What to Expect the Toddler Years (63 page)

“Ever since our daughter started cutting her molars, she’s been waking at night. I don’t even know if her teeth are bothering
her anymore, or if it’s just become a bad habit.”

It’s possible that teething pain is what started your toddler’s night waking habit, but it’s likely that the response she got is what kept the habit going strong long after the pain was gone. While everyone awakens three or four times during the night and then drifts back to sleep, a small child who has been conditioned to receive parental attention and comfort when she wakes isn’t likely to go back to sleep until she gets it. To reverse that conditioning, and that night waking habit, see the tips on page 65.

“My son snores in his sleep—so loudly we can hear him down the hallway. I’m concerned that snoring is abnormal for a child.”

When we think of snoring, we usually think of hulking men—not pint-size toddlers. But some of the biggest nocturnal noises actually come from some of the smallest sources; studies show that 7% to 9% of children snore. The rate is higher in homes where parents smoke. Though snoring reaches its peak between ages three and six, it often shows up much earlier.

Snoring is the sound that is created when a child’s breathing is partially blocked by enlarged adenoids and/or tonsils. These bits of lymphatic tissue in the nose-throat breathing passage often swell when a child has a cold, flu, or sore throat, sometimes triggering temporary snoring. Persistent allergies and exposure to tobacco smoke may also cause tonsils and/or adenoids to become enlarged. Sometimes, however, they grow excessively for no apparent reason. When this happens, snoring often becomes a nightly occurrence, though not all children with enlarged tonsils and adenoids snore (there seems to be an inborn or environmentally induced susceptibility). In addition to snoring, enlarged adenoids may also cause mouth-breathing (both day and night), nasal speech, and noisy breathing, especially during sleep.

Snoring alone is not cause for concern; it tends to diminish as the tonsils and adenoids stop growing and begin to shrink (after age seven or eight). But when it’s associated with obstructive sleep apnea (a momentary halt in breathing during snoring or noisy breathing when the child is asleep, which is occasionally the reason for frequent night wakings), it requires immediate medical attention. Suspect this problem, which occurs in a very small percentage of snorers, when snoring is particularly persistent and extremely loud (this may be difficult to judge, since what’s loud to one parent may be barely noticeable to another); or when your toddler seems to pause during snoring in an attempt to breathe; appears to be working hard to breathe at night, straining the muscles of the neck and stomach (you can actually see these muscles tighten as the child tries to breathe); seems to choke, gag, or gasp for breath during snoring; thrashes a lot in bed; seems tired or drowsy after a good night’s sleep; is not growing and thriving. Any of these symptoms should be reported to your toddler’s doctor; a referral to a specialist may be necessary.

Obstructive sleep apnea is generally diagnosed during an overnight observation in a sleep laboratory. The child is tucked into bed in a comfortable, home-like hospital room, and painlessly hooked up to electrodes connected to machines that monitor breathing, heart rate, and blood oxygen levels. Mom or Dad is close by in the next bed. Erratic breathing and heart rate plus oxygen deprivation supports a diagnosis of
obstructive sleep apnea. The treatment, successful in more than 95% of children, is removal of tonsils and adenoids. The surgery, in addition to allowing the child to breathe normally, may also reduce or eliminate the frequent colds, chronic ear infections, runny noses, and weepy eyes these children also often experience.

“Our son’s nose runs almost constantly. He doesn’t seem sick or uncomfortable, but I still worry that something’s wrong.”

A constantly runny nose is not normal for most toddlers, but is very common among children with allergies. Though the runny nose may only annoy your toddler right now, when he’s older it could cause him some embarrassment. In addition, the nasal stuffiness that accompanies it could make his speech less intelligible, which in turn could make him hesitant to speak. To head off such problems, discuss your child’s runny nose with his doctor; perhaps a referral to a pediatric allergist is indicated (see page 703).

Because toddlers tend to wipe their runny noses on their sleeves or the backs of their hands, smearing the mucus across their faces, the major side effect of a toddler’s chronic runny nose is chapped cheeks. If your child’s cheeks, or the area beneath his nose, become raw and red, use a moisturizing ointment or lotion, such as Eucerin, Moisturel, or Baby Magic with Aloe. You can also teach your toddler how to wipe his nose with a clean tissue or a handkerchief instead of his hand or his clothing (though it will likely be years before he regularly remembers to).

“Our son never stops moving, from the time he wakes up in the morning until he finally falls asleep at night. I suspect he may be hyperactive, but my wife says he’s ‘just a toddler.’ Who’s right?”

Chances are pretty good that she is. To most parents, toddlers—with their seemingly endless energy—appear overactive. But only about 1 in 20 will ever be diagnosed with the condition known as “attention deficit hyperactivity disorder,” or ADHD. This condition was once called attention deficit disorder (ADD), but was renamed by the American Psychiatric Association. It affects about 4% to 12% of school-age children, and is typically more common in boys than girls.

Children who are ultimately diagnosed with ADHD were often very intense and high strung as infants; they cried and thrashed a lot, and were very sensitive to sound and other stimuli (though far from every high-strung baby becomes a hyperactive child). Most children with ADHD calm down when their nervous systems mature and they are better able to focus their attention for longer periods, usually about the time they enter puberty. Some experts see this condition not as a “disorder” but as the super-active end of the activity continuum, which places the very quiet, least active children at the other end.

Although hyperactive children are sometimes thought to be slow learners, ADHD is not related to intellectual deficits. In fact, children with ADHD usually have average or above average intelligence; they
appear
scattered, however, because of their difficulty screening out distractions and concentrating on anything for more than a few minutes.

Nor is the hyperactive child “bad.” He is overly active because he can’t sit
still, not because he wants to drive his parents up a wall. And his parents are not bad parents. If your child turns out to have ADHD, it isn’t your fault. You didn’t cause his condition and shouldn’t feel guilty or responsible.