Communication Breakdown

Q: My daughter is 22 months old and we cannot understand her. She talks and is trying to put words together, but no one knows what she is saying most of the time. Is this normal? Someone told us that it is because she is not in day care and does not listen to other children talk. Is this true? Her hearing seems to be fine, and she is trying really hard. Her pronunciation is just very bad.

A: Congratulations on your talkative child! It's great to hear that she's interested in language and that she is putting two words together. As a rule of thumb, she should be understood about half the time at her age.

Children learn to talk from talking with others, children and adults, with adults being a better model, of course. Firstborn children generally talk a little ahead of later children, in spite of having no siblings around. The lack of day care is probably not relevant here unless your family doesn't talk at all.

Talk to her often, ask her questions, and respond to her meaning, not her pronunciation. Expect her to use words for requests, to express feelings, and to comment on interesting things in her environment. Her understanding of language is more important than what she says at this stage. Can she follow a two-step command such as, "Get your sweater and come to the door"? If so, that tells me she's really on track. Have your health care provider listen to her speech at the 2-year checkup just to get some assurance. —-- Suzanne Dixon, M.D., M.P.H.

Jumpin' Around

Q: My 3-year-old son likes to jump up and down when he is going up and down the stairs. I try to discipline him and tell him that he is going to hurt himself. He knows how to walk up and down the stairs by himself, but I think he does it to make me mad. What should I do?

A: I understand your concern for his safety. However, I doubt that he does it to make you mad. More likely, he does it for two reasons: It's fun and it gets him extra attention from you. So let's address both of those issues.

First, arrange for a time every day when he can jump. Doing this outside would be best, so that he can get some practice balancing on short walls and jumping to the ground from a height of a few inches to a foot or so. Pay extra attention to him and praise him when he does this.

Remember that climbing stairs is an achievement he's proud of mastering. Use that to your advantage. Tell him that he's not allowed to jump and that he has to hold onto the railing with one hand whenever he's on the stairs. Remind him that he can jump outside when he plays, but not on the stairs.

If he starts to jump, simply pick him up and say, "No jumping on the stairs" in a matter- of-fact tone of voice. Then carry him up or down the stairs (whichever way he was going) without saying another word. Since this isn't really extra attention, and he doesn't get to test his mastery of stair climbing, he'll quickly learn not to jump on the stairs. —--Lawrence Kutner, Ph.D

Overeating Issue

Q: Everywhere, I read about kids that won't eat. But our daughter is just the opposite -- she eats everything. Is there such a thing as too much? She'll be 4 soon and she is now 65 pounds. She eats veggies, potatoes, meat and maybe once a day a treat, but she eats almost as much as I do. If I cut that down won't she be losing her nutrition?

A: The question you raise is a complex one. First of all, are you a family of large people? Are you tall and heavily boned? Are either you or her other parent obese? Genetics is probably the most powerful force that controls children's eating and body types.

About one in four children in the US are overweight and 10 to 15 percent are obese. Obesity is the cause of many life-shortening problems such as high blood pressure, diabetes and certain cancers.

The vast majority of children who are obese at age 10 to 13 will end up as obese adults, so it is important to try to control this early.

That being said, solving this problem is not an easy task. Of course, you should review your diet. Pay attention not only to the food and fat content of the diet but also to lifestyle issues. Exercise is essential, but that does not necessarily mean joining a gym. Using stairs instead of an elevator, parking far from the mall entrance, taking an after dinner walk rather than collapsing into a couch, throwing balls in the yard rather than taking a drive -- there are many small ways to encourage activity for the whole family.

You should start with a visit to your pediatrician. The chances of a medical problem causing overweight or over-largeness are small; in only about 1 out of 100 children is there a medical cause. Once that has been eliminated, it helps to talk with a dietitian or nutritionist for help in accommodate everyone's individual preferences in a healthful meal plan. —--Loraine Stern, MD