however this discomfort should lessen as the infant begins rhythmical suckling. If it is necessary to take the infant off of the breast during a feeding make sure to break the suction by gently inserting your finger in between baby’s gums prior to removing from the breast. If soreness is present throughout the entire feeding, or if blisters, cracks, or bleeding occur to the nipples, you should be evaluated by a lactation consultant.

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Duration of Feedings

After breastfeeding is well established there is no need to watch the clock while feeding. Some babies will nurse 5 to 10 minutes on each side while others will nurse 15 or 20 minutes from one side total. As long as nutritive sucking is taking place, with sucking and swallowing heard, the infant should be allowed to remain on the breast until finished eating. The longer the infant remains on one side the more hindmilk (and more fat) they will receive, so allow them to finish on the first breast before switching them to the opposite side.

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Frequency of Feedings

Babies need to breastfeed between eight to twelve times in a 24 hour period during the first few weeks to stimulate mother’s milk supply and gain appropriate weight. The best thing to do is to breastfeed when your infant shows signs of wanting to nurse, such as rooting toward the breast, or putting her hands up to her face and mouth. Breastfeeding during the night is one of the best ways to stimulate both early and abundant milk production. While some babies will nurse every 2 to 3 hours, others will want to nurse every hour for several hours followed by sleeping for four or five hours. If your baby is having difficulty waking for feedings place them skin to skin on your chest approximately 20 to 30 minutes before they routinely show readiness to breastfeed.

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Breast Feeding Positioning

A correct latch:

• Make sure that your baby’s chin, chest, and knees face your breast.
• Baby’s mouth should be open wide.
• Baby’s tongue is over the lower gum.
• Baby’s lips curl out in a flanged position.
• Baby’s chin firmly touches your breast.
• Baby’s nose & cheeks lightly touch your breast.
• Swallowing is heard with breastfeeding.
• Nipples may appear longer after breastfeeding, however should not be flattened or creased.
• Discomfort with breastfeeding should only be experienced at the start of a feeding, no more than 20 to 30 seconds after starting.

An improper latch:

• Baby’s chin, chest, or knees do not face your breast.
• Baby’s mouth is barely open.
• Baby’s tongue is behind the lower gum.
• Baby’s lips curl in.
• Baby’s chin barely touches your breast.
• You do not hear or see swallowing when baby breastfeeds.
• A clicking sound is heard.
• Baby’s cheeks dimple when feeding.
• Nipples are flattened or creased after breastfeeding.
• Pain is felt throughout the entire feeding.

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Talking to Teens About Drugs and Alcohol

What is the best way to talk to my teen about tobacco, alcohol, and other drugs?

Some of the most common concerns for parents of adolescents are tobacco, alcohol, and drugs. The pressure to experiment with these substances can come from friends and peers. If you suspect your child is using these substances, open a discussion about the dangers involved with using tobacco, alcohol, and drugs. Here are some key points you should try to emphasize:

Smoking and tobacco
Smoking can turn into a lifelong addiction that can be extremely hard to break. Discuss with your adolescent some of the more undesirable effects of smoking, including bad breath, stained teeth, wrinkles, a long-term cough, and decreased athletic performance. Long-term use can also lead to serious health problems like emphysema and cancer.

Chew or snuff can also lead to nicotine addiction and causes the same health problems as smoking cigarettes. In addition, mouth wounds or sores can form and may not heal easily. Smokeless tobacco can also lead to cancer.

If you suspect your teen is smoking or using smokeless tobacco, talk to your pediatrician. Schedule a visit with her doctor when you and your daughter can discuss the risks associated with smoking and the best ways to quit before it becomes a lifelong habit.

If you smoke. . .quit

If you or someone else in the household smokes, now is a good time to quit. Watching a parent struggle through the process of quitting can be a powerful message for a teen who is thinking about starting. It also shows that you care about your health, as well as your teen’s.

Alcohol
Alcohol is the most socially accepted drug in our society, and also one of the most abused and destructive. Even small amounts of alcohol can impair judgment, provoke risky and violent behavior, and slow down reaction time. An intoxicated teen (or anyone else) behind the wheel of a car makes it a lethal weapon. Alcohol-related car crashes are the leading cause of death for young adults, aged 15 to 24 years.

Though it’s illegal for people younger than 21 to drink, we all know that most teens are not strangers to alcohol. Many of them are introduced to alcohol during childhood. If you choose to use alcohol in your home, be aware of the example you set for your teen. The following suggestions may help:

• Having a drink should never be shown as a way to cope with problems.
• Don’t drink in unsafe conditions — for example, driving the car, mowing the lawn, and using the stove.
• Don’t encourage your teen to drink or to join you in having a drink.
• Never make jokes about getting drunk; make sure that your children understand that it is neither funny nor acceptable.
• Show your children that there are many ways to have fun without alcohol. Happy occasions and special events don’t have to include drinking.

Drugs
Your child may be interested in using drugs other than tobacco and alcohol, including marijuana and cocaine, to fit in or as a way to deal with peer pressure. Try to help your adolescent build her self-confidence or self-esteem. Ask her also about any concerns and problems she is facing and help her learn how to deal with strong emotions and cope with stress in ways that are healthy. For instance, encourage her to participate in leisure and outside activities with teens who don’t drink and use drugs.

Marijuana (Cannabis)
Many people today learn about drugs while they are very young and might be tempted to try them. Teens say that marijuana is easy to get, and it tends to be the first illegal drug they try. Marijuana use is often portrayed as harmless, but the truth is that marijuana is an addictive drug that can cause serious risks and consequences.

As a parent, you are your child’s first and best protection against drug use. The following is information from the American Academy of Pediatrics (AAP) about marijuana and how to help your child say “No” to drug use. (Child refers to child or teen in this publication.)

Marijuana use affects health and well-being

School
Marijuana users have a hard time thinking clearly, concentrating, remembering things, and solving problems. Frequent marijuana use often causes grades to drop. Users often lose interest in school and may quit.

Driving and physical activity
Marijuana impairs judgment, complex motor skills, and the ability to judge speed and time. Those who drive or take other risks after smoking marijuana are much more likely to be injured or killed.

Sexual health
Teens who smoke marijuana are more likely to take sexual risks and have unwanted or unprotected sex.

Long-term health
Teens’ bodies and brains are still growing and maturing, so marijuana use at this age can lead to a wide range of serious health problems, including heart and lung damage, cancer, mental health problems, and addiction. Depression, anxiety, and schizophrenia occur more often in marijuana users.

How is marijuana used?
Dried marijuana plant material is usually rolled with tobacco into cigarette joints or cigar blunts and smoked. Some users mix it in food or brew a tea. Other drugs like PCP or crack cocaine can also be added to the joint, increasing the dangers from use.

Marijuana is an addictive drug
Just like with alcohol, nicotine, and other illicit drug use, children who smoke marijuana can lose control over their use and become addicted. Many people overlook marijuana addiction because its withdrawal symptoms are not prominent or may not be present at all. However, withdrawal is only one symptom of addiction.

Teens who are addicted to marijuana likely smoke several times a week or more. Although most believe they are in control and can quit at any time, most can’t. Those using marijuana heavily often perform poorly in school or sports, lose interest in hobbies, and develop interpersonal problems with family and friends. Teens continuing to use marijuana into adulthood tend to have lower job achievement and less stable families than their siblings who don’t use drugs. As with alcohol, the younger a person is when starting marijuana use, the more likely she will become addicted.

Signs of marijuana use
Recognizing the signs of drug use is the first step in getting help for your child, but some signs are vague. Consider marijuana or other drug use if your child

• Spends less time with family and friends and more time alone or away from home
• Often seems moody or irritable Begins to skip classes, often shows up late for school, or has a drop in grade
• Buys things like CDs and T-shirts with pro-marijuana messages or symbol
• Loses interest in hobbies
• Comes home high (talkative, giggly, red or glassy eyes) or goes straight to his room
• Smells of marijuana
• Possesses drugs or drug paraphernalia

What you can do
Take these steps to help prevent your child from becoming interested in using marijuana or other drugs.

• Set high expectations and clear limits. Instill strong values. Let your child know that you expect her not to use drugs. Teach her healthy values that are important to your family and to use these values when deciding what is right and wrong.
• Talk with your child about the dangers of drug use, including marijuana. Young people who do not know the facts may try drugs just to see what they are like. Start talking with your child at an early age about the dangers of drug use. Encourage him to ask questions and tell you about his concerns. Be sure to really listen. Do not lecture or do all the talking. Ask what he thinks about drug use and its risks.
• Use teachable moments. Discuss car accidents and other tragedies that are caused by drug use and are in the news or your child’s life.
• Help your child handle peer pressure. Peers and others can strongly influence young people to try drugs. As a parent, your influence can be even stronger in helping your child learn to be confident, make healthy choices, and resist unhealthy peer pressure. Tell her that it is OK to say “No!” to risky behaviors and mean what she says. Help her find and spend time enjoying positive interests that build self-esteem.
• Help your child deal with emotions. Especially during the teen years, many young people face strong emotions for the first time. Teens sometimes get depressed or anxious and might consider drug use to try to escape these feelings and forget problems. Explain that everyone has these feelings at times, so it is important for each person to learn how to express his feelings, cope with them, and face stressors in healthy ways that can help prevent or resolve problems.
• Set a good example. Avoid using tobacco and illicit drugs. Minimize alcohol use, and always avoid drinking and driving. Be a good role model in the ways you express, control, and relieve stress, pain, or tension. Actions do speak louder than words!
• Get a professional evaluation. If you think your child is using drugs, tell your child’s doctor your exact concerns. Your child’s doctor can help.

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Sun Safety

What’s the best way to protect my child in the sun?

Follow these simple rules to protect your family from sunburns now and from skin cancer later in life.

• Keep babies younger than 6 months out of direct sunlight. Find shade under a tree, umbrella, or the stroller canopy.
• When possible, dress yourself and your kids in cool, comfortable clothing that covers the body, like lightweight cotton pants, long-sleeved shirts, and hats.
• Select clothes made with a tight weave – they protect better than clothes with a looser weave. If you’re not sure how tight a fabric’s weave is, hold it up to see how much light shines through. The less light, the better.
• Wear a hat or cap with a brim that faces forward to shield the face.
• Limit your sun exposure between 10:00 am and 4:00 pm, when UV rays are strongest.
• Wear sunglasses with at least 99% UV protection (look for child-sized sunglasses with UV protection for your child).
• Use sunscreen.
• Set a good example. You can be the best teacher by practicing sun protection yourself. Teach all members of your family how to protect their skin and eyes.

Sunscreen

Sunscreen can help protect the skin from sunburn and some skin cancers, but only if used correctly. Keep in mind that sunscreen should be used for sun protection, not as a reason to stay in the sun longer.

How to Pick Sunscreen

• Use a sunscreen that says “broad-spectrum” on the label – that means it will screen out both UVB and UVA rays.
• Use a sunscreen with an SPF (sun protection factor) of at least 15. The higher the SPF, the more UVB protection the sunscreen has.
• Look for the new UVA “star” rating system on the label.
  • One star is low UVA protection.
  • Two stars is medium protection.
  • Three stars is high protection.
  • Four stars is the highest UVA protection available in an over-the-counter sunscreen product.
• For sensitive areas of the body, such as the nose, cheeks, tops of the ears, and the shoulders, choose a sunscreen or sunblock with zinc oxide or titanium dioxide. While these products usually stay visible on the skin even after you rub them in, some now come in fun colors that kids enjoy.

Sunscreen for Babies

• For Babies younger than 6 months. Use sunscreen on small areas of the body, such as the face and the backs of the hands, if protective clothing and shade are not available.
• For babies older than 6 months. Apply to all areas of the body, but be careful around the eyes. If your baby rubs sunscreen into her eyes, wipe the eyes and hands clean with a damp cloth. If the sunscreen irritates her skin, try a different brand or try a sunscreen stick or sunscreen or sunblock with titanium dioxide or zinc oxide. If a rash develops, talk with your child’s doctor.

How to apply sunscreen

• Use enough sunscreen to cover all exposed areas, especially the face, nose, ears, feet, and hands and even the backs of the knees. Rub it in well.
• Put sunscreen on 30 minutes before going outdoors. It needs time to absorb into the skin.
• Use sunscreen any time you or your child might sunburn. Remember that you can get sunburn even on cloudy days. Also, UV rays can bounce back from water, sand, snow, and concrete so make sure you’re protected.
• Reapply sunscreen every 2 hours. Sunscreen wears off after swimming, sweating, or just from soaking into the skin.

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2011 Car Seat Information

Car Safety Seats: Information for Families for 2011

One of the most important jobs you have as a parent is keeping your child safe when riding in a vehicle. Each year thousands of young children are killed or injured in car crashes. Proper use of car safety seats helps keep children safe. But with so many different car safety seats on the market, it’s no wonder many parents find this overwhelming.

The type of seat your child needs depends on several things, including your child’s size and the type of vehicle you have. The following information from the American Academy of Pediatrics (AAP) offers guidance on choosing the most appropriate car safety seat for your child.

Infants and toddlers: rear-facing

The AAP recommends that all infants should ride rear-facing starting with their first ride home from the hospital. All infants and toddlers should ride in a Rear-Facing Car Safety Seat until they are 2 years of age or until they reach the highest weight or height allowed by their car safety seat’s manufacturer.

Types of rear-facing car safety seats
There are 3 types of rear-facing car safety seats: infant-only seats, convertible seats, and 3-in-1 seats. When children reach the highest weight or length allowed by the manufacturer of their infant-only seat, they should continue to ride rear-facing in a convertible seat or 3-in-1 seat.

Types of Car Safety Seats at a Glance

Figure 1: Infant-only car safety seat

Infant-only seats

• Are used for infants up to 22 to 35 pounds, depending on the model.
• Are small and have carrying handles (and sometimes come as part of a stroller system).
• May come with a base that can be left in the car. The seat clicks into and out of the base so you don’t have to install the seat each time you use it. Parents can buy more than one base for additional vehicles.
• Are used only for travel (not for positioning outside the vehicle).

Convertible seats (used rear-facing)

• Can be used rear-facing, then “converted” to forward-facing for older children. This means the seat can be used longer by your child. They are bulkier than infant seats, however, and do not come with carrying handles or separate bases.
• May have higher rear-facing weight (30–40 pounds) and height limits than infant-only seats, which make them ideal for bigger babies.
• Usually have a 5-point harness that attaches at the shoulders, at the hips, and between the legs. Older convertible seats may have an overhead shield—a padded tray-like shield that swings down over the child.

3-in-1 seats (used rear-facing)

• Can be used rear-facing, forward-facing, or as a belt-positioning booster. This means the seat may be used longer by your child.
• Are often bigger in size so adequate space within the vehicle when rear-facing should be determined.
• Do not have the convenience of a carrying handle or a separate base; however, they may have higher rear-facing weight (35–40 pounds) and height limits than infant-only seats, which make them ideal for bigger babies.

Installation tips for rear-facing seats
When using a rear-facing seat, keep the following in mind:

• Place the harnesses in your rear-facing seat in slots that are at or below your baby’s shoulders.
• Ensure that the harness is snug and that the harness clip is positioned at the mid-chest level.
• Make sure the car safety seat is installed tightly in the vehicle. If you can move the seat at the belt path more than an inch side to side or front to back, it’s not tight enough.
• Never place a rear-facing car safety seat in the front seat of a vehicle that has an active front passenger air bag. If the air bag inflates, it will hit the back of the car safety seat, right where your baby’s head is, and could cause serious injury or death.
• Be sure you know what kind of seat belts your vehicle has. Some seat belts need locking clips to keep the belt locked into position. Locking clips come with most new car safety seats. If you’re not sure, check the owner’s manual that came with your vehicle. Locking clips are not needed in most newer vehicles, and some seats have built-in lock-offs to lock the belt.
• If you are using a convertible or 3-in-1 seat in the rear-facing position, make sure the seat belt is routed through the correct belt path. Check the instructions that came with the car safety seat to be sure.
• If your vehicle was made after 2002, it may come with the LATCH system, which is used to secure car safety seats. See below for information on using LATCH.
• Make sure the seat is at the correct angle so your infant’s head does not flop forward. Many seats have angle indicators or adjusters that can help prevent this. If your seat does not have an angle adjuster, tilt the car safety seat back by putting a rolled towel or other firm padding (such as a pool noodle) under the base near the point where the back and bottom of the vehicle seat meet.
• Still having trouble? There may be a certified child passenger safety (CPS) technician in your area who can help. If you need installation help, see below for information on how to locate a CPS technician.

Common questions

Q: What if my baby’s feet touch the back of the vehicle seat?
A: Your child can bend his legs easily and will be comfortable in a convertible seat. Injuries to the legs are rare for children facing the rear.

Q: What do I do if my baby slouches down or to the side in his car safety seat?
A: Blanket rolls may be placed on both sides of the infant and a small diaper or blanket between the crotch strap and the infant. Do not place padding under or behind the infant or use any sort of car safety seat insert unless it came with the seat or was made by the manufacturer of the seat.

Figure 2: Car safety seat with a small cloth between crotch strap and infant, retainer clip positioned at the midpoint of the infant’s chest, and blanket rolls on both sides of the infant.

Q: Can I adjust the straps when my baby is wearing thicker clothing, like in the winter?
A: Yes, but make sure the harnesses are still snug. Also remember to tighten the straps again after the thicker clothes are no longer needed. Ideally, dress your baby in thinner layers instead of a bulky coat or snowsuit, and tuck a blanket around your baby over the buckled harness straps if needed.

Q: Are rear-facing convertible seats OK to use for preemies?
A: Premature infants should be tested while still in the hospital to make sure they can ride safely in a reclined position. Babies who need to lie flat during travel should ride in a crash-tested car bed. Very small infants who can ride safely in a reclined position usually fit better in infant-only seats; however, if you need to use a convertible seat, choose one without a tray-shield harness. The shields often are too big and too far from the body to fit correctly and the child’s face could hit the shield in a crash.

Q: What is LATCH?
A: LATCH (Lower Anchors and Tethers for Children) is an attachment system for car safety seats. Lower anchors can be used instead of the seat belt to install the seat and may be easier to use in some cars. The top tether improves the safety provided by the seat and is important to use for all forward-facing seats. Read the vehicle owner’s manual and the car safety seat instructions for weight limits for lower anchors and top tethers.

Vehicles with the LATCH system have anchors located in the back seat. Car safety seats that come with LATCH have attachments that fasten to these anchors. Nearly all passenger vehicles and all car safety seats made on or after September 1, 2002, come with LATCH. However, unless both your vehicle and the car safety seat have the lower anchor system, you will still need to use seat belts to install the car safety seat.

Toddlers and preschoolers: forward-facing

All children 2 years or older, or those younger than 2 years who have outgrown the rear-facing weight or height limit for their car safety seat, should use a Forward-Facing Car Safety Seat with a harness for as long as possible, up to the highest weight or height allowed by their car safety seat’s manufacturer. It is best for children to ride in a seat with a harness as long as possible, at least to 4 years of age. If your child outgrows his seat before reaching 4 years of age, consider using a seat with a harness approved for higher weights and heights.

Figure 3: Forward-facing car safety seat

Types of car safety restraints
There are 5 types of car safety restraints that can be used forward-facing.

1. Convertible seats—Seats that “convert” from rear-facing to forward-facing seats. These include 3-in-1 seats.
2. Forward-facing only—These seats can be used forward-facing with a harness for children who weigh up to 40 to 80 pounds (depending on the model).
3. Combination seat with harness—These seats can be used forward-facing with a harness for children who weigh up to 40 to 80 pounds (depending on the model) or without the harness as a booster (up to 80–100 pounds).
4. Built-in seats—Some vehicles come with forward-facing seats built in. Weight and height limits vary. Read your vehicle owner’s manual or contact the manufacturer for details about how to use these seats.
5. Travel vests—These can be worn by children between 20 and 168 pounds and can be an alternative to traditional forward-facing seats. They are useful for when a vehicle has lap-only seat belts in the rear or for children whose weight has exceeded that allowed by car safety seats. These vests may require use of a top tether.

Installation tips for forward-facing seats

• Make sure the car safety seat is installed tightly in the vehicle and that the harness fits the child snugly.
• To switch a convertible or 3-in-1 seat from rear-facing to forward-facing
• Move the shoulder straps to the slots that are at or above your child’s shoulders. On some convertible seats, the top harness slots must be used when facing forward. Check the instructions that came with the seat to be sure.
• You may have to adjust the recline angle of the seat. Check the instructions to be sure.
• Make sure the seat belt runs through the forward-facing belt path. When making these changes, always follow the car safety seat instructions.
  If your vehicle was made after 2002, it should come with the LATCH system, which is used to secure car safety seats.

A tether is a strap that attaches to the top of a car safety seat and to an anchor point in your vehicle (see your vehicle owner’s manual to find where the tether anchors are in your vehicle). Tethers give important extra protection by keeping the car safety seat and the child’s head from moving too far forward in a crash or sudden stop. All new cars, minivans, and light trucks have been required to have tether anchors since September 2000. New forward-facing car safety seats come with tethers. Check the car safety seat instructions and vehicle owner’s manual for information about the top weight limit and locations of the tether anchors.

School-aged children: booster seats

Booster seats are for older children who have outgrown their forward-facing car safety seats. All children whose weight or height is above the forward-facing limit for their car safety seat should use a Belt-Positioning Booster Seat until the vehicle seat belt fits properly, typically when they have reached 4 feet 9 inches in height and are between 8 and 12 years of age. The owner’s manual that comes with your car safety seat will tell you the height and weight limits for the seat. As a general guideline, a child has outgrown his forward-facing seat when any one of the following is true:

• He reaches the top weight or height allowed for his seat with a harness. (These limits are listed on the seat and also included in the instruction booklet.)
• His shoulders are above the top harness slots.
• His ears have reached the top of the seat.

Types of booster seats

Booster seats are designed to raise the child up so that the lap and shoulder seat belts fit properly. High-back and backless booster seats are available. They do not come with harness straps but are used with the lap and shoulder seat belts in your vehicle, the same way an adult rides. Booster seats should be used until your child can correctly fit in lap and shoulder seat belts. Booster seats typically include a plastic clip or guide to help ensure the correct use of the vehicle lap and shoulder belts. See the instruction booklet that came with the booster seat for directions on how to use the guide or clip.

Figure 4: Belt-positioning booster seat

Installation tips for booster seats

• The lap belt lies low and snug across your child’s upper thighs.
• The shoulder belt crosses the middle of your child’s chest and shoulder.

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