Anger Management

Q: My son just turned 2 years old. He is a great kid, but sometimes he will get very angry at a toy if he cannot figure it out, or at his dad and me if he is told "no." He will go off spouting all sorts of things that only he understands, but I know he is clearly angry. How do I help him to avoid this, or should I ignore it?

A: To many 2-year-olds, daily life is filled with frustrating events. Compared with infancy, there's so much more that they want to do and see, but they still don't have the physical coordination or intellectual abilities to do it all. That's why one of the most important tasks faced by toddlers is learning how to handle frustration.

Frankly, I'm impressed that your son is showing his frustration through words -- even if the words are made up. Learning to use words instead of kicking and screaming to express strong emotions is a sign of maturity. So instead of worrying, I'd feel proud of his accomplishment. When he's feeling frustrated, help him calm down by giving him a hug and distracting him for a few seconds. Also, help him label his emotions (“I can see that you're angry because you can't do what you want to do”) so that he can eventually use words to share his feelings.

—Lawrence Kutner, PhD

Food for Thought

Q: My 3-year-old daughter will be starting a “pre” preschool class three days a week, for about three hours per day. There are usually snacks for the kids. At home, the vast majority of the foods we eat are made from scratch. We only eat fresh, organic foods/fruits/veggies. I don’t want her eating anything with trans fats in it. However, it seems that it's nearly impossible to keep her from throwing a fit when other children eat these things in class (for a birthday party, for instance).

A: I applaud your devotion to healthful eating. The way you eat at home will be the way your child eats throughout her childhood and, with any luck, the rest of her life. However, she is going to go to birthday parties and special occasions when she is too young to make choices -- and later she may rebel against rigid restrictions. In other words, your child is going to have to live in the real world, and she is too young to understand why you do what you do. I do not say that you have to change your principles, but you do need to be realistic.

If she had a life-threatening allergy to milk or peanuts, for example, it would be appropriate for you to monitor what is served at school and parties closely. In this case, however, I think the only choice you have are to put her into a small, perhaps home-based preschool with only a handful of children who all eat the same way. You can’t force other parents to adopt your eating preferences, and making your daughter stand out as the different one may lead her to be resentful. Besides, as she gets older, you cannot monitor what she trades out of her lunch box or what another child tempts her with, you can only control the types of food she eats at home. Remember that good nutrition is a long-term process, not destroyed by a processed cracker making its way past the lips once in a while.

—Loraine Stern, M.D.

Wobbly Walker

Q: My son is 18 months old and isn't yet walking on his own. He does walk (wobbly) when pushing his walking stroller. Also, he only stands when holding onto something. He's been slow in development in other ways, such as crawling, lifting and supporting his head, etc., so I assume he's just on his own schedule. We took him to a neurologist last week that is concerned about his muscle tone and reflexes, and is going to be doing two days of tests to make sure everything is okay. Are there any specific things we should be worried about?

A: You have been doing an excellent job of keeping an eye on your son's development, and you are doing the right thing by seeking a specialist's help.
You are correct that children develop and progress at different rates, and most of these differences do not signal problems. Throughout the first three to four years, parents and healthcare providers should monitor a child's progress carefully and use each checkup as a chance to decide if there are any concerns.
Along the way, there are certain warning signs or "red flags" that may signal a problem. In your son's case, the fact that he is not walking at 18 months and that his muscle tone may be weak are warning signs. That is why it is good for you to find out for sure if there is an underlying problem.

You will want to make sure your specialist is skilled in this type of concern. You will likely do best to see a pediatric neurologist or a pediatrician specializing in developmental disorders. At this point, the most important step is to get the best possible understanding of the cause of your son's developmental issues. The specialist will try to give a precise diagnosis, but this is not always possible. Parents may not always like to hear the specialist's opinion, but you should be able to get a feeling of confidence that the opinion is accurate. When parents do not have confidence in the opinion, it may be appropriate to obtain a second opinion.

After these steps, the most important item for you and your son is a treatment plan. Developmental experts have found that certain therapies will help a child catch up and reach his potential. These therapies usually involve working with a therapist and daily work at home with family. It is important to start therapy while the child is young. That is why I said you are doing the right thing. With your love and support and help from the specialists, your son is getting exactly what he needs —Stephen Muething