Toddler Health

Signs of possible serious illness - contact a doctor

• Drowsiness or seeming less alert than usual

• Less active than usual, lethargic, lying around

• Breathing problems

• Pale skin, bluish skin, cold hands and feet

• Poor feeding

• Less urine than usual

Get urgent medical care - go to the hospital emergency department or call and ambulance if your toddler displays the following signs:

• Vomiting green fluid

• Convulsion (fit). Gently lay the child on their side and let them move freely

• Child stops breathing for more than 15 seconds

• Lump in the groin area that could be a hernia

• Rash on legs or torso

• Temperature of more than 38°C

Food groups that toddlers need

• Protein foods, e.g. peas and beans (any kind, including frozen peas and canned baked beans), eggs, fish, chicken, meat, milk, yoghurt, cheese • Vegetables, e.g. broccoli, green beans, carrots, sweet potato, tomatoes, spinach, cucumber with skin
• Fruit, e.g. peaches, apricots, pears, apples. Wash fruit and leave the skin on.
• Starchy carbohydrates with fibre, e.g. fibre-enriched bread, wholegrain rice, couscous, pasta, pancakes, low-sugar cereal
• Good fats (long-chain polyunsaturated fatty acids), e.g. fish (tinned or fresh), avocado, olive oil, canola oil. Avoid or limit deep-fried food.
• Tap water – this is the cheapest and best source of fluids. Most Australian tap water is fortified with fluoride for strong teeth.

Food facts

Toddlers have small stomachs (about the size of their fist), so they can’t manage large amounts at a time. They need small servings of nutritious food 5–6 times a day.

Children go through growth and activity spurts, so sometimes they can be really hungry and at other times seem uninterested in food. As long as you offer a balanced variety of nutritious foods, it doesn’t matter if the child has a small appetite. Children should be allowed to trust their appetite. Forcing children to eat can lead to problems.

Letting them fill up on empty calories will interfere with the body’s natural appetite for nutritious food. You may need to offer a new food several times before a toddler will accept it.

Meal planning

Schedule snack and meal times. Don’t give snacks too close to meals, and don’t offer anything in between planned snacks and meals. Always offer a range of nutritious food. If your toddler will only eat one type of food for a while, but it is a healthy food, let them. Keep offering other choices and eventually they will eat something else.

Serve small amounts. It’s better to have them ask for more if they are still hungry than have uneaten food on the plate. Water is best. Avoid cordial, and don’t let them fill up on too much fruit juice. It is high in sugar and will spoil the child’s appetite for other foods. Don’t let them fill up on milk outside of snack times.

Tips for happy mealtimes

If your child won’t eat, be relaxed about it. Try not to give in to whinging for alternatives to the food you have prepared. Offer the colourful vegetables and protein first, when they are most hungry. Let them stop eating when they are full.

Try placing the food on communal plates in the centre of the table and encourage them to serve themselves. It can be good for them to feel they have chosen the food themselves.

If your toddler is too tired to eat at dinner time, try giving them most of their dinner for afternoon tea and offer a light supper later.

Try eating in different places, e.g. a picnic or a barbecue. Invite one of your child’s friends over for a meal. The feeling of fun around the table often encourages a fussy eater to eat.

Don’t force your toddler to eat. This could cause choking. It’s almost impossible to chew and swallow if you’re crying. Be calm, firm and consistent. Making mealtimes a battleground is unlikely to work.

How to encourage good behaviour

Create opportunities for toddlers to explore their world safely. Put precious or dangerous items away or out of reach.

Constantly saying ‘no’ can dampen a toddler’s natural curiosity and desire for exploration. Choose your battles. Before you say ‘no’, decide if its really important, instead of changing your mind later.

Offer two choices and let them choose which of the choices they want. This gives them some control over what they do.

Show them how you feel. Let them know if they hurt you, so they can begin to learn that what they do affects other people and how others react to them. Explain the consequences of bad behaviour so that your child can understand why it is wrong.

Avoid giving attention when the child is doing something you don’t like. Put them down, if you are holding them, or walk away from them. Let them know that they may have your attention again when they stop their behaviour.

Manage transitions carefully – young children can find it hard to go from one activity to the next if they don’t want to. Some extra time, sensitivity and planning can help avoid the tantrums.

Reward and praise good behaviour. Positive reinforcement for good behaviour usually works better than punishment for bad behaviour.

Sleep facts

Toddlers need about 10–12 hours’ sleep a night. Most will have a nap in the afternoon as well. Getting toddlers to go to sleep can be hard. A consistent bedtime routine helps prepare the child for sleep (e.g. clean teeth, spend some quiet time, read a story, put child into bed and kiss goodnight.) Most toddlers are ready for bed between 6.30 and 7.30 pm. This is a good time to aim for, so the deepest sleep often occurs between 8:00 pm and midnight.

Nightmares usually happen between midnight and 4 am. During a nightmare, your child will usually wake up fully, and will often remember details of the frightening dream. Children can usually be settled by a parent and will remember the incident in the morning. About one in twenty children will experience ‘night terrors’. These are part of normal development and do not have any lasting effects on the child. Most children will outgrow them.

Night terrors

Night terrors tend to occur in the first few hours of sleep when the child is sleeping deeply.

A night terror often starts with the child screaming or calling out and looking very scared.

Your child may stay in bed thrashing their legs and arms wildly about, or may get up and start running around the house as though someone or something is chasing them. The child may have a very rapid heartbeat and rapid breathing, may be sweaty, and have their eyes open with a glassy stare.

Children are asleep during night terrors. They will not recognise anyone and cannot be comforted.

The best way to handle a night terror is to wait it out patiently and make sure your child does not get hurt if they thrash around. Your child will usually settle down and return to quiet sleep on their own in a few minutes.

Night terrors usually last around five to ten minutes and may happen more than once during the same night. The child will not remember anything about the episode in the morning.

Tips for a good night's sleep

Try adjusting the daytime nap. Too much sleep in the day, or too late in the day, might affect your night time routine. On the other hand, an overtired child might find it hard to settle. Establish a consistent, calming routine. Avoid boisterous play before bed.

Before leaving the room, check your child has everything they need and remind them they must stay quietly in bed. Try not to respond to the calls after lights are out, no matter how loud. If you give them attention, they will get into the habit of expecting you to come in when they call, making it harder to stop.

If the child gets out of bed, try to return them without saying anything – no eye contact or talking. Take them back again and again in the same way if necessary, however long it takes. If you give in, it will be very hard to get them to stay in bed. Be consistent, it may take a few nights but they will get the message. Get your partner to help – make sure you both use the same method.

Tips to deal with temper tantrums

Make a plan before it happens about how you will deal with tantrums that happen at home, when out shopping, or when playing at a friend’s house. When it happens, focus on your plan rather than on the tantrum. This will help you keep calm and in control.
Remind the child of what happened last time they misbehaved. If your child is old enough to understand, you can remind them of past experiences and the consequences of misbehaving.
Distract the child’s attention by calmly offering something else to do, see, eat or play with. Try saying ‘You are feeling really upset and I will stay with you until you feel better. It’s alright to cry when you are upset, but I won’t let you hit/kick (or whatever).’
Once a tantrum is over, let the child start over again.

You can comfort them, but don’t give in to the original demand. If you are in a supermarket, leave the shopping basket there and take your child out to the car or somewhere quiet until the tantrum is over.
Look for the pattern. If tantrums always happen around dinner, try giving the child an earlier dinner, giving them a bath before dinner, let them ‘help’ you prepare the meal, or have some special time with them at this time of day.

If you feel that you are losing control and are worried about what you may do, tell your child that you will be leaving for a short time but will be back soon to look after them. Make sure they are safe (e.g. have someone else stay with them if you can). When the tantrum is over, suggest something to do that you are happy with.

Toddler safety in the home

• Toddler-proof your home.
• Turn off heaters when you leave the room.
• Don’t let your child move about while eating – sitting is safest.
• When using hot liquids or drinking hot drinks, make sure toddlers can’t reach them.
• Keep plastic bags and wrappers away from toddlers.
• Keep appliance cords out of reach. When cooking, turn pot handles to the back of the stove and use the back elements when possible. Buy a stove guard.
• Never leave children home alone.
• Never leave a toddler along in the bath, even for a second. Young children can drown quickly and quietly.
• Start teaching your child where they can and can’t go in the house, and what isn’t safe to touch.
• Teach your child to come down stairs backwards (on their tummy) or on their bottom.
• Have a first aid kit, and keep it out of reach.
• Check smoke alarms regularly.
• Only deadlock doors when there is no-one inside.
• Keep a list of emergency numbers near the phone, including the poisons information centre (13 11 26), doctor, local hospitals, police etc.

Toddler-proofing your home

• Mount TVs on walls or place them so they can’t fall on your child if climbed on.
• Move chairs and other things away so your child can’t climb up to windows or benches where there are dangerous things.
• Make sure your windows are locked and safe. Curtain tie-backs and window blind cords can strangle your child – keep them out of reach or remove them.
• Make sure there is nothing in reach that is small enough to choke on.
• Keep medicines, cleaning fluids and other dangerous substances locked away or up high.
• Turn down the water temperature in your hot water heater.
• Install safety glass in windows and doors. Put stickers on glass doors at toddlers’ eye level to stop them running into them.
• Put up barriers to areas where your child might be at risk (e.g. safety gates at the top and bottom of stairs and on balconies, guards around heaters).

Toddler safety outside

• Always use child restraints in the car.
• Never leave children in a car by themselves.
• If you are near a pool, check that the fence and gate are secure yourself (even if someone tells you it’s fine). Watch children the whole time around pools.
• When moving vehicles, always know where your child is and make sure they are supervised.
• Make it a rule that your child must hold hands when crossing the road, every time.

Additional resource

www.raisingchildren.net.au