BEHAVIOR:
ASK THE EXPERTS

HABIT OF WAKING UP FOR A DRINK OF MILK

Q A 16-month-old boy wakes every night at midnight and asks for milk. After he drinks about half an ounce, he falls back to sleep. The parents need a rest. How can they break this habit?

Achilles Litao, MD
Bronx, N.Y

A This behavior is common, more often among breastfed infants and toddlers than those who are fed formula. It is unlikely that the child needs calories in the middle of the night—particularly if he is growing and eating well during the day. The nighttime feeding is probably a well-entrenched habit that is probably not harmful to the child—except for his dental health, as I doubt the parents brush his teeth after his drink.

There are two ways to change his behavior. First, simply stop getting up and feeding him. He will cry for at least three to seven nights. His parents can check on him, assure him that he is fine, and leave the room. If he sleeps in their bed, they should ignore his crying. But they must not give in during this difficult period.

An alternate approach is less abrupt: gradually dilute the milk with water. The first two or three nights, his parents should dilute the usual bottle or cup with about 25% water. They should then increase the water to half volume. After another two or three nights, they should make the fluid 75% water, and then water only.

The child may catch on and protest, or he may not notice. In either case, the parents need to be matter of fact about their plan. By the time the child is on pure water, he may no longer be interested in getting a drink, which solves the problem. If he persists, at least his teeth won't be at risk; the parents should then gradually decrease the volume of fluid offered.

Both approaches require a firm parental decision and agreement, acceptance of the consequences, and resolve to proceed no matter how much the child cries.

Kathi Kemper, MD

DR. KEMPER is director, Center for Holistic Pediatric Education and Research, Children's Hospital, Boston, Mass.

THUMB SUCKING IS AFFECTING MOUTH STRUCTURE

Q What can be done for an 8-month-old who sucks his thumb, mostly at night? His habit seems to be distorting his mouth. A deformity in the maxillary structures is becoming pronounced, but it is limited to one side.

Brian Goldstein, MD
Old Bethpage, N.Y.

A Sucking the thumb, fingers, or hand occurs in almost all healthy newborns—usually harmlessly. When the activity persists past 4 to 6 years of age and is frequent and vigorous, however, it can cause dental problems, paronychia, and, rarely, deformities of the thumb or altered growth of facial bones.

This infant's habit does not seem to be associated with any of the risk factors that lead to deformity. The child is young and the sucking is not intense or frequent (since it occurs mostly at night). If the deformity involves only mild protrusion of the maxilla, treatment may be unnecessary. But if the deformity is more severe or includes asymmetry of the face, the maxillary deformity may not be related to thumb sucking; several genetic syndromes are associated with asymmetric facial growth. I would suggest consultation with a pediatric dentist or a clinical geneticist.

Nathan J. Blum, MD

DR. BLUM is assistant professor of pediatrics, University of Pennyslvania School of Medicine and Children's Seashore House of Children's Hospital of Philadelphia.

 

Behavior: Ask the experts. Contemporary Pediatrics 2002;1:26.