Toddlers
The toddler years cover the ages from 13 to 36 months. This is a time of exploring, learning to walk, learning to communicate, toilet training, weaning, dealing with separation anxiety, and developing trusting relationships. It is also a time of throwing temper tantrums, head banging, throwing food, fearing strangers, stripping off diapers, and climbing onto everything in sight.
This behaviour is typical of toddlers whether or not they have hemophilia. But there are special concerns for toddlers with the disorder, and issues you will want to be aware of to help keep your or your loved one's child safe.
Ups and Downs
The toddler years are some of the most difficult for the parents of a child with hemophilia—and challenging for other family members caring for the child. Remember that at this age children need to explore freely and learn to set their own limitations—and being overprotective may inhibit the child's desire to explore.
The toddler may fall several times and at this age will not readily develop a connection between falling and injuring himself. Injuries will happen. And when they do, it's very important to teach the toddler that treatment—in the form of factor infusions—will make the injury better. Emphasizing the importance of treatment at this early age will help lay the foundation for the child to understand and accept the treatment he will need throughout his life.
Protective Measures
A one-year-old child is somewhat far-sighted and has limited depth perception. By age two, normal vision improves to 20-60, and by age three vision improves to 20-40. So in these early years it's almost impossible to prevent minor injuries—the child will continually bump into things. Some parents pad sharp corners or sew padding into their child's clothes. But it's important to avoid the "padded world syndrome." Some pediatricians suggest wearing a helmet, while others feel that some children become unbalanced wearing one and should learn to walk without one. Talk to the child's pediatrician to determine the best strategies for your situation.
Treatment Options
If a toddler in your family has severe hemophilia, he will probably develop his first bleed at this age. It is important that you—as well as other family members and caregivers—know the available treatment options in the event of an injury. Prophylaxis—regular, ongoing factor infusions to try to prevent bleeds from occurring—can be a valuable way to help normalize your child's lifestyle. Also make sure anyone involved in the toddler's care is aware of:
- What to do if an accident or injury occurs
- How to know if the child is having a bleeding episode—and who to contact about it
- When preventative treatment may be needed, such as when physical activities are planned
The toddler years are often when the possibility of home infusion is introduced to the family. There may be obstacles that need to be overcome, such as difficulty accessing veins for injection or fear of needles. These should be discussed with the child's doctor, nurse coordinator, or other members of the care team, who are there to provide support on all hemophilia-related issues.
Keeping It All in Perspective
Above all, remember: have fun with the toddler in your family! Remember that they are a normal child—like all toddlers, they need to explore and test their surroundings. As time goes by, you and your family will become more experienced and confident, and the child's care will become second nature to all of you. There will still be ups and downs—but this is true whether or not a child has hemophilia.
It's natural to have lots of questions about the care and treatment of your or your loved one's toddler. You'll find a great deal of useful information on this website, but just remember that for medical advice, always contact your doctor, nurse coordinator, or other Hemophilia Treatment Centre staff member.