Why isn't my baby talking?

Q: "My baby is 13 months old and not talking at all. He hears sounds because I'll tap on a table and he looks, but he won't say any words, just noises. Should I worry?"

A: Is there anything more thrilling than when a baby first starts talking? It's a brilliant developmental advance. Think about it. Your baby has learned that a sound -- which is, after all, nothing more than waves in the air stimulating the eardrum and the ear nerves -- actually means something. She's learned that this noise actually stands for this person or thing I love so much. The first word marks the beginning of the ability to think symbolically. It marks the beginning of what sets us humans most apart from all other animals on the planet.

The first word is, in short, a miracle!

Of course, that's also why parents tend to worry so much when their baby may be a little slow in talking. So for all of you whose infant still isn't saying any meaningful words at 13 months, here's some reassurance and here's some advice.

First, the reassurance.

There is tremendous variability in when children say their first meaningful words. (Note the emphasis on meaningful. Just saying "dada" doesn't count unless the word really represents and refers to that guy who is such a big part of the baby's life.) Some say their first words at nine months; other perfectly normal kids don't do so until as late as 18 months. And, by the way, if there's no problem otherwise, early or slightly later language is not a sign of how smart your infant is going to be.

Now, the advice.

Although it's too early to worry and your baby's probably OK, you (and/or your pediatric provider) need to remain alert to the possibility of a potential problem. Here are seven questions to ask yourself:

• Does he understand the meaning of single words (e.g. "where's mommy?" "NO!" "give me ...")?


• Is he making a lot of different sounds with a lot of expression to them?


• Could there be a hearing problem?


• Is he developing normally in other areas?


• Is he being spoken to a lot? Is someone reading to him every day?


• Is he exposed to any significant family (or other) stress?


• Is there a family history of slow language?

Reassuring answers to these questions are, well, reassuring. In such a case, a real problem is unlikely and, if I were your pediatrician,I'd say that it would be OK to wait another three to five months before an evaluation would be necessary.

But if you are not reassured, by all means talk to your pediatric provider about how best to keep an eye on yourchild's language development and whether an evaluation by a speech language therapist or other child development specialist would be helpful.

Tools to Try

• Slideshow: Toddler Milestones
• Slideshow: Baby Milestones

Sibling Rivalry

Q: I have a 3 1/2-year-old son who is jealous of his 4-month-old sibling. The signs include bedwetting, baby talk, and fits of rage in which he demands that I give him something by screaming "DO IT RIGHT NOW!" How do I make this transition smoother for him?"

A: Picture this scenario: Your partner comes home tonight with another woman in tow. He says to you:"Honey, I've brought home this new woman to live with us. Isn't that great? Isn't she cute? She's going to take a lot of my time and attention. But don't worry, I love you as much as I always have. I just thought our cozy little family needed expanding."

From his point of view, that's exactly what has happened to your little guy. He was quite content to be king of the hill and can see no earthly reason for your needing another child. So sibling rivalry and a sense of having been betrayed are inevitable in these circumstances. But all the attention in the world won't erase what the stunning change in his circumstance means to him.

That's not to say that his mixed feelings are bad.

Firstborns have had to learn to deal with this dethronement since the first mom had her second child. I think that as children learn to cope with that rivalry, they are learning to deal with stress, learning that they can be loved and valued even if there is competition for parental attention, and that there are better and worse ways to express one's ambivalence toward a sibling. They also learn to care for a person smaller and more helpless than themselves. They learn what it means to be a family. It's a great opportunity for learning important lessons, even if it's a bit painful at times.

So if you can't convince him at this stage that it's wonderful to have a little sister, there are tricks of the trade to make his road a little easier:

• Frequently reassure him how much you love him.


• Be sympathetic to his regressions and tantrums. Tell him you know he's having a hard time being a big brother and that's OK.


• Try to make some "special time" available to him every day where just the two of you are together and "the baby can't come."


• If he's interested, give him a new teddy or toy to take care of, "Just like Mommy is taking care of the new baby."


• Involve him as much as possible in the care of his new sibling. Ask his advice: "The baby's crying! What should we do?" Allow him to feed the baby a little or assist in changing.


• Don't accept bad manners, even if you're sympathetic to his plight. Tell him your expectations for his behavior.


• Appeal to his desire to move on developmentally. Emphasize to him how he's the "big boy" now and his sibling needs his instruction and guidance, as do you.

Sibling rivalry almost always resolves in a positive, constructive way and represents a wonderful opportunity for emotional growth for your oldest. Although it can be a bumpy ride, the end result is usually siblings who have learned to love and care for each other, a lesson that extends far beyond the family as they get older.

Tools to Try

• WebMD Video: Preparing Siblings For a New Baby
• Ages 2-5: What to Expect

My Toddler Stutters. Is this normal?

Q: Our 2 1/2-year-old son began stuttering about two weeks ago. Up until that time he really had no problem speaking at all. He has quite an extensive vocabulary and speaks in full sentences. Help!"
A: >I'm pretty sure your child has "transient dysfluency of childhood." Wait, don't be nervous! It's just a fancy name for a common stuttering problem that goes away.

Transient dysfluency (temporary stuttering) is typically seen in 2- to 4-year-olds. They usually are very verbal and often advanced for their years. The dysfluency results from their talking abilities going faster than the language centers of their brain. It's as if their brain can't catch up to their motor mouth, so it slows things down by repeating sounds over and over (i.e. by stuttering).

Stuttering is probably, at least in part, an inborn, genetic problem. There are lots of theories, but nobody really knows what causes it. Boys are about three times more likely to stutter than girls. When it comes to developmental issues, boys always get the short end of the stick!

Once your little guy's brain catches up to his mouth, the stuttering will disappear. In the meantime, Iwouldn't make a big deal out of it. He's too young to be very bothered by the stuttering, and if you get anxious about it, so will he, which may just make it worse. Continue to talk to him in a nice, slow, relaxed way and patiently wait for him to make his points. The odds are very good he'll outgrow it in less than a year.

So I wouldn't worry if I were you, but while I'm on the subject, let's discuss when a parent should begin to worry about a child's stuttering, which is seen in 1% of school-aged children.

Personally, I usually don't worry about stuttering unless it's still happening after the age of 4 years. Here are some things that would lead me to bring a child to a speech-language therapist's attention:

• The child is very bothered and upset by the stuttering.


• The stuttering occurs in all situations, not just when the child is excited or nervous.


• The child seems to be struggling to get the words out, with an increase in the pitch of his/her voice.


• The repetitions are very frequent and very long.


• There are frequent prolongations or blockages of words and sounds.


• The child avoids saying certain difficult words.

We've all known people who stutter and we all know how hard it can be for the stutterer. The good news is:

1. Most kids get better.


2. Speech therapy helps. If you have any concerns about your child's dysfluency, talk to your pediatric provider or find a good speech-language pathologist (the Stuttering Foundation of America can recommend one).

Tools to Try

• WebMD Video: Treating Kids Who Stutter
• Conquering Fear of Public Speaking

Should my child have his tonsils out?

Q: My child has persistent strep throat and my pediatrician says his tonsils should be removed. I'm not sure I agree. What's your opinion?

A: Not so long ago a child had a couple of strep throats and WHACK! … his tonsils or adenoids (or both) were unceremoniously removed, with all the ice cream s/he could eat as meager compensation.

Times have changed and for good reason. We now believe the tonsils play a role in how the immune system functions (though we're not exactly sure what that is). So we're loath to lop out what Mother Nature has so carefully provided. Also, scientific studies have shown only modest benefits for tonsillectomies in preventing future strepthroats. Finally, although generally quite safe, any surgical procedure has some risks, so there better be good reasons to do it. [It gets a little confusing. Remember the tonsils are lymphoid tissue at the back of the throat; the adenoids are higher up, behind the nasal passages. There are different criteria for taking out the adenoids (e.g., heavy snoring with obstruction of breathing during sleep, frequent ear infections, swallowing problems, etc.) which I'm not going to address here. Sometimes you just take out the tonsils, sometimes just the adenoids, sometimes both.]

The studies aren't entirely clear, so honestly professionals disagree when to perform a tonsillectomy for recurrent sore throats. Based on my understanding of the medical literature, my criteria are:

• At least three strep throats in each of the past three years, or five in each of the past two years, or seven in a year.


• Each episode should have been accompanied by fever, tender swollen glands, and a positive throat culture.

So what to do? I'm concerned that you've felt the need to contact someone other than your pediatric provider about this. Do you trust him/her? Are you afraid to question his/her advice?

I think you should gather up your courage and sit down with him or her to discuss this. What are his/her reasons for recommending it? Are the potential benefits worth the potential risks? What might happen if you don't do it? Most importantly, ask what the scientific studies and text books suggest?

If you're still uncertain about how to proceed after the discussion, get a second opinion. No physician should ever object or be angry at a patient or parent looking to do what's best for their child or themselves. Find another experienced pediatrician or an ears/nose/throat doctor to discuss the issue. You definitely should feel certain that it's the right way to go before doing anything. Good luck!

Tools to Try

• WebMD Video: Child Behavior Issues Could be Linked to Tonsils
• WebMD Video: Tonsil Surgery Just Got Easier

My Child's Growth is Slower than the Chart. What do I do?

Q: What are the growth charts used in the pediatric office? Should I worry if my child doesn't fall in the "normal" range?

A: I'll answer your question, but first let's talk about growth charts -- how they were made, what they mean, and how to use them. I want you to become an informed consumer of those mysterious graphs in your pediatrician's office. They are important.

How They Were Made
Growth charts represent the average (mean) weight, height, or head size of a bunch of normal children. The authors simply followed the growth of these children and made the chart.

You will see the percentile lines running parallel to each other. If a child's weight is at the 50th percentile line, that means that out of 100 normal children his or her age, 50 will be bigger and 50 smaller (i.e. he's right in the middle of the pack). Likewise the 86th percentile means your child is bigger than 86 and smaller than only 14, compared with 100 children his age. There are separate charts for weight, height, and head circumference.

To see if your child is too skinny or overweight, there is a 'weight for height' chart or a BMI index, which tells you what percentile the weight is for a child who is that particular height. Decreasing percentiles in this area is often the first sign that a child is taking insufficient calories. Depending on the extent of the poor caloric intake, the child could begin to get stunted -- the height begins to fall off the growth chart. Lastly, and this takes a long time to happen, the head growth slows down, indicating not enough calories for the brain to grow at a normal rate.

What They Mean
The growth percentiles by themselves don't say much. What really matters is the velocity of growth. A normal velocity of growth means the child's growth points will closely parallel the percentile line above it on the chart. We usually don't worry about insufficient (or excessive) growth until a child's growth velocity has crossed at least two percentile lines (e.g., from above the 90th to below the 50th percentile).

Additionally, if a child's weight, height, or head size is below the 5th percentile, we might also call them small for age. In that case, what's most important is to see if the growth points parallel the 5th percentile line (meaning growth velocity is normal) or if the child is falling further behind (which is more concerning).

How to Use Them
The growth chart lines are smooth and perfect. The problem is that no child's growth and development is always so smooth and perfect. Kids bounce up and down the growth charts, depending on appetite, feeding issues, illnesses, and who knows what.

Some parents obsessively follow the growth curves and worry unnecessarily about insignificant deviations from that perfect line on the chart. Put the growth chart into context. Does your child appear otherwise happy and healthy? Is she making nice developmental progress? Is she taking in at least some protein (milk, yogurt, eggs, meat)? If she's become very picky, a multivitamin covers all the vitamins she would get from the vegetables she loathes, so don't sweat it.

Tools to Try

• WebMD Video: New Growth Charts
• Kids' Height Predictor

How can I get my child to take medicine?

Q: My daughter refuses to take her medicine. What to do?"

A: As always, before we propose what to do, we need to figure out why the behavior is occurring in the first place. Assuming this is your daughter's main bone of contention and there aren't major power struggles in other areas, here's my educated guess as to what's going on.

I'm betting that this is an issue of temperament and that your daughter has what's called a low sensory threshold for some tastes. Some children, for example, are very sensitive to touch, others to sound. Perhaps your daughter happens to be very sensitive to taste. (Interestingly, we've learned that some kids and adults are "super-tasters" -- people who are very sensitive to tastes because they simply have more taste buds and nerves at the back of their tongue. Super-tasters may grow up to be master chefs or wine stewards, but they can be very challenging as children when you need them to swallow something they're not used to.)

So first, it may be important to recognize that your child probably is not purposely misbehaving or being spitefully willful. For whatever reason, the stuff probably really does taste yuckier to her.

So now that you understand it, hopefully you're not going to blame her or demean her for it. That's great, but, hey, one way or another you still have to get the medicine down her gullet! So here are some tricks of the trade to consider:

• See if the medicine comes in other, more palatable flavors. Are there chewable tablets she could try?


• Mix the stuff in with a favored cold food (like ice cream or yogurt) or peanut butter or applesauce or whatever works (make sure the pharmacist OKs this).


• Encourage her to swallow quickly.


• Wash the medicine down with a favored cold drink or with chocolate syrup.


• Have her hold her nose when she takes the medicine and/or drink it through a straw (less smell = less taste).


• Refrigerate the medicine. It may not taste as bad cold.


• Have her suck on a Popsicle or something cold to numb her taste buds right before downing the medicine.


• Try sticker charts and/or bribery for success.


• Give the medicine by squirting with a medicine syringe (much less likely to spill). In most cases you should allow your child to spritz it in herself so she feels in control. Practice this ahead of time. Occasionally, some children prefer to close their eyes and have you do it.

No matter what strategies you chose, you should have a planned discussion with her about it. (After all, it's hard to hold a rational discussion when, like The Exorcist, she's spewing purple liquid at you!) Explain that the next medicine will have to be taken and that's final. Don't spend much time explaining why. Ask her how you can help her to make the process easier. Tell her what you'd like to try and be very optimistic about how helpful will be whichever interventions you chose. Some children then do well with a dress rehearsal, using a syringe full of juice.

Be firm, authoritative, and patient about the whole thing. Your daughter needs to know that you're willing to wait until the cows come home for her to drink the stuff and that you're not going to bend.

In the absolute worst-case scenario -- when nothing has worked -- you may need to simply resort to brute strength and superior determination. Use two adults, one to restrain her, the other to administer the medications. If necessary, hold her nose so she is forced to open her mouth. Slowly pour in the medicine. Sometimes blowing in the face triggers the swallowing reflex.

After the ordeal is over, remind her that you are doing it so she will get better and that you don't really want to have to do it and wouldn't she like to get with the program? At that point almost all children quite sensibly decide it's better to comply, as they realize that this is simply a battle they are not going to win. Then you can go back to plan A and find the right tricks to make it easier for her.

Tools to Try

• Immunization Chart for Children and Adults
• Slideshow: Baby Milestones: First Year

When Should My Baby Eat Solid Food?

Q: When should I feed my baby solid food?

A:
The "gospel" of pediatrics is to wait until 6 months or so. So unless there is a reason otherwise, that's typically what I recommend.

But, to be honest, the reasons to wait that long aren't that compelling (such as the theory it may prevent food allergies, which are rare anyway), and most infants do OK no matter when you start.

As long as whenever parents start, they go slowly, start one at a time, and look for new associated digestive problems, it's unlikely to create trouble.

Confused? You should be. The good news is that it's one of those early choices that parents obsess about that probably really doesn't make much difference either way.

Tools to Try

• What to Feed Your Baby
• Healthy Weight Calculator

When should I switch to cow's milk?

Q: "I'm so confused about when to switch my baby to cow's milk. Can you help?"

A: It is confusing! You're not alone. That's because there really is very little research in this area, so everyone has a different (unproven) opinion. Here's mine:

Some babies have a problem with digesting cow's milk or are sensitive to its proteins. Often this goes away by about age 12 months, hence the recommendation to continue formula until 12 months and then switch over. There is nothing magic about 12 months; it's an arbitrary date.

Theoretically, the same arbitrary date (12 months) should hold true for all milk products (for example, yogurt), but many parents introduce these products before 12 months and, of course, their infants do just fine.

So it is confusing and you'll get different advice, but most babies do fine no matter when you start up the milk and/or milk products.

Tools to Try

• What to Feed Your Baby
• Healthy Weight Calculator

My Child Bites Other Children! What should I do?

Q: Help! My 2-year-old son is biting the other kids at daycare!"

A: The first thing to know is that this is a distressing, but common, behavior for a 2 year old. It is rarely a sign of emotional problems or that he will grow up to be an aggressive person. Someone said even Ghandi was a biter when he was 2!

What to do?

Remember: He is way too young to understand WHY biting is morally wrong. At this age there is even little to no awareness of the bad consequences of his actions. He really lacks the capacity understand that his biting really hurts others and the ability to empathize with their distress.

For these developmental reasons, it is not possible for him to understand why he should not bite. It will be your job and that of his other caregiver to simply teach him that he should not bite.

That means making him learn that biting causes things to happen to him that he doesn't like. As you begin to contemplate how to do this, first think if a cause for other than "normal" biting could be in the picture. Are new teeth erupting? Is he frustrated in some way? In my experience, for example, children whose expressive language is a little behind tend to become frustrated at their inability to express their feelings and intentions. Occasionally, this frustration emerges as biting in social situations, other times as temper tantrums. Is his daycare overwhelming him with their tasks? Are there too few providers in daycare to provide oversight?

Clearly, any possible reason he may be experiencing excess stress should be addressed. In some cases, for example, a child's biting may be a window into family dynamics where s/he might be witnessing a lot of yelling, physical violence, or punishing.

As I suggested, however, for most children, however, biting is a just a normal stage which will eventually pass. Almost all children have bitten at least once during the first few years of life and it is estimated that 50% of toddlers in childcare have been bitten up to three times every year by their colleagues.

The approach in the uncomplicated case is both simple and direct. Your child needs close surveillance by the daycare providers (and at home, if it happens there) so that any premonitions of biting can be acted on immediately, for example by distracting and moving him away.

If he does manage to bite, he should be immediately and firmly admonished with a strong "NO! DON'T DO THAT!" This must occur within a minute of the episode if the child is to associate the social disapproval with the biting.

Then he should be taken away from the bitee, placed in another part of the room, and given no adult attention for about a minute in a "time-out," during which time the providers should shower lots of sympathetic attention on the victim.

Most children quickly learn that biting is not acceptable behavior, that there is little attention to be gained by doing it, and they promptly cease and desist, simply an experiment that failed.

If the biting continues, other options need to be explored. For example, does the daycare environment cause a lot of frustration in the child for some reason? Are there too many children and not enough supervision? Is there not enough space for free exploratory play? Is he frustrated because he is at the lowest (or highest) developmental level of the group?

Finally, remember that in the vast majority of cases, biting does not lead to aggressive behavior in later life. It's simply a common developmental stage on the long evolution of your child from uncivilized toddler to civilized adult.

Good luck.

Tools to Try

• WebMD Slideshow: Toddler Milestones
• WebMD Video: Setting Limits for a Child

Potty Training Blues?

Q: My child is late in potty training. Should I worry?

A: Welcome to the Potty Wars! I'll bet you've gotten a lot of completely different advice from parents and professionals on this one.

One side advises you to bend your child's behavior to your will in a "parent-centered approach": Throw away the diapers! Stop tolerating his infantile behavior! Show him who's in charge! Get a (diaper-free) life!

The other camp cautions you to take a "child-centered approach" and respect your child's wishes and needs, wait until he's ready, don't browbeat him, relax, and just use pull-ups in the meantime.

The problem with either position is their rigidity: each has decided what's right without taking the individual child (yours) into account. I think there's more than one good way to handle this and the best approach will depend on your child.

Did you know that in the U.S., the average age for toilet training is 29 months for bowel and 32 months for bladder, but the range in normal children varies from about 18-60 months? So it's important to remember that your child will achieve success almost no matter what you do; the only question is when and what lessons he will learn in the process.

Here's my advice.

First, see your pediatric provider and be sure there's no medical reason for the problem.

Next, know your child! Think about why this might be happening before thinking about how to intervene. Here are some possible reasons:

• He's not developmentally ready. Does he have the necessary language to understand what is expected of him and to express his need to go? Does he have the ability to control his body? Can he pay attention to the sensations signaling a bowel movement?



• He's developmentally ready, but not emotionally ready. Perhaps he has mixed feelings about growing up and prefers the care and attention from caregivers that a diaper brings. Is he afraid of the potty? Some children harbor fantasies about what it means to use the potty and, for example, worry about losing a precious (to him, if not to you) part of his body down a mysterious chasm, never to be seen again!



• He's developmentally and emotionally ready, but he's showing you who's the boss. Power struggles around "the battle of the orifices" (eating, pooping) are quite common. Children don't have control over much, but they can control their body's orifices. Is this a way for him to show that he's in charge of at least this part of his world?

Now, what to do depends on what you think is going on. There are a couple of roads you might follow:

1. Don't push. Use sympathetic reminders and encouragement, empower him to handle this himself, and let developmental forces take their course. Reassure him if he is afraid. Don't try to force the issue. Most children become especially motivated to change when they see others their age further down the road, so you might expose him to other well-trained 4-year-olds. Provide sympathetic encouragement but don't make a big deal of it.



2. A gentle but firm push. If you think he is fully capable of success, set a date to "give the diapers to baby Margaret." Make a big to-do about what a big boy he is, how the time has come to move ahead, how proud and happy you are, and how much baby Margaret needs his diapers. Make a ritual of putting all the diapers in a bag and "sending" them off to another baby. Put on big boy underpants and cross your fingers. Many children who just need a little nudge in the right direction respond well to this.

Potty training is one of the great early developmental challenges a child and his or her family face. What matters most is not when he meets the challenge, but how he and you resolve it. It's his job to do it and it's yours to teach and encourage him. Try not to let it become a power struggle.

I personally guarantee that, sooner or later, your child will lose the diapers. What's most important is that in doing so he feels like a competent and good little boy, and doesn't feel belittled, diminished, or shamed by the process, because those are feelings that can persist long after the Potty Wars have become an amusing episode in your family history.

Tools to Try

• Slideshow: Toddler Milestones
• Your Guide to Raising a Healthy Family

Reflux or Not?

Q: My baby spits all the time. Is this reflux?

A: It sounds like he's joined the burgeoning ranks of baby spitters / refluxers.

Usually, it's not diet-related. Rather it's caused by a relaxed valve at the bottom of the esophagus where it meets the stomach. Since it is relaxed and doesn't close completely, as it should, milk or cereal or food (or whatever) easily comes back up from the stomach to the esophagus to back of the throat to the world and onto your favorite dress.

Some kids are called "happy spitters." That is, they frequently spit and vomit (more forceful than the dribbling of spitting), but are:

• Growing well


• Happy


• Not at all uncomfortable with it


• Have normal development


• Suffer no coughing or choking or other breathing problems as a result

Happy spitters are by definition doing okay from a medical viewpoint, and will eventually outgrow it. It's no fun but they really don't really need any medications.

On the other hand, "refluxers" (with gastroesophageal reflux or GERD) do experience one of those problems. So they often require medications (eg., something to block acid production in the stomach [eg, Zantac] and/or something to move things along and tighten the valve [eg., Reglan]).

Your pediatric provider has a lot of experience and can help you with this.

Tools to Try

• Baby Milestones: The First Year
• Your 1-month Old: Dr. P's Guide

Should I Worry About My Picky Eater?

Q: Picky eaters are tough and usually stubborn as nails.

A: First, the good news: they almost never develop any significant nutritional or medical problems from eating so sparingly.

Since there is no way to make a child not be picky (it's a hypersensitivity to taste or textures he was born with, neither his nor anyone's fault), all you can do is try to maximize what he does eat.

Here's my advice:

1. Give him a high-quality daily vitamin so you don't have to worry about what he does or doesn't eat.



2. Don't try to force him to eat. Power struggles tend to make things worse as the child decides not to eat just to show you who is boss.



3. Let him eat pretty much what he wants of the reasonably nutritious foods. But keep the junk food to a minimum, as it will curb his appetite without meeting any nutritional needs. Offer him food but make sure he knows it's his choice.



4. Keep mealtime fun. If he doesn't eat, that's okay. Forget about it. Most kids, in the long run, will eat better if they associate meals and food with family closeness and fun. And they'll eat less if mealtime is an ordeal to get through where no one is happy and everyone just focuses on how much food is eaten.

If you stick to these principles and everyone lightens up about the whole thing, 99 kids out of 100 do fine.

Tools to Try

• Picky Eaters: Recipes to Feed the Whole Family
• Chef Jamie Oliver Makes Over School Lunches

Are Temper Tantrums Dangerous?

Q: "My 20-month-old will bang his head on the carpet, kitchen floor, walls...so hard he cries and creates bruises. I'm concerned for his safety..."

Q: "My 1-year-old throws his head back and hits it when he is throwing a tantrum or sometimes even when he is not. How can I stop him from doing this?"

A: Two different kids, two different ages, same problem: head banging during a temper tantrum. It's very distressing to watch.

First, some reassurance. I have never seen (nor has anyone else I know, nor has anyone written about it) a child do serious damage to their head by banging it by themselves. They appear to be sensible enough to know how hard is too hard and to stop short of really hurting themselves. So that's good news.

But why do they do it anyway? That's a hard question to answer because by the time they have the ability to explain it to us, they don't do it any more. Therein lies a clue: Children who are too young to express themselves -- that is, to explain their frustrations and to verbally negotiate their demands -- become easily frustrated and fall out. That's one reason why temper tantrums are a developmental inevitability in toddlers.

There are other reasons that tantrums are so common. Toddlers have little ability to delay gratification. When they want something, they want it now! They are also egocentric and simply can't think of a good reason why they shouldn't be allowed to have or do everything they want to.

Additionally, they have little ability to inhibit or dampen their strong feelings that come pouring out the floodgates without any ability to control them. Temperament also plays a role. Children with intense temperaments, for example, have especially dramatic tantrums. Children who don't like things to change have more frequent tantrums.

In time, almost all children slowly learn to deal with frustration in a more controlled, developmentally appropriate way. That's why I recommend simply making sure the child is safe (more about that in a second) and generally ignoring them during a tantrum. What you don't want to happen is for the child to learn that she will get a lot of attention for the tantrum. In that case she may continue to have them just to gain your attention.

Avoid frustrating experiences when possible (lots of luck with that!), but when the tantrum comes -- as it surely will -- let it pass, like a summer squall. Don't carry a grudge, just move on when it's over.

Most of you will have noticed by now that I still haven't answered the question of why children bang their heads. That's because I don't really know. I'm guessing that there's something about the feeling that the child enjoys. It certainly gives you a new perspective on things and it certainly serves to shut out the rest of the world! (There are some normal toddlers who bang their heads on the mattress every night to get themselves to sleep.)

I would advise that, whenever possible, you make sure the head banging occurs on a carpeted area to avoid any bruises. Then just ignore it as you would any tantrum. I don't know of any way to convince them it's not in their best interest to bang their heads. And, remember: if you pay too much attention to the head banging, you just might prolong this troublesome behavior.

Tools to Try

• WebMD Video: How to Deal With Temper Tantrums
• Is Your Child Spoiled?