Computer Conundrum

Q: How much time each day should a 4-year-old be allowed to play on the computer? My son is adept at both educational programs and games, and if we allowed it, he would spend literally all day at the computer. I try to limit his time, but I don't know how much time is acceptable (and healthy) for a child his age.

A: The American Academy of Pediatrics recommends that children spend no more than one to two hours in front of a video screen per day. This includes television, computer games, and video games. Spending more than this amount of time takes away from play periods when children could be outside getting exercise and interacting with other children. (Sitting watching video viewing also encourages snacking -- another drawback).

There is nothing wrong with spending a little time on shows or games that are purely entertaining, but that shouldn't be the way your child spends the majority of his time. You could use this situation to teach your child how to budget time. Give him, for example, a 1-hour "budget" each day to plan for his screen activities. Since 4-year-olds don't have a profound understanding of time, use a system of tokens or stars representing 15-minute periods and show him how many he has for each day. He can spend them like coins. But don't give him extra computer time as a reward for good behavior. Remember that you are the one who has the ultimate authority to pull the plug. —--Loraine Stern, MD

Tantrums That Hurt

Q: I can't get my 1-year-old daughter to stop having tantrums when she can't get her way, and she often ends up falling and bumping her head. I'm worried she will really hurt herself. Any suggestions?

A: Most parents who watch the strength of a child's tantrums can't imagine that a child will not hurt herself. But an injury doesn't happen except in the most bizarre and rare of circumstances, such as a child throwing herself down a stairway (your stairs are blocked, aren't they?) or falling out a window (you do have window locks, don't you?). Falling from her own height will do her no harm unless she falls directly on a pointed object, a very rare occurrence. Even a "goose egg" bump on the head doesn't mean there is serious injury.

Let her blow off the steam. Tantrums are normal at this age as she struggles with gaining independence and testing the limits of her power. Your job is not to stop the tantrum, but to give her firm and consistent limits, redirect her when she gets into trouble, and a chance to express her frustration and get herself back under control. If you give in and let her have her way, she won't know what the limits are and will always be pushing the boundaries to find out.

Discipline is the second most important thing you give a child after love. Show her ways of using words when she can, provide an alternative activity, and be sure she doesn't need a snack or a rest. Life as a toddler can be tough, so make sure she is rested and fueled up and ready for the task of learning about life's frustrations. —--Suzanne Dixon, MD, M.P.H.

Eating Dilemma: "Pouching"

Q: My son is 2 1/2 years old and I would like to ask something about eating habits. He lets his food stay in his mouth for a very long time. That's why it takes him forever to finish eating. Even if the food looks soggy inside his mouth already, he still lets it stay there while he plays. Is there anything I can do to help him swallow faster?

A: What he is doing is called "pouching," and it's not an unusual behavior at this age. Toddlers and preschoolers are sensitive to textures in food and they sometimes can't or won't chew food enough to swallow it easily. Pouchers can carry food around for hours. Some children take it out of their mouths and leave little packages in inconvenient places, such as under the couch.

The best thing to do is not let your son leave the table with anything in his mouth. Sweep the food out with your fingers if he won't spit it out or swallow it. Never let him take a nap or go to bed with the food in his mouth. The food may come loose and pose a choking hazard. Also, keeping food next to the teeth for a long time can promote decay.

If it is usually a specific food that your child pouches, like meat, see if there is a texture that he accepts more willingly. Ground meat in spaghetti sauce may be easier to eat than hamburger or slices of meat, therefore less likely to be pouched. Pouching is usually a phase that stops on its own, but if it continues beyond the preschool years talk to your pediatrician. At that point it may be a sign of emotional issues. —--Loraine Stern, MD