Lessons Learned: Toddler Broken Bones

I want to share an important lesson we learned with our daughter, Sabrina, with the hope that other parents can learn from all of our mistakes on this one.

When Sabrina was just shy of two years old, she came home from Grandma's ranch with a very fat middle finger. Nobody saw what happened, but the suspicion is she dropped a very heavy lid from Grandma's outdoor storage bin on it. Her finger didn't look any better by Monday, so I called our pediatrician's office. The nurse suggested watching it for a few days, but if the swelling didn't go down by the end of the week, to make an appointment with the local pediatric orthopedic office. Still twice as large as her other fingers, we made an appointment that Friday.

The first doctor we saw immediately took an x-ray and showed us the small break in Sabrina's finger. She suspected that our active two-year-old would not be very happy with a splint on her finger and recommended wrapping it in some pretty pink tape to the next finger over, limiting the use of her hand as much as we could and coming back to check it in a week.

We tried to keep it wrapped as much as we could, but Sabrina unwrapped it often. When we returned to the office a week later, it looked exactly the same as it had when we left. This time we had a new doctor - a specialist in hands. He put a splint on it and wrapped it, said she needed to use her hand as little as possible, and come back in another week.

It was very hard to keep the splint on Sabrina's finger. I will admit it was probably off more than it was on. The next week it was still as fat as a cocktail hot dog. The doctor took another x-ray and it showed the same break that wasn't healed. We were starting to get worried at this point. Was there something wrong with her body that she couldn't heal a broken bone? Was there an infection in the bone? He recommended we schedule a MRI to make sure there wasn't a more serious issue at hand (pun intended).

A MRI for a two-year-old is an ordeal because they have to be under sedation. I wish I had gotten a second opinion, but we were already seeing the pediatric orthopedic specialist and the doctor we were dealing with was their hand specialist! There's a reason for the phrase hindsight is 20-20. So we had an MRI (an ordeal all on its own) and were scheduled to go back to the orthopedic office the next day. Our hand specialist was at a Hand Conference, so we met with the office's most senior doctor. And this is where we learned our biggest lesson.

The senior doctor said, "Everything looks fine with her finger except that there is still swelling and a break there. I understand why Dr. So-and-so ordered the MRI, but what I've learned in 35 years of cases is that with toddler broken fingers and toes, you have to cast them. Otherwise, they're just aggravating those broken bones over and over in their everyday play." So we were essentially preventing the bone from healing because it wasn't completely protected. Needless to say, I wish we'd had this doctor first.

They put on a cast that morning. Sabrina handled it well - actually seemed to like it a little - and when it finally came off a few weeks later, the finger was looking 60% better (still swollen but the break had healed). It wasn't until a month or two later that it finally looked like a normal middle finger.

Lesson Learned Recap - Cast any broken finger or toe in a child under three years old. Wrapping and splints aren't likely to cut it! It took us five appointments, an MRI and $2,000+ to learn this very simple lesson.

Parent Tips: That Last Nightly Bottle...and Pacifiers

I read A LOT of books about getting babies to sleep when we had Sydney. There were tidbits in all of them that I used to try to get Sydney to sleep through the night, and eventually, they either worked or she was tired enough and wired appropriately to sleep ten or eleven hours straight. But we still had a lot of challenges with her sleeping through the night consistently until she was four.

                            Sabrina Miller - Four Months Old

When Sabrina came along, she was a pretty good sleeper by three months, but she was still waking up once a night for milk. A friend recommended the book Twelve Hours' Sleep by Twelve Weeks Old: A Step-by-Step Plan for Baby Sleep Success by Suzy Giordano. I'd read it when Sydney was a baby and didn't see how in the world I could follow it successfully with her. There were so many rules to follow, including how many naps they could take during the day and how often to feed them. But I was determined to try it with Sabrina and end the middle-of-the-night wake-up. I followed the 12 Hours in 12 Weeks format of reducing her last bottle by a half ounce each night. It worked like a charm. By the time I got down to two ounces, she stopped waking up in the night for a bottle. She probably figured it wasn't worth the effort for two measly ounces. Things were going well in the sleep department.

At five months, we had another hiccup. Sabrina suddenly started waking up and crying out three or four times a night. Sometimes she’d go right back to sleep when you put the pacifier back in her mouth. Sometimes she'd stay awake crying for an hour or more. I was convinced it was the pacifier after a little online research. Everyone recommended going cold turkey. They warned it might be a painful week, but from then on, Sabrina would be sleeping through the night again.

So, I had our wonderful night nanny, Janis, come take care of Sabrina and got a great night’s sleep to prepare myself for the challenge. Then I rounded up every pacifier in the house, backpack, diaper bag, both cars and my purse, put them all in a bag that I hid away, and declared that Sabrina would no longer be using them. (I'd tried to implement a no pacifier policy before and other family members and nannies just ignored me. But it's impossible to ignore if they can't find them!) By the end of the week, she was only waking up once in the night, and in less than a week, she was sleeping 12 hours straight.  And Sabrina did that consistently until the next hiccup, at age 2.5, when she started climbing into our bed in the middle of the night. That's a topic for another post...

It's amazing how different our three kids are - in so many ways, including sleep. I'm happy to report that with Luke, we never had to do a thing about sleep. He took care of it all by himself, sleeping twelve hours a night by two months. He's woken up during the night less than a handful of times since.

Parent Tips: Special Time

When Sydney was a two-year-old, I went to a talk at her preschool with Suzanne Duncan Ph.D., a local Austin parent consultant. She had many wonderful suggestions for parenting, but one tip turned out to be a critical addition to our repertoire. 

Special time is the first thing Suzanne suggests to parents to help curb the typical toddler issues, like temper tantrums and general misbehavior. Harvey Karp also talks about special time in his book, The Happiest Toddler on the Block: How to Eliminate Tantrums and Raise a Patient, Respectful, and Cooperative One-to Four-Year-Old.

What defines special time? It’s 15 minutes that you’ve initiated and named – “Sydney, do you want our 15 minutes of special time now?” – that is uninterrupted and where the child gets to direct the play. And it’s ideally as interactive as possible, like a tea party versus reading books. You are not teaching or molding or directing. They get to pick what they want to do and you are their sous chef - the assistant who does what they're told.

Sydney and I played all the time, so I was skeptical how this approach could change anything. But one of my New Year’s Resolutions that year was to carve out 15 minutes every day for special time with her (I found that initiating it or labeling it was the hardest part to remember). After a month, I noticed some big differences, the most important one to me being less meltdowns. She also seemed generally happier.  It definitely brought us closer together. Sometimes she asks for more special time, which according to the expert, means she needs it.

It got much harder to do consistently once Sabrina was old enough for special time, and even harder still when Luke got old enough. It wasn't necessarily because of time, although that was a factor some days. It was more the competition for Mommy's attention - nobody wanted to be left out while someone else was getting their special time. We finally figured out a good schedule - Sabrina gets her special time in the morning after I drop Sydney off at school, Luke has special time after Sabrina gets dropped off and Sydney has special time when she gets home from Kindergarten (and usually lets Sabrina sit in to watch). Another option that works great is to have Daddy do special time with one while you're doing special time with the other.

Give it a try and let us know if special time has an impact on your kids!

Book Review: The Whole-Brain Child

I just finished reading The Whole-Brain Child: 12 Revolutionary Strategies to Nurture Your Child's Developing Mind by Daniel J. Siegel, M.D. and Tina Payne Bryson, Ph.D. It's now in my Top 5 list for child development books.

The idea is to turn everyday interactions into brain-shaping opportunities. There's what most of us usually do as parents - for example, dismiss and deny. And then there's what we should do to help develop their brains.

There are 12 Whole-Brain Strategies in the book. The first strategy I tried - "Name It to Tame It" - worked immediately for all three of our kids. Now I tell everyone my new trick to stop the tears after a fall. You simply get them to talk about it, or for younger kids like Luke, repeat what's happened. "Ouch! You were running really fast and tripped on that rock!" That turns on their upper brain (thinking and reason), so that they're no longer stuck in their lower brain (fight or flight/tears).

The Whole-Brain Child talks about the science of our brains, but never speaks over your head. The content is fascinating. The examples and illustrations are simple and smart. The strategies are easy to implement. 

The book is geared toward parents and kids alike. Both of our girls sat down with me for over an hour looking at the pictures and having me read the examples. Sydney loved it so much, she has asked to see it again several times over the last few weeks. And when I find myself in a challenging situation, like Sydney crying because she suddenly doesn't want to go to school when last week she begged the doctor to let her go back, I've referred to a similar example from the book to help get us through the crisis.

Two other brain books I also recommend are Raise a Smarter Child by Kindergarten, by Dr. David Perlmutter and Einstein Never Used Flash Cards by Kathy Hirsh-Pasek and Roberta Michnick Golinkoff. The overall theme is that spending time with our children - talking, singing, interacting and playing - is the most important step we can take to help them learn.