They don't call it the "terrible twos" for nothing. In fact, the age of 2 is just about when tantrums begin as children start to explore their independence. For both parents and tots, it can be a time fraught with frustration, trying to understand one another. But it doesn't have to be this way. Global parenting expert Jo Frost, best known from ABC's "Supernanny," has some tips to navigate these turbulent times in her new book "Jo Frost's Toddler Rules: Your 5-Step Guide to Shaping Proper Behavior." Frost says by following her five rules of disciplined parenting, you can ensure a happier and more peaceful household.
Rule 1: Sleeping. Make sure your toddler gets the right amount of sleep! Frost says "sleep isn't so much the end of the day as it is the beginning of the next," particularly for little ones. Without a good night's rest, toddlers can become moody and hyperactive -- and more willing to test you. In addition, not enough sleep makes them less prepared to learn, and it can inhibit their brain development. According to Frost, "sleep also prepares the body to extract the necessary glucose from the bloodstream to maximize focus and attention in the brain." How much sleep should your child be getting? Children ages 1-3 need 12-14 hours of sleep, including naps, during a 24-hour period. For ages 3-5: 11-13 hours. For ages 5-10: 10-11 hours.
Rule 2: Food. Eating smart doesn't just mean kids with healthier weights and fewer issues like diabetes and obesity. It also means better brains. Getting the proper nutrition means the brain is not only primed for optimal learning, but it has the energy to explore and learn. Good food also translates to better mood and impulse control. Make sure kids eat at regular intervals throughout the day, and strive for a well-balanced diet of proteins, carbohydrates, fruits, vegetables, dairy and oils. Think your child is a picky eater? Frost says you might have to try broccoli 12-15 times before you know if your kid is giving you the thumbs up or down.
Rule 3: Socialization. It's important to get your kids out and about. Playing on the swings, going swimming, engaging in play groups -- these are all good ways to not only use up your kids' energy, but help them become more comfortable with new people and places. Getting your little ones exposure to other kids teaches them to share space and toys. It also better prepares them to go to school and work in groups. And don't hesitate to take them out on your errands as well. Just make sure you limit the time. Don't spend more than 30-60 minutes on your errand. Keeping it short prevents tantrums. Also make sure to go on an errand after a meal or a nap, and carry a snack and some water just in case.
Rule 4: Early learning. A child's brain is 85% developed by age 5, much of it happening in the first three years of life. So make sure you stimulate children's brains by reading and singing to them. That helps stimulate the auditory skills that they will use to express their thoughts and feelings. Make sure to also give them opportunities to test their visual skills of tracking and memory. But also make sure that they are getting a lot of physical exercise to practice both gross and fine motor skills. All of this stimulation helps children become more coordinated and do better in school. And while for some, this may mean preschool, learning doesn't have to be expensive. Libraries are great sources of books and activities.
Rule 5: Good behavior. Making a rule about good behavior may seem obvious, but it needs to be practiced. Frost says we not only need to tell our children what to do, but we need to show them how to behave. And when we see them behave well, praise and reward them. The better behaved they are, the more easily they will be able to work with others and the more attuned they will be to listening to directions and asking questions. But just as you set expectations, set boundaries and make sure they know what the boundaries are.
A problem? Try the SOS method. Whenever there is a problem trying to implement one of these five steps, you can always rely on the SOS method to pull you through. Frost's SOS method -- step back, observe and step in -- can actually be applied to any situation, toddler or adult! Whenever you see a meltdown unfolding, first step back and get some perspective on the situation: Why is my child upset? Observe what is happening: Who is saying and doing what? Finally, step in and make a decision about how you want to respond. Having a method in place helps make a tantrum much more manageable.
Remember that tantrums are a natural part of growing up. Around 18 months, children begin to experience a lot of emotions that they have no way of communicating. And the result most often is a tantrum. Tantrums peak between the ages of 2 and 3, and if handled appropriately they usually disappear by the time a child turns 4 or 5. There are three types of tantrums to be aware of: the emotional meltdown, when a little one is just overtaken with emotions of sadness or hurt; the situation tantrum, when toddlers are tired of having to wait and get upset because they can't do something they want to; and finally the mock tantrum, when a child uses a tantrum to get something. If parents give in to emotional and situation tantrums, children can learn to use the mock tantrum to get what they want. You won't be able to get rid of tantrums completely, but by knowing what type of tantrum your child is having, you can identify why your child is upset more easily.
(CNN) -- A potent little painkiller is causing a big stir.
A coalition of more than 40 health care, consumer and addiction treatment groups is urging the Food and Drug Administration to revoke approval of the prescription drug Zohydro.
The hydrocodone-based drug is the latest in a long line of painkillers called opioid analgesics. The FDA approved the medication last fall to treat chronic pain, and it is set to become available to patients in March.
"In the midst of a severe drug epidemic fueled by overprescribing of opioids, the very last thing the country needs is a new, dangerous, high-dose opioid," the coalition wrote in a letter to FDA Commissioner Dr. Margaret Hamburg.
"Too many people have already become addicted to similar opioid medications, and too many lives have been lost."
"It's a whopping dose of hydrocodone packed in an easy-to-crush capsule," said Dr. Andrew Kolodny, president of the advocacy group Physicians for Responsible Opioid Prescribing. "It will kill people as soon as it's released."
The letter is the latest in a series of entreaties to the FDA related to Zohydro.
In December, 29 state attorneys general sent a similar letter to the FDA. The month before, members of Congress asked the agency to review its decision to approve the drug.
The concerns echoed by all groups are broadly about the drug's potency and abuse potential. They say they fear that Zohydro -- especially at higher doses -- will amplify already-rising overdose numbers.
"This could be the next OxyContin," says a petition on Change.org asking the FDA to reconsider.
According to the Centers for Disease Control and Prevention, prescription opioid deaths more than quadrupled since 1999 -- there were 4,030 deaths involving the drugs in 1999, compared with 16,651 in 2010.
"You're talking about a drug that's somewhere in the neighborhood of five times more potent than what we're dealing with now," said Dr. Stephen Anderson, a Washington emergency room physician who is not part of the most recent petition to the FDA about the drug. "I'm five times more concerned, solely based on potency."
Both Zohydro's maker, Zogenix, and the FDA assert the drug's benefits outweigh its risks.
"We do not expect the introduction of Zohydro ER (extended release) to increase the overall use of opioids," said Dr. Brad Galer, executive vice president and chief medical officer at Zogenix, in an e-mail. "In fact, prescription data from the last five years shows that total use of ER opioids is constant and independent of new entrants to the market."
Galer said the company will focus its commercial efforts on a small group of doctors with good experience prescribing opioids, so that only appropriate chronic pain patients would receive the drug.
Advocates for pain patients say that concerns about abuse, while valid for some, are not necessarily an issue for those patients.
"We know that a person with pain is not a person who abuses medications," said Paul Gileno, founder and president of the U.S. Pain Foundation, a group that receives some funding in unrestricted grants from the pharmaceutical industry. "A person with pain is a person suffering to get pain relief in order to live a fulfilling life."
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In their petition to the FDA for approval, Zogenix representatives cited examples of patients who might benefit from Zohydro: a 46-year-old male with chronic back and leg pain who had two failed back surgeries; a 52-year-old female with metastatic breast cancer experiencing diffuse pain; a 32-year-old woman with multiple orthopedic fractures.
If Zohydro follows in the footsteps of its opioid-containing predecessors, such a narrow, focused patient group may expand -- to patients with low back pain, fibromyalgia, arthritis or countless other chronic conditions.
"The problem is, it costs a lot of money bringing a drug through clinical trials and then bringing it to market," said Anderson, past president of the Washington chapter of the American College of Emergency Physicians. "You have to anticipate (the drug company) being able to market and get its money back.
"I see this as a marketing ploy where eventually it's 'I've got bigger, I've got stronger, why don't you prescribe this,' and I'm terrified of that."
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Bigger, stronger opioids -- especially those containing hydrocodone -- are a concern. Hydrocodone (Zohydro's sole ingredient) is one of the most frequently prescribed -- and abused -- opioids.
For that reason, in October, the FDA said it intended to shift hydrocodone-containing drugs from Schedule III to Schedule II. That rescheduling (still pending approval by the Drug Enforcement Administration) would mean much stricter dispensing and prescribing rules for hydrocodone-containing products.
At the time of that recommendation, the FDA posted a statement on its website that it "... has become increasingly concerned about the abuse and misuse of opioid products, which have sadly reached epidemic proportions in certain parts of the United States."
A day after announcing the proposed drug schedule change for hydrocodone, the FDA announced Zohydro's approval. It was a confusing juxtaposition, some say.
"Shocking, outrageous and genuinely frightening," said Kolodny of the Physicians for Responsible Opioid Prescribing.
FDA spokeswoman Morgan Liscinsky said that Zohydro's approval was separate and distinct from the agency's recommendation about rescheduling hydrocodone-containing products.
"I find great difficulty (with) the wisdom of the FDA's approval in terms of protecting the public's health," said Dr. Alex Cahana, professor of pain medicine at the University of Washington in Seattle, who was not among those who signed the letter to the FDA. "Risk-benefit thinking suggests that not everything we can do, we should do."
Zohydro will enter the market already classified as a Schedule II -- one reason both the FDA and the drug's maker are confident it will not contribute to the broader overdose problem.
Zohydro's labeling will feature warnings about abuse, addiction and misuse, and Galer said Zogenix is working on an abuse-deterrent version of Zohydro that should become available in three years.
None of those precautions has assuaged concerns. Anderson said that while a small subset of patients may benefit from Zohydro, unleashing such a potent drug in the current environment is unsafe.