Ask a Pediatric Urologist

Emily Oster

21 min Read Emily Oster

Emily Oster

Ask a Pediatric Urologist

With Dr. Liza Aguiar

Emily Oster

21 min Read

This week, I have another special treat for you. You’re going to hear an interview that I did on Instagram Live with Dr. Liza Aguiar. Liza is a pediatric urologist, and when we asked you to submit questions for her, you sent us hundreds. In this conversation, we were able to dive deep into some of your questions about circumcisions, daytime potty-training, nighttime potty-training, and bedwetting, and her real thoughts about MiraLAX. Hope you enjoy.

Emily Oster:

Yay. Hello. Okay, so I was saying we’re going to talk about pediatric urology. We’re going to record this. I want to start, I think people who are watching this probably know who I am, or at least some of them, but I would love you to introduce yourself and tell us who you are.

Dr. Liza Aguiar:

Sure. I’m Liza Aguiar. I am a pediatric urologist, so I specialize in kidneys, bladders, the urinary system, and also genitals as well. And I’m a mom. I have a three-year-old boy.

Emily Oster:

I like the way you said that. It’s like, and I have a side project. I have a side project in genitals.

Dr. Liza Aguiar:

Yes, penises. So, I am a mom of a three-year-old boy, and that’s me.

Emily Oster:

Awesome. And you’re my neighbor. I mean, that’s not how we know each other-

Dr. Liza Aguiar:

And I’m your neighbor. Yes.

Emily Oster:

… but it turns out you’re my neighbor. So, it’s a good street. It’s a good street. Okay, so let’s start. We’re going to start by talking… We have like three buckets of questions. The first bucket is penises. The second bucket is daytime potty training, holding pee. And the third is nighttime. So, we’re going to start with penises. And I would say there’s a set of questions about circumcision that people ask all the time, and people sent in a bunch of them. And I think the first one I want to start with is just can you talk about this procedure and is it painful? Which I think is sort of almost where everybody starts. What happens and how should I think about it?

Dr. Liza Aguiar:

Sure. So, by far, the majority of circumcisions happen a few days after life, within the first few days. And what we know about pain and circumcision is that boys do feel pain even as newborns. The nervous system is relatively developed and we know, based on more objective data, their heart rates go up, they cry. So, yes, there’s some pain associated with it, but most kids tolerate it very well. And by the day after, they’re pretty much behaving somewhat normally. And most OBs and pediatricians who do newborn circumcisions offer some local anesthesia, so some lidocaine or numbing cream to make it less painful. It’s, in general, a pretty low risk procedure.

We talk about risks of bleeding and infection, but serious injury to the penis is very rare. And what happens is that most newborn circumcisions, there’s a little bit of a clamp that goes over the tip of the penis. And the foreskin gets clamped off, and then the skin just heals. So, there’s no stitches in a newborn circumcision. And typically, no bandage is necessary, just a lot of Vaseline or A & D Ointment and routine like diaper care.

Emily Oster:

One question people often come to me with is, what is the reason to do this? Okay, so what are the risks? And then, what are the reasons to do this, other than this is sort of an important part of your cultural traditions? But other than that, what are the reasons?

Dr. Liza Aguiar:

So, I get asked that question a lot. Are there any medical benefits to a circumcision? And I’ll add a little bit of context to that, because I get asked specifically about this a lot. So, in 2012, the American Academy of Pediatrics came out with this policy statement about circumcision, and it said that the benefits of circumcision outweigh the risks. And the specific benefits that they mentioned were reducing the risk of three things, urinary tract infection, penile cancer, and transmission of some sexually-transmitted diseases, including HIV. So, like, whoa, that’s big. And of course, as you can anticipate, a lot of phone calls to pediatric urologists saying, “Should I circumcise my son because of this?” And there’s a lot of anxiety and worry. And I don’t think that was their intention, but the headlines obviously promote that.

So, when I talk to parents, I address all three. So, reducing the risk of urinary tract infection, that is a benefit for the first year of life. So, after the age of one, that’s no longer a benefit. And the risk of a urinary tract infection in boys is extremely low at baseline. So, about 1% of boys get a urinary tract infections. So, I don’t use that as a medical reason to recommend circumcision, unless my patient has other congenital abnormalities or medical conditions that would put them at increased risk of urinary tract infection. So, penile cancer. Cancer is a scary word, but the risk of penile cancer is extremely low. About one in 100,000 men get diagnosed with penile cancer every year, and it’s more associated with the inability to retract your foreskin as an adult and hygiene. So, not a medical reason, for me, that I would use to recommend circumcision.

And then, transmission of sexually transmitted diseases. A lot of this data comes from countries where HIV is much more of an issue, and access to care and access to condoms is a problem. So, in the United States where access to appropriate protection is less of an issue, it’s just really not applicable. So, I would never circumcise a boy and say, “You can have unprotected sex.” That would not be okay.

Emily Oster:

All right. So, I want to get to a bottom line question about the circumcision, which it sounds like basically your take on this is that there are not a lot of positive reasons to do this. Is that right?

Dr. Liza Aguiar:

Yeah. So I leave it up to the parents. I say, “It’s a personal decision. It sometimes is a cultural one, a religious one. And if you prefer your kid’s penis to appear circumcised, that’s okay. I’m happy to do it. And if not, then that’s okay too.” So, I leave it up to them.

Emily Oster:

Yeah, it’s interesting because it is one of the things I talk about in crib sheet as an example of something where maybe there are some small costs, maybe there are some small benefits, and it’s also so personal. People say on the internet, “You should do this. You should not do it.” But the lady on the internet doesn’t know what your son’s penis should look like. It’s not really any of her… It’s not a lot of-

Dr. Liza Aguiar:

Some people feel very strongly one way or the other.

Emily Oster:

Yeah. So one thing to ask is actually, I think when I was a kid, circumcision, we were way above half, but now I think we’re down more like 50% in the US.

Dr. Liza Aguiar:

Yeah, about 60% of boys are circumcised, and 40% aren’t, and it kind of varies state to state.

Emily Oster:

If you do not circumcise, are there hygiene things you should be aware of with the foreskin?

Dr. Liza Aguiar:

Yeah, so a newborn uncircumcised penis, the foreskin is covering the tip of the penis and it’s tight. So, that’s called phimosis, and that is very normal during childhood. And with growth of the penis and erections, yes, babies get erections, that tightness loosens up, and eventually kids are able to retract fully. The timing of that varies. So, sometimes kids are able to retract fully by age two, and then other times it takes up until the preteen years. And it is never okay to forcefully retract the foreskin. So, your pediatrician, for example, you should not pull the foreskin back forcefully, causing tears in the skin or bleeding or discomfort. That’s not necessary. It is okay to manipulate the foreskin and pull it back gently, and see how far it goes back over time.

And eventually, you’ll notice that the adhesions underneath, so the stickiness of the skin to the tip of the penis, become less. And you can see more of the tip of the penis, called the glands. And then as you’re able to retract more and more, then it’s appropriate to retract and clean underneath when the foreskin naturally relaxes. And at an age appropriate time, like during potty training or a little bit after, then kids teaching boys to sort of pull back as far as they can comfortably to pee and to wash underneath is part of routine hygiene for an uncircumcised boy.

Emily Oster:

Okay. All right. So, we did the penis. I’m sure there’s many other questions about the penis, but we’re going to move on to the set of questions people had about daytime potty training. And so, one version of this, one thing people ask is just, “My kids holding their pee all the time. How many times do they have to pee? Are they going to be sick if they never pee? What’s a regular amount of times? How many times a day should we pee?”

Dr. Liza Aguiar:

Yeah. So, after potty training, so one of the things that I focus on is potty training’s really important, but what happens after potty training is actually just as important, and sometimes more important. Kids are really good at prioritizing, and they often have much better things to do than go to the bathroom. And holding is very common, but it can get you into trouble. So, holding promotes stasis of urine, urine just sitting there in the bladder. And especially for girls, our urethras are short, bacteria does slip into our bladders, and our job is to flush our bladders out regularly. And same thing for kids.

Kids should be peeing about every one to three hours is normal for a toddler. And then, as you grow and your bladder capacity is more, then every two to four hours is fine. But holding past that does promote bacterial growth, and bladders don’t like to be over distended. The bladder muscle itself doesn’t like to be overstretched, but ignoring those signals is just part of childhood. It does take a little bit of awareness. So, during potty training, parents are often very on top of when their children are peeing and when they’re pooping, and sometimes I see diaries during potty training, but after, they do forget-

Emily Oster:

They write that shit down. They have a spreadsheet. [inaudible] spreadsheet, that’s the best.

Dr. Liza Aguiar:

Yeah, right. But afterwards, we forget about it and we don’t really think about how often our kids are peeing, and then we’re at Target and we’re in the checkout line and then all of a sudden it’s like, “Oh my god, I have to go now.” And those are the habits that I try to work on because it can get you into trouble with urinary tract infections. So, by far, the two most common risk factors for urinary tract infections in children are holding and constipation. So, I often talk about holding and constipation when I see recurrent urinary tract infections in kids. And holding obviously is much more bladder-related, but somewhat related to constipation. And my spiel is like two things need to happen for your bladder to empty in a healthy way. One is your bladder muscle needs to squeeze, and that’s reflexive. We don’t tell our bladders to squeeze. But the second is that our pelvic floor muscles need to relax, and that is something that kids really have.

Emily Oster:

If you’re constipated? I see.

Dr. Liza Aguiar:

Yeah. And it affects pee and poop, right? If kids cannot relax their pelvic floor muscles, they get into the habit of holding. They sometimes have pain with urination. So, if your child has pain with urination and their urine tests are negative, chances are they’re having pelvic floor tightness or spasms. And that’s where we struggle. And shout out to all of my pediatric pelvic floor physical therapists, they work on that with kids who really struggle past baseline recommendations of pee more frequently, spread your legs when you pee, try to relax. They actually, with some older kids, work on that specifically and it really helps.

Emily Oster:

So, somebody has a question very specific. “Can I get a UTI from the bubble bath?”

Dr. Liza Aguiar:

Oh, there’s one paper that suggested that and now I answer-

Emily Oster:

Yeah, I read that paper.

Dr. Liza Aguiar:

… this question all the time. So, really, no. It’s more the irritation that the bubble baths cause externally that can promote stickiness of the tissue to the bacteria. So, I think if you use just gentle soap, it’s not… No. But can you cause some skin rashes and irritation? Yes. But basically-

Emily Oster:

So, you don’t need a bubble bath is what you’re telling me?

Dr. Liza Aguiar:

Yeah, but I get asked this all the time, like, “Oh, they’re wearing their bathing suits for a long time.” That’s really not a cause of urinary tract infections, that can cause yeast infections. But yeah, I think it’s more like habits. It’s more constipation, peeing less frequently than you should. That’s what puts kids at risk.

Emily Oster:

So, one thing I wanted to pull in about the sort of frequency of the pee is a lot of people ask the question with the frame of, “My kid has regressed, and they used to be perfect. And we were potty-trained, and now they don’t know when they need to pee or they’re kind of peeing in other ways.” And I wonder if some of that is this kind of like you were paying so much attention, and then you just stopped paying attention and then they’re developed normally they’d rather play with their trucks than pay attention to when they need to pee.

Dr. Liza Aguiar:

Absolutely. I approach that problem a little differently at different ages. If a parent comes in and their four-year-old or was perfectly potty-trained for eight months and then all of a sudden they regressed, totally normal. If a 12-year-old came in and they were perfectly potty-trained and now just started having accidents, I’m a little bit more investigative and kind of questioning what is going on. By far with little ones, I focus on like, “Okay, let’s talk about habits again and let’s just do a bladder diary. Let’s start keeping track of things.” And most of the time when I describe, “Here’s what a perfect urology patient looks like, let’s try to mimic that for the next two to three weeks and see what happens.” Most of the time parents are like, “Oh, we’re good.” The other thing is constipation can cause decreased signals to the brain. It kind of messes up the signaling. And so, if your child suffers from constipation, I would definitely, “Let’s treat that first and then work on habits.” A lot of poop in the rectum pushes up against the bladder. Also, not a good thing. So, I talk a lot about constipation.

Emily Oster:

I know you’re not a poop doctor specifically, but one of the things people ask a lot about is MiraLAX as a sort of standard treatment for constipation. And there’s this idea going around that it’s poisonous, which I don’t believe to be true-

Dr. Liza Aguiar:

It’s not, no.

Emily Oster:

… but I’d love your opinion.

Dr. Liza Aguiar:

So I think MiraLAX should be in the water. I think it… Yeah, if you have a child-

Emily Oster:

So, you’re not in the poison camp? Okay.

Dr. Liza Aguiar:

No, not in the poison camp. Absolutely not. I give it to my son every day, whether he is constipated or not. No pediatric urologist’s child is constipated. And if you need a little bit of MiraLAX to soften your stools, it’s perfectly safe. So, I’ve talked to my GI friends about this because there was one article to suggest neurocognitive issues and questioning the safety of MiraLAX. Really, it is safe. It is not poisonous, and I think it is perfectly appropriate to increase hydration and increase fiber in the diet. That’s always the right answer to start off with, but it’s okay if your child isn’t drinking the perfect amount of water a day that you add a little bit of MiraLAX in their drinks. And it doesn’t have to be a full cap full, and it can be like a teaspoon or a tablespoon.

Emily Oster:

Yeah. I think the thing people sometimes miss on this, I think you see in the data is that once kids get constipated, then they get afraid, then it’s painful, and then they get afraid. And so, the feedback there is very bad. So, even if you weren’t going to use it for a long period of time, getting past the initial constipation is really crucial.

Dr. Liza Aguiar:

Yes. One of the things that I wish parents knew even prior to potty-training, there are a few things, but one of them is that please do not start potty-training your child if they’re constipated. Because pain with pooping is such a strong trigger for children, and it creates, for some kids, fear of going to the bathroom, and not wanting to poop on the toilet and avoiding pooping and holding in your poop. And it takes a while to retrain and expose them enough to get back to, “Okay, pooping can be comfortable.” So, again, constipation is just a really important thing to consider. I would really aggressively treat that prior to even starting the potty-training process, which is sometimes not an obvious thing.

Emily Oster:

Yeah. No.

Dr. Liza Aguiar:

Oh, and in addition, during potty-training, if your child is prone to constipation, keep the MiraLAX on board or whatever you’re doing for constipation, because I can guarantee you they’re going to get constipated because this is just a whole new thing.

Emily Oster:

Okay. So, our last question is about nighttime potty training because this is, as I understand it, quite different than potty-training during the day, but there are a number of books about potty-training, which are quite specific about the need to do nighttime potty-training at the same time, including the book somebody had in the comments, the book, Oh Crap, says if you don’t potty-train at night by, whatever, three, your child’s muscles will start to atrophy. I mean, I don’t know which muscles, some of them probably urinary-related. So, what is your take on sort of nighttime potty-training, same time, later, do it aggressively?

Dr. Liza Aguiar:

Yeah, I get really confused about these recommendations, and I hear this all the time from parents too. It’s completely separate. It’s just a completely separate box than daytime training. Your child can be perfectly potty-trained during the day and still struggle with nighttime. What I tell parents is nighttime wetting is very common, and 20% of five-year-olds wet the bed, 10% of seven year olds wet the bed. So, it is something that comes later. It’s not something that you can actually train. It’s usually due to… It’s a little bit multifactorial, but it’s usually due to slightly smaller bladder capacity, maybe not having enough hormone in your system to reduce the amount of urine that you make at night, but most of the time it’s because they’re just really sound sleepers. There is a genetic component to all of this. If you have a family history of bedwetting than you’re more likely to be a bed-wetter, your child is more likely to be a bed-wetter. So, I tell parents, “I’m not really going to entertain aggressively treating bedwetting until seven at the minimum age.”

Emily Oster:

So, that’s where I want to be thinking about seven, eight as kind of the place where we start to talk about it.

Dr. Liza Aguiar:

That’s when the referrals process starts. Yeah, that’s when the referral process starts. Most pediatricians are comfortable with reassuring parents that if you have a family history, if you have these risk factors, then it might take a little longer, but really, it’s perfectly appropriate to see a pediatric urologist after that point. And what I talk about, usually, is these are your options. There are medications that help with potty-training, but they’re mostly band-aids, maybe used for sleepovers and/or camps. And then the dreaded bedwetting alarm, which is really the only thing that’s been proven to sort of nip the problem in the bud and get to the root of the problem, which I am not excited about using until there’s some buy-in from the patient. The patient has to be either bothered by the bedwetting and okay with somebody waking them up at night or something waking them up at night.

Emily Oster:

Yeah. I think what’s interesting about this with kids is that you can experience many of us had as parents is my kid was in a pull up until he was pretty old, and then just one day it was just was done. One day he just was like, “Okay, now I’ve kind of understood the idea of waking up,” and it happened two nights in a row and then he never peed in the bed. He never peed again.

Dr. Liza Aguiar:

Yeah, exactly. I mean, I think eventually that arousal system part of your brain gets a little bit more sensitive to your little bladder signal. I do think that there is some evidence to support perfecting… Think about daytime habits. So, there are things that you can’t control. And nighttime wetting is just something that I tell parents, “You really can’t control that.” But you can control daytime habits and there is evidence to suggest that perfecting daytime habits actually doesn’t solve nighttime problems, but sets your child up for success. So, if your child is holding during the day and ignoring those signals, not purposely, but just again, they have better things to do than go to the bathroom, then guess what? When they’re asleep, forget it. They’re never going to respond to those signals when they’re asleep. So, regular bathroom breaks during the day is something that can promote that ability to respond to those signals, and constipation.

Emily Oster:

And constipation. And so, just to reiterate this last point. Your view is basically if my kids wearing a pull-up, if they’re still peeing at night and I want to have them wear a pull-up until they’re five or six, that is a totally reasonable approach to the world?

Dr. Liza Aguiar:

Totally fine. Yeah, absolutely. I think you may want to consider… A lot of parents ask me, “When do I pull that pull-up? When do I take it away?” I would just for the sake of reducing the torture and the laundry load, I think expecting at least 50% dry nights is reasonable, at least just so we’re not going-

Emily Oster:

Doing the laundry every single…

Dr. Liza Aguiar:

… through the ups and downs. And it can be really discouraging for kids. It depends on how your child copes with setbacks and if you think that they’re not going to cope well then just keep the pull-up on, it’s fine.

Emily Oster:

Yeah. All right. Well, I feel like we could talk for a billion years, but I have a 30-minute Instagram Live rule because of people’s attention span. So, I’ll just say thank you so much and we will post this and we will post the audio in the podcast, and so we will have all kinds of ways for people to keep listening.

Dr. Liza Aguiar:

Thank you.

Emily Oster:

Thank you so much.

Dr. Liza Aguiar:

[inaudible].

Emily Oster:

Thank you everybody.

Thanks for listening. If you like what you heard, subscribe to ParentData in your favorite podcast app, and rate and review the show in Apple Podcasts. You can subscribe to the whole newsletter for free at www.parentdata.org. Talk to you soon.

Distressed toddler eating yogurt while sitting on a training potty and dressed as a bear.

Jan 16 2023

2 min read

What to Do About Chronic Constipation

And the scoop on Miralax

Emily Oster
A window in a house is lit up in the night with a full moon.

May 12 2023

2 min read

How Can I Nighttime Potty Train My Child?

My 6-year-old still needs a pull-up at night and sleeps so deeply he sometimes pees through his pull-up. Is this Read more

Emily Oster
Small child in pink dress sits on a toilet in a peach bathroom.

Jul 24 2023

4 min read

The Best Potty Training Advice

Many parents plan to potty train on a 3-week day weekend. If that's you, I hope you find this helpful! Read more

Emily Oster
A parent reads a phone on the toilet.

Nov 28 2023

9 min read

Everything You Need to Know About Poop

It struck me the other day how astonishingly imbalanced our discussion of digestion is. Think about how much time we Read more

Emily Oster

Instagram

left right
Exciting news! We have new, high-quality data that says it’s safe to take Tylenol during pregnancy and there is no link between Tylenol exposure and neurodevelopmental issues in kids. Comment “Link” for a DM to an article exploring this groundbreaking study.

While doctors have long said Tylenol was safe, confusing studies, panic headlines, and even a lawsuit have continually stoked fears in parents. As a result, many pregnant women have chosen not to take it, even if it would help them.

This is why good data is so important! When we can trust the data, we can trust our choices. And this study shows there is no blame to be placed on pregnant women here. So if you have a migraine or fever, please take your Tylenol.

#tylenol #pregnancy #pregnancyhealth #pregnancytips #parentdata #emilyoster

Exciting news! We have new, high-quality data that says it’s safe to take Tylenol during pregnancy and there is no link between Tylenol exposure and neurodevelopmental issues in kids. Comment “Link” for a DM to an article exploring this groundbreaking study.

While doctors have long said Tylenol was safe, confusing studies, panic headlines, and even a lawsuit have continually stoked fears in parents. As a result, many pregnant women have chosen not to take it, even if it would help them.

This is why good data is so important! When we can trust the data, we can trust our choices. And this study shows there is no blame to be placed on pregnant women here. So if you have a migraine or fever, please take your Tylenol.

#tylenol #pregnancy #pregnancyhealth #pregnancytips #parentdata #emilyoster
...

How many words should kids say — and when? Comment “Link” for a DM to an article about language development!

For this graph, researchers used a standardized measure of vocabulary size. Parents were given a survey and checked off all the words and sentences they have heard their child say.

They found that the average child—the 50th percentile line—at 24 months has about 300 words. A child at the 10th percentile—near the bottom of the distribution—has only about 50 words. On the other end, a child at the 90th percentile has close to 600 words. One main takeaway from these graphs is the explosion of language after fourteen or sixteen months. 

What’s valuable about this data is it can give us something beyond a general guideline about when to consider early intervention, and also provide reassurance that there is a significant range in this distribution at all young ages. 

#cribsheet #emilyoster #parentdata #languagedevelopment #firstwords

How many words should kids say — and when? Comment “Link” for a DM to an article about language development!

For this graph, researchers used a standardized measure of vocabulary size. Parents were given a survey and checked off all the words and sentences they have heard their child say.

They found that the average child—the 50th percentile line—at 24 months has about 300 words. A child at the 10th percentile—near the bottom of the distribution—has only about 50 words. On the other end, a child at the 90th percentile has close to 600 words. One main takeaway from these graphs is the explosion of language after fourteen or sixteen months.

What’s valuable about this data is it can give us something beyond a general guideline about when to consider early intervention, and also provide reassurance that there is a significant range in this distribution at all young ages.

#cribsheet #emilyoster #parentdata #languagedevelopment #firstwords
...

I saw this and literally laughed out loud 😂 Thank you @adamgrant for sharing this gem! Someone let me know who originally created this masterpiece so I can give them the proper credit.

I saw this and literally laughed out loud 😂 Thank you @adamgrant for sharing this gem! Someone let me know who originally created this masterpiece so I can give them the proper credit. ...

Perimenopause comes with a whole host of symptoms, like brain fog, low sex drive, poor energy, and loss of muscle mass. These symptoms can be extremely bothersome and hard to treat. Could testosterone help? Comment “Link” for a DM to an article about the data on testosterone treatment for women in perimenopause.

#perimenopause #perimenopausehealth #womenshealth #hormoneimbalance #emilyoster #parentdata

Perimenopause comes with a whole host of symptoms, like brain fog, low sex drive, poor energy, and loss of muscle mass. These symptoms can be extremely bothersome and hard to treat. Could testosterone help? Comment “Link” for a DM to an article about the data on testosterone treatment for women in perimenopause.

#perimenopause #perimenopausehealth #womenshealth #hormoneimbalance #emilyoster #parentdata
...

What age is best to start swim lessons? Comment “Link” for a DM to an article about water safety for children 💦

Summer is quickly approaching! You might be wondering if it’s the right time to have your kid start swim lessons. The AAP recommends starting between 1 and 4 years old. This is largely based on a randomized trial where young children were put into 8 or 12 weeks of swim lessons. They found that swimming ability and water safety reactions improve in both groups, and more so in the 12 weeks group.

Below this age range though, they are too young to actually learn how to swim. It’s fine to bring your baby into the pool (if you’re holding them) and they might like the water. But starting formal safety-oriented swim lessons before this age isn’t likely to be very helpful.

Most importantly, no matter how old your kid is or how good of a swimmer they are, adult supervision is always necessary!

#swimlessons #watersafety #kidsswimminglessons #poolsafety #emilyoster #parentdata

What age is best to start swim lessons? Comment “Link” for a DM to an article about water safety for children 💦

Summer is quickly approaching! You might be wondering if it’s the right time to have your kid start swim lessons. The AAP recommends starting between 1 and 4 years old. This is largely based on a randomized trial where young children were put into 8 or 12 weeks of swim lessons. They found that swimming ability and water safety reactions improve in both groups, and more so in the 12 weeks group.

Below this age range though, they are too young to actually learn how to swim. It’s fine to bring your baby into the pool (if you’re holding them) and they might like the water. But starting formal safety-oriented swim lessons before this age isn’t likely to be very helpful.

Most importantly, no matter how old your kid is or how good of a swimmer they are, adult supervision is always necessary!

#swimlessons #watersafety #kidsswimminglessons #poolsafety #emilyoster #parentdata
...

Can babies have salt? 🧂 While babies don’t need extra salt beyond what’s in breast milk or formula, the risks of salt toxicity from normal foods are minimal. There are concerns about higher blood pressure in the long term due to a higher salt diet in the first year, but the data on these is not super compelling and the differences are small.

Like with most things, moderation is key! Avoid very salty chips or olives or saltines with your infant. But if you’re doing baby-led weaning, it’s okay for them to share your lightly salted meals. Your baby does not need their own, unsalted, chicken if you’re making yourself a roast. Just skip the super salty stuff.

 #emilyoster #parentdata #childnutrition #babynutrition #foodforkids

Can babies have salt? 🧂 While babies don’t need extra salt beyond what’s in breast milk or formula, the risks of salt toxicity from normal foods are minimal. There are concerns about higher blood pressure in the long term due to a higher salt diet in the first year, but the data on these is not super compelling and the differences are small.

Like with most things, moderation is key! Avoid very salty chips or olives or saltines with your infant. But if you’re doing baby-led weaning, it’s okay for them to share your lightly salted meals. Your baby does not need their own, unsalted, chicken if you’re making yourself a roast. Just skip the super salty stuff.

#emilyoster #parentdata #childnutrition #babynutrition #foodforkids
...

Is sleep training bad? Comment “Link” for a DM to an article breaking down the data on sleep training 😴

Among parenting topics, sleep training is one of the most divisive. Ultimately, it’s important to know that studies looking at the short- and long-term effects of sleep training show no evidence of harm. The data actually shows it can improve infant sleep and lower parental depression.

Even so, while sleep training can be a great option, it will not be for everyone. Just as people can feel judged for sleep training, they can feel judged for not doing it. Engaging in any parenting behavior because it’s what’s expected of you is not a good idea. You have to do what works best for your family! If that’s sleep training, make a plan and implement it. If not, that’s okay too.

What’s your experience with sleep training? Did you feel judged for your decision to do (or not do) it?

#sleeptraining #newparents #babysleep #emilyoster #parentdata

Is sleep training bad? Comment “Link” for a DM to an article breaking down the data on sleep training 😴

Among parenting topics, sleep training is one of the most divisive. Ultimately, it’s important to know that studies looking at the short- and long-term effects of sleep training show no evidence of harm. The data actually shows it can improve infant sleep and lower parental depression.

Even so, while sleep training can be a great option, it will not be for everyone. Just as people can feel judged for sleep training, they can feel judged for not doing it. Engaging in any parenting behavior because it’s what’s expected of you is not a good idea. You have to do what works best for your family! If that’s sleep training, make a plan and implement it. If not, that’s okay too.

What’s your experience with sleep training? Did you feel judged for your decision to do (or not do) it?

#sleeptraining #newparents #babysleep #emilyoster #parentdata
...

Does your kid love to stall right before bedtime? 💤 Tell me more about their tactics in the comments below!

#funnytweets #bedtime #nightimeroutine #parentinghumor #parentingmemes

Does your kid love to stall right before bedtime? 💤 Tell me more about their tactics in the comments below!

#funnytweets #bedtime #nightimeroutine #parentinghumor #parentingmemes
...

Got a big decision to make? 🤔 Comment “Link” for a DM to read about my easy mantra for making hard choices. 

When we face a complicated problem in pregnancy or parenting, and don’t like either option A or B, we often wait around for a secret third option to reveal itself. This magical thinking, as appealing as it is, gets in the way. We need a way to remind ourselves that we need to make an active choice, even if it is hard. The mantra I use for this: “There is no secret option C.”

Having this realization, accepting it, reminding ourselves of it, can help us make the hard decisions and accurately weigh the risks and benefits of our choices.

#parentingquotes #decisionmaking #nosecretoptionc #parentingadvice #emilyoster #parentdata

Got a big decision to make? 🤔 Comment “Link” for a DM to read about my easy mantra for making hard choices.

When we face a complicated problem in pregnancy or parenting, and don’t like either option A or B, we often wait around for a secret third option to reveal itself. This magical thinking, as appealing as it is, gets in the way. We need a way to remind ourselves that we need to make an active choice, even if it is hard. The mantra I use for this: “There is no secret option C.”

Having this realization, accepting it, reminding ourselves of it, can help us make the hard decisions and accurately weigh the risks and benefits of our choices.

#parentingquotes #decisionmaking #nosecretoptionc #parentingadvice #emilyoster #parentdata
...

Excuse the language, but I have such strong feelings about this subject! Sometimes, it feels like there’s no winning as a mother. People pressure you to breastfeed and, in the same breath, shame you for doing it in public. Which is it?!

So yes, they’re being completely unreasonable. You should be able to feed your baby in peace. What are some responses you can give to someone who tells you to cover up? Share in the comments below ⬇️

#breastfeeding #breastfeedinginpublic #breastfeedingmom #motherhood #emilyoster

Excuse the language, but I have such strong feelings about this subject! Sometimes, it feels like there’s no winning as a mother. People pressure you to breastfeed and, in the same breath, shame you for doing it in public. Which is it?!

So yes, they’re being completely unreasonable. You should be able to feed your baby in peace. What are some responses you can give to someone who tells you to cover up? Share in the comments below ⬇️

#breastfeeding #breastfeedinginpublic #breastfeedingmom #motherhood #emilyoster
...

Potty training can feel like a Mount Everest-size challenge, and sadly, our evidence-based guidance is poor. So, I created a survey to collate advice and feedback on success from about 6,000 participants.

How long does potty training take? We found that there is a strong basic pattern here: the later you wait to start, the shorter time it takes to potty train. On average, people who start at under 18 months report it takes them about 12 weeks for their child to be fully trained (using the toilet consistently for both peeing and pooping). For those who start between 3 and 3.5, it’s more like nine days. Keep in mind that for all of these age groups, there is a range of length of time from a few days to over a year. Sometimes parents are told that if you do it right, it only takes a few days. While that is true for some people, it is definitely not the norm.

If you’re in the throes of potty training, hang in there! 

#emilyoster #parentdata #pottytraining #pottytrainingtips #toddlerlife

Potty training can feel like a Mount Everest-size challenge, and sadly, our evidence-based guidance is poor. So, I created a survey to collate advice and feedback on success from about 6,000 participants.

How long does potty training take? We found that there is a strong basic pattern here: the later you wait to start, the shorter time it takes to potty train. On average, people who start at under 18 months report it takes them about 12 weeks for their child to be fully trained (using the toilet consistently for both peeing and pooping). For those who start between 3 and 3.5, it’s more like nine days. Keep in mind that for all of these age groups, there is a range of length of time from a few days to over a year. Sometimes parents are told that if you do it right, it only takes a few days. While that is true for some people, it is definitely not the norm.

If you’re in the throes of potty training, hang in there!

#emilyoster #parentdata #pottytraining #pottytrainingtips #toddlerlife
...

For children or adults with severe food allergies, they can be incredibly scary and restrictive. We may imagine that it’s easy to deal with a peanut allergy by, say, not eating peanut butter sandwiches. But for someone with a severe version of this allergy, they may never be able to go to a restaurant, for fear of a severe reaction to something in the air. Right now, there’s only one approved treatment for severe allergies like this and it’s limited to peanuts.

This is why the new medication Xolair is very exciting. It promises a second possible treatment avenue and one that works for other allergens. A new trail analyzed data from 177 children with severe food allergies. Two-thirds of the treatment group were able to tolerate the specified endpoint, versus just 7% of the placebo group. This is a very large treatment effect, and the authors found similarly large impacts on other allergens. 

There are some caveats: This treatment won’t work for everyone. (One-third of participants did not respond to it.) Additionally, this treatment is an injection given every two to four weeks, indefinitely. This may make it less palatable to children. 

Overall, even with caveats, this is life-changing news for many families!

#xolair #foodallergies #allergies #peanutallergy #emilyoster #parentdata

For children or adults with severe food allergies, they can be incredibly scary and restrictive. We may imagine that it’s easy to deal with a peanut allergy by, say, not eating peanut butter sandwiches. But for someone with a severe version of this allergy, they may never be able to go to a restaurant, for fear of a severe reaction to something in the air. Right now, there’s only one approved treatment for severe allergies like this and it’s limited to peanuts.

This is why the new medication Xolair is very exciting. It promises a second possible treatment avenue and one that works for other allergens. A new trail analyzed data from 177 children with severe food allergies. Two-thirds of the treatment group were able to tolerate the specified endpoint, versus just 7% of the placebo group. This is a very large treatment effect, and the authors found similarly large impacts on other allergens.

There are some caveats: This treatment won’t work for everyone. (One-third of participants did not respond to it.) Additionally, this treatment is an injection given every two to four weeks, indefinitely. This may make it less palatable to children.

Overall, even with caveats, this is life-changing news for many families!

#xolair #foodallergies #allergies #peanutallergy #emilyoster #parentdata
...

If you have a fever during pregnancy, you should take Tylenol, both because it will make you feel better and because of concerns about fever in pregnancy (although these are also overstated).

The evidence that suggests risks to Tylenol focuses largely on more extensive exposure — say, taking it for more than 28 days during pregnancy. There is no credible evidence, even correlational, to suggest that taking it occasionally for a fever or headache would be an issue.

People take Tylenol for a reason. For many people, the choice may be between debilitating weekly migraines and regular Tylenol usage. The impacts studies suggest are very small. In making this decision, we should weigh the real, known benefit against the suggestion of this possible risk. Perhaps not everyone will come out at the same place on this, but it is crucial we give people the tools to make the choice for themselves.

#emilyoster #parentdata #tylenol #pregnancy #pregnancytips

If you have a fever during pregnancy, you should take Tylenol, both because it will make you feel better and because of concerns about fever in pregnancy (although these are also overstated).

The evidence that suggests risks to Tylenol focuses largely on more extensive exposure — say, taking it for more than 28 days during pregnancy. There is no credible evidence, even correlational, to suggest that taking it occasionally for a fever or headache would be an issue.

People take Tylenol for a reason. For many people, the choice may be between debilitating weekly migraines and regular Tylenol usage. The impacts studies suggest are very small. In making this decision, we should weigh the real, known benefit against the suggestion of this possible risk. Perhaps not everyone will come out at the same place on this, but it is crucial we give people the tools to make the choice for themselves.

#emilyoster #parentdata #tylenol #pregnancy #pregnancytips
...

Parenting trends are like Cabbage Patch Kids: they’re usually only popular because a bunch of people are using them! Most of the time, these trends are not based on new scientific research, and even if they are, that new research doesn’t reflect all of what we’ve studied before.

In the future, before hopping onto the latest trend, check the data first. Unlike Cabbage Patch Kids, parenting trends can add a lot of unnecessary stress and challenges to your plate. What’s a recent trend that you’ve been wondering about?

#parentdata #emilyoster #parentingtips #parentingadvice #parentinghacks

Parenting trends are like Cabbage Patch Kids: they’re usually only popular because a bunch of people are using them! Most of the time, these trends are not based on new scientific research, and even if they are, that new research doesn’t reflect all of what we’ve studied before.

In the future, before hopping onto the latest trend, check the data first. Unlike Cabbage Patch Kids, parenting trends can add a lot of unnecessary stress and challenges to your plate. What’s a recent trend that you’ve been wondering about?

#parentdata #emilyoster #parentingtips #parentingadvice #parentinghacks
...

As of this week, 1 million copies of my books have been sold. This feels humbling and, frankly, unbelievable. I’m so thankful to those of you who’ve read and passed along your recommendations of the books.

When I wrote Expecting Better, I had no plan for all of this — I wrote that book because I felt compelled to write it, because it was the book I wanted to read. As I’ve come out with more books, and now ParentData, I am closer to seeing what I hope we can all create. That is: a world where everyone has access to reliable data, based on causal evidence, to make informed, confident decisions that work for their families.

I’m so grateful you’re all here as a part of this, and I want to thank you! If you’ve been waiting for the right moment to sign up for full access to ParentData, this is it. ⭐️ Comment “Link” for a DM with a discount code for 20% off of a new monthly or annual subscription to ParentData! 

Thank you again for being the best community of readers and internet-friends on the planet. I am so lucky to have you all here.

#parentdata #emilyoster #expectingbetter #cribsheet #familyfirm #parentingcommunity

As of this week, 1 million copies of my books have been sold. This feels humbling and, frankly, unbelievable. I’m so thankful to those of you who’ve read and passed along your recommendations of the books.

When I wrote Expecting Better, I had no plan for all of this — I wrote that book because I felt compelled to write it, because it was the book I wanted to read. As I’ve come out with more books, and now ParentData, I am closer to seeing what I hope we can all create. That is: a world where everyone has access to reliable data, based on causal evidence, to make informed, confident decisions that work for their families.

I’m so grateful you’re all here as a part of this, and I want to thank you! If you’ve been waiting for the right moment to sign up for full access to ParentData, this is it. ⭐️ Comment “Link” for a DM with a discount code for 20% off of a new monthly or annual subscription to ParentData!

Thank you again for being the best community of readers and internet-friends on the planet. I am so lucky to have you all here.

#parentdata #emilyoster #expectingbetter #cribsheet #familyfirm #parentingcommunity
...

Just eat your Cheerios and move on.

Just eat your Cheerios and move on. ...

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide

The AAP’s guidelines recommend sleeping in the same room as your baby “ideally for the first six months.” However, the risk of SIDS is dramatically lower after four months, and the evidence in favor of the protective effect of room sharing is quite weak (both overall and even more so after four months). There is also growing evidence that infants who sleep in their own room by four months sleep better at four months, better at nine months, and even better at 30 months.

With this in mind, it’s worth asking why this recommendation continues at all — or at least why the AAP doesn’t push it back to four months. They say decreased arousals from sleep are linked to SIDS, which could mean that babies sleeping in their own room is risky. But this link is extremely indirect, and they do not show direct evidence to support it.

According to the data we have, parents should sleep in the same room as a baby for as long as it works for them! Sharing a room with a child may have negative impacts on both child and adult sleep. We should give families more help in navigating these trade-offs and making the decisions that work best for them.

#emilyoster #parentdata #roomsharing #sids #parentingguide
...

It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents

It was an absolute pleasure to be featured on the @tamronhallshow! We talked about all things data-driven parenting and, in this clip, what I call the plague of secret parenting. To balance having a career and having a family, we can’t hide the fact that we’re parents. If mothers and fathers at the top can speak more openly about child-care obligations, it will help us all set a new precedent.

Watch the full segment at the link in my bio 🔗

#tamronhall #tamronhallshow #emilyoster #parentingsupport #workingparents
...