Stage 1 Baby Food: When to Start, Recipes, and More

The first few years of a child’s life are an exciting time.

Their bodies go through so many changes, and it’s important to not only stay on top of things but also make sure they’re getting everything they need to fully realize their potential. Food is just one of the ingredients for a healthy child—albeit a very important ingredient.

Especially during the first few years of rapid development, it can be difficult to gauge what your child should be eating, what they are eating, and if you’re doing enough to introduce them to a wide-enough range of foods and nutrients.

While every child is different to some extent, their chronological age should tell you enough about where they should be when it comes to weaning off of breast milk. If you feel confident that your child can move onto the first stage of eating solid foods, there’s a number of things to remember when it comes to safety.

Finally, we’ll look at some recipes for your baby’s first foods, and how you know when your child is ready for stage 2.

From Breast Milk to Stage 3

While there are some basic guidelines in terms of appropriate food and age, there is no one-size-fits-all guide for introducing different children to solid foods.

There are, however, some fundamental principles to keep in mind when trying to make the switch.

Babies will, in general, be completely fine with breast milk up until 12 months of age. While the stages begin at 4 to 6 months, introducing your child to solid foods is less about nutrition and more about “wading into” the world of food that’s not breast milk. This means developing the baby’s interest in new tastes along with their oral motor functionality.

Especially when it comes to stage 1 baby food (but this is still true all the way up to 12 months), the primary source of nutrition will come from the breast milk. This is why it’s important to frame baby food as merely supplementary to breast to milk, rather than an alternative.

When first introducing a child to solids, it should be seen as more of a snack. Most ingestion should still come from the standard 24 to 32 ounces of breast milk or formula a day. Baby food will only probably amount to 3 to 4 tablespoons only once or twice per day.

The Stages and the Foods

While we’ll be focusing on stage 1 baby food here, it’s a good idea to see how it fits into the greater scheme of things. A very rough rundown of the 3 stages looks like this:

Stage 1: Purees, not much thicker than breast milk or formula beginning from 4 to 6 months.

Stage 2: Thicker consistency than stage 1, beginning at 6 to 9 months.

Stage 3: Food can include easily chewable chunks, beginning at 10 to 12 months.

While we’ll go through some good food choices down below for purees, the emphasis is on the texture rather than the contents.

One should always avoid honey in the first 12 months of life in order to avoid the risk of infantile botulism and it’s a good idea to focus on foods that are low on the allergy index. However, other than these two points, the baby food can be made out of almost anything—as long as it’s smooth, lacks chunks, and is relatively thin and watery.

It is true that in the past new parents were advised to start their children off with cereals made consisting of single grains, but thinking has changed since then and we’ve learned that it doesn’t really make a difference in what order you introduce children to food. As long as the texture is correct.

Stage 1: Baby Food 101

“So, what exactly is stage 1 baby food?”, you might be asking. Like we’ve mentioned above, they’re very thin when it comes to consistency. Furthermore, they also only contain one single ingredient and are very smooth without any chunks at all.

You can either buy them or make them at home (since the single-ingredient aspect makes things pretty easy).

And while babies can begin solids as early as 4 months in some cases, it’s a good idea to wait till 6 months. But all children are different, and if you have doubts about whether your child should be starting eating solids, it’s a good idea to consult with a pediatrician.

Remember that breast milk and formulas are much better when it comes to providing the necessary nutrients to babies. Food isn’t necessarily needed (in most cases) in the first 12 months of life. However, there is a reason that the 6-month mark is usually chosen for beginning solid food feeding.

Iron is a mineral that’s essential when it comes to brain development, and every infant builds up a store of it in their bodies during pregnancy. As their life progresses, their iron stores also deplete. While formula and breast milk are excellent sources of iron as well, it can be beneficial to boost their brain development with some supplementary sources of iron with iron-rich baby purees.

On the other hand, however, there are also risks associated with starting solid food feeding too early. Not only will the baby probably not be too interested in solid foods at too young of age but offering solid food too early has also been associated with excessive fat gain in older years. “Too early” in this case means a 4-month-old baby or younger.

How to Know When a Child is Ready to Start Stage 1

While chronological ages are a good general tool, they’re often too simplistic when it comes to gauging all the intricacies that make an individual, individual. This is why it’s important to supplement your feeding decisions not only with age but also with other developmental and social cues.

The best way to see if your child is ready to begin eating baby food puree is to notice whether they seem to be interested in everyone else’s food. If, whenever you’re eating near your child, they seem to be staring at your food—that’s a good indication that they’re ready to move onto something other than breast milk or formula.

Another sign is if they’re able to sit upright with minimal (or no) support, or if they can hold their head up with relative ease and stability.

Both of these points also play into the safety of introducing your child to solid foods.

Lastly, they should actually be able to accept a spoon (or a finger with your baby’s food on it) into their mouths. While a seemingly obvious requirement, babies do have an involuntary reflex during about the first four months of their lives. This reflex causes them to use their tongues to push out anything that enters their mouth.

Keeping Safety in Mind

When it comes to nutritional safety, keep in mind that milk still reigns supreme. Especially when just starting out with solids, make sure not to give to many “meals” per day. Your baby is still far off from the classic 3-meal day, and stage 1 baby food should be thought of as a snack rather than a meal.

Furthermore, when you’re introducing a new type of food to your baby (in puree form), it’s important to wait for 3 to 4 days between each new introduction.

This is so you can probably gauge any adverse affects the foods might have. If a child has been fed 4 or 5 different new foods in the span of 2 days, it’s going to be much more difficult to find out which food it was that caused the reaction.

A couple more safety tips include:

  • Keep in mind that the child should be sitting in an upright position, so as to lower the possibility of choking.
  • Don’t put solid foods inside of a bottle—either use a spoon or your finger.
  • And of course, no honey before the age of 12 months!

Keeping these things in mind, your child should grow strong and healthy in no time!

How to Start Offering Solid Foods

Depending on the child, any new change might be met with swift avoidance—and this is no less true when it comes to food. Thankfully, there are a few tricks you can use to make the transition easier for your child (and yourself).

Adding breast milk or formula into the puree is a good way to get the child used to the texture and taste. It’ll also help in working up to more solid food. Stage 1 baby food shouldn’t be much thicker than formula or breast milk by itself.

Another good way to progress to solid food is by giving a child some milk or formula beforehand. When they’re relaxed, well-fed, and happy is the time when young ones will be more open to trying new foods—and that extends to adults as well.

If the child seems to be turning their head away from the food, they might just not be ready. Try again in a few days or try to offer a different type of food.

But now the question is, what can they actually eat?

Homemade Baby Food Recipes

While there is no evidence that suggests whether one food group should be introduced before another, it is recommended that these early pureed foodstuffs contain a significant amount of iron, protein, and zinc. An example could include iron-fortified baby cereals (that are single grain, such as rice cereal) and even pureed meats that are rich in iron.

Furthermore, when making your own baby food, it’s important to keep to the single-ingredient principle—at least when first introducing solid foods. This will give you a much better idea of any likes, dislikes, and food allergies that your little one might have.

And since the ingredient list is so basic, you’ll find that the recipes are as well. Boiling is necessary for some of the ingredients, and a food processor will definitely help out as well. Here are some of our favorite ingredients to use in stage 1 baby food.

Avocado: Healthy for all ages, not just for kids, the avocado is an amazing source of healthy fats, vitamin A, and fiber. It’s also easy to prepare since it’s naturally very soft—just remove the pit and take out the flesh. If you need a thinner consistency, add breast milk or formula.

Sweet potatoes: Excellent sources of vitamin C and A, sweet potatoes are a delicious treat. You’ll need to peel and either steam or boil these. Once cooked through, a blender will make short work of them. You will probably need to adjust the thickness by adding in milk or formula.

Apple puree/applesauce: A very healthy snack that’s more than just great baby food, it’s recommended that you boil the apple flesh until tender. Use a food processor or blender to break them down and add formula or breast milk to find the right consistency.

Butternut squash: A great source of potassium (and sweetness), butternut squash should be cut in half and baked face down after scooping out the seeds. After it’s baked, scoop out the flesh and find the consistency that you’re looking for.

Banana: Similar to butternut squash in that they’re also sweet and a rich source of potassium, bananas are fantastic when it comes to having baby food on the go. Easily mash-able, all you need is a little bit of water, formula, or breast milk to get the right consistency.

Carrots: Also a favorite when it comes to baby food, carrots provide a good source of beta-carotene. Just steam or boil them until they become soft enough to blend or mash and add an appropriate liquid for the right consistency.

Mango: Rich in vitamin C, mangoes are delicious as well. Make sure you have one that’s ripe enough or put in the blender or food processor for long enough to break it up. Afterward, just add formula or breast milk for the desired consistency.

Peaches: Both a good source of fiber and vitamin C, all you need to do to prepare these fruits is to remove the pit and steam them over boiling water. Blend and add appropriate liquid to get them to a nice thickness.

The Other Option: Baby-Led Weaning

While the above methods and practices are the most popular when it comes to introducing solid foods to babies, there is another option that’s been gaining popularity: baby-led weaning.

This method completely forgoes the idea of baby foods, purees, and stages when it comes to feeding babies. Rather, it’s based on the principle that a baby should be able to eat solid, non-pureed finger foods right from the beginning, at around 6 months of age.

Possible benefits include having the child become more used to different food textures at an earlier age. Not only will this potentially help them gain independence, but you also won’t need to prepare any special food for them—just make sure that it’s cut into small enough pieces. It’s also purported that children who are weaned with this method are less likely to become fussy eaters.

Furthermore, this method also claims that children who feed themselves are more likely to be able to control their appetite when they’re older—minimizing the risk of obesity later in life. While there is some research that suggests this, other research does not find a connection. What is clear, however, is that more research needs to be done in order to find a clearer picture of baby-led weaning and any effects it might have on development.

One negative that comes to mind is the risk of choking. This, however, doesn’t seem to be a major issue with baby-led weaning. What’s of greater note is that baby-led weaning diets seem to consist of less iron-rich foods, along with less iron, zinc, and vitamin B12.

The Next Steps

If your child has been doing well with stage 1 baby foods, it might be time to look into advancing their progress to stage 2.

Stage 2 foods are usually of a thicker consistency than stage 1 foods. Furthermore, they may contain a few, small mash-able pieces in them. More importantly, this stage is still for those children that are not quite yet ready to chew. Along with the thickness comes more variety. Foods in stage 2 usually have multiple ingredients and spices that can make them tastier.

The estimated age of when a child should be ready for stage 2 is anywhere from 6 to 9 months. However, what you’re looking for is that they’ve been consistently taking any food that has been offered to them in stage 1, and not shying away. Additionally, you should have noticed that their oral motor skills have been continuing to develop.

After this comes stage 3, where the real variety comes in. Food can now be given with soft, small chunks rather than solely purees. But remember, breast milk or formula should be given up until 12 months of age.

Although every child is different, following these general guidelines and keeping track of your child’s progress will guarantee good nutrition and overall health.

What is a Receiving Blanket? And Should You Get One?

As a first-time parent, you might be shocked at the amount of products there are for your new baby. Even when it comes to blankets, there’s a number of things to look for.

The first baby-centric blanket you might’ve been introduced to already is the receiving blanket.

The iconic pink-and-blue cotton receiving blanket is the one that’s first used to dry and warm newborn babies in the hospital. But while they’re standard items in the maternity ward, their uses extend much further than the first day of life.

Useful for a wide variety of applications—including swaddling and burping—receiving blankets are workhorses in the nursery. But even when your child’s grown and doesn’t need it anymore, you’ll still be able to utilize them.

Not to mention that they make a terrific keepsake and reminder for when your little ones were little.

What is a Receiving Blanket?

As we mentioned, receiving blankets are the ones first used to swaddle, dry, and warms newborns (hence the name).

While hospitals usually have the iconic pink-and-blue cotton blankets, they came in a variety of shapes, sizes, and colors. Usually coming in packs of 3 or 4 when bought in a store, they’re most often either squares or rectangles. The most common size is 30 inches by 30 inches, but some may be larger at 30 by 40 inches.

The fabric they’re made of is usually flannel, cotton, muslin, and sometimes even bamboo. What’s most important is that it’s soft.

It’s a good idea to start with at least 3 or 4 of these receiving blankets since they’re very functional and practical items to have. For example, you can have one in your diaper bag and another one around the house when the other gets too dirty to use.

But why exactly would you want one?

A receiving blanket can be a great addition to your baby accessories.

The Benefits of Having a Receiving Blanket

First and foremost, a receiving blanket is useful in swaddling a baby, effectively keeping them warm and dry.

Although it’s first used right after birth, the benefits of swaddling your baby in a receiving blanket extend much further than. The material not only provides some insulation and heat for the baby, but it should also be thin enough to be breathable and allow airflow to prevent overheating.

A baby blanket is also useful after a bath. This is an especially fragile time since the baby comes out of a warm bath into a cooler air temperature which can be bad for catching colds. With a receiving blanket, however, the baby can get dry and retain some of that heat after a bath.

A baby receiving blanket is also a fantastic way to block out any sun or rain, especially in a stroller. It’s recommended that you keep one close by, or even in your stroller, if there’s ever a surprise rain shower or if the sun is shining particularly hot on a day.

Furthermore, swaddling and snuggly wrapping a newborn is a simple and effective way to keep them calm and feeling secure. Cuddling and swaddling is a fantastic method for calming down a baby.

But not only are they useful when covering up from the sun, they can also be used when breastfeeding for some extra added privacy as a nursing cover. Their small size means that it’s easy to take them with you wherever you go and can help out in a pinch. Furthermore, they’re also very useful when it comes to cleaning up any spit or dribble afterward.

They’re also extremely useful as changing mats. If you ever need to establish a clean changing space to change your baby’s diaper, a receiving blanket is an excellent tool to have. This can mean placing it on not very sanitary areas such as the changing tables in public restrooms. Or, you can put it somewhere that you want to prevent a diaper mess from happening, like a bed.

But that’s not the only messes they can prevent. While there are specific burp cloths sold as well, a receiving blanket is an excellent alternative—especially for those very messy eaters. Even if your baby isn’t particularly messy, a receiving cloth still provides amazing coverage because of its larger size. Babies spit up a lot, and a receiving blanket will keep your baby clean and neat—even against all odds.

If you opt for a slightly larger receiving blanket, it can be easily utilized as a playmat. Although you probably have some space at home for your baby to play in, a receiving blanket can be useful when visiting a friend’s place or even going to the park. Once again, their compactness helps when it comes to bringing one around wherever you go.

And finally, a receiving blanket is awesome as a security item. There might be no better option for a security item than a blanket. But not just any blanket—a blanket the baby has had since birth.

But, as with most things, all receiving blankets are not built equal.

The Types of Receiving Blankets

One of the more common receiving blankets is the flannel variety. Soft and usually patterned, they’re very useful when it comes to burping, swaddling, and even as a stroller cover.

Muslin blankets are often larger and softer than the flannel variety—and the more you wash them, the softer they’ll become. But not only are they soft, but the cotton they’re made out of is also breathable, effectively preventing any overheating. Paired with their ability to keep babies warm during the winter months, this is a perfect addition to your baby item collection.

There are also polyester varieties that come with the benefit of being cheaper in price, and they often have beautiful patterns on them.

Lastly, we have organic receiving blankets. They have the benefit of being hypoallergenic in some cases, while also being extra soft and cozy. They tend to not stretch or wrinkle, and they’re breathable and warm enough for all seasons.

How to (Safely) Use a Receiving Blanket

A blanket might seem like a harmless object that doesn’t come with any intrinsic dangers, but there are some safety guidelines one should follow to avoid putting babies at risk. These are necessary things to keep in mind when taking care of your own child, and having other caretakers also be on the same page as yourself in terms of safety.

If your child is under the age of 12 months, all blankets should stay out of the crib—not just the receiving blanket. This stays true whether your child is playing inside of the crib or napping.

Blankets, at a young age, increase the chances of smothering and suffocation, and also sudden infant death syndrome (SIDS). But blankets aren’t the only things that should stay out of the crib in order to make the crib a risk-free environment.

The keep-things-out-of-the-crib rule also applies to items such as bumper pads, soft toys (and other soft objects), pillows, comforters, and sheepskins. When it comes down to it, the only thing in your crib should be your child to ensure that your baby sleeps soundly.

What About Keeping Them Warm?

More than anything as a new parent, you want your child (and yourself) to get enough sleep. So, it’s valid to worry about your child’s comfort when they’re trying to sleep—you wouldn’t them to be too cold to fall asleep.

However, babies can get the level of warmth they need without anything else being in the crib.

First and foremost, it’s important to keep the room’s temperature at a comfortable level, around 70 to 72 degrees. When dressing your little one for bed, make sure they’re cozy, but don’t put on more than one extra layer than they’d normally wear.

Fabrics like cotton are not only soft enough for your baby, but they also breathe well which allows your baby to better moderate their temperature. Popular choices include things like sleep sacks, footie pajamas, and swaddles—but whatever you opt for, you still want to be checking in on your child every now and then to make sure they’re not overheating or too cold.

A good way to check is by placing your hand on their chest. If it feels too warm, they might be overheating. Obvious signs of this are a red face, sweat, and a quicker rate of breathing. On the other hand, if the baby’s chest feels too cold, then that’s probably a sign they’re chilly.

Swaddling should also be stopped once the baby begins rolling over on their own.

When is it Okay to Place a Blanket in the Crib?

Over the age of 12 months is usually when babies are able to have blankets in their crib. This is because by that age they usually have the necessary dexterity and strength to move blankets away from their face if it becomes necessary. This dramatically reduces the risk of SIDS.

But even when your baby is over their first year in age, make sure they’re not too heavy and thick. They should never be swaddled in thick, heavy blankets since this increases the chances of overheating, which in turn increases the risk of SIDS occurring.

How to Choose the Right Receiving Blanket for Your Baby

So, you’ve been convinced of the practicality and usefulness of always having a receiving blanket nearby—but how do you pick the right one for your child?

Chances are you’ll probably have received at least a couple at your baby shower, but it’s always a good idea to stock up before your baby arrives. Not to mention that the wear-and-tear of daily use will inevitably make short work of the thin fabric.

Other than a soft, thin, and breathable fabric, the choice of receiving blanket comes down to personal preference. Size is also something that you might consider looking into, but most receiving blankets come in 30-inch by 30-inch sizes, give or take a few inches. Otherwise, there’s a plethora of available designs, colors, and patterns to choose from.

But before you go out shopping for the perfect receiving blanket, you should also keep in mind the swaddle blanket!

The Difference Between a Receiving Blanket and a Swaddle Blanket

While “receiving blanket” and “swaddle blanket” are often used interchangeably, there is an important difference, as the names suggest.

First of all, swaddling your baby refers to the act of wrapping your baby in a thin blanket for the purpose of making them feel calm, safe, and secure. As with most things, however, it’s important to utilize common-sense by not leaving swaddled babies unattended, and not over-swaddling. A swaddle blanket is made specifically with this purpose in mind.

Receiving blankets tend to be smaller than swaddle blankets. Furthermore, swaddle blankets are normally made from muslin, and they’re shaped in a way with which to make swaddling easier. They usually also come with some kind of clasps or Velcro to make it easier to swaddle a baby with.

However, as we looked at above, receiving blankets can be used to swaddle as well.

Whether you’re thinking of getting one or the other, or both, comes down to what you’ll be using your receiving blanket for most of the time. If your aim is to swaddle, and convenience is important to you, we recommend that you invest in a swaddle blanket. Receiving blankets on the other hand are beneficial due to their versatility. Not only do they swaddle, but they do a whole lot of other things as well.

It would probably be beneficial to first get a few receiving blankets and see where things go—do you normally find yourself swaddling with them and do you have trouble with swaddling? If so, a swaddle blanket is a good investment to make that’ll help make things more convenient and save you time and energy.

Re-Purposing a Receiving Blanket

There will come a time, alas, where babies will no longer be babies, and therefore, will have no more need of a receiving blanket.

Although a hard pill to swallow on its own, the bad news stops there!

A receiving blanket can be repurposed into a laundry list of different functions, almost as long as the number of functions it has as a receiving blanket. Here are just some of the things you can do with your old receiving blankets, even if you’re not the DIY type:

Make them into banners and garlands:  Decorate a room by cutting these blankets into strips and tying them together—made super easy by their thinness.

Furniture covers: Along with putting them on car seats, a receiving blanket will go along way in preventing potential stains and damage, whatever the source might be.

Cleaning rags: Speaking of preventing stains, receiving blankets are also a fantastic choice for cleaning up day-to-day spills and messes around the house. You can even use them as aprons or bibs for your little ones when doing crafts or art projects, making clean-up that much easier.

Car rags: Adding to the point above, you can also keep them in the car for any emergencies or messes.

Mementoes: A receiving blanket on its own is a fantastic memento for you and your children to have as they age. It’s something that doesn’t take up much space, and you can keep it somewhere safe through the years easily. Or, if you’re the craftier type or want them in a more prominent location, you can also make quilts out of them. Additionally, you can also try your luck at making some stuffed toys or pillows for your growing children.

Not only is a receiving blanket versatile in its own right, but it can also be utilized in so many different ways they’re almost always worth the money. And even when your child is done with them, it’s easy to find a second life for these blankets somewhere around the house.

The Verdict on Receiving Blankets

These blankets can be used to dry, warm, swaddle, and can even prevent a child from overheating. They’re essential when it comes to cleaning up messes or when trying to make a soft, clean environment to either change a diaper, or to play in.

While they come in various styles, the most important aspects to look at are the size, fabric, and thickness. While most come in 30-inch by 30-inch squares, they can also be found in slightly varying sizes. Above all, make sure the fabric is breathable, thin, and soft, to be confident that your child is as comfortable as they can be.

While a swaddling blanket might make your swaddling needs easier to accomplish and with more effectiveness, nothing can quite match up to a receiving blanket when it comes to versatility. And not only is that versatility apparent in its own lifespan, but it also extends much further into the future.

Much like Douglas Adams claimed that a towel is the most useful item for an interstellar hitchhiker to have, you’ll probably find that the same can be said for a receiving blanket and a parent taking care of their newborn.

When Do Boys Stop Growing?

Even though they seem to get taller every year without fail, boys do, in fact, stop growing.

But unlike with girls who usually stop growing around age 14 or 15—or 2 to 2 ½ years after the first menstrual cycle—boys’ height-limiting age is more difficult to pinpoint. Nevertheless, the growth curve starts flattening from ages 18 to 20.

However, boys can stop growing anywhere from 17 to their early 20s in some cases.

To better understand the mechanisms at play behind their vertical development we’ll take a deeper dive into how they differ from girls, how puberty plays a part, and what to do if there are suspicions of a boy not reaching their potential height.

From Baby to Adolescent

The first few years of life are when some serious growing takes place. Children average 4 inches of growth from year to year, up until about the age of 4. From 4 years old onwards, the rate of growth decreases until they hit their pubertal growth spurt. This pre-puberty growth rate is usually in the ballpark of 2 to 2 ½ inches per year.

Then, puberty hits.

For girls, this happens from the age of 8 to 13, and for boys, it generally happens sometime between ages 9 and 14. While girls grow from 3 to 3 ½ inches per year during their growth spurt, boys can grow 4 inches per year. Children will usually reach their adult height from 4 to 5 years after their peak growth surge.

But while girls stop growing around the age of 14 and 15, boys can keep growing into their early 20s in same cases—but growth generally stops around the ages of 18 to 20. Another difference is that most girls hit their growth spurt significantly earlier than boys, about 2 years in fact. This means that many girls are taller than boys in early adolescence.

The timing of puberty, along with the genetics of the parents, both determine where a boy will fall on the growth curve. These genetic factors are intertwined with a number of environmental factors that all work to determine the height of a boy at any one age.

And while it might be more difficult to determine exactly when a boy stops growing, it’s safe to assume that the growth curve almost entirely flattens by the time boys reach the age of 20—with some exceptions growing into their very early 20s.

What is clear, however, is the close link between puberty and growth.

Height and Puberty

A conversation about height cannot be had without taking a look at puberty and the changes which occur during this time for boys. Nevertheless, it’s almost important to remember that each child has their own individual development timetable.

This is especially true when it comes to boys going through puberty since there’s such a wide variability because of their dramatic growth.

As most of us know, puberty for boys does not happen with a surge of hormones—specifically, testosterone. This flood of hormones is what spurs the changes in boys that usually happen between the age of 9 and 14.

Pubertal Changes for Boys

Along with height, there’s a number of changes that come along with puberty in boys.

One of these changes is the growth of pubic hair. Hair grows at the base of the penis and begins to darken. It spreads over the upper thighs and up to the navel throughout puberty. It’s also important to note that pubic hair begins growing before other body hair on the chest, underarms, and face.

The testicles and scrotum also begin to grow, almost doubling in size throughout puberty. The scrotal sac darkens and the testes hang lower, along with hairs appearing.

This change is paired with other body composition changes that come with a more thickset physique. Boys, unlike girls, tend to layer on muscle as their body goes through puberty, giving them a heavier look. Girls on the other hand tend to layer on fat to their body composition. Both sexes will have their bones become denser, all the way into their early 20s as well.

Voice changes also occur during this time. The voice may begin to crack as the voice box grows throughout puberty. This usually happens after the peak of the growth spurt. Along with voice changes comes the growth of the penis. The adult penis size can be developed anywhere from age 13 to age 18.

Furthermore, boys also tend to develop breast tissue during puberty. This is because the male hormone, testosterone, converts to estrogen inside of the body due to a chemical process. Estrogen is the female hormone, which can give boys going through puberty, breast buds. This is called gynecomastia—a condition that usually resolves itself within 1 or 2 years of developing. If this condition either occurs too early or sticks around late, then it’s recommended to consult a doctor.

The Tanner Stages

The Tanner stages are a way in which we can measure the development of an adolescent boy. It specifically looks at two things: pubic hair and genital development.

These stages consist of five different levels, all corresponding to different testicular volumes, penis sizes, and the amount (and type) of pubic hair. Stage one corresponds to no signs of puberty in the boy, while stage five means that the body has fully grown into its adult form.

Using the Tanner stages along with the growth chart, a doctor can see how far along a boy is in their development during puberty. Both of these things can be useful tools in determining whether a boy is on track, or whether extra tests and steps should be taken in order to make sure everything is going smoothly.

Height During Puberty

There tend to be the boys who mature early, starting around the ages of 11 or 12. Then there’s those who mature later, around the ages of 13 or 14.

Whether the boy falls into the former or the latter group doesn’t matter all that much, since both groups tend to gain the same average amount of inches in height. The one difference is that those who mature late tend to grow faster in order to make up for the time they’ve lost.

The average age-adjusted height that American men will reach from 20 years old onwards is 69.1 inches, or just over 5’9”.

On the other hand, at age 10 (which is one of the earliest starts for puberty), the median height for boys will be 54.5 inches.

The Center for Disease Control’s male growth chart is a fantastic way to gauge how tall a boy might grow, and for how much longer. But speaking of estimating heights, there are two ways to go about it.

Predicting Height

While there is no way to predict height that’s 100% accurate, there are two commonly used methods that can get results that are close enough to be useful.

The first method, which is the most popular, is the “mid-parental height calculator”. As the name suggests, it takes the heights of the parents of the boy to predict his potential height. While it exemplifies the importance that genetics play when it comes to height, it’s also very inaccurate. If you do use this method, be sure to keep within a ballpark range of minus 3 ½ or plus 3 ½ inches to your final height.

The way this method works is by adding 5 inches to the mother’s height and then adding that sum to the father’s height. When you divide that number by 2, it will give you the mid-parental height estimate.

So, for example, let’s take a father who’s 5’10” and a mother who’s 5’5”.

With the mother’s height of 5’5”, add 5 inches to 5’10”. Adding that to the father’s height of 5’10”, you get 11 feet and 8 inches. Dividing this number by two, you get your estimate: 5 feet and 10 inches. But as we mentioned above, keep in mind the significant margin of error. The true height could really be anywhere from 5’6” to 6’2”—especially keeping in mind the number of variables that come into play when deciding the height of a person.

This differs from predicting a girl’s height. If looking to predict the final adult height of a girl, you would subtract 5 inches rather than add 5. But in general, the taller the parents, the taller the child will be.

The Growth Chart

The other method which seeks to find an estimated height is the growth chart.

This method is as simple as checking out the CDC’s growth chart for boys between the ages of 2 and 20 and then following the line depending on what percentile the boy falls into. So, for a 10-year-old boy in the 50th percentile (half of all boys are shorter), he would stand at 61 inches tall.

Following the curve on the chart, one would expect that the boy reaches an adult height of 69 to 70 inches, or about 5’9” to 5’10”.

The chart can also be used for showing potential adult weight—this also depends on percentiles and curves but is more dependant on diet and activity levels.

What’s most important to note is that it doesn’t matter in which percentile the boy falls into, but it does matter that they stay in their percentile. What does this mean?

Consistency is important, and it’s important to take note that boys are following their curve. If a child drops from the 50th percentile to the 20th, there might be some underlying causes that need to be fixed right away. It’s also important to note that the growth curve is less exact at younger ages, and boys are more prone to jumping around percentiles when younger. However, an older adolescent should stick to their percentile consistently.

There’s a number of reasons why a boy might not be following their respective curve.

What Affects Height?

Genetics are the most important indicators of height—if the father and mother are tall, chances are the child will be tall as well. But that’s not the end of the story, there’s a number of reasons why a boy might be shorter (or taller) than expected.

One of the most important of these “nurture” aspects is the nutrients that adolescents consume. Children who are living in poverty and malnourished may not reach their full adult height growth during puberty. It goes without saying that the human body needs the proper macronutrients, the proper ratios of macronutrients (fats, carbs, and proteins), vitamins, and minerals, in order to properly develop and function.

The time when a child is developing, especially during puberty, is an essential time for proper nutrition to take place in order for the child to fully maximize their potential growth. Even if a boy does not show any deficits when it comes to body weight and height, it’s a good idea to check the growth chart to make sure that everything is on track.

But even if an adolescent may have been malnourished early on during puberty, it is possible for the body to bounce back in its growth when a proper, well-rounded diet is introduced again before adulthood.

Other Factors that Affect Height

There are some medications that can slow down growth. One of the most prominent examples is the overuse of corticosteroids. This medication an anti-inflammatory agent that aids in asthma and arthritis. However, if used excessively during puberty, it also has the potential of slowing down growth.

It should also be noted that those diseases that require corticosteroids can also negatively affect growth. Some studies have also shown that ADHD medications can possibly slow down growth, but the research doesn’t show a consensus with results so it’s also a better idea to consult with a doctor first.

Long term chronic diseases can also have a negative impact on potential growth. This includes diseases such as celiac disease, kidney disease, and cystic fibrosis—among others. All of these can result in shorter potential adult height. Cancer is also among these diseases, with children who have battled it ending up shorter in their adult lives.

Hormonal imbalances may also negatively affect growth in adolescent boys. For example, low thyroid or low growth hormone levels can have detrimental effects on height in puberty and going forward in adulthood.

Lastly, there are genetic conditions (other than those outlined by the mother and father) that play an important role in the potential height of a boy. For the most part, these are considered atypical conditions that play a negative role in height. This includes things such as Noonan syndrome, Turner syndrome, and Down syndrome—all leading to shorter children.

On the other hand, we have a condition known as Marfan syndrome. This syndrome affects the connective tissues within the body and can be life-threatening in extreme cases. But what makes it unique is that children with Marfan syndrome actually grow taller than expected, with longer fingers and arms.

Boys that have healthy diets typically tend to grow more than those who don’t, though genetics are the most important factor.

How Growth Problems Can Be Detected

As we mentioned above, the best way to see if a child is growing normally is to check their growth curve. If they’re staying consistently within their percentile, then everything should be fine—even if they’re relatively short.

It’s more of an issue if the child seems to be crossing percentiles. But even then, this is more common during the early years of puberty and is usually a sign of a constitutional growth delay—otherwise known as being a “late bloomer”.

However, it’s possible to detect potential problems by noticing any chronic problems that might be occurring, such as vomiting, fever, diarrhea, weight loss, poor nutrition or appetite, or a significantly delayed puberty. If these issues are noticed, it’s best to go to a pediatrician to make sure that the child is on track according to their growth records and the CDC growth chart.

At a clinic, further steps can be taken to determine whether there’s a problem.

Most commonly, a bone age test is done. Using an x-ray, the bones of the child are compared to the bones of other children at certain ages. What is looked for in these circumstances is that the bone age matches up to the chronological age of the child.

While girls usually continue growing until a bone age of 14, boys tend to stop growing after a bone age of 16. If the bone age in the x-ray seems to be significantly less than the chronological age of the child, chances are that the bones will continue to grow after the age that one would expect the child to stop growing.

Making Sure Your Child is on Track

What’s most important is to keep track of a boy’s height as he goes through puberty. With a solid height history and a growth chart at your disposal, it becomes easier to make sure that everything is on track.

Like any person, developing or not, it’s essential that a growing child gets a balanced diet, plenty of rest, and enough physical activity. 

When Do Girls Stop Growing?

We’ve all seen it happen. Children are born, and before anyone realizes it, they’ve already outgrown you—seemingly overnight.

While this is a funny occurrence with someone else’s kids, when it comes to your own, it’s a good idea to be on the ball when it comes to their growth. And not just their growth, but their expected height and the timeline of how it’ll look like.

We’ll be looking at girls and what their height is dependent on, the factors that might delay growth spurts, and ways on estimating height.

Springing Up

Monitoring your child’s height when they’re born almost becomes a job in of itself, and for good reason. It’s always a good idea to make sure that your baby is on track.

Depending on how far along your child is, you might’ve noticed how much your baby’s grown in the first few months of their lives. And that extends all the way up to the growth spurt that happens during puberty.

The average girl will grow approximately 10 inches in her first year, followed by about 5 inches per year from ages 1 to 2. After that, the median growth is about 3 ½ inches per year, until they hit puberty. By the time kids have reached the age of 4, most of them will have doubled their height at birth.

So, when does this all end?

Girls tend to grow all the way up to ages 14 to 15, with a final growth spurt spurred on by puberty. Furthermore, the median height in the USA for adult women over the age of 20 is just under 5 feet and 4 inches—which is the age-adjusted height.

This differs from boys significantly, since not only does their growth spurt come later, but they also continue growing into their college years.

For girls, however, the puberty growth spurt is usually what their adult height will be, which is why the conversation of girls’ height is so intertwined with the conversation around puberty.

Puberty for Girls and Height

This transition from childhood to adulthood describes a series of both mental and physical changes that people go through depending on the hormones which their bodies produce, differing in terms of sex. For girls, these changes tend to begin happening between the ages of 10 and 14, with the average start for girls’ puberty being 11. It is, however, important to note that these changes are different for everyone. And since puberty comes at different times for each person, one can expect that growth will also stop at different ages for different people.

Puberty tends to last until 16 years of age. However, if puberty for girls happens before the age of 8, this is considered atypical and it’s recommended to see a pediatrician. Likewise, it is also considered atypical if a girl has not developed breasts by the age of 13, nor began her menstrual cycle by the time she’s 16.

However, the average girl will stop growing about 2 to 2 ½ years after her first period (known as the menarche). There is also an important connection between height, puberty, and breast development.

The Connection Between Puberty and Breast Development

The development of the breasts, otherwise known as “thelarche”, is usually the very first sign of puberty. This begins with the development of breast buds, which will in time form into mammary glands and fatty tissues. In regards to a timeline, breasts can begin developing 2 to 2 ½ years before a girl begins her first menstrual cycle.

However, this varies from person to person. Some girls may not notice breast buds until a year after first menstruation, and others may only see developing breasts from 3 to 4 years after. Furthermore, the breast buds may not develop at the same time, but will usually appear sometime within 6 months of each other.

Breast development is both hereditary and dependant on environmental aspects. Many of these aspects run in the family, but breast size also depends on the women’s weight. Breast tissue continues to change after puberty because of the various hormones which affect it during a women’s life. This includes scenarios such as pregnancy, breastfeeding, the menstrual cycle, and menopause.

It is normal for breasts to continue developing until around the age of 18, but it’s also important to take into account the many factors we’ve touched on above.

Furthermore, it’s also normal to have one breast slightly larger than the other. Puberty can also bring along bumps, hairs, or pimples around the nipples, along with soreness—particularly around the menstrual cycle.

But this isn’t the only way in which boys and girls differ from one another.

The Difference Between Boys and Girls

Things are slightly different with boys, especially when it comes to puberty and their growth spurts.

For boys, puberty usually begins earlier than for girls, between the ages of 10 and 13. Similarly, growth spurts usually happen 2 to 3 years after puberty begins, around the ages of 12 and 15. When speaking in averages, this means that a boy’s growth spurt usually happens about 2 years after a girl’s.

Boys usually stop gaining significant height by the age of 16, but their development can continue into their college years—late teens to early 20s at the maximum. While the height development is minimal during these years, there is some significant development when it comes to muscles.

A parallel can be drawn to girls in this regard.

Something to keep in mind is that a girl’s bone density will continue to develop after she stops growing. Furthermore, her muscles will also develop to a lesser degree. There have been parallels drawn between earlier first menstruations and greater bone densities, while those who often miss their periods usually have a lower bone density.

Bones in girls become thicker, heavier, and denser up until about the age of 25. Along with the bones, the muscles will also develop to some degree.

So, What Impacts Potential Height?

As with most things when it comes to human physiology, height, and growth, in general, are complex functions of both nature and nurture aspects of life.

One of the biggest things to look at is genetics. If the father and mother are tall, chances are that the child will end up being tall as well—simple enough.

However, it’s not always as easy as that. While the hereditary aspect is very useful in estimating the “end” height of a girl, there’s also a number of other things that come into play and can have an even larger effect on final adult height.

One of the most important of these “nurture” aspects is, as you might’ve guessed, nutrients. It’s no surprise that malnourished children and those living in poverty will most likely not reach their full adult height potential. The human body needs the proper macronutrients, vitamins, and minerals in order to properly function and grow—and there is no time where that’s more important than in the child’s developmental stage and puberty.

Even if the child doesn’t exhibit any deficits in terms of body weight when it comes to height, it’s always a good idea to check a growth curve to see if the child is on the track they’re supposed to be on.

However, even if a teen has been malnourished for a while, it’s possible to “bounce back” in terms of development, even in the later stages of growth before adulthood. This obviously necessitates a step in the direction of better nutrition. Always emphasize the consumption of whole foods that are varied, fresh, and of high quality, whenever you’re able to.

But food isn’t the only thing you can put in your body that has an influence on height gain.

Factors that Can Inhibit Height

Some medications slow or stunt growth as well. For example, an overuse of corticosteroids (anti-inflammatory medication that helps with asthma and arthritis) during puberty can slow down growth. Obviously, one shouldn’t stop using these medications because of this slow-growth aspect, and it’s always best to talk to your doctor beforehand. Furthermore, keep in mind that diseases which require corticosteroids (such as aforementioned asthma), can also negatively affect growth.

There have been some studies that have shown that ADHD medications can also slow down or stunt growth, but there doesn’t seem to be a consensus as of yet. Best to speak to one’s doctor and find out the best way forward.

Speaking of chronic illnesses, asthma isn’t the only one that can negatively affect potential height gain. Especially when it comes to long-term health conditions such as kidney diseases, celiac disease, and cystic fibrosis—all of these can result in shorter adult heights. Furthermore, those children who have battled against cancer may also have a shorter height as adults than they otherwise would’ve had.

Additionally, hormonal imbalances may also prevent a child from reaching their maximum potential height. A low thyroid and low growth hormone levels are two examples that can have a detrimental effect on height.

And finally, there are genetic conditions that play a role in development. But unlike the genetic conditions that deal with the parents’ height, these are atypical conditions that can lead to a reduced height. For example, Noonan syndrome, Turner syndrome, and Down syndrome are all conditions that usually lead to shorter children.

On the other hand, however, we have Marfan syndrome. This inherited condition affects 1 in 5000 people, and mainly affects the connective tissues in the body. It ranges from mild to life-threatening, but corrective therapy and treatment will mean that life expectancy is the same for people with and without Marfan Syndrome.

The interesting thing about this syndrome is that people with it tend to be taller than average, with unusually long fingers and arms.

Estimating the Height of a Girl

As we can see, there’s a large number of variables that go into “setting” the height of a girl as she grows into her adult age. Expectations of overall growth are subject to many variabilities that makes it difficult to estimate height or see where a child should be on a height chart.

This effectively gives us two ways to estimate the potential adult height of a relatively healthy girl.

The first method is the “mid-parental height” calculator—since the best way to estimate someone’s height is by using their family history. But keep in mind, although this is a commonly used method of estimating height, it still doesn’t come too close, with a margin of error between 3 and 4 inches.

Nevertheless, this is how it works. You take the father’s height and subtract 5 inches, and then add that number to the mother’s height. After you have that number, you divide it by 2. The resulting number is the estimated height of the girl, plus or minus anywhere from 3 to 4 inches.

An example would be a 5’10” father and a mother who is 5’5”.

With the father’s height of 5’10”, take away 5 inches to get 5’5”. Add that to the mother’s height of 5’5” and you get 11 feet. Divide by two and you have your estimate: 5 feet and 5 inches. And keep in mind the significant margin of error, so the real height could be anywhere from 5’1” to 5’9”—not to mention all of the other factors that might come into play during adolescence.

If trying to find the predicted height of a boy, on the other hand, you would add 5 inches to the father’s height instead of taking it away. In general, the taller the parents, the taller the child will be.

The other method of estimation utilizes the Center for Disease Control (CDC)’s girls’ growth chart. It normally has a more exact estimation than the method above, so it’s a good idea to check it once in a while.

Using the example of a girl at age 10 at the 50th percentile (average height) would put her at 4’6”. That means that by age 20, she should be just over 5’3”—giving us the median age of women, adjusted for age.

The chart is useful because it has the benefit of being created with a large sample size and can therefore properly estimate future growth and potential height. To use it, just find the age of the girl and match it up with the current height. Then, follow the line up and reference the final height it lands on.

Some girls just grow faster and taller than others and it’s important to understand why.

Atypical Heights and When to See a Doctor

A chart like the CDC’s is a great way to see if there’s any atypical development going on—whether that might mean being taller or being shorter than expected.

As we mentioned above, it’s also important to keep in mind the development of the breasts, puberty, and the first menstrual cycle.

If puberty for a girl happens before the age of 8, this is considered atypical and it’s recommended to see a pediatrician. Likewise, it is also considered atypical if a girl has not developed breasts by the age of 13 and/or not begun her menstrual cycle by the time she’s 15 or 16.

Similarly, it’s best to see a doctor if a girl begins showing signs of puberty too early, at 6 or 7 years old. Whatever extreme the girl is at, it’s best to have a doctor take a look because such development may be a sign of medical problems or some kind of hormonal imbalances.

One of the many tools that pediatricians can use to determine health problems is an X-ray. By checking out the bones of a child, they can determine if they’re on track to reach their expected height. Blood tests might also be taken to determine if there are any diseases that might be affecting growth and development.

Things to Keep in Mind

So, in summarizing the points above, girls stop growing around the ages of 14 or 15. This age is dependent on the first menstrual cycle and when puberty hits. Growth usually stops 2 to 2 ½ years after the first cycle. The average age of grown women is 5’4’’, and if you want to see if your child is on track, the CDC growth chart is a great place to start.

Breast development usually stops at around age 18, but it comes down to the hormonal changes throughout the life of the women which dictate the final size of breast tissue.

There are near-infinite combinations of factors that guide the development of a girl, first and foremost being genetics—the height of her parents. Other than genetics, height can come down to medication, hormones, illnesses, and genetic conditions.

For any developing young body, it’s essential that they get enough sleep, are eating a balanced diet, and are also taking part in some kind of physical activity regularly. Barring illness, late bloomers, or other circumstances, a well-rounded routine that takes health as a priority will have every child on track with their growth rate on the curve.

Positive vs. Negative Reinforcement: Examples and Differences

In the world of behavior modification and operant conditioning, researchers widely agree that positive reinforcement is one of the more effective ways to teach a new behavior, and much of the work on this concept was brought into prominence by B. F. Skinner. Skinner taught at Harvard from the late 1940s through the 1970s, and he pioneered many of the groundbreaking experiments on operant conditioning in animals (which he and others then applied to humans). 

Rather than focus on the inner workings of the mind like many of his peers did during the mid-20th century, Skinner chose to focus on the manifestations of behavior. In other words, he focused on what his subjects did and did not do, particularly in response to some sort of stimulus, rather than how the subjects felt or thought about the stimulus. 

The concept of operant conditioning is simple enough: behavior that is followed by something pleasant or desirable is more likely to be repeated, while behavior that has unpleasant consequences is less likely to be repeated. In the lab, this might look like teaching a mouse to push a certain lever. The lever on the right gives a small piece of food, and the lever on the left delivers a small electrical shock. In a very short amount of time, the mouse learns which lever to push and which lever to avoid. 

As we delve into the topic of positive and negative reinforcement, we will also talk about what the terms mean in the field of psychology and how they might apply to the way parents or caregivers manage behavior in children. 

Reinforcement: Where punishment is designed to discourage undesired behaviors, reinforcement is something that encourages a particular behavior or action. Punishment and reinforcement are often used in combination to craft a child’s behaviors (as well as an adult’s behaviors!), and you can learn more about punishment by reading our prior post on Positive vs. Negative Punishment. The two types of reinforcement are positive reinforcement and negative reinforcement. 

Positive Reinforcement: As with other cases in the psychology of operant conditions, “positive” does not mean something that is enjoyable or fun. Positive simply means that something is added, so it may help to think of positive as “plus” and negative as “minus.” Positive reinforcement, therefore, means something is added to increase or encourage desirable behavior.

Like positive punishment, positive reinforcement may occur as a natural result of the behavior (like receiving a good grade due to putting in extra study hours), or it may occur because someone else provides the reinforcement as a consequence of a behavior. Let’s look at some more examples of positive reinforcement to get a better idea of how positive reinforcement can be applied. 

Examples of Positive Reinforcement

Praise and compliments: One of the easiest things a parent can do to reinforce good behavior is to notice it and compliment the behavior. For example, “I appreciated your good manners at dinner. Saying please and thank you is such a grown-up thing to do.”

Recognition: Public praise, as when a teacher compliments a child in front of the class or in front of other teachers, is another form of positive reinforcement. Attaching a good quiz grade on the refrigerator is another good example of how to recognize (and therefore reward) effort and focus.

Physical expressions: Fist-bumps, high-fives, a wink and a grin, or a literal pat on the back are all simple ways to signify, “Good job,” or, “I’m pleased by your actions.”

Quality time: Spending one on one time with someone special, such as making crafts with Dad, playing a game with Mom, or reading with a big sister are all ways to recognize and reward desired behavior. In many cases, misbehavior is a way to seek attention, so rewarding good behavior with attention and quality also helps to counteract the child’s need for attention-grabbing misbehavior. 

Special assignments: Children love the idea of being in charge, so allowing them to be in charge of something, especially after they demonstrated responsibility, is another way to reinforce the target behavior. Being a teacher’s helper or getting to choose first which chore to do are subtle but significant ways to use positive reinforcement. 

Extra time or free time: Spending more than the typical amount of time doing a pleasurable activity, like playing outside or watching cartoons, is another way to reward good behavior. Extra screen time can also be used as a reinforcer, especially when screen time is generally limited to specific times of the day or a certain amount of time. 

Special snacks, money, or gifts: Going out for ice cream after finishing a tough assignment or receiving compensation such as cash or toys for completing tasks are some of the clearest and most common examples of positive reinforcement. 

An important thing to note about positive reinforcement is that it does encourage behaviors, so it is critical to recognize that undesired behaviors can also be reinforced. For example, when a student calls another kid a name, they may receive positive reinforcement in the form of their friend’s laughter. The name-caller may have to write lines about bullying (positive punishment) or they may have to skip recess (negative punishment), but the reward of laughter from peers (positive reinforcement) may outweigh the punishment. Understanding possible reinforcers from the point of view of the child will help teachers, parents, and caregivers evaluate the best way to deter that behavior (name-calling) while encouraging good behavior, like recognizing and reinforcing acts of kindness.

Negative Reinforcement: In the sense that negative means to take something away, negative reinforcement is when a stimulus is removed as a method to encourage specific behavior. Sometimes the term negative reinforcement gets confused with punishment, but remember that reinforcement encourages a behavior, while punishment discourages a behavior. In the case of negative reinforcement, the examples are typically when something ends or is avoided because the stimulus is removed. 

Positive reinforcement is important to understand for caregivers as well as parents.

Examples of Negative Reinforcement

Avoiding or ending nagging: When Rafael’s mother continues to remind him that he has to do the dishes and the nagging stops once he does the dishes, this is an example of negative reinforcement. In other words, the unpleasant stimulus (nagging) ends when the desired behavior is achieved. If instead of nagging Rafael’s mother took away his iPad, then that would be an example of negative punishment. 

Stopping alarms or other noises: That steady beeping that occurs in a car until the seatbelt is buckled is another example of negative reinforcement. The beeping ends when the desired behavior (buckling the seatbelt) occurs. 

Avoiding any unpleasant stimulus: When someone does something proactively to avoid an unpleasant consequence, they are practicing negative reinforcement. Leaving for work early to avoid traffic, putting on shoes to avoid stepping on something sharp, and slathering on sunscreen to avoid a sunburn are all examples of negative reinforcement in practice. 

Just like positive reinforcers, negative reinforcers can also be factors in encouraging undesired behaviors. Parents and caregivers should be aware of the ways they may be inadvertently encouraging unwanted behaviors. For example, little Junie pouts because she does not want to eat creamed broccoli, so Auntie Marion takes the broccoli away. By removing the broccoli, Auntie Marion has provided reinforcement for Junie’s pouting, and the side effect is that Junie has been encouraged to pout when she does not want to do something (like eat creamed broccoli). Positive reinforcement might look like Junie being allowed to have extra dessert as a reward for trying the broccoli, and this method would be more likely to encourage the desired behavior.  

Why Should I Reward My Child for Doing What They Are Supposed to Do?

Rewards for good behavior exist at all levels of society, and consistent application of reinforcers should not be confused with bribing a child to “be good.” Adults work, and they receive compensation for that work. Sometimes, they receive bonuses or extra pay for special work, and most corporate cultures have some sort of system in place to recognize and reward the desired actions of their employees. 

“Employee of the Month” recognition, special parking spaces, getting the opportunity to work on an interesting assignment, and promotions are all examples of positive reinforcers in the workplace. Likewise, children are working at the job of learning to be good humans who contribute in a useful way to their home, their school, and their community. Directing and rewarding their efforts is one of the ways to help encourage them at their “job,” just as adults are more likely to perform well when they are recognized and rewarded for their jobs. 

In a 2010 study of the efforts of the Earning by Learning group found that incentivizing children to read not only improved reading comprehension in a group of Dallas schoolchildren, it also created a behavior (reading) that continued in many students even after the program ended. The group offered $2 for every book read provided the student passed a short quiz after reading the book. It turns out that kids like earning their own money, and so they accepted the “job” of reading in return for a monetary reward. The Earning by Learning team eschews the word “bribery,” noting that it had connotations of rewarding corrupt behavior. In positive reinforcement, good behaviors are reinforced through various kinds of rewards. 

Positive reinforcement at home can look very much the same. Creating an incentive chart where stickers or check marks are made each time the child finishes a chore or specific activity provides small incentives (the sticker or checkmark) that can be added up to redeem bigger incentives (like a trip to a favorite park with a friend or getting to pick out a new toy) is used by teachers and parents alike to create a system of reinforcement.

Reinforcement vs. Punishment 

Using reinforcement rather than punishment gives kids and adults alike a sense of control over what happens to them, and it also does what punishment often fails to do, namely, to provide a roadmap for learning what kinds of behaviors are good and acceptable (vs. simply learning what not to do). 

But My Child Is Not Doing ANYTHING I Want to Reinforce!

Baby steps, my friend. Baby steps. Skinner and other behavioral psychologists also explored ways to reinforce close approximations of the desired behavior. This concept is called shaping, and it is a useful way to guide the child toward the desired behavior even before they exhibit it. 

Shaping involves breaking actions and behaviors down into smaller steps and reinforcing close and closer approximations of the desired behavior, until, eventually, the desired behavior is achieved (and reinforced). For example, a child routinely throws tantrums upon not getting cookies. This behavior is ignored or punished, but then one day the child does not throw a tantrum and instead only sulks. While sulking is not something the parent wants to reinforce, it is a behavior change that is better than screaming, so some form of reinforcement, such as saying, “I am proud of the way you are trying to control your temper,” is a way to recognize that sulking is better than screaming. 

Another example of shaping may occur when teaching complex or longer duration actions, such as having a child clean their room or complete a protracted homework project. Rather than having the child clean the entire room, the parent or caregiver breaks the task into smaller parts with small reinforcements (praise, a healthy snack, a story). To give the child a greater sense of control, the parent may also offer the child choices. For example, the parent may say, “Would you like to put away your clothes, pick up your toys, or make your bed? You can decide which one you want to do first.” The child then has some level of ownership since they chose the activity.

Primary and Secondary Reinforcers

Reinforcers can be divided into things that innately drive behavior in humans and other animals (primary reinforcers) and things that have no value in and of themselves but are linked to primary reinforcers (secondary reinforcers). Because they happen naturally and are intrinsically embedded in our need for safety and survival, primary reinforcers are also called unconditioned reinforcers or unconditioned stimulus. 

Examples of Primary Reinforcers

Food: Edible treats are the primary reinforcers for teaching animal behaviors, like providing a treat to teach a dog to sit, but food can also be motivating for children and adults. An ice cream sundae is a perfectly acceptable reward for completing an unpleasant task (no matter how old you are!), but you can also see primary reinforcement occurring when a baby cries to be fed. The baby issues a stimulus (crying) that is removed when the baby eats (positive reinforcement for the baby). Seen another way, the parents want to stop the crying, so they feed the baby (negative reinforcement for the parent).

Pleasure: When something produces a pleasurable sensation, it is more likely to be repeated (which is why sex is such a powerful behavior motivator in adults). But other pleasurable activities, like floating in a cool lake on a hot day or having your back scratched, are also ways to produce a physical sensation that is enjoyable. 

Other things, like water, shelter, and sleep or rest are also considered primary reinforcers.

Just like positive reinforcement, negative reinforcement is also important for both caregivers and parents to use wisely.

Examples of Secondary Reinforcers

Money: Money is only useful if used to acquire things, and the paper or metal that money is made from is only useful if the money can be spent on things that provide primary reinforcement. For example, stacks of cash have no value on a deserted island, but food, water, and shelter have intrinsic value. Money is only as good as what it can be exchanged for. 

Stickers: Many teachers and parents use behavioral charts with stickers awarded for certain actions and behaviors. The stickers have no true intrinsic value, but they are linked to reinforcers in a sort of token economy where more stickers equal more and better rewards. Collecting stickers to acquire something that is pleasurable is another example of a secondary reinforcer.

A Note About Love and Affection

Love is not a biological need per se, but love and affection are closely tied to one’s overall health, well-being, and sense of self-worth. Hugs, expressions of warmth, and many types of praise are all considered generalized reinforcers and can be used to reinforce behavior as well as to build stronger bonds between the child and the parent or caregiver.

Does Positive and Negative Reinforcement Really Work?

As with other types of behavior modification, making positive and negative reinforcement work for your child comes down to a few key tenets: the reinforcement must be relevant to the child, it must be applied with some consistency, and it must be evaluated for effectiveness as you go. Like punishment, reinforcement is also much more effective when it is paired with the desired behavior as soon as possible after the behavior occurs. 

Want some more examples of punishment and reinforcement as characterized by Disney movies? Check out this clip to see how your favorite characters demonstrate the main principles of operant conditioning. 

Positive vs. Negative Punishment: Examples and Differences

Before exploring the topic of positive and negative punishment, we first need to make sure that we understand the language used in discussing these types of behavior modification. Even the term “behavior modification” sounds ominous, conjuring up images of an overbearing teacher rapping the knuckles of a disobedient child with a wooden ruler. In fact, almost all parents, teachers, and caregivers practice some form of behavior modification.

In essence, behavior modification simply means providing undesirable consequences for an undesired behavior (like refusing to put on shoes) in order to shift the individual to the desired behavior (like putting on shoes when asked). Behavior modification evolved from a version of operant conditioning as made prominent by renowned psychologist, B. F. Skinner, who taught at Harvard from the late 1940s through the 1970s. According to Skinner’s principle of operant conditioning, behavior that is followed by pleasant consequences is more likely to be repeated, while behavior that results in unpleasant or undesired consequences is less likely to be repeated.

Now that we know basically what behavior modification means, let’s explore some of the other terms that will help us understand what they mean and how they can be applied to working with children. 

Punishment: This one seems clear enough, right? Punishment simply means undesired consequences that occur as a result of an undesirable action. Punishment is designed to discourage particular behaviors. In an upcoming post, we will discuss negative and positive reinforcement which is considered the counterpart to punishment. Where punishment discourages undesirable behaviors and actions, reinforcement encourages desired behaviors. 

Positive punishment: In this case, “positive” does not mean good or pleasant, but rather something new that happens (a consequence) or that is given to the child as a result of the undesired behavior. It may be helpful to think of positive in terms of “plus.” 

Examples of Positive Reinforcement

Positive punishment may occur as a natural result of the behavior (like getting a brain freeze from eating ice cream too fast), or it may occur because an authority figure provides it. The best way to understand the concept of positive punishment is by looking at some additional examples. 
Examples of Positive Punishment

Slapping or grabbing: When a child is reaching for a full drink, sometimes the most effective and immediate deterrent is a gentle but quick slap of the hand or grabbing the child’s arm. In some cases, such as crossing a busy street or other potentially dangerous actions like touching a hot stovetop, this type of punishment is almost like a reflex to keep the child out of harm’s way. 

Having a “special talk” or scolding: A stern reprimand or lecture about the consequences of disappointing actions is something most of us want to avoid, and children are no different. 

Writing or “homework” tasks: This method is used by some teachers as well as other people involved in the care of children, and it may include writing sentences over and over, e.g., “I will not put gum in my brother’s hair or peanut butter in his shoes. Doing so is disrespectful of my brother and I love him.” It could also take the form of drafting an essay about the nature of the behavior and its effect on others or completing a sheet of math problems. Since these types of activities are part of the child’s academic life and future, caregivers should be cautious about setting up tasks that could affect the way the child approaches similar work in an education setting. 

Chores or additional tasks: Assigning chores or additional tasks such as cleaning up a bedroom, folding laundry, or even just having the child clean up a mess they made, such as scrubbing spaghetti sauce off a wall, are all examples of positive punishment. 

Extra rules: This form of positive punishment is fairly common, and it is represented by things like imposing curfews or adding household rules.

Physical punishment (spanking): Spanking and physical punishment (remember the example of rapping on a child’s knuckles with a ruler?) are among the most contentious forms of positive punishment, and research has shown limited efficacy in deterring undesired behaviors through physical punishment. 

It probably does not help that corporal punishment is ripe for misuse, and many parents and caregivers have fallen into the trap of using it as an immediate recourse for thwarting undesired behavior and instead find they are simply venting their own frustrations. In addition, the potential impacts often outweigh the perceived benefits, and the child may learn to hide behavior or rebel rather than changing behavior. 

It is also important to that not that corporal punishment can send mixed messages, as when a child is getting a spanking for hitting his sister or losing control of his temper. In a 2012 study, Sandra Graham-Bermann, Ph.D., a professor at the University of Michigan who also serves as an investigator for the university’s Child Violence and Trauma Lab, noted, “Physical punishment can work momentarily to stop problematic behavior because children are afraid of being hit, but it doesn’t work in the long term and can make children more aggressive.” Spanking is essentially an adult hitting a child who cannot fight back, and based on the overwhelming body of research, spanking is not recommended as a routine way to punish children if a parent is expecting it to improve behavior. 

Negative punishment: In the same way that positive punishment means something that occurs or that is added as a consequence to undesired behavior, negative punishment means something that is removed or taken away as a consequence of undesired behavior. If positive means “plus,” then negative means “minus.” Like positive punishment, negative punishment can occur naturally (like when a toy is lost or broken because the child left it in the rain), or it can occur when enforced by someone else (like a parent changing the Wi-Fi password until a teenager completes their chores). 

Positive punishment can be a great way to reward the person you are caring for.

Examples of Negative Punishment

Grounding or a “time out”: The defining factor in negative punishment is a loss. In the case of grounding or a time out, personal freedom is taken away as a deterrent for undesired behavior. When administering a time out, a good rule of thumb is one minute for every year of a child’s age, and it is important to note that the child must be moved from a desirable location or activity (the swing set on a playground) to an undesirable one (on a bench watching other children play). 

Losing access to fun things like toys and electronics: When children are arguing over a toy, removing the toy would be an example of negative punishment. Other common examples include taking away a cell phone, limiting or taking away screen time, or taking other desired items from the child are all types of negative punishment.  

Loss of income: Although children do not typically have income, many children do receive some sort of allowance, often as a sort of reward for completing basic chores. Loss of the allowance, particularly if it is tied to incomplete or undone chores, is another example of negative punishment. 

Do I Really Have to Punish My Child?

We want to raise good humans, and it is natural and appropriate to second-guess any disciplinary approach in our efforts to make sure we as parents and caregivers are guiding children down the right path. The term itself is off-putting: punishment. But there are some real benefits to thoughtful, consistent punishment, including helping the child understand what types of behavior are acceptable at home, in school, and in the world at large. 

Through punishment, children also learn about consequences, and they learn to associate inappropriate behavior with unpleasant consequences. Children who face no consequences for their behavior run the risk of becoming adults who are confused about the way the world works. 

Nonetheless, punishment should be used in moderation. Parents should be aware that punishment can have undesired effects on the child, and punishment alone may not work to deter undesired behavior. Some of the potential downsides to punishment may include increased aggression (especially with corporal punishment) or withdrawal, especially when the child is not clear what behaviors are undesirable.

For example, running and shouting may be perfectly fine out of doors, but the child is punished for being boisterous at a restaurant. If the child is not clear about why the behavior is wrong (in this case, because of the setting), they may generalize the punishment and apply the “be quiet and be still” guidelines across the board.

Another potential issue with punishment is that the child learns what NOT to do, but they do not learn suitable alternatives exist, i.e., they may not learn what to do instead. In addition, the behavior may be hidden or suppressed rather than truly modified, and this does not help the child or the family.

If all forms of discipline are accompanied by thoughtful discourse, clear explanations, and calm reasoning, both the parent and the child are more likely to come through it with an understanding of boundaries and a strong sense of self. 

One form of positive reinforcement, unlike positive punishment, can be taking the person you are caring for outside for a bit.

Does Using Positive and Negative Punishment Work? 

Both types of punishment work best in conjunction with positive and negative reinforcement, which is a form of behavioral conditioning that encourages good behaviors (as opposed to punishment, which discourages bad behaviors). Although we will discuss reinforcement in a later post, below are eight tips for increasing the effectiveness of both positive and negative punishment, and some of these tips apply to other types of discipline or consequences as well. 

Now rather than later: Positive and negative punishments, like most other forms of behavior modification, are most effective when they occur immediately or very soon after the undesired behavior so that the child sees a clear link between the behavior and the consequence. If the child scribbles on the wall and the parent waits until the next day to have the child scrub the wall clean and/or waits until the other parent gets home to take away the markers, the child is less likely to connect the behavior to the consequence. This is especially true in younger children. 

Today, tomorrow, and the next day, and the one after that: Likewise, consistent consequences are key to deterring undesired behavior. For example, imagine that one day the child receives a time out for throwing a temper tantrum on the floor because she did not get extra cookies. The next day, another temper tantrum occurs, and the weary parent gives the child the chocolate chip cookie she so clearly desires. This inconsistency can actually make the behavior worse since the child may be learning (correctly, in this example) that persistence and volume are the keys to getting what they want. 

Make sure the crime fits the time: In other words, the punishment or consequence to the behavior should outweigh the benefits of continuing the behavior. If a three-year-old child rips the pages out of a book, grounding him for a month may render the punishment useless for its extremism. Likewise, if the behavior is punished only by saying, “Don’t do that,” without an explanation of why the behavior is unacceptable, the reward (the thrill of ripping pages and tossing them in the air) may be more enticing than the punishment. 

One size does not fit all: The particular type of punishment employed should be tailored to the child, e.g., discouraging a lie told by a pre-teen is different from discouraging lying in a toddler. Irrespective of age, each child is unique, so the consequences should be something that matters to the child. For example, taking Bobby’s cell phone away may be an effective punishment for Bobby, but his social butterfly brother Nicholas may be more upset if he is confined to his room for the rest of the evening. 

Link the behavior to the consequence: Moreover, it is best if the negative consequences are closely tied to the action when possible. For instance, if a child pulls another child’s hair, having the child apologize, spend some quiet time thinking about why it is not good to try to hurt another person, and/or having a discussion about other ways to show anger or frustration may all be good ways (especially when used in combination) to deter the unwanted behavior in the future. 

But it’s not fair: Avoid debating consequences and be clear and firm in your decision. Arguing with the child and the punishment or yielding to tantrums only makes matters worse, as does lessening or worsening the punishment based on perceived immediate effect. For example, when a teenager rolls their eyes after learning they will be grounded for a week, do not take the bait and threaten to ground them for a month, just as you may wish to avoid lightening the punishment after a tearful, “But, Mooommmm, it’s not fair!”

Be a Jedi: As hard as it is, the parent or caregiver must be the one to demonstrate desired behavior. As such, sarcasm, disdain, uncontrolled anger, and rudeness can all serve to derail otherwise appropriate disciplinary actions.

Talk about it: Engage the child in the discussion about why the behavior was wrong, as well as about alternatives to the undesired behavior. Consider asking straightforward questions to allow the child to participate in the discussion. Would you like it if someone pulled your hair? And why not? Do you understand why pulling your sister’s hair is wrong? What do you think you should do next time you feel this way?

So, Should I Try These Types of Punishments or Not?

Like any other form of discipline or so many aspects of raising responsible children, positive and negative punishments only work as well as they are administered. If the punishment follows the guidelines listed above and also includes thoughtful discourse and relevant reinforcement techniques, then it has a better chance of doing what it is intended to do: deter unwanted behavior.

When administering punishment or any other form of discipline, it is important to focus on the behavior as undesirable rather than the child. Consider the difference between saying, “You are a bad girl and I’m disappointed that a child of mine would act that way,” and “That behavior is not acceptable, and your friend is hurt because you kicked her.” 

In the first example, the words are focused on two people — the child and the parent. The child is bad, the parent is disappointed that they have a bad child. In the second example, the focus is on the action and the immediate result of that unacceptable action, i.e., that the friend is hurt. This distinction is important, and although it may seem like semantics, words and the actions we tie to them resonate in children and affect how they perceive themselves, their parents and caregivers, and the world in general. 

Whether you are a parent, a nanny, a teacher, or another important person in a child’s life, remember that punishment is only one tool in your toolkit, and it is one best used with thoughtfulness and in conjunction with other behavioral approaches to raising good humans. 

Toileting Assistance: What Caretakers Should Know

Everyone poops. Perhaps due in part to all the psychological and societal hang-ups associated with toileting, incontinence care for aging or injured adults is a topic avoided by even the most dedicated family members. But, let’s face it, everyone poops, everyone pees, and sometimes folks need a little assistance with one or both of these natural bodily functions.

Toileting is one of the activities of daily living (ADLs) that can be central to the individual’s sense of dignity and control, so it is imperative that a caretaker be well-versed in toileting assistance as well as how to manage urinary and/or bowel incontinence. Toileting assistance is an area in which family caregivers appreciate the competence and support of an experienced caregiver more than most, and this article will walk through the basics of toileting assistance as well as methods for adapting to bladder and bowel control issues. 

Note: If incontinence is a new or worsening issue, a physician should be consulted to evaluate possible treatment plans to assist with or alleviate incontinence. 

Getting in Potty Position

In many cases, getting to the toilet in time is the main part of the patient’s issue, and this may be a natural extension of problems with other activities of daily living like ambulation, bathing, grooming, and dressing (or undressing). A few tools and assistive devices can help with this process, as can careful planning. Raised toilet seats make it easier to move from standing to sitting (and vice versa), and grab bars on the wall can help the individual transfer to the commode. For nighttime needs, a bedside commode or bedpan may be in order. 

Potty time: One of the most successful ways to avoid accidents is through observation and planning. Most of us have potty patterns, meaning we tend to go to the bathroom at around the same time every day. Observing an individual’s natural elimination pattern is a good way to create a bathroom schedule. Much like working with potty-training children, certain occasions may be indicators of good times for a bathroom break. In particular, upon waking, whether after a nap or in the morning, after meals, and before leaving the house are all times that the caregiver may wish to encourage their charge to attempt to use the toilet. Beyond those times, a potty break every two hours will help to reduce urgent bathroom needs.

Being watchful: For certain patients, such as those with dementia or those who have difficulty communicating, the caregiver should also be on alert for signs that indicate the individual needs to use the bathroom. These signs may vary, but they can include tugging on clothing (especially around the crotch area), fidgeting, pacing or foot tapping, and general displays of agitation. Being aware of and reacting in time to these kinds of signs can prevent unnecessary accidents.

This way to the toilet: A clear, well-lit path to and in the bathroom can help the person ambulate as quickly and smoothly as possible to the toilet when the need strikes, and leaving the bathroom door open will help the person zero in on where they need to go. Another factor that can help with finding and getting to the toilet on time is removing obstacles, such as potted plants or throw rugs, that can impede progress to the bathroom.

You can do it: As with other activities, the caregiver should demonstrate patience and encouragement when they are helping someone with toileting. They may need assistance pulling down pants and underwear, or they may need a gentle reminder to actually pull down their pants before sitting down. House dresses and pants with elastic waistbands are good choices for individuals who may need assistance with toileting. 

Take your time: Once the person is on the toilet, the caregiver must be careful not to rush them. Bladders and bowels move at their own pace, and what seemed urgent only seconds before can be a long time coming once in position. Rushing the person or showing frustration can cause the individual to feel shame, and it also increases the risk of constipation and accidents. 

I’ll be right out here: If possible, give the individual some privacy by waiting outside the bathroom. If they need assistance cleaning up, consider using wet wipes in addition to standard toilet paper to make sure the skin is fully clean before pulling pants or underwear back up. Ensuring that the person has properly adjusted and zipped up clothing afterward reduces potential embarrassment and fall risks. 

Having patience during toileting assistance is one of the most important traits a caregiver can have.

Different Types of Incontinence

There are several types of incontinence, and knowing a little about the different types can help the caretaker and the family make the best decisions about what levels of toileting assistance should be included in the care plan of their loved one.

Urinary Incontinence

Overflow Incontinence: This refers to the urine leakage that occurs when the bladder is full, and it generally involves only a small amount of urine. This type of incontinence can usually be managed with a combination of regular trips to the bathroom, limiting fluid intake at bedtime, and using incontinence pads on the bed or in underwear. 

Transient Incontinence: This term refers to temporary problems with urine retention. This type of incontinence goes away when the root cause is identified and treated, and this is one of the reasons new or worsening cases of incontinence need to be medically evaluated. Urinary tract infections, surgeries, or new medications are often the culprits for this type of incontinence. 

Functional Incontinence: When a patient experiences this type of incontinence, their urinary tract is normal, but external factors may affect their ability to get to the toilet on time. Common external factors include difficulty with ambulation, trouble removing clothing, or forgetfulness. In the case of functional incontinence, the caretaker is essential to helping the individual maintain their dignity by developing a potty schedule and physically assisting with toileting activities. 

Stress Incontinence: Many women become familiar with this type of incontinence after childbirth or during pregnancy. Stress incontinence occurs when a small amount of urine is released due to intra-abdominal pressure caused by actions like sneezing, climbing stairs, exercising, or laughing.

Urge Incontinence: Also referred to as overactive bladder, this manifests as a strong, sudden urge to urinate even though the bladder may not be full. This may occur more frequently among people who have had extensive chemotherapy or radiation treatment as well as those who have sensation loss or nerve damage. 

Individuals may also experience mixed urinary incontinence, which is a combination of stress and urge incontinence. Regardless of the type of urinary incontinence an individual is experiencing, the respectful response of the caretaker is key to helping them through the process. Assisting with toileting, developing a bathroom schedule or routine, and cleaning up accidents with compassion are all considered to be part of the duties of the in-home caretaker.

Bowel Incontinence and Constipation

Bowel incontinence can be much more problematic, frustrating, and embarrassing for individuals, not to mention messy. Like urinary incontinence, it is important for the person to undergo a medical evaluation for new or worsening symptoms of bowel incontinence. 

Common contributing factors to bowel incontinence include nerve injury, injury or weakness of the anal muscles as is common after some surgeries, reactions to medication, reaction to food or fluids consumed, or simply confusion and forgetfulness. Certain conditions, like paralysis or gastrointestinal illnesses, can also cause bowel incontinence. Issues like diarrhea, constipation, and fecal impaction may cause or be a result of ineffective bowel function. 

Part of the responsibility of the caretaker is to monitor bowel movements so that they can ensure the person in their care is voiding their bowels on a regular basis and so that they are aware of changes in bowel patterns. 

Treating and Managing Incontinence 

Some types of in-home treatments for incontinence and toileting may be covered by health insurance, long term care insurance, disability insurance, Medicare, Medicaid, government benefits (like VA benefits), and/or local community programs. Caretakers may wish to encourage families to explore the options for covering the costs associated with incontinence care. 

There is a common misconception that aging inevitably leads to incontinence. This assumption is false, but many of the conditions that affect older adults may contribute to the inability to control one’s bladder or bowels. Aging bladders may have reduced urine capacity or the inability to completely void the bladder, and urinary incontinence is more common among women than it is among men. Nonetheless, a few key behaviors can help improve bladder and bowel control.

Eat, Drink, and Be Regulated: Diet and fluid intake can affect urination urgency and bowel incontinence, so incorporating high fiber foods, such as whole grains, bran, beans, nuts, fruits, and vegetables, into a person’s diet while encouraging sufficient fluid intake is the first step in managing bowel and bladder irregularity. Drinking six to eight glasses of water a day is recommended for most people, but, in some cases, individuals are reluctant to drink water or take in a lot of fluid for fear of peeing on themselves. However, dehydration can lead to more serious problems, so it is imperative that the person receiving care drinks enough fluid. The color of urine can be an indicator of hydration levels. Clear or yellow urine is fine, but orange or brownish urine can be a sign of dehydration. 

Caffeine, alcohol, citrus, and sugary drinks can contribute to increased urgency with urination, so it may be helpful to limit those types of beverages in general. In contrast, cranberry juice helps with urinary tract health and it also reduces the odor commonly associated with urine-dampened clothing or bedding. As a caretaker, it is critical that you ensure the person you are caring for is consuming appropriate levels of fluids and high-fiber foods throughout the day, though it may be helpful to limit fluid intake at night in individuals with urinary incontinence.

Move for Better Movements: People who are bedbound or sedentary are more likely to experience problems with regular bowel function. If possible, encourage your charge to take a walk or participate in other exercises and physical activities to keep things moving through the digestive system. 

It’s Poop O’Clock: Bowel retraining is one method that some caretakers and individuals find useful in managing bowel movements. After determining the approximate times each day a person uses the bathroom, the caretaker can establish a potty routine that mimics the person’s natural patterns. Individuals with Alzheimer’s or dementia can especially benefit from routine potty breaks, and incorporating a regular bathroom schedule for seniors suffering from these conditions can help train their body to void waste at more predictable intervals. 

Catheters: Catheters are often the last resort for incontinence treatment, and improper use can increase the risk of infections and damage to the urinary tract. If the individual uses a catheter, the caretaker should monitor the catheter for signs of irritation or infection as well as report on any changes in urine output. 

Be prepared, because you might need to help the person you are caring for get from one room to another rather quickly.

Accidents Happen

Planning for accidents can help mitigate the embarrassment and messiness that inevitably accompanies a missed toileting opportunity. When accidents occur, the caretaker should move swiftly to help the person clean themselves and get into clean clothes. If accidents occur frequently, the family may need to invest in additional tools for incontinence and other health care needs. 

Some of the items that can assist with toileting and incontinence care include the following: 

  • Adult diapers and continence pads for undergarments, furniture, and bedding
  • Plastic or rubber sheeting (include a soft, washable fabric between plastic/rubber and the fitted sheet)
  • White vinegar and water solution (for soaking stained fabrics and removing odors)
  • Bedside commodes, bedside urinals, and/or bedpans
  • Wet wipes, powders, and lotions 
  • Rails or bars to assist with weight-bearing when sitting down or getting up from the toilet
  • Washing machine for soiled linens and clothing
  • Household cleaners for toilets and floors
  • Assistive lifting devices or slings (for transferring to and from the toilet)
  • Bidet attachment on the toilet seat
  • Personal hygiene assistive devices, like the Freedom Wand or extended reach tools

Personal care and personal hygiene support activities expected of caretakers may include the following:

  • Changing bed linens and washing soiled towels, sheets, and blankets
  • Emptying and cleaning bedpans or bedside commodes
  • Changing adult diapers and/or incontinence pads
  • Monitoring bathroom activities and patterns and reporting any changes to family members or medical personnel
  • Monitoring skin condition (since incontinence can lead to tissue breakdown or skin irritation)
  • Helping the person clean themselves, both after toileting as well as after accidents
  • Communicating with compassion and respect (tips on this below)

Communicating with Compassion and Respect

Some people may try to hide their accidents due to their own embarrassment at their situation, but a good caregiver should be able to break down these barriers by clear, direct communication and swift action. Thoughtful and regular communication is key to improving or maintaining a good quality of life for the person receiving in-home care, and this is especially important with an activity like toileting that is central to a person’s independence.

Be direct and proactive. Make sure the individual knows that incontinence or difficulty toileting in a common but often treatable problem. Reassure them that reporting or asking for help when accidents occur is the best way to get appropriate treatment and deal with the situation.

Stay calm. An individual who urgently needs to get to the bathroom or who has just soiled their clothes may become angry, fretful, or just plain anxious. Using phrases like, “It’s okay” or “These things happen,” can put the person at ease. A matter of fact, “I’ve been through this before and it’s no big deal” approach is especially useful for addressing the problem at hand and moving the person past the incident. 

Never reprimand or yell. No one enjoys losing control of their bladder or bowels, and caretakers should make sure they are employing all of the strategies at their disposal to prevent accidents from occurring. When accidents do happen, remember that most older adults have likely been toileting independently their whole lives and, as such, they know when they have missed the mark. Fear of recrimination only worsens the problem. 

Pay attention and adapt the assisted toileting process to the individual’s preferences. One of the many things younger or fully able-bodied people takes for granted in that we all have our own unique habits in the bathroom. How much toilet paper does the individual person tend to use? Do they stand to wipe? Do they prefer briefs or boxers? Do they like to take a book or magazine with them for longer potty sessions? Learning and responding to these habits can make the person receiving toileting assistance feel a little more relaxed about needing help. 

Know Before You Go

For caretakers providing live-in care or working in an assisted living facility, approaching toileting behaviors with knowledge, respect, and compassion can make all the difference in the world for the person receiving care. 

After all, everyone poops.