Welcome to the Health Visitor advice page. On this page you will answers to some common frequently asked questions (FAQs) by parents and carers.
A common issue parents may face is Headbanging, and this is usually a phase that will pass.
Head banging is when a child knocks their head on a solid object (e.g. a wall or bars of a cot). They may also rock their whole upper body at the same time. It may happen when they are tired, in their sleep, or during a temper tantrum.
How common is headbanging?
Head banging is very common. It is thought that up to 20% of healthy children head bang during the first few years. It is a normal developmental process. It usually begins towards the end of the first year. It can then peak between 18 and 24 months and ease off by around four years of age.
Is it harmful?
It is unlikely to be harmful. Children don’t tend to engage in habits to injure themselves. It is unlikely they will bang their head hard enough to cause pain or brain injury. It won’t affect their development.
It can look and sound violent. However, many experts suggest that head banging provides children with a sensation similar to what they experienced in the uterus (i.e., when they were constantly rocked and jostled). Toddlers love movement (e.g., jumping, tumbling, and being swung).
Why do children head bang?
There are several reasons:
- Comfort: The rhythmic movement may be a comfort mechanism similar to rocking
- Balance: It can test brain systems and improve balance
- Stimulation: Children may head bang for stimulation
- Self-soothing and Relaxation: Head banging can be a way to release tension (e.g., to help sleep)
- Distraction: Some young children may head-bang for relief if they are teething or suffering from an ear infection
- Attention: If your child is frustrated or angry, head banging may become part of a temper tantrum. The more attention they receive for doing it, the more likely they will repeat it
What is the best way to deal with it?
As long as your child is healthy and developing normally, the best way to deal with head banging is to ignore it. Keep your child safe by moving them away from any sharp edges etc.
Giving the action attention will worsen the habit, especially if it occurs during tantrums. Distracting them with a toy or offering a drink may stop them. If it is occurring during a tantum, try to nip in the bud with your distraction techniques.
If your baby sleeps in a cot, regularly check the bolts and screws aren’t being loosened. Attaching a piece of foam rubber to the wall will reduce noise. If your toddler sleeps in a bed, move it away from the wall.
Positive paise (suitable from birth) is the best way to reinforce your child’s good behaviours and this can really help reduce the unwanted behaviours, such as biting and headbanging.
Praise helps your child feel good about themselves. It works better at encouraging the behaviour you want than criticising and punishing your child for problem behaviour. It helps your child feel good about themselves and feel good about you.
Praise is when you tell your baby, toddler or child what you like about them or their behaviour. Praise will also encourage your baby or child to learn new skills. When you praise your child or baby for positive behaviour or learning a new skill, then they’re more likely to repeat it.
Giving praise also helps you build a good relationship with your child, which will make you and your child happier. Research has shown that children who are close and have a good supportive relationship with their Mum or Dad have higher self-esteem and are more successful in school and beyond. To learn more about praise, watch or listen to the video below.
Food refusal is a normal phase that most toddlers pass through. Fear of new foods in the second year may be a survival mechanism to prevent increasingly mobile toddlers from poisoning themselves through eating anything and everything.
Toddlers may limit the variety of foods they eat. This phase will normally pass without any problems but remember this phase may last for a few years and will be more evident in some toddlers than in others.
Your toddler may refuse a food if it is new to them. They need to taste it a few times to learn to like it, so always offer it the next time you are eating it. They may also refuse a food that they have eaten before, if it doesn’t look right.
Some toddlers are more likely to refuse foods than others, even in the same family.
Toddlers refuse extra food when they have eaten enough and may be self-regulating how much food they want, which is a good thing! Remember that the quantity of food toddlers eat may vary from day-to-day. Some parents get anxious about this, and toddlers then tend to react to parental anxiety by reducing intake.
For more information, read Why Toddlers Refuse Food: Guidance & Tips for Parents (pdf).
Your toddler may eat less food than other toddlers of the same age. If your toddler is growing and developing normally then he or she is taking the right quantity of food for his or her own needs. If you are concerned, then you can always book a weight and height check at a Starting Well Open Advice Clinic. We often offer too much food as a portion size, so watch or listen to the video below to find out some top tips for portion size.
Toddlers may also lose their appetite if they are:
- not feeling well
- shouted at
- pressured to eat more food when they have had enough
- pressured to eat food they dislike
- frequently offered foods that they dislike or find disgusting
- continually offered food and drinks throughout the day
- rushed at mealtimes
- feeling sad, lonely, anxious or insecure
For most toddlers fussy eating is just a phase that they eventually pass through.
However, if the problem persists or you have some concerns, speak to the Starting Well Team or GP. They will be able to check your child’s growth and development.
What can I do?
Here are some ideas which may help:
- Let your child decide how much to eat. Toddlers have small stomachs and can’t eat much food at one time. Give them small portions and praise them for eating, even if they only manage a little. Offer healthy snacks, like fruit, between meals.
- It isn’t always easy to get the family to sit down to enjoy a meal together. But it is worth the effort. Sharing family meals gives everyone a chance to catch up and enjoy each other’s company. Watching you and other family members eat a range of foods can encourage your child to try new foods. Research suggests that children who have meals with their family do better in lots of ways, including being healthy and doing well at school.
- Offer your child a few different things to eat on their plate to encourage them to eat. You may be tempted to offer your child treats just so they ‘eat something’. If you offer fatty, sugary or salty snacks instead of healthy foods your child may become fussier because they know they will be offered other options.
- It helps to have meal times at a similar time every day. Try to have meals before your child gets too hungry or tired to eat.
- Your child may not eat the same amount each time. Just like you, some days your child will be hungry and other times they will be less hungry.
- Get your child involved in preparing the meal. Your child will love doing this and it may help them to try new food.
- Let toddler’s feed themselves. Give a toddler finger food (cut food into strips or fingers) and let your child use their hands rather than a spoon or fork. In the early days of learning to eat, your child will find this easier to manage.
- Let older children serve themselves and have limited choices – “do you want broccoli or green beans?”.
- Give them the same food in a different way. Your child may refuse cooked carrots but enjoy raw carrots cut into sticks.
- Ignore the fussing as much as you can. If you give your child lots of attention when they are fussy or refusing food, it may encourage them to keep behaving that way. Instead, be positive and calm and praise them when trying new foods.
- Avoid distractions. Try to switch off the TV and eat at the table away from their toys or other distractions.
- Handle accidents in a calm way. Your child’s skills are still developing, so spills are likely to happen. Meal time messes will be easier to clean up if you put some plastic or newspaper under your child’s highchair.
Biting (suitable for 6 months - 3 years)
Most children go through a phase where they will bite another child or their Mum and Dad.
They do not understand that they will hurt someone if they bite. Luckily this is usually just a phase and doesn’t mean your child is aggressive or has any behaviour issues.
As your child develops they will learn that biting hurts people.
They will also learn the words and coping skills to express and manage their strong feelings.
Your child might bite because they are:
- exploring things and people (babies and toddlers use their mouths to explore)
- frustrated, excited or angry and don’t have the words to express themselves
- wanting your attention
- over tired
- responding to another child’s aggressive behaviour
- copying others
- worried or anxious about a change in their life like a new baby or house move
- interested in the reaction they get and don’t understand it causes pain.
Tips for dealing with your child’s biting
Stay calm. Don’t smack or bite your toddler back. This will hurt your child and give them the wrong message that this behaviour is ok.
If your child bites you:
- Calmly say something like “No biting. I don’t like that – it hurt me.”
- Put them slightly away from you briefly.
- After a minute pick your child up again.
- Praise your child when you see them being kind to you, another child or adult. They will learn this is the behaviour you want to see
If they bite another child:
- Say something like “No biting, it hurts”. Comment on how the other child is feeling: “Look, Jack is crying. He is crying because you bit him”.
- Tell them what you want to see “We use gentle hands”.
- Move your child away from the game they were playing for a few minutes.
- Praise your child when you see them being kind to another child. They will learn this is the behaviour you want to see.
Have lots of safe objects for biting, for example teething rings or crunchy snacks (like plain crackers, carrot sticks or apple pieces).
- Try to anticipate trouble and move your child before they bite.
- Give your child some simple choices, for example “red top or blue top?”, “apple or banana?” If you give your child some choices they will feel a sense of control. This may help reduce biting.
- Help your child express their feelings. Label your toddler’s feelings when you observe them, for example when you see that they are happy, sad, cross, disappointed or frustrated. It will help them learn the word for that feeling or emotion so they are able to learn to express how they feel later.
- Make time for active play every day. Go to the park, play in the garden or put some music on and dance. This will reduce your child’s anger and frustration.
- Try to avoid stressful activities or places where there will be lots of other children on days when your child is very tired.
This video talks about biting as well as other common behaviours in the early years and explains why it happens and how we can manage it as parents.
It can be messy!
There will be accidents!
How do I know if my child is ready to be toilet trained?
Potty or toilet training is an important milestone for your child but learning to gain control of your bowel and bladder can be a complicated process and your child needs to be emotionally and physically ready to potty train such as being physically able to sit themselves on the potty and be able to stand up when they’ve finished.
If your child can follow instructions and let you know what they want or need, that could also be a sign of readiness. It has to be the right time for toilet training to start; when you can devote lots of time and effort to it. If you’re moving house or there’s a new baby on the way, it’s probably not the best time to start teaching your child to use the potty
When to Start
All children are different and when to start potty training will depend on the individual child. Every child is different; they learn to walk and talk at different times and they learn how to use the toilet at different times too. However, most children are ready to be potty trained between 18 months and 3 years old. You know your child better than anyone else so don’t feel you have to start potty training just because other people think you should.
It helps to keep track of your child’s wee and poo habits and get an idea of how many times a day they go for a wee and poo. Babies do lots of little wees but as their bladder develops it learns to store more so toddlers do fewer, bigger wees. If they can stay dry for an hour or two, they are ready for potty training as their bladder is storing more wee and developing control.
It can be hard to tell if a child is wet as disposable nappies are so good at soaking up wee and keeping it off the skin. A good tip is to put some folded kitchen paper into the nappy which will stay wet when they do a wee. As well as letting you know when they’ve done a wee, it may also help your child connect the feeling of being wet with weeing.
If your child starts to notice when they’ve done a wee or a poo it means they are starting to learn the signals their body is giving them – a great time to get ready for potty training.
Check out this video on ways you can see if your child is ready!
How do I get my child ready for potty training?
It helps if you can:
- Get your child involved with changing their nappies. Change them standing up, get them to help with their clothing and wash your hands together when you've finished.
- Talk about wee and poo. Tell them if their nappy is wet or dry when you change them and talk about the wee or poo inside.
- Keep the nappies in the toilet and change your child in there so they associate wees and poos with that room.
- Plan a reward system like a sticker chart or lucky dip bag. Reward every little step towards potty training like getting dressed or washing their hands.
- Read picture books about potty training together. There are lots of great books out there !
- Show that you do wees and poos too! Leave the toilet door open and ask family members to do the same. Young children learn by watching and copying.
Children with additional needs can be potty trained too but it may take longer - see the link’s below for more support with this. You’ll want to plan carefully and prepare in the same way.
READY. SET. GO!
Get a potty or a toilet seat and step for your bathroom and practice with your child. Sit them on the potty or toilet in the bathroom (just get them used to sitting on it and relaxing first - we often skip this step !) and do all nappy changes there too standing up. Involve your child in the process as much as possible. This is how they will learn independence.
Top tips for potty training
- Make sure your child is not constipated: Your child should pass soft stools at least four times a week. If they are passing fewer poos than this and /or harder poos they may be constipated. Leaking, runny poo can also mean constipation……
- Don’t limit drinks to help them stay dry: This doesn’t work. The bladder needs to be filled and emptied to behave properly.
- What should your child drink? Water is best and aim for a minimum of 6-8 drinks every day to keep the bladder and the bowel healthy.
- Use pants: Today’s disposable nappies soak up the wee really well and you can’t potty train in a nappy or a pull up so make the move to pants and just wear a nappy at night (nightime may take a bit longer) and make the underwear colourful and fun – involve your child with this process and if you can get some with their favourite characters on the pants even better! Buy lots also as they will have accidents. Don’t use pull ups, they are just a different shaped version of a nappy so just choose a day and stop using them. If it's not possible to remove the nappy, use a liner so that the child will still feel wet.
- Let the child be involved with buying the potty, choosing the type or colour of the potty if possible and keep in the bathroom. Or invest in a family toilet seat and use a stool if using the toilet (so they feel supported when sitting). Make sure the room where your child is using the potty or bathroom is kept warm and inviting and keep tissues next to the potty also. You could also get a second potty if your only bathroom is upstairs.
- Build up a routine - don’t ask your child if they need a wee or a poo as they probably haven’t learnt to recognise that yet - simply say its ‘potty time’ every couple of hours
- Clothes - choose ones that are easy to pull up and down – avoid zips and buttons and practice getting dressed and undressed. Choose clothes that are easy to wash as accidents WILL happen.
- Make it fun - use a sticker chart (with one of your childs favourite characters if you can), rewards need to be small and instant and make the tasks achievable - such as a reward for sitting on the potty initially rather than staying clean and dry
- Use the bathroom together whenever possible - make it a special time for you both. The whole experience will be much more positive if you invest time to learn together. Have a toilet toy/bag of toys, which is kept by the potty/toilet, so they can remain happy to sit on for 2-3 minutes.
- What if the child will only poo in a nappy? In the short term if they ask for a nappy to do their poo, I would them let them. Otherwise they are likely to hold onto their poo and the vicious cycle of constipation will begin. Some children are frightened of the poo falling into the potty or toilet. Give them lots of reassurance but be firm that the place poos happen is in the bathroom. Involve them in bottom wiping and emptying the nappy into the toilet and saying bye to the poo. Aim to gradually move them to removing the nappy - first by sitting on the potty with the nappy on and then loosening the nappy a little more each day, moving it away from their bottom bit by bit.
- Wiping - can take time - show your child how much paper to use and how to get clean and give lots of encouragement. Flushable wet wipes and coloured patterned toilet paper can help.
- Going out - when you have made some progress at home - make sure you go out in pants ( rather than a nappy). Keep the trips short and make sure you have access to a toilet and take everything you need - potty, wipes, change of clothes as accidents WILL happen.
- Accidents are very very normal and just part of the learning process - just deal with the accident calmly and praise your child when they get it right! If you do decide that they are not ready then don’t chop and change just have a break for a couple of weeks and restart with new enthusiasm.
- Night-time - when your child is reliably dry during the day you can start to think about night time. Watch out for dry nappies and get your child used to stopping drinks an hour before bed and sitting on the potty/toilet before sleep and when they wake up. Protect the bed with a waterproof sheet, put a gentle light by the bed and practice going to the potty or toilet. Make sure your child can pull their pyjamas up and down. Some children take longer to learn to have nightime dryness - if bedwetting persists – you can always contact the Starting Well Service for advice.
GOOD LUCK - IF YOU NEED ANY EXTRA SUPPORT YOU CAN ALWAYS CONTACT THE HEALTH VISITOR DUTY TEAM
Helpful videos for toilet training
Start brushing your baby's teeth as soon as the first milk tooth breaks through (usually at around 6 months, but it can be earlier or later).
It's important to use a fluoride toothpaste, as this helps prevent and control tooth decay.
- Use fluoride toothpaste containing levels of fluoride between 1,350ppm and 1,500ppm to give your children's teeth the best protection.
- Brush teeth twice daily for about 2 minutes.
- Brush last thing at night before bed and on 1 other occasion.
- For children aged 0-3 use only a smear of toothpaste on their brush.
- For children aged 3-6 use a peasize amount of toothpaste on their brush.
- Make sure children don't eat or lick toothpaste from the tube.
- Babies and children should visit the dentist twice a year.