What to Expect the Toddler Years (213 page)

Non-aspirin fever reducer, but only if fever is high. Check with your doctor for guidelines (see page 597).

Commercial decongestant nose drops or sprays, but only under medical supervision; used for more than 3 days, they can cause “rebound,” making stuffiness worse than before.

Antibiotics, only if a secondary bacterial infection (such as a middle ear infection or pneumonia) develops. Antibiotics are
not
effective against cold viruses.

Dietary changes.
Plenty of fluids, particularly warm ones (chicken soup really is effective), and a nutritious diet. Be sure to offer two or three servings of vitamin C-rich foods (see page 506) each day. Frequent small meals may be more appealing than three squares. It’s not necessary to limit milk intake; contrary to popular belief, it doesn’t increase mucus production. Also see Dietary Guidelines for the sick child, page 588.

Prevention.
Good overall health habits. Ban smoking near your child, at home and away, and avoid the use of wood stoves that emit indoor air pollutants. (Smoke from tobacco and fumes from wood stoves reduce resistance to colds. If you have a wood-burning stove, check it for emmissions.) Keep your child away from infected individuals, when possible; make washing hands after touching someone with a cold or handling something they’ve handled mandatory; promote frequent hand-washing in general. Use a disinfectant solution to clean surfaces that may be contaminated with cold germs, and follow other tips for preventing the spread of illness (see page 609). But remember that nothing (short of locking your child in a sterile room) will entirely protect your toddler from cold viruses. The average child has six to eight colds a year; some have nine or ten, and even this is not usually a concern as long as the child is growing and developing well.

Possible complications.
Ear infection, sinus infection, and—much less often—pneumonia.

When to call the doctor.
If your child is lethargic, has no appetite, or has difficulty sleeping; has greenish or yellowish, foul-smelling nasal discharge or sputum (phlegm); is wheezing, breathing more rapidly than usual (see page 574), or complaining about chest discomfort; has a cough that’s getting worse or continues during the day after other symptoms are gone; seems to be having throat pain, trouble swallowing, or a red throat (especially if there are white or yellowish spots visible (see page 613); has swollen glands in the neck (see page 576); pulls on ears day or night, or is very restless or wakes up screaming in the middle of the night; is running a fever over 102°F (38.9°C) or has a low-grade fever for more than 4 days; gets worse instead of better. Also call if symptoms last longer than 10 days—this usually indicates a secondary sinus infection.

Note:
If your toddler seems to have a continuous cold or very long-lasting or frequent colds, talk to the doctor about the possibility of allergy being responsible.

Symptoms.
Small, hard stools every 3 or 4 days; hard, dry stools (even if they are passed daily) that are difficult or painful to eliminate; abdominal pain relieved by a bowel movement. Infrequent movements alone are not a sign of constipation; some children just go less often than others.

Season.
Anytime of year, but may be more likely when there is a change in diet and schedule (as during a vacation).

Cause.
Many possible, including a diet low in fiber and fluids. Temporary constipation may develop during or after an illness; certain medications can also be responsible. In addition, constipation often develops in toddlers going through the toilet-learning process, especially when there is parental pressure to perform (see suggestions for low-key toilet teaching in Chapter Nineteen). Constipation may also develop in a toddler who is uncomfortable using the toilet away from home (at day care, preschool, a friend’s house, or a store) or who withholds a bowel movement out of pique, because of being otherwise engaged, or for any other reason. The longer a movement is held, the harder and drier it becomes, and the more difficult and painful it is to pass. Fear of passing these hard, dry stools often prompts a child to continue withholding, and a cycle of withholding and constipation is set in motion. Movements that are withheld too long, in addition to becoming hard, can become very large. When passed, they can stretch the rectum; repeated overstretching can make it more difficult for a child to recognize the urge. This, too, helps to perpetuate the cycle. When constipation becomes chronic and home treatment measures fail, the doctor may look for a medical cause, such as an underactive thyroid gland or a spinal-cord anomaly, though these are very rare.

Transmission.
Constipation is not contagious, but the poor eating and exercise habits, which often lead to or perpetuate it, can be passed from parent to child.

Duration.
Anywhere from 1 day to a lifetime.

Treatment.
When an underlying medical problem is a factor, medical treatment generally focuses on identifying and dealing with it, as well as on softening and removing (usually with the help of an enema) any impacted stool that has become lodged in the rectum and can’t be passed. But home treatment usually plays the most important long-term role in preventing recurrence. Treatment should include plenty of:

Fiber. Be sure your toddler is getting whole-grain breads, cereals, and pastas (“
whole
wheat,” not just “wheat”; rolled oats rather than instant; and so on); fresh fruit (ripe apples and pears are particularly effective), and dried fruit (especially raisins, prunes, apricots, and figs); vegetables (cooked until tender but not mushy); and legumes (cooked dried beans and peas). Do be sure you always offer age-appropriate foods; dried fruit, whether cooked or raw, should be diced for younger toddlers, and beans and peas should be mashed or split. For older toddlers, raw vegetables and salad are a good dietary addition. Give wheat (or miller’s) bran, which packs a major laxative wallop, only when the doctor has advised its use. It can be added
to cereals, pancakes, muffins, breads, other baked goods, pasta sauce, and almost anything with a gooey texture. Always serve the bran with plenty of liquid, don’t exceed the recommended quantity, and use it only for as long as it’s necessary.

Fluids. Many toddlers who’ve been recently weaned off the bottle or breast drink much less than they did before weaning; in some cases, it’s less than they need. Be sure that’s not the case with yours. If he or she isn’t managing to drink at least a quart (a quart and a half would be better) of fluids a day at meals and snacks, try offering sips of milk, juice, or water frequently in between. Fruit juices are particularly beneficial; limit cow’s milk to about 3 cups a day, since the calcium salts in it can harden stools.

Exercise. Although you don’t have to sign your toddler up at the local health club to make sure he or she is getting enough constipation-combating exercise, you should see that the whole day isn’t spent in the car seat or stroller, with little opportunity for physical activity. Treat your toddler to some outdoor play every day, weather permitting. On inclement days, try an impromptu calisthenics class on the living room floor (jumping jacks, toe touches, upside-down bicycling).

Lubrication. Daubing a bit of petroleum jelly at the anal opening may help the movement slip out more easily.
Do not
use enemas or suppositories for constipation without a doctor’s advice. Except in rare instances, these treatments make the problem worse, not better.