Parenting: Toddlers

From the moment the pregnancy test comes back positive, our responsibilities as parents begin. While we have many hopes and dreams for what our children will one day become, all parents share the same universal wish ’Äì for happy and healthy children.

The first year as parents flies by in a flurry of round-the-clock feedings, diaper changes, first coos and smiles and keeping the closet stocked with clothes that Baby will grow out of in a matter of weeks. But because all babies are different and that first year is so hectic, many parents don't notice potential behavioral and developmental problems in their children until the toddler years begin.

"A child's development is impacted long before they're even born," says Dr. Elizabeth Nelsen, a clinical adjunct instructor in the Department of Pediatrics at SUNY Upstate Medical University in Syracuse, N.Y. "Maternal health has a significant impact on a child's development prior to birth. Things like nutrition and complications from hypertension and gestational diabetes, to name a few, could potentially alter a child's future development."

However, as the child grows older, Nelsen says parents should suspect a hearing problem if their toddler appears to have problems localizing sound, such as not being able to tell where Mom is in the room just by her voice or if they have problems hearing over a noisy background.

Signs that a toddler may have impaired vision include the following:

• Holding books or toys close to the face.
• Sitting close to the television.
• Problems seeing people or objects that are far away.
• Excessive squinting or rubbing of the eyes.

If a parent suspects any problems with their toddler's hearing or vision, it's best to point it out to a pediatrician as soon as possible for further assessment.

"Sometimes its an emotional thing rather than a developmental problem," Garcia says. "Some children feel more shy or anxious around other children."

Caring for Your Baby and Child: Birth to Age 5 (Bantam, 2004), a comprehensive guide published by the American Academy of Pediatrics, says signs of a possible speech delay include the following:

• Does not speak at least 15 words by 18 months of age.
• Does not use two-word sentences by age 2.
• Does not imitate actions or words by the end of the second year.

While many parents can expect some difficult behavior as a toddler approaches age 2 (hence, the "terrible twos") more serious problems such as autism typically crop up between the ages of 18 and 24 months.

Garcia says warning signs of such developmental problems include a child losing speech he or she has already developed, repeating themselves, extreme interest in objects or actions that could be considered obsessive and antisocial behavior.

In the case of autism or Asperger's syndrome, a milder form of autism, Garcia says early intervention is the best thing to help a parent who suspects their child may have autism. "It's about breaking through those barriers," she says.

"Night terrors" occur during sleep stages 3 and 4, the stages of deep sleep prior to the onset of REM sleep, Nelsen says. Their cause is unknown but they can be associated with stress, tension or conflict and are heralded by a scream. She adds that they are not inherited but to tend to run in families. Symptoms of night terrors include these:

• Sudden awakening from sleep.
• Persistent fear or terror that occurs at night.
• Screaming.
• Sweating.
• Confusion.
• Rapid heart rate.
• Inability to explain what caused the waking.
• No recall of bad dreams or nightmares (but may have a vague sense of frightening images).
• Unable to fully arouse.
• Difficult to comfort.
• No memory of the event upon awakening the next day.

Nelsen adds that night terrors typically scare a parent more than the child. "The best thing a parent can do is provide reassurance and put the child back to bed, following the typical bedtime routine," she says. It may take some time before the child is consoled, but this is normal. Nelsen points out that night terrors are a phase, and the child will eventually grow out of it, usually by age 5 at the latest.

Nelsen also says that the environment in which a child is raised also has a direct impact on how a child develops. "Not all parents have access to educational toys or even quality educational television programming," she says. "Also, children who have older siblings or parents with developmental delays or learning difficulties are more likely to develop similar problems as they get older."

Hearing, vision, language, speech and sleep patterns are all areas a parent should pay close attention to during the toddler years, particularly since parents aren't required to take their toddler in for well checkups as often as they did during their baby's first year of life. A parent is a child's best and most important advocate. Children rely heavily on Mom and Dad to get them the help they need in light of any potential problems that may develop.