Tag Archives: sleep

Bedtime Bliss for Everyone (Pedcast)

Here we go with another portable, practical, episode of DocSmo.com, the pediatric blog designed to empower parents. I’m Dr. Paul Smolen, your host. Thank you for tuning in today. Topics around the subject of sleep are always important to parents since many often get so little shut-eye. Long time listeners probably remember my pedcast called “Straight talk about sleep in infancy,” where we discussed sleep training for infants. If you have a infant in your house, you don’t want to miss that one. You may also remember the talk titled “Sleep beyond the crib,” which was designed to help parents with older children who resist sleep. In that episode, I laid out a strategy to gently help children become independent in the going-to-sleep process. Well, today I am going to give you some tips on how to make sleep resistance by older children easier on everyone and at the same time improve your child’s chances of school success. Sounds like a tall order, but actually it’s easy, as you will see in a moment. Let’s get started, shall we?

It seems like all children fight sleep. I know I did. I didn’t want to miss the action, and I always felt like I was being punished by being sent to bed. You may have some children in your family that feel the same way; we certainly did. So, this is how we dealt with their resistance to go to bed. First, you need to establish a bedtime routine for your older children that is fairly consistent.  Try to repeat the exact same steps every night so that your children know exactly what to expect; for instance, it’s dinner and cleanup, then an after-dinner activity like being read to or a game, next it’s bed preparation of pajamas and teeth care, and then time to get into the bed. So far so good, but now comes the trouble… the natural resistance to separation. Here comes the “I have to go to the bathroom,” and the “I need a drink of water,” and of course the “I am scared, you need to stay with me” talk. I recommend that you only put up with this very briefly and then you make it clear to your child that the excuses are over. Nada mas.  No more!

After all this fussing, your child is probably anything but tired and can’t understand why you are making them go to bed… think about it from their perspective: not tired but being forced to go to bed? What’s with this? To help your child and yourself, I recommend, at this point, that you give your child some control of their fate and tell them that they don’t have to go to sleep; you will leave some light on for them, and they can READ in their bed as long as they wish. Call their bluff and tell them they can have what they want, no set bedtime! Make sure to provide them with plenty of reading material they may like.  Weekly trips to the library can really help here. If this strategy works like it did in my family, bedtime arguments will gradually fade away, your children will become addicted to reading, their language skills will go off the scale, and their academic achievement will skyrocket… all because you stopped fighting with them about going to bed. Not bad, huh?! Try it and see for yourself. Your children may end up staying up later than their parents, but over time they will adjust their actual sleep time to get enough sleep to be alert during the day, I promise.

Portable, practical pediatrics is what I promised you and what I try and deliver in each pedcast. I hope I succeeded today. I welcome your stories and comments at www.docsmo.com or at my site on iTunes. This is DocSmo, recording from studio 1E,  hoping that bedtimes in your house are as quiet as a church mouse. Until next time.

The Tired Teen (Pedcast)

Doc Smo here, you know Dr. Paul Smolen, your pedcast host.  Today we are going to discuss a topic that is most relevant for parents with teens in the house.   You folks with younger children, you listen up as well:  your time is coming before you know it. We all know that teenagers tend to be moody but what should a parent do when their child has persistent fatigue and changes in mood. Well, that’s the topic we are going to take on today.   It’s not too uncommon for parents to bring their teenagers to the pediatrician with physical complaints of fatigue, irritability,  dizziness, and sleep problems.  More times than not, these physical complaints turn out to due to difficulties with mood, either excessive sadness, worry, or even anger.  As a pediatrician, I always have my radar up for physical symptoms that might indicate a serious disease process but most of the time fatigue is an emotional symptom.  So once we are sure that our tired teen does not have fatigue from a something like diabetes or thyroid disease, what’s next?  How can we help them feel better?  I thought it would be useful to take a few moments and share with you my practical suggestions that I have found can be very helpful to children and families in who find themselves in this situation… having physical symptoms from emotional fatigue and stress.     I think step one is to visit a pediatrician who has cared for your child and knows them well.  I think a large part of the healing process comes from a child feeling that those around them care and take their complaints seriously.  Reassuring them that they don’t have some dreaded disease by taking their complaints seriously is also an important aspect of the doctor visit.  I feel this is best done by someone who they already know and trust. Don’t underestimate the power of a health professional listening, touching, reassuring, and demonstrating understanding.   Next I suggest that all my tired teens work on a few things that have been shown to improve mood in anyone, child or adult:   -I make sure that they are getting enough physical exercise.  I think they should exercise a minimum of an hour a day.  Walking is fine, riding a bike, throwing a Frisby, whatever but they need to get out and do it!  Movement and enjoyment is the key! And I mean out, that’s outside where there are green trees and lots of light.  Light sets our clocks for sleep and can help your child get enough sleep and the light also improves their mood…for real. Actually researchers have found that physical exercise is as effective at improving mood as most anti-depressants and a whole lot cheaper and safer! -Next, we go over their sleep habits and possibly make improvements there. Experts think that children older than 12 years old need 8-9 hours of sleep nightly. Regular bedtimes, turning off electronics, quieter activities in the evening are an important part of a healthy sleep formula.  I encourage the child to establish a regular bedtime ROUTINE. Many parents tell me that evening, near bedtime, is a good time to talk about your child’s feeling.  Bedside conversations like these can be very powerful and I think you should try and initiate these talks.  Enforce no cell phones or other electronics in your teens room.   -Nutrition is also an important aspect of mood and energy.  I explain to the tired teen that certain fats found in fish and other foods can really be helpful.   Fish consumption or an omega 3 supplement is a must as is vitamin D supplementation  in case the child’s level should be low.  In this situation, I actually recommend a multivitamin, especially if the teen’s diet is poor.  It also goes without saying that reducing soda, caffeine, and processed food will help anyone feel better.   -Finally, I think that having friends, helping others, and being praised for even the smallest of achievements can all be very uplifting activities. I encourage families who have a tired teen to try all these things. Parents can facilitate their child’s friendships by making an extra effort to provide transportation and activities their teens might like as well as encourage their teen to help around the house, neighborhood, or community… and of course they can praise and recognize any helpfulness, success, or healthy attitude their teen exhibits.     And finally, I think a follow-up visit to assess how your teen is doing is really important at which time we determine if things are getting better or a mental health referral is indicated.  Let me reiterate that what we have talked about is for mildly depressed or anxious teens and not for children with severe disturbances in mood or behavior.  If these measures doesn’t improve things for your child or you think they may be having serious thoughts of harming themselves or others, please…. get some professional psychological help.  You’ll be glad you did.   For more portable, practical parenting information, take a few minutes and explore the literally hundreds of pedcasts and articles posted at my blog, www.docsmo.com.  Your comments and stories are always welcome and of course we love when you share these posts with friends and family.  This is Doc Smo, hoping you can find a simple step to increase your teen’s pep. Until next time.

Book Review: Bringing up BeBe by Pamela Druckerman(Book Review Pedcast)

Help support DocSmo.com by buying this reviewed book using this affiliate link. You get Amazon’s best price and DocSmo.com earns a small affiliate marketing fee.  Thank you.
Bringing Up Bébé: One American Mother Discovers the Wisdom of French Parenting (now with Bébé Day by Day: 100 Keys to French Parenting)

Bringing up BeBe

Publisher: The Penguin Press, New York, 2012

Author:  Pamela Druckerman


-Thank you for joining me for another edition of DocSmo.com, a blog dedicated to bringing information, insight, and thought provoking ideas to parents with children of all ages.

-I have decided to expand the scope of my blog by adding a new feature that I think parents will find interesting…book reviews.

-I read a lot of things regarding pediatrics but not enough of the popular parenting books that seem to be constantly published.

-So I thought that I needed to read more of these books and while I’m at it, why not write reviews at the same time.

-Here is my first attempt at a book review for public consumption. I hope you like it and who knows, it might inspire you to just go out and read the book-Just like many of you, I recently heard about a book that a Wall Street Journal journalist, living in France, wrote about her French parenting experiences and I thought I would give it a read.

-I am glad I did.  Not only is she a good writer, but getting an inside glimpse at childrearing practices in another culture is fascinating.

-We all understand that you cannot assume a monolithic or uniform approach to parenting in either the US or France, but some general observations are probably valuable.

-This is exactly what our author does in her book titled “Bring up BeBe.

-Here is a quick summary of the four main themes I saw in the book in 10 megabytes or less:


First Theme: French babies generally sleep through the night, truly sleep through the night by 3-4 months of age, and this is because French parents teach them independence from a very young age.   French mothers refer to babies “doing their nights.”  Mrs Druckerman noticed that American and British babies have a lot more trouble mastering this skill–hence the myriad of baby books and blog posts on the subject. My own current #1 downloaded post is “Straight Talk about Sleep for infants!”  The author contends that French babies “Do their nights” because French parents allow their babies to learn to put themselves to sleep with what they call “la pause.” This simply means that parents pause before they run to their crying babies to give them a chance to settle down on their own, or to connect with their sleep cycles ,so to speak.  Listeners to this blog will recognize this as what I call the 10-10-10.

Theme number 2: French children are more patient than  American children because French parents teach them to wait. Starting from their feeding and sleep schedules as infants, French children are trained to wait.  When a child interrupts a parent he or she is asked to wait.  Children are taught to control their hunger till meal time, and they must wait until each course of a meal is served; in- between meal snacks are just not done.  When cooking with mom, French children learn to patiently await the outcome–no eating batter or frosting. Patience is a mindset that is taught to young French children.

Theme 3: The people and children of France have a healthier relationship with food than Americans have.  First, foods in France are fresh vegetables rather than white rice.  Vegetables and fruits are embraced in France, not sneaked into other foods.  Snack foods and processed foods are just not offered. In France, if a child rejects a food, never mind…just keep trying!  No emotion.  French parents take the long view and realize that eventually their children will overcome their resistance.  Be patient is their attitude and eventually you will have a wholesome eater.

Theme 4: If children are asked to entertain themselves, they will.  Trying to teach stuff to children is not as important in France as letting them explore and discover things on their own.  Getting a head start is not a goal of French parenting. Learning to awaken to the world is their model, and this implies self-discovery… self play… and the ability to entertain oneself.

-I do recommend this very readable book. Watching how other cultures parent can be very instructive on this side of the pond. According to Mrs Druckerman, the French parents do many things right by expecting patience, proper eating, good behavior and by encouraging self sufficiency and self discovery.

-I would love to hear what you think. Take the plunge and join the conversation. Write a comment into the blog and you might just see it posted.

Please visit and subscribe to my website www.docsmo.com so you can get the latest content hot off the docsmo press.

I work hard to bring parents relevant content, so take advantage of my hard work.

This is your host Dr. Paul Smolen hoping you now know what to say about parenting the French way.

 Until next time


Don’t be passive about pacifiers (pedcast)

Welcome to another edition of DocSmo.com.  Welcome new listeners and welcome back old ones.  I hope you are having a great day, I am. In today’s pedcast we are going to get into some serious Doc Smo  opinion about a topic that parents often agonize over, pacifiers.  We are going to take on the topics of whether parents should start their children on pacifiers as well explore how and when they should finally say good bye to these devices: you know, the  pacifier’s end game.  How and when should parents consider doing away with the yum yum, the binky, the ya ya.  Let’s do it shall we!


When it comes to pacifiers, everything is controversial.  Emotions are high when it comes to these little pieces of plastic.  Some people, especially breastfeeding advocates don’t think they are ever appropriate for infants or children since some of the infant’s sucking cues can be masked by the paci. The AAP on the other hand, think that there is good evidence that for infants under 6 months, falling asleep with a paci reduces the risk of sudden infant death.  Otolaryngologists are convinced that ear infections are far more common in children who use them. Speech therapists think that language acquisition is slowed by them and orthodontists think they sometimes cause a child’s teeth not to fit properly because the pacifier can change a child’s natural bite. Wow, my head is spinning after reading all these opinions.  I will give you one pediatrician’s opinion, mine, in just a few moments.

There is no right or wrong answer for parents when it comes to starting a pacifier habit. Some babies absolutely refuse them no matter how hard parents try to get them to suck on them. Others babies will use them until they get enough hand control to suck their own thumb.  And others love them and get very attached to them. Go figure. Babies are as different and unique as their parents!  There are arguments both pro and con and ultimately this comes down to a parent’s choice.


I suspect that many of  the listeners to this podcast have children who love their binky and you, the parent, are looking for some information about how to get rid of it.  Maybe you have a 1, 2, 3, or 4 year old? Controversies continue on the best age to stop them just like whether to ever get started. What is the right age to make them go away?  Again, “experts” vary greatly in their opinions about this one as well.  Some say they need to go by 12 months along with the bottles. Others, advocate getting rid of them by age 4 years…you heard me, by 4 years of age.  Most advocate an age somewhere in between 1 and 4 years. Again, my opinion is coming shortly. Stay tuned!


How do you make it go away? Again, there is no consensus about this either. Methods vary greatly.  Here are some I have seen.

– simply making them disappear. Its gone Johnny, get over it!  I call this the direct approach.

-sniping the nipple off and showing the child that the binky is broken and cannot be fixed.  Let them get mad at the binky not the parents. Clever!

-Getting the child to agree to give the binky to a new baby or kitty they know.  Amazingly, this often works with 2.5 year olds and older.

– Then there is the gradual making the binky fade away, limiting it to certain times and places: the method that most parents choose to use.

-I saw one mother once get so fed up with her son’s pacifier that while driving down the road with her crying child who couldn’t get his pacifier to him, she simply rolled back the sunroof, tossing it toward the sky, and declared that the binky was going to “paci heaven”.  That method worked for her.

-One expert that I read said it is crucial to give your child warning that the paci is about to disappear. He is of the notion that you treat children like adults, they will act like them…a definite maybe on that!


So what do I see in my practice? How do I help parents deal with this issue?  First let me say that everything I am about to tell you is based on my experience and is my opinion…lets get that out on the table first. I personally, am not a big fan of pacifiers. I think they can interfere with successful breastfeeding, create too much work for parent, and I think they delay the age when children can learn to sooth themselves.  I also think that children who use pacifiers have far more orthodontic problems their thumb sucking friends.  I can usually tell by age 2, without asking, which children are still using pacifiers.  I think they deform a child’s mouth more than their own thumb.  I also don’t think it matters which type of pacifier a child uses, they all have a tendency to change the shape of a child’s upper teeth, making them not fit properly against the lower teeth.  This malocclusion as dentists call it can cause both speech difficulties, especially a lisp, and an unwanted cosmetic change in a child’s face. Both of these problems can be very expensive to remedy with orthodontic expanders.

I think that pacifiers should be gone by age 2 years. If parents do this, I rarely see a child substitute their thumb for the paci at this age. More importantly, I see any deformity that has developed from the paci disappear fairly quickly.  A child’s natural facial features return to normal without expensive dental appliances. And finally by age two, most children have good enough language to allow them to calm themselves down in other ways other than sucking on a paci.


-As you can see from this discussion, pacifiers can be both a blessing and a curse. On the one hand, they can save lives in  infants and provide mom with a non nutritive sucking outlet for her infants  but they can also greatly increase the number of ear infections in some children, pose a choking hazard, and cause speech delay as well as facial deformity in some children.

– Your call parents.  You can see why pediatricians have trouble giving advice on this issue.  There is no clear answer. What I do strongly believe is,  that if your child is a paci user in the second year, make it disappear by age two. I think you will be glad you did.  Remember, children get more rigid and stubborn not less as they age.  What is hard at 2 years of age may be impossible at 3. Remember that Doc Smo pearl,“Parenting decisions that are easy in the short run may not look so easy in the rearview mirror” or “Parents who chose the path of least resistance are often rewarded with a rocky path”


-Thanks for joining me.

-If this is your first pedcast, take a look at the extensive DocSmo library of pedcasts and articles.

-If you are so moved, send in your comments and join the conversation.

-If you like talking about children, go ahead and subsribe to the feed on my website by hitting the rss feed button or linking to us by facebook or twitter.  We would love to have you.

– This is Dr Paul Smolen, broadcasting from the low country of south Carolina, hoping your little angel doesn’t get too sassy about getting rid of their paci.

-Until next time.


Smo Notes:

Pacifiers: Are they good for your baby? – MayoClinic.com

BMC Pediatrics | Full text | Predictors of and reasons for pacifier use in first-time mothers: an observational study

Bye-Bye Binky: Ending the Pacifier Habit