Kids' Wellness Matters Podcast Ep. 16: Navigating Infant & Toddler Challenges

The infant and toddler years can be a challenging time for parents when it comes to navigating behavioral issues. Lurie Children’s Little Ones program is the only program of its kind in Illinois that supports parents of young children directly by offering expert guidance, assessment, and intervention. Miller Shivers, PhD is a clinical psychologist in the Pritzker Department of Psychiatry and Behavioral Health at Lurie Children's. She's also the Director of the Lurie Children's Little Ones program. In this episode, she discusses strategies for managing issues many parents face at home such as infant anxiety, toddler tantrums, strengthening the parent-child bond and more.

“We had a lot of people looking for help with their young children, and there's really not a lot of places to go. And so I thought, let's make a cohesive program where we can do everything literally from birth to age five…​​sleeping, feeding issues, toileting, anxiety, tantrums, you know, just any kind of phase of life.”

- Dr. Miller Shivers

Show Notes

• The Little Ones program was started to bridge the gap in behavioral issue support for parents of children aged 0 to 5, offering specialized support for sleeping issues, feeding issues, toileting, anxiety, tantrums, and other common obstacles parents face. 
• Relational health between a child and caregivers can play a critical role in behavioral health. For example, if a child is refusing to eat, Dr. Shiver might consider how the food is being offered by parents as well as family ideals about eating and mealtime.
• Sleep deprivation is one of the most challenging aspects parents face when children are young. Dr. Shiver works with parents' individual comfort levels when it comes to sleep training with babies.
• Difficult behaviors like hitting and biting can be especially challenging. Dr. Shiver says that biting, for example, can sometimes be a symptom of feeling overwhelmed, whereas hitting can sometimes be a means to get a parent’s attention. Observing the child in context can help identify triggers. 
• When it comes to tantrums, a parent’s reaction can be crucial to mitigating escalation and recurrence. For example, anticipating a tantrum ahead of time by offering supportive language can be helpful. 
• The notion of “time-out” as a consequence to bad behavior may have developed as a non-physical alternative to spanking. But Dr. Shivers finds time-out to be an all-around negative experience for both parents and children, ultimately reinforcing bad behavior. 
• Modeling and encouraging children to say “I need help” can help children mitigate strong emotions with parental support.
• Dr. Shivers observes that some children receive negative feedback all day from teachers, parents, and other family members. She suggests that not all behaviors need correcting. For example, if a child’s popsicle is dripping everywhere, a parent can simply offer a napkin rather than reprimanding the child. 
• When it comes to spending time with your child, quality time is always more important than quantity. Establishing evening routines can support the whole family, and can provide regular opportunities for quality time such as reading together. 
• Parents can also take advantage of the Little Ones app, which provides guidance and support for a wide variety of behavioral challenges. It also provides suggestions for how parents can take care of themselves too. 

Transcript

[00:00:00] Dr. Nina Alfieri: Welcome to Kids' Wellness Matters. I am Dr. Nina Alfieri.

[00:00:07] Dr. Rob Sanchez: and I'm Dr. Rob Sanchez. We are both parents and pediatricians at the world renowned Ann and Robert H. Lurie Children's Hospital of Chicago.

[00:00:15] Dr. Nina Alfieri: On this show, we'll chat with a wide range of experts about caring for children from newborn to young adult because kids wellness matters.

Rob, I have a reflection on life.

[00:00:31] Dr. Rob Sanchez: Go for it.

[00:00:32] Dr. Nina Alfieri: Parenting, is the great equalizer. Thinking about being a parent the last few years, nobody is immune from the challenges. Tantrums, sleep problems, everyone's got them, right?

[00:00:45] Dr. Rob Sanchez: Nothing like the large. communal feeling of being around another parent who just gets it. And I think you and I share that. And I think we also share it with the families that we get to work with.

[00:00:56] Dr. Nina Alfieri: Absolutely.

[00:00:57] Dr. Rob Sanchez: Especially if they have kids around the same age or, or just have experience that we're going through. Toilet training is a big thing that we connect on, that I'm going through right now. but your point about challenging behaviors and some of those difficulties, that's such a common denominator.

[00:01:11] Dr. Nina Alfieri: Yeah, absolutely. And it's something that, you know, I think we view it as a behavioral issue. It's actually very normal in childhood. When kids have really, really, really big feelings and maybe don't have all the words to explain them. A lot of our behavior as adults is after years of practice on how to manage our feelings, and some of us are still working on that. There's a lot that we can talk about in terms of managing behaviors of children and also trying to decode a little bit about what they mean and what kids are trying to tell us.

[00:01:39] Dr. Rob Sanchez: I love the way that you're normalizing it. It's something that we can all struggle with. And I think that's such a good thing that we can find commonality in and an opportunity for us to share support and share ideas and resources.

[00:01:51] Dr. Nina Alfieri: There's so many people have been there before us, and that's why it's always helpful to pick other parents' brains, your pediatrician's brain. You know, I was laughing the other day because I was trying to explain sharing to my older one, and I was thinking to myself, it's actually really wild to think that you're going to give something really exciting to your kid and then expect them to just give it to someone else. It's pretty crazy, right? Trying to view things from their eyes, I think is really illuminating and, it made me chuckle a little

[00:02:16] Dr. Rob Sanchez: We get to be there for the highs, you know, the great successes when they do well, but also a lot of the challenges when it can be super tiring and frustrating. And, and just make you sigh, that's why we talk and learn from others who, like you said, have been through it and can share important resources and tips. I am really excited that we get to talk with Dr. Miller Shivers today. She is a clinical psychologist in the Pritzker Department of Psychiatry and Behavioral Health here at Lurie Children's Hospital. She's the Director of the Lurie Children's Little Ones Program, which is a really unique program offering support, guidance, assessment, and intervention to families of young children. And so we're so excited to have her expertise here today as we tackle topics such as infant anxiety, toddler tantrums, strengthening the parent child bond, and more. I look forward to hearing what she has to say.

[00:03:06] Dr. Nina Alfieri: Welcome Dr. Shivers.

[00:03:10] Dr. Miller Shivers: Thank you. I'm so happy to be here and talk about my favorite things.

[00:03:14] Dr. Nina Alfieri: Me too. Well, first I wanna start with a little bit about you. I would love to know what drew you into this area of pediatric psychiatry and behavioral health. What got you into this and what keeps you here today?

[00:03:26] Dr. Miller Shivers: When I first started this whole mental health/behavioral health psychology journey, I wanted to work with adults. I had gotten a master's degree and the job that I happened to get was at a children's home in Dallas actually. And my supervisor at the time was a psychologist and we were working with school aged kids and mostly doing like cognitive testing and things like that. And my supervisor, she had this group for new moms and babies, and I was like, what does a psychologist do with babies and what is this? And just after hearing about it, she really inspired me to get a PhD and go back to school to learn more about this whole infancy toddlerhood, early preschool age. So that's kind of how I got into it. I didn't start out really interested in it, but now it's been my real passion for the last, gosh, 20 plus years.

[00:04:17] Dr. Nina Alfieri: I love that and I'm so excited to talk about the program that you've built. So, Lurie Children's Little Ones launched in 2019 and it's the only program of its kind in Illinois for very young children. Can you talk a little bit about Little Ones and what is the gap it fills for parents. And what kind of services does your team provide?

[00:04:36] Dr. Miller Shivers: Well, we really started it because we had a lot of you know, young patients and people looking for help with their young children, and there's really not a lot of places to go. And so I thought let's make sort of a cohesive program where we can do everything literally from birth to age five. And we sort of cut it off at age five because we thought, okay, we have to cut it off at some point. But most children, when you start, when you're five years old, you start kindergarten. So we kind of define that as that school age. And there's a lot of providers that can intervene or work with kids that are school age and not as many, really very few, that work with younger kids. And so, what's really unique about us is that we will see a two month old and a two and a half year old and a 4-year-old. We don't do too much developmental issues because we have other departments for that and they're better served, but we do all kinds of sleeping, feeding issues, toileting, anxiety, tantrums, you know, just any kind of phase of life like we're moving or the parents are separating or really anything in this young age.

[00:05:43] Dr. Nina Alfieri: That's incredible. And, as we both know, you know, having this kind of support and intentional intervention at these young ages can really help a child through all the stages of their life afterwards. So it's really critical that we're able to provide these kinds of services to families. So, let's get into the meat here. For me as a pediatrician, whenever a family comes in and they're struggling with a challenging behavioral issue, one of my first questions, rather than just giving blanket advice, is what's going on with the child's development? What's going on with their environment at home? Can you talk a little bit about how you approach a behavioral issue in that context and why all of those developmental and environmental factors are important to ask about.

[00:06:25] Dr. Miller Shivers: I think, particularly in this young age , right, the development is happening so rapidly versus other stages of life, and so that's critical. You have to look at where they are in their development. So, sometimes, like if I have, let's say a 2-year-old comes to my office or two and a half year old, and the main concern is they're not talking and they're having tantrums, let's just say. I wanna know why is this child having no expressive language? You know, are they hearing impaired? Did they ever make noises, babble, speak any words? And they've lost that. Those are sort of the basic things we look at, but also we look at other things, like a lot of times we know that if parents are depressed or not at their best, they're quiet and they're not really interacting. So kids could have a delay in language because, you know, something going on with the adults in their environment. So we really have to assess all of those things to know where is the critical point of intervening? And so then we might say, okay, let's do X, Y, and Z, but also, we can work on your tantrums, but let's try to get this child in a better developmental place. Like, figure out the basic things like why aren't they talking first? And then move to the second part of what do we do about the tantrums that are upsetting.

[00:07:39] Dr. Nina Alfieri: Those are all really great points. And I wanna go back to something you mentioned, which was the parent child interaction. There's a lot of talk about relational health and what that means in terms of the back and forth between a parent's interaction with the child and how that might impact their behavior, their development. Can you talk about the importance of relational health and what it is?

[00:07:59] Dr. Miller Shivers: Well, I think for us in Little Ones and most people that work with young kids, it's critical. These young children are not in a vacuum. They don't exist without the adults in their life, and so you have to assess sort of the interaction, the relationship. What is going on? Most people come to us, you know, we're a children's hospital, our program is geared toward children, because there's an issue with the child, right? But say for example, if your child's not eating, we have to look at how the food is being offered, or family ideals about eating. We sort of break down what is happening at the mealtime, all of those little things because we can help the child and do some things with the child directly, but we also have to help the parents or the adult caregivers and their response and reaction. Because that influences the child's behavior too. it's a back and forth. And I will also add everyone's child is different. You may have three kids that it worked for the first one, but the second one is really throwing you for a loop. And so, you know, a different strategy sometimes is really helpful and it's nice to have an outside person's perspective instead of like, you know, your mother-in-law, or the neighbor or somebody who's more emotional about the outcome.

[00:09:10] Dr. Nina Alfieri: What are your thoughts on sleep training or infant sleep problems? Are there top tips you have that parents can use to sort of prevent them or address them?

[00:09:20] Dr. Miller Shivers: It goes a little bit to temperament, you know, I think there are some babies that have a really easy temperament will just lie there or grab their lovie or a pacifier or whatever they have, and kind of just eventually go back to sleep. And you as a parent may never even know, you know, because maybe you're actually sleeping and so you haven't heard on the monitor any noise. There are other babies who awaken a little bit and immediately cry or really get upset. And I think the biggest thing is finding a way for that baby to learn to kind of soothe a little bit on their own. And that's tricky sometimes. Every baby's different. We have to sort of do trial and error what might work, but also at the same time we're sort of exploring what things we can use to help them. It's been my experience that most parents have a really hard time with sleep training. Like the cry out method. I mean, it does work, but I think to get parents to do it is a big ask. You know, if parents are willing, I'm like, great, let's do that. But most I find like a slower sort of gradual, let's do these sort of baby steps to get there because it seems doable. We kind of have to meet the parents where they are. And figure out together how we're gonna solve this problem. Because if your baby's not sleeping, you're not sleeping either. And that's no good for anybody. So let's get people sleeping better.

[00:10:42] Dr. Nina Alfieri: You know, that was one of the things people ask me sometimes, what's it like being a parent and a pediatrician? And that was one of the most eye-opening things for me. When we got to the point where we were supposed to be sleep training per all of the recommendations, I was like, wow, this is really hard. It's been my experience that most parents have to get super tired and frustrated before they're willing to try something. So I'm like, great, here's our time. You haven't slept in two months, you're exhausted. This is the perfect time. There's a reason why sleep deprivation is a military tactic and for all the parents struggling with sleep I cheers you with my coffee here. Let's move into the toddlerhood time. So your baby's getting bigger. They're starting to move around. They're starting to be a little version of themselves with feelings and thoughts and, oh my gosh, everything that comes with it, including some challenges. What's your approach to some of these common toddler issues like hitting, biting, tantrums. When should parents seek help or when is it not normal?

[00:11:41] Dr. Miller Shivers: Tantrums certainly are normal. I think if they're having tantrums several times a day that are lasting a while. I mean, it's probably above something that's typical, 'cause a lot of times I think parents come in sort of apologetic, like, you probably see worse. Or, this isn't. I'm like, if it's a problem for you and your family, it's a problem. Come, let's fix it, you know, even if we, I see you one time or 25 times. Biting can be a concern, especially if you're in daycare. They don't like biting, you know, they will send a child home. But I always wanna know what happened before the biting. You know, maybe this child is not as verbal as some of the classmates. And so that's how he or she gets his frustration out, or maybe they were overwhelmed. A lot of kids, when they're overwhelmed, they will bite or bang their head on the floor or something just to kind of recenter themselves and it looks terrible. Parents don't like it when kids bang their head on the floor or bite, but it's really just trying to help them. Okay, if you got overwhelmed at daycare and you're doing this, let's observe you. And when we start to see you first do that the daycare workers or the preschool can say, let's come over here in this little space, or take you sort of somewhere else because a two and a half year old is not gonna be able to recognize and do that on their own. So again, we need the relationship. Hitting is kind of the same thing. I mean, I think hitting a lot of times happens because it gets attention, which is reinforcing to it. You know, some kids hit their parents, some kids hit other kids at school or preschool. Some kids hit their siblings, but every time a kid hits somebody, you're like, stop. Like little kids will scream, stop. Siblings will scream and parents will maybe not scream, but say lots of things like that hurt my feelings, or you shouldn't be doing that. And all that explanation just gives it so much attention and makes it happen more because all of us, but especially little kids, we do things for attention, right? And so I often just tell parents to ignore it and they're like, oh my gosh, I can't just ignore that. I'm like if you do consistently, they will stop doing that, and then be sure and give your attention when they're doing something positive or something neutral. And tantrums are an interesting thing. I think kids have tantrums for so many different reasons. And you have to figure out what are some of the reasons, you know, obvious things like tired, all those things. But also, you know, maybe they're being responded to in a way that's not helpful for that child or we really have to pick apart why this is happening and I know little kids who have any sort of anxiety, they can have really extreme tantrums that seem out of the blue and are prolonged, but we have to address the anxiety. We can't just intervene with the tantrums or that's not really gonna be helpful for anybody.

[00:14:32] Dr. Nina Alfieri: Well, that's helpful to know. And you talked a little bit about this idea of reinforcement or what do you do in reaction to a tantrum? Why is it important to like, think about how you react to a tantrum or a biting behavior?

[00:14:46] Dr. Miller Shivers: Well, I think a parent's reaction to behavior. Is everything, you know, because if you want a behavior to stop, you have to stop giving it attention, which is also the hardest thing to do as a parent, because even sighing or rolling your eyes or like, ugh, that's attention. But once your child has gotten to the point of a tantrum, there's really nothing you can do. You kind of just have to ride the storm and make sure they're in a safe environment, you know, and those sorts of things. But. I know a lot of parents try to go over there and like console them or hold them or you know, they're flailing around so they're trying to confine them. And to me that's just giving so much of your attention to this behavior. I mean, I know we all do that as parents, like if we're out in public or whatever. Say you go to the park and your child has a meltdown and throws themself on the ground. You know, it's kind of embarrassing to just let them do that. Everyone at the park's looking at you, so you know, you manage it as best you can, but the work is really like, okay, let's plan ahead for the next time you wanna go to the park. What are you gonna do? What are the clear expectations for your child that you tell them in a developmentally appropriate way for their age level and then you have a plan with a parent if it goes okay, or if it goes terribly, you know, kind of what's the out 'cause I think a lot of parents, it's helpful to have, like, I know what I'm doing. If we go in and there's another meltdown at the park, I know what I'm supposed to do, because we want our kids to learn to not have to have those big reactions. Like you can be upset, but not a huge, full blown tantrum. We don't need that all the time. So, little things and trying to recognize when your child is getting a little bit upset and just saying, you look like you're getting a little bit upset. Let's take a little break over here. 

[00:16:29] Dr. Nina Alfieri: Since you mentioned timeout, I think the thoughts on timeout have changed a lot over the years, I think, and it used to be a really commonly recommended parenting strategy. What are some strategies you recommend, maybe in place of it?

[00:16:41] Dr. Miller Shivers: Well I think, you know, back way when there was spanking, right? And so I think timeout sort of became popular because people were trying to find an alternative, you know, sort of a consequence that wasn't physical. And you know, in my practice and what I do, I don't recommend timeout, and these are the reasons. I think timeout is really difficult to do correctly. And I think it takes a lot of practice and training that I think most families don't have time for and don't really wanna take the time to do it. And also usually when you're using timeout, when you say go to timeout, you're frustrated, you're mad as a parent. And so it just causes a lot of tension back and forth. And then the child's in timeout and inevitably they get up and then you're putting them back and you're frustrated and you're supposed to be ignoring them, but you're not because you're upset, so you're saying things under your breath or whatever. And the whole thing to me just is so negative. And the main reason is because all of this is just giving this negative behavior more attention, which is actually reinforcing. So you're kind of doing the opposite of what you want to do. I would just leave them alone, ignore them. If they are, you know, in a safe environment, just let them scream and yell and kick their feet, whatever. I mean, I know it's awful to listen to, but go somewhere else, go in a different room, and then as soon as they've calmed down, you give them back your attention and say, gosh, you were really upset. I'm glad you've calmed down. Let's go pick up your brother from school or whatever. And that's your time to give your attention back. So I just think there's better things. And most of the work, like we said before, is sort of planning ahead and catching the signs before there's a full blown tantrum so that you can prevent them from happening so often.

[00:18:25] Dr. Nina Alfieri: I think these are all great tips, and I've also heard of this idea of time in which is pretty mind blowing to me. And I think as a parent, I find it helpful that, you know, if a child is really struggling with something, their quote, negative behavior, tantruming, kicking, exploding, might actually just be a cry for help for us to support them. And how would it feel for us if we needed help and someone told us to go sit in a corner. Sometimes they really need an adult to like help them process those feelings and name it and move through it. I think the other side of that is not giving it too much attention and reinforcing it, but oftentimes kids don't have the verbal ability to come to us and say, I'm feeling frustrated. 

[00:19:06] Dr. Miller Shivers: Yeah, that goes back to the importance of the adults in their life. I tend to say like, okay, so that happened one time, so next time you're trying to build a Lego tower and you see it sort of teetering, you as a parent could say, I see your Lego Tower teetering. I know last time that was really frustrating for you. So, should we take a break or can I help you hold it? Or something like that, and practicing that, because the first time you do it, it may work, right? Then the next three times it might be a disaster and your kid still has a tantrum. But you have to keep saying that and modeling for them and encouraging them to say, I need help. They don't know their emotions. They don't know they're frustrated, but, you say, gosh, I'm so proud of you for letting mommy help you. Next time, let's try something else. What do you think? Like, next time, should we try taking a break or holding it again and just sort of, and whenever they say, you're like, fine. And then you just move on. 

[00:19:58] Dr. Nina Alfieri: That really resonates with me. And one thing that, you know, I've learned being a parent is slowing down. I think we're so fast, we're used to cramming our schedules every 30 minutes with a meeting or something, and toddlers just don't work like that. Slowing down was something that was really hard for me in our fast-paced world and I think has really helped my relationship with my toddler and really kind of setting expectations and kind of meeting her where she's at. You talked a little bit about positive behavior, and I think when we talk about discipline and behavior, we focus a lot on the negatives. Why is recognizing positive behavior so important?

[00:20:33] Dr. Miller Shivers: Well, I think most of the time when I see families, most families are really good at consequences or like, you know, a timeout or a take stuff away when you are misbehaving because I think that's just ingrained in our culture, right? Like we think, okay, we need a consequence. But I think let's flip it around and let's sort of, okay, so if there's no screaming at dinner tonight at the table, then you can watch, you know, a Daniel Tiger episode or something. Like sort of turning it around instead of like, if you scream at the table, you don't get dessert or, you know. I just think kids are used to that and at some point it gets sort of meaningless. It's like Charlie Brown's teacher, they just talk and talk and they don't even listen. But I also think it's a nice way to show kids like you're recognizing the good things that they're doing, and it's nice for them to work towards it instead of just negative feedback all day long. Especially if you have a kid that is a little more difficult, right? They probably get negative feedback all day long from grandparents. Other people like, sit down. Don't do that. Don't touch that. Stop screaming. Why are you doing that? You're dripping your Popsicle everywhere. Like all this nattering, they call it all day. And I think if you just stop and some of that you don't really even need to comment on. You're dripping your Popsicle, you could say, oh, here's a napkin. You know, or I think if we say, sit down, sit down, sit down, sit down. It doesn't make them sit down any faster. They probably just don't even hear it. To your point, a lot of times, we tell parents like, say something like, put the toy down and then we say sometimes count like five seconds in your head before you say it again. Because even if they sort of make one little tiny move to go towards that, they're doing it, like, to your point, they're just a little slower. Like give them, if you say it more times, it doesn't make it happen better. I think in our fast-paced world, we're like, get your shoes on. Do this, get down. We gotta, and the kids are like, what? What happened? You know?

[00:22:25] Dr. Nina Alfieri: I also heard another great piece of advice from a friend, which was that, you know, your child can help you with things. For example, my two and a half year old Mia loves to quote, help me cook, and it's really cute. But let's be honest, like, you know, she's not chopping onions for me, but it's a shared experience I love. But the tip my friend gave me is just budget like three times more time for every task that you are gonna do that you're allowing your kid to help you with and turn it into an activity knowing that it's gonna take longer.

[00:22:54] Dr. Miller Shivers: You know, I feel like a lot of parents feel like they don't have that time built in. But I always say that's not something you have to do every day. And I always say to parents, when you're having a day where you feel more patient than other days, that's the day that you cook with your daughter. You know, don't do it on a day, you're rushed and you feel guilty because you haven't spent that much time with her the past two days, because that's not gonna end well. And one minute, two minutes of like sitting down and, you know, looking at a book playing tic tac toe, like, whatever, is all you need. Like as soon as you get home or soon thereafter, just, you know, sit your child on your lap and just say, oh, this, you know, for a minute or two. That's a nice sort of routine part of connection. It doesn't have to be 30 minutes, an hour or two hours. And I think that's a misconception too. Parents are like, I don't really like to play with my child because it takes so long, or they won't stop. And I'm like, you don't have to play with them all the time. You shouldn't, you know, they need to play independently, but just have a little minute or two and if your child is one that's hard to say, no, I wanna stay in your lap, then you know, you could set a little timer, you could say. You know, you're gonna sit in my lap and we're gonna sing the Happy Birthday song, and then when it's over, it's time to get up and we're gonna go make dinner.

 [00:24:08] Dr. Nina Alfieri: I love that and I think that's such a key point that I wanna highlight here is that,if you have like five hours to play with your kid, that's amazing, but most parents don't, and that's okay. It's better to spend a couple of minutes or a small fragment of undivided time then try to multitask where your kid doesn't ever get to make eye contact with you. So I really think that resonates in like the busy, practical world, which is that most of us really don't have, you know, the entire day to like patiently sit and read books with our kids. And occasionally that's, you know, a Saturday morning, we have more time. That's great. But in the busy world, it's definitely enough to just spend a little bit of time each day or every couple days really truly connecting with your kid. And one of the earlier podcasts we did was with Dr. Mariana Glusman, whose life passion is on early childhood literacy. And there's a big relationship aspect to sitting and reading together. And so, you know, that's for our family, that's the way we get our quality time together as a guarantee at the end of the night. Yeah, I mean, it's definitely the quality versus the quantity. And I think that's something that is so eye-opening and like, I feel like sometimes when I say that to parents, their shoulders kind of relax. They're like, oh, so I don't have to spend so much time. I'm like, no, it's a couple of minutes. And I also work here in the hospital in the NICU supporting families. There's so much guilt that parents feel for lots of different reasons. I'm like, if you can come in and read a book for 10 minutes, that's better than sitting here in the room all day long. So I think that's a really important point.

[00:25:42] Dr. Nina Alfieri: What would you say are like your top three to five tips in today's crazy busy society to help move toward that and build that within family structures?

[00:25:50] Dr. Miller Shivers: Well, I think the number one is like I think you have to, as a parent or an adult caring for little kids, you have to take care of yourself. And I know that sounds trite and we all say, oh, we have to take care of ourself. But you know, in whatever way that means for you. I mean, does your child need a bath every night?

[00:26:07] Dr. Nina Alfieri: No, they don't.

[00:26:08] Dr. Miller Shivers: You know, you know better than I do, but I, you know, I think as sometimes as parents, we think, oh, our kids have been in daycare or preschool, whatever, they need to have a bath. But it's really stressful to give little kids a bath every night. So I would say, let some of that go. And it's always also nice to set a routine. I mean, kids do better, parents do better. So you know, like, okay, this is around the time we're gonna eat dinner, then we're gonna read a book or whatever you do, and put our pajamas on and go to bed. And, I really love a bedtime because the kids need it, but also the parents need it. You know, you need a little time to decompress because as soon as you get home from where you've been during the day with little kids, it's go, go, go. You know, you don't have a minute to spare. So I think just being mindful of some of those things can be really helpful.

[00:26:59] Dr. Nina Alfieri: I love that. And in the words of my favorite Disney movie right now, let It Go. Right? I actually got this advice from one of my mentors recently, which was that you just can't do everything. And during this couple of really busy years in your life, it's okay to, you know, maybe don't do dishes so often. And I think that grace and space for families is really important. And I hope that if there's parents out there that are struggling with just the crazy busyness that you don't feel alone and you know, I'll probably have my dishes waiting for me tomorrow, just like you.

[00:27:29] Dr. Miller Shivers: One of the things I think when I became a parent, I mean my kids are teenagers now, but just the whole notion of you really can't finish anything. You know, I'm one of those like a list checker. You know, I wanna make a list, check things off. And I remember when I first had kids thinking I'm in the middle of this and I can't finish because my baby's crying, or my toddler needs something, and that was a real sort of awakening for me. I'm like, okay. And now I just, you kind of have to just let it go and accept it. Like, I'm gonna have things unfinished or I have to circle back later. It's hard. I mean, it really changes your whole life that you knew.

[00:28:03] Dr. Nina Alfieri: Truer words were never spoken.

[00:28:05] Dr. Miller Shivers: Yeah.

[00:28:06] Dr. Nina Alfieri: Dr. Shivers, I heard that you're launching a Little Ones app to help spread your program's knowledge to more people. Can you tell us a little bit about the app and how parents might use it?

[00:28:16] Dr. Miller Shivers: Sure. I mean, it's kind of a labor of love. It's called Little Lessons. And it's available wherever you get your apps. And it's really just everything we've been talking about. Mostly geared at toddlers and preschoolers, just kind of like basic strategies that are good to use with every child in any kind of situation. And also just some foundations we called them. Why is praise important? Like those basic sort of foundational things that any family can use. And then we have a section and they're like, how parents can kind of take care of themselves a little bit. And then we really go through all the different kinds of anxiety, what they are, the symptoms, what they look like in these young kids, and then examples of ways to manage them. Like based on if you have, if you're scared of bees or you know, are upset going to preschool, how do you manage that? We go through like inattention and disruptive behavior, tantrums. And then we'll be adding new content. Like we're gonna be adding a thing on sleep and eating and hopefully get some feedback of other things that people would want to learn about. And it's really geared toward parents, you know, educators with young kids, really any adult who spends time around a young child.

[00:29:27] Dr. Nina Alfieri: That's wonderful. I can't wait to check it out. I wanted to thank you so much for joining us on the show today. This is one of my favorite topics and I just wanted to also, you know, give a hat tip to all of the parents out there who are at various stages of tackling some of these issues and maybe struggling with others. I think as I tell my parents, the one thing that unites us is that we all go through the same things with our kids. There's nothing that pediatricians are immune to. So, these are all shared experiences that we can all learn from each other with. And there's definitely help out there if you're struggling with something. So reach out to your pediatrician, check out this app. There's a lot of great resources out there. And I just wanted to thank you so much for all of your sage advice and for all of the amazing work that you're doing in this field.

[00:30:11] Dr. Miller Shivers: Well, thank you for having me and having this lovely conversation. It was great.

[00:30:15] Dr. Nina Alfieri: Thanks for listening to Kids' Wellness Matters. For more information on this episode and all things kids wellness, please visit luriechildrens.org.

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