A 6-YEAR-OLD’S ‘DOUBLE DILEMMA’

NEW YORK TIMES COLUMN: FAMILIES TODAY:
A 6-YEAR-OLD’S ‘DOUBLE DILEMMA’
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Our 6-year-old is a happy-go-lucky boy. But he has potty accidents at school about once a month and wets the bed up to three times per week.

My instinct tells me that sometimes he is too exhausted to sense his need to go to the bathroom. I give him a change of clothes and some suggestions. I am careful not to shame him.

Also, our boy can’t sleep through the night.

We listen to CDs like “Indigo Dreams” and his favorite story, “The Velveteen Rabbit.” We say a good-night prayer. We make sure he has a few of his “friends” – stuffed animals.

He insists on a light in the hall in addition to his night-light. During the night, he will come into our bedroom and want to crawl into our bed.

We are consistent and firm and take him to the bathroom, then to his bed.

This pattern happens every night two to four times, and it is wreaking havoc on our sleep lives. What can we do about this double dilemma?

A. About 15 percent of 5-year-olds and 5 percent of 10-year-olds still wet their beds. Let your child know that you understand that the bedwetting happens while he is asleep, that it is not under his control, and that you don’t mind helping him change and wash his pajamas and sheets.

Set up a routine for handling the “accidents” that cuts down on tension and embarrassment. You can restrict fluids from suppertime on and remind him to urinate twice before he goes to bed.

I have found that if parents wake up the child before they go to bed it gives him another chance to empty his bladder and may help prevent bedwetting.

As for the middle-of-the-night awakenings, you can insist that his room is the limit: You will come to him but he can’t come to you. Then be sure you respond when he calls.

You can sit by his bed without lying next to him, reassuring him that you are there. The combination of bedwetting and awakening raises a possibility that might explain both: obstructive sleep apnea, or another related form of sleep disturbance.

OSA occurs when breathing during sleep is briefly but repeatedly interrupted by a blockage. Fortunately, people with this disorder wake up to get themselves breathing again – at the cost of poor sleep quality and lower oxygen levels.

The most common sign of OSA is snoring, although many children who snore don’t have this condition. At age 6 or 7, the tonsils and adenoids are largest relative to the size of the airway and therefore likelier to obstruct it.

Not all children with OSA wet their beds, but some do. Along with snoring, other OSA symptoms include breathing pauses, restless sleep, difficulty awakening in the morning, daytime sleepiness and behavior problems.

To make the diagnosis, a sleep study – which measures heart rate, breathing and sleep cycles – can be performed. However, the test may not detect a few related disorders (for example, Upper Airway Resistance Syndrome).

Asthma and allergies may also disrupt sleep. We suggest you consult your pediatrician.

For more information: “Take Charge of Your Child’s Sleep,” by Dr. Judith A. Owens and Jody Mindell, Ph.D. (Marlowe & Co. 2005), and “Solve Your Child’s Sleep Problems,” by Dr. Richard Ferber (Simon & Schuster, 1985).


Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

9 MONTH OLD AND NAPTIME RESISTANCE

NEW YORK TIMES COLUMN: FAMILIES TODAY:
9 MONTH OLD AND NAPTIME RESISTANCE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Our healthy 9-month-old son has started to resist going down for his naps. We have tried every method in the book (quiet time, reading, rocking, dark room) but he still cries/wails before each nap.

On good days, he takes two one-hour naps; on bad days (more often lately), one or two 45-minute naps. He goes to sleep easily at night without nursing and sleeps through for about 10 hours.

A. Most 9-months-olds require about 12 hours of sleep during each 24-hour period – including nighttime sleep and naps. Sleep needs vary among babies. The range for 9-month-olds is from 11 to 13 hours per day, according to pediatric sleep specialist Richard Ferber, M.D. So on “good days” your son is within the average.

Many children resist naps, even when they need them. Up until 6 months, most babies take three naps a day – one in the morning, one midday or early afternoon and one later in the afternoon.

At around 6 months, one nap is dropped. At around 12 months, babies often drop one of the two remaining naps. A little ahead of schedule, your baby may be getting ready to switch from two naps to one.

When a baby is on the verge of dropping a nap, a period of back-and-forth may follow for a few weeks. This transition is typical of what we call a touchpoint, when an area of development such as sleep becomes briefly disorganized to reorganize into a more mature pattern.

One day, your baby may take one nap and skip the other, or he may have trouble falling asleep before both. He’ll also be cranky and tired when he has had fewer or shorter naps. Falling asleep at night may be harder, also.

When one nap replaces two, naptime also shifts – between the old morning and afternoon naps. The remaining nap’s length may be longer, or the baby may sleep a little longer at night. At 12 months, the sleep total is only about 30-45 minutes less than at 9 months, so the single remaining nap may be longer than before.

Can a parent help this transition? Try to be sure that the baby is getting enough sleep over each 24-hour period. Inadequate sleep can interfere with falling asleep and sleeping restfully.

Help your baby consolidate his two naps into one by putting him down for his morning nap a little later. Put him to bed later, too, which might lead him to sleep longer – thus easing the shift to consolidate morning and afternoon naps.

The transition will happen anyway in a few months, if not sooner. You may be just as glad for him to keep napping twice a day for a while longer, even if he struggles to get himself to sleep and the naps are shorter.

If he gets tired and cranky, encourage quiet time for cuddling and reading together so that he can get a little rest and comfort even if he can’t sleep then.

(For more information, see “Solve Your Child’s Sleep Problems,” by Richard Ferber, M.D. published by Simon & Schuster.)


Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

FEEDING A PICKY EATER

NEW YORK TIMES COLUMN: FAMILIES TODAY:
FEEDING A PICKY EATER
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My 3-year-old son is a very picky eater. As we weaned him from baby food and bottles around age 1, he refused to eat anything other than yogurt and crackers. I assumed it was just a transition issue that would sort itself out as he grew older.
He is now almost 4 and refuses even yogurt, sticking only to Cheerios, crackers, apples, applesauce and milk. He takes a daily multivitamin. He continues to grow taller and gain weight at a normal rate.

I’ve encouraged him to try new foods but I haven’t pressured him too much because he can be very determined when he makes a decision. Am I doing the right thing to wait it out?

A. You don’t have much choice. You can’t force a child to eat.

You’re doing the right thing by giving your son a daily multivitamin (be sure it also contains iron), taking him to the pediatrician for regular growth checks – and, hardest of all, not pressuring him too much. We urge you to see if you can make the move to not pressuring him at all.

Why? Every time he senses your attention to what he’s eating, you’re giving him power over you. The power struggle may distract him from the pleasures of eating. Even a little pressure can turn the dinner table into a battlefield. Parental hovering can be counterproductive whether it’s pressure (“just one bite”) or praise (“you tried the broccoli – good job”). Cajoling and bribing may backfire.

Let eating be his issue, not yours. Holding back can be difficult when you fear you may not be fulfilling one of your most important responsibilities as a parent – making sure your child is well fed. Yet you may help him get closer to this goal when you turn it over to him.

Your job is to present him with the food, whether or not he eats it. At each meal, you can add to his standard fare a small amount of a new food he hasn’t tried, just enough so that if you have to throw it away you won’t feel frustrated or discouraged – which he’s bound to notice.

Many children need to be presented with a small amount of the same kind of food at 15 successive meals before they’ll give it a try. Children’s taste buds mature over time. Tastes that bother them at an earlier age are easier for them to accept later.
For some children, specific food textures may be troublesome. So as you pick a new food to introduce, start with ones that aren’t too different in taste and texture from those he likes.

Since milk seems to be his only source of protein, you might try adding protein-rich food to his diet – for example, ground meat, egg, beans or nuts. Perhaps you can spread a teaspoonful on the crackers he likes.

Your other job is to keep mealtimes relaxed and fun. You may need to take a deep breath and accept that your son will only eat what he decides to put in his mouth. Regular checks from a pediatrician can reassure you. A consultation with a nutritionist may help, too.

When mealtimes are sociable rather than stressful, the positive associations of being together and enjoying each other’s company are likely to make the food on his plate seem tastier – but not if he gets even the slightest inkling of your strategy.

(For more information: “Feeding: The Brazelton Way,” by T. Berry Brazelton, M.D., and Joshua Sparrow, M.D. Da Capo Press.)


Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

LEARNING TO BE A ‘BIG BROTHER’

NEW YORK TIMES COLUMN: FAMILIES TODAY:
LEARNING TO BE A `BIG BROTHER’
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D

The new baby has come home and suddenly the older sibling doesn’t get the same attention as before. The newcomer is ever more demanding of their mother, whose energy may not yet have returned.

The older brother’s demands increase, too. It’s almost as if he must test to be sure that his mother will recover and that she can still care for him. Teasing and testing, refusing bedtime and waking up each time the baby does – all are to be expected.

Sometimes an older child will take on the helping role of “big brother” or “big sister,” but don’t be fooled. Along with pride in helping, and his discovery that he is more “grown-up,” he’ll still resent the baby and feel sad about losing you.

You can make it clear that there are times when he can help, and times when he can be a baby, too. He’s telling you, “Why did you need her? I can do anything she can. I can still be your baby and please you.” He is facing one of life’s crises and learning how to cope with it in the safety of your loving care.

Expect the older child to lose ground again at some point. Usually it’s in the developmental area he’s just mastered. If he has begun speaking, he may resort to baby talk. If he’s feeding himself, sleeping through the night, becoming toilet-trained or conquering fears of strangers – count on a slide backward. This is what we call a touchpoint, a temporary falling apart that anticipates a new step ahead. He is learning how to be a big brother.

Think what it means to the older child when a 2-month-old baby fusses every afternoon and parents rush to attend to her. You can help him understand his feelings. He’s working so hard to understand the new baby, and to imitate her. “Of course you want to talk like the baby: Everyone pays so much attention to her right now.” Or, “Don’t worry about wetting the bed. Once you get used to having a baby sister, it’ll stop.”

Your understanding will be far more effective than getting annoyed or pressuring him to be a “big boy.” These responses are bound to backfire into even more dramatic bids for you to let him be your baby again.

Some children seem to sail through these first months. They are compliant, even helpful. But this interlude won’t last. The price of such a challenging new role for a child may have to be paid at a later touchpoint, or in reaction to one of the baby’s own touchpoints.

Each of his steps backward is an opportunity for you and the child to learn together to master the next stage of development.

An older sibling who is 5 or 6 years old may not express his resentment and frustration through tantrums or meltdowns; instead, he may devise ways to attract your attention by spilling things, falling, or needing your help with homework. Or he may come to your side as if to help, only to drag around and get sassy with you. But he needs the same understanding as a younger child. He will be better able to tell you how he feels than his sibling, and more able to help in a useful way once he feels understood.

DISCIPLINING THE OLDER CHILD

  • Stop him firmly but quietly.
  • Hold him, or use a time-out if he’s ready to comply.
  • Pick him up to hug and love him. “It’s tough having a baby sister, isn’t it? But I can’t let you do that and you know it. I must be here to stop you until you can stop yourself.” Watch his face and his eyes take it in and soften.
  • After you’ve made contact with him and are feeling close again, let him help you with the baby. In that way, he’ll begin to sense the goal of discipline and to feel like a “big brother.”

(This article is adapted from “Understanding Sibling Rivalry,” by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D., published by Da Capo Press, a member of The Perseus Books Group.)


Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center.  Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

14-MONTH-OLD, EARLY TO BED AND EARLY TO RISE

NEW YORK TIMES COLUMN: FAMILIES TODAY:
14-MONTH-OLD, EARLY TO BED AND EARLY TO RISE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My 14-month-old is an excellent sleeper – he has slept through the night since he was 2 months old. However, he goes to bed early and wakes up early (typically 7:15 p.m. to 5 a.m.)

I have tried shifting bedtime a little later but it hasn’t affected wake-up time; instead he is cranky and tired until his morning nap, which shifts earlier.

I don’t want to mess with a full night’s sleep, even if it’s not on my preferred schedule. But I find it hard to make evening plans with the rest of the family.

Do you have suggestions for (a) shifting to a later bedtime and/or (2) explaining to relatives and friends why it’s so important either to turn down invitations or to leave early to keep his sleep schedule?

A. At 14 months, 10 hours of nighttime sleep is about average. A child this age would also need another hour or two of sleep during the day. (Of course, many children are not average, so sleep requirements vary.)

An early-to-bed early riser’s sleep schedule is healthy so long as the child gets the sleep he needs. If you want to try to change his sleep schedule, you will need to shift every sleep-related event – naps, bedtime and mealtimes – in each 24-hour cycle.

And you must maintain the pattern consistently, advancing by 10 to 15 minutes each day. The process is like adjusting to a new time zone.

At first, your child probably won’t wake up later and may be tired and cranky. But if you continue this schedule for a few weeks, chances are he eventually will start waking up later in the morning.

At that point you would not advance his bedtimes, naptimes and mealtimes any further. He should still obtain the same amount of sleep at night and during naps. If not, you may need to go back by 15 minutes or so, settling on a new schedule that works best for him.

None of this is necessary unless his current schedule bothers the family enough to make the effort. You may indeed prefer not to “mess” with a good night’s sleep.

You don’t tell us whether your child appears well rested and wide-awake when he is up: important signs of a healthy sleep pattern.

As for the pressure to make your baby conform to others’ schedules, you are his parent. Decisions like these are up to you. You may deflect criticism by making it clear that this is a matter of the child’s biology, not a lack of parental backbone. Assert your authority: “He’s an early bird. Some people just are, and we intend to respect that.”

Others’ opinions will bother you less once you feel confident about your stance on your child’s sleep.


Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

A CHILD’S ‘SENSORY PROCESSING DISORDER’

NEW YORK TIMES COLUMN: FAMILIES TODAY:
A CHILD’S ‘SENSORY PROCESSING DISORDER’
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. What is your opinion of “sensory integration dysfunction?” My 3-year-old has been diagnosed with this condition and is in occupational therapy to address it. Is this a new fad or something real? Does occupational therapy help?

A. Sensory integration dysfunction, now called sensory processing disorder, is not a fad.

The occupational therapist and developmental psychologist A. Jean Ayres first wrote about sensory integration almost 40 years ago.

I knew Ayres was onto something. My observations showed me that each newborn has a different tolerance for sensory stimulation. Such differences help make a unique individual – but they can be disabling.

For example, premature babies often are often so hypersensitive to sight, sound or touch that when overstimulated they register changes in their vital signs. As children grow, differences in their experience of their senses can affect their behavior and learning.

During the past decade, science has affirmed the disorder. The Sensory Processing Disorder Foundation (www.sinetwork.org) features research as well as information for parents.

To make sense of our world, we must put together what we see, hear, smell, feel and touch, and we start learning to do this at the beginning of life.

Some children are more – or less – sensitive than others to sensation. The differences show up in how children react to, and understand, the information their senses detect.

We now think of sensory processing disorder as a large diagnostic category with three subtypes: sensory modulation disorder, sensory discrimination disorder and sensory-based motor disorder.

All involve some kind of disruption in learning. As a result, children may have trouble understanding about their world. They may react to it in ways that are hard to fathom until the specific challenges are identified.

For example, a child who is hypersensitive to loud noises may have tantrums in response to them. Nobody else may even hear the noises, but everybody notices the tantrum. Another child may not correctly process information that her joints and muscles send about her body’s location in space. As a result, she may be clumsy, bump into things and avoid sports.

For some children, a day with the usual barrage of stimulation from the environment can feel uncomfortable, even traumatizing. They and their parents may be immensely relieved just knowing the source of the problem.

Occupational therapists can help identify the differences in how children’s senses work and how their brain processes information from their senses. The therapists can also help children learn how to avoid problem situations and how to cope with those that can’t be avoided.

For more information: “The Out-of-Sync Child,” by Carol Stock Kranowitz. Perigree 2005.


Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

A 5-YEAR OLD WITH TROUBLED SLEEP

NEW YORK TIMES COLUMN: FAMILIES TODAY:
A 5-YEAR OLD WITH TROUBLED SLEEP
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My almost 5-year-old son is very tired during the day, even though he gets 10 hours of sleep most nights. He is in school now, so he can’t take daily naps. I’ve noticed that he kicks a lot during the night. Should I look into another cause, like periodic limb movement disorder?

A. By age 5, most children no longer need naps, so not napping is unlikely to explain the fatigue. Ten hours of sleep is enough for most children his age although the necessary amount varies from child to child.

So sleep quality may indeed be the problem. A number of disorders can disturb a good night’s sleep, including narcolepsy and obstructive sleep apnea, which is commonly caused by allergies, asthma and obesity.

Period limb movement disorder is another cause to consider when a child (or adult) kicks or moves his legs while asleep and is tired during the day. (Certain kinds of seizures can also cause unusual movement during sleep.)

Child sleep experts Judy Owens, M.D., and Jodi Mindell, Ph.D., note that PLMD is often missed because the symptoms are not reported. Also, many doctors don’t know about of this condition. PLMD is relatively common in adults, especially as they age. But not until recently has the condition, been recognized in children.

Your pediatrician could refer you a pediatric sleep specialist who can conduct a sleep study, make a diagnosis and recommend treatment.

Such a study is carried out in a sleep lab (usually in a hospital), where the child spends the night – and where a parent should be encouraged to stay too.

The lab monitors and records the child’s heart rate, blood pressure, breathing rate, movements and brain waves through the night.

A child with PLMD may also have Restless Legs Syndrome. A child with PLMD isn’t aware he’s kicking. RLS, however, involves an uncomfortable sensation in the legs, often described as a tingling, or the need to move.

Children with RLS will resist going to bed at night because lying down brings on the distressing sensations at their worst.

Both RLS and PLMD seem more common in children with Attention Deficit
Hyperactivity Disorder. Some scientists think that similar brain chemicals may be involved in the conditions.

Sleep disorders often lead to irritability and other behavioral problems at school, with related trouble in concentrating and remembering. But these problems often clear up when sleep quality improves.

PLMD’s cause is unclear, but the condition appears to run in families. It may be associated with iron and folate deficiencies. Sometimes, if the deficiencies are treated, the condition abates. (PLMD is also more common in children with leukemia, but most children with the disorder do not have leukemia.)

Usually, however , PLMD persists. Medication may effectively treat it. Avoid caffeine, present in many soft drinks, and be sure that the child devotes an adequate amount of time to sleep. Some doctors think that moderate exercise a few hours before bedtime may help.


(For more information, see “Take Charge of Your Child’s Sleep,” by Judith A. Owens, M.D., and Jodi A. Mindell, Ph.D, published by Marlowe & Co.)

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child’s health or well-being, consult your child’s health-care provider.

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

Early Language Matters

Early Language Matters

Early Language Matters by Louise Packness

In an undergraduate communications class I was taking at Hunter College in NYC, many years ago, we were shown videos of Washoe the chimpanzee learning American Sign Language. (ASL) I was mildly interested in attempts to determine primates’ ability to learn language. But my real focus in these videos and in this class was American Sign Language itself.

I was taken with how “expressive” I found the visual-gestural language of the Deaf community. Peoples’ facial expressions were animated. There were large and small, fast and slow gestures and body movements. Eye contact was vital. I became consumed with questions about different forms of language. Could it be that a language that was expressed visually was somehow more “honest”, more “direct”? Certainly I had experienced misuse of spoken language: twisting of phrases and words; verbal manipulation of a sort. Could ASL use by-pass abuse of speech and more easily get to the heart of an issue? I felt compelled to explore this issue. I already loved language related learning, I.e., foreign languages, the origin of language, how languages change over time – and the nitty gritty of speech sound production as well as grammar and morphology and syntax.

I went on to graduate school and became a Teacher of the Deaf. I got my answer. ASL can be used in a manipulative way just the same way a spoken language can be. A visual gestural language may look more “immediate” and “‘direct” – “honest “if you will. But ASL is a full and true language; it follows rules, has exact vocabulary, word meanings, sentences and syntax and it is entirely possible to be false and manipulative in the visual-gestural form as well as the spoken language.

In my deaf education teacher training, the question of language acquisition for deaf and hard of hearing children born in to a hearing world came to the forefront. How do deaf children learn language and how do they learn to think? I went to study language acquisition of both deaf and hearing children and speech language development has been my professional work for 35 years.

In general conversation, we often talk about communication and language interchangeably. They absolutely overlap; communication is a form of language and language is a part of communication, but they are not entirely the same.

Communication starts the moment a baby is born. It is about connecting emotionally with other living beings. We humans are hard-wired to make and find comfort in these connections and we are born with a set of innate emotional expressions and an instinctive understanding of other people’s emotions. We express joy, sadness, fear, disgust, interest, surprise anger, affection and more, and recognize them in others.

These early non-verbal connections are shared through vocalizations, facial expressions, and physical movements. Adults and babies engage in looking at each other, copying each other, taking turns on an emotional level – interactions known as “serve and return”. They are recognized by psychologists as important in shaping brain architecture in powerful ways, and helping to create a strong foundation for future learning. These interactions, conversations back and forth of sounds, gestures, facial expressions, tones of voice, eye-contact, posture and use of space give the young child a sense of belonging and are important to both partners.

Verbal communication, language, is also hard wired in the brain.
It is a rich, complex, adaptable system with rules; it is the way in which we combine sounds, create words and sentences in speech, signs and later writing to communicate our thoughts and understand others.

Verbal language provides us with the tools to know what we think and want, and understand others’ thoughts and wants. We need language to socialize and learn. Through both communication and language, we are able to learn new information, engage in rich pretend play, solve problems, ponder, invent, imagine new possibilities, and develop literacy.
Verbal language develops over time and follows universal, developmental milestones. Children learn at different rates, but there is a critical period in which a child must experience and develop language for it to develop fully.

None of us remember how we learned language. For the child with no interfering cognitive or physical challenges it seems that it simply happens. It is “caught” not “taught”. It is “caught” when a child is immersed in a world with caring adults who talk and interact and engage with this child. The particular language – or languages – a child masters is the one that the child experiences and has the opportunity to practice.

Language learning requires no tools or training – only these conversations.
When we say that early language matters it is the early, emotionally attuned engagement between adults and young children that matter.

When an interested adult is fully attending, talking and listening – making it easy for the young child time to start conversations; responding with interest to what the child is expressing with or without words, talking about those things the child is interested in at a level the child can understand, having conversations that go back and forth a number of times – these behaviors promote the natural development of language.

My work has been with children with special needs who have speech and language delays and disorders. For these children specialized early intervention is extremely important. The earlier the better to take advantage of a young child’s developing body and brain.

For the typically developing child, however, if language develops easily and naturally, what can interfere??

How strong children’s language skills are affected by their surroundings. Challenging environmental circumstance, such as food insecurity, poor housing, lack of health care, no access to books make a difference in the young child’s development; an adult, parent or caretaker who is not able to sustain attention or be attuned to the child makes a difference in the child’s development. When the adult is highly distracted – perhaps by troubling personal concerns or the ever-increasing interruptions caused by technology; i.e., needing to check Face Time, take a phone call, look at Instagram, check notifications, etc., the child is adversely impacted. The tremendous value of on-going conversations gets lost with many interruptions. Being aware of the factors that are challenging, we can begin to address them.

The early conversations are what matter. They say that a good conversation is like a good seesaw ride; it only happens when each partner keeps taking a turn.

Louise Packness,
Speech-Language Pathologist, M.A. CCC-SLP


Books and Resources for Early Language Matters

American Speech-Language Hearing Association: articles and books. Including:
– Activities to Encourage Speech and Language Development
– How Does your Child Hear and Talk?
– Apel, Ken & Masterson, Julie, J. Beyond Baby Talk: From Sounds to Sentences – A Parents Complete Guide to Language Development, 2001

Early Years Foundation Stage, (EYFS) Statutory Framework- GOV.UK
2021 Development Matters in the Early Years.

Eliot, Lise, What’s Going On in There? : Bantam Book, 1999

Galinsky, Ellen. Mind in the Making: Harper-Collins, 2010

The Hanen Centre Publications. Helping You Help Children Communicate.
– Manolson, Ayala, It Takes Two To Talk: The Hanen Early Language Program ,1992
– Parent Tips
– “Tuning In” to others: How Young Children Develop Theory of Mind

Lahey, Margaret. Language Disorders and Language Development: Macmillan Publishers, 1998

Lund, Nancy & Duchan, Judith. Assessing Children’s Language in Naturalistic Contexts: Prentice-Hall, 1988

National Association for the Education of Young Children (NYAEC)
Articles
– Reinforcing Language Skills for Our Youngest Learners by Claudine Hannon
– 12 Ways to Support Language Development for Infants and Toddlers by Julia Luckenbill
– Big Questions for Young Minds, Extending Children’s Thinking. 2017

Princeton Baby Lab. A Research Group in the Dept. of Psychology at Princeton studies how children learn, and how their incredible ability to learn support their development. 2022 babylab@princeton.edu

Pruett, Kyle,D: Me, Myself and I: Goddard Press, 1999

Ratey, John,J. A User’s Guide to the Brain, Vintage Books, 2001 : 253-335.

Rossetti, Louis,M: Communication Intervention, Singular Publishing, 1996

Siegel, Daniel J,& Hartzell, Mary. Parenting from the Inside Out: Penguin Group 2003

Presence and Perspective

Perspective

Presence and Perspective By Murielle DiBiase, M.D.

In the chaos of the world we are living in today I find the challenge that rises to the top of my heap across settings and interactions with others of all ages is to be present and consider the perspectives of others. We are so inundated with the stressors of everyday living complicated with all of the Covid chaos that it’s a true challenge to stay in the moment and even consider the perspectives of others.

In my work in the field of Early Care and Education, I have many opportunities to engage with families, children, professional colleagues, teachers, and a wide variety of support staff involved as educators in this phenomenal field. We know that parents/family are children’s first “teachers”. Everyone involved in the classroom dynamics has an impact on the foundation of learning for each child in their care. We are all “cognitive coaches”, incidentally as well as intentionally, for every child we connect with, even for those we come to know in utero. It’s simply amazing to consider that the first 3 years of our lives are known to be the time in our lives that we will learn at an extraordinary pace like no other time in our entire lives. This, to me, magnifies the importance of intentionally being present as much as we possibly can across settings and ages for all to truly benefit from the interaction.

As I engage in the work of coaching educators to elevate the quality of their engagement with children, there are frequent conversations about taking a child’s perspective in the moment given any number of daily situations we encounter. As adults, we often make unintentional assumptions about children’s perspectives… “When you push your chair away from the table, you’re telling me you’re all done with snack.” (said to an 18 month old) I had to wonder if that was so or was this child merely experimenting with cause and effect given the moment… Just as unintentionally, we often forget that young children are just beginning to understand their world and are learning things like self-regulation. They are truly novices at social engagement and are new to the concept of emotions. They learn what they are living with no regard to “right or wrong” ideations at such a young age. Understanding a young child’s perspective is key to quality engagement. The more we learn, the more we are able to support learning for our youngest human beings.

This is all food for thought, which might shift our perspectives a bit. We don’t know what we don’t know and we do the best we can with what we do know at any given time in our lives. Thank goodness we have a lifetime to learn and grow and there are so many opportunities for us to do so! Learning is a work in progress, not an aim for perfection…

Favorite Resources:

Ted Talks : Jun Li, Fred Rogers (Google these individuals for more resources)

ZERO TO THREE 
Brazelton Touchpoints Center
Connection Parenting, Pam Leo (Google her for more resources to her credit)

Creative Connections LLC
Murielle S. DiBiase, M.Ed.
PO Box 15
Palermo, Maine 04354
207-931-6615

Polyvagel Theory

Eye Contact with baby

Polyvagel Theory By Mark Rains, Ph.D.

How can parents help soothe stress in infants and build their capacity for attachment, self-regulation, social engagement, and resilience? Of all the many ways to understand this, one article that transforms how we look at relationships and stress response systems is “Neuroception” by Stephen Porges1. Published in Zero to Three in 2004, it remains timely; applicable to current problems with traumatic or “toxic” stress, childhood protective factors, and prenatal substance exposure, as well as classic infant mental health challenges with temperament, attachment, parenting, etc. It also introduces concepts of personal and social stress management that support coping with the psychosocial and professional challenges of COVID care.

Neuroception involves how the brain senses safety or threat through (primarily) visual, auditory, and tactile cues in the social environment and organizes responding. A complementary article by Porges, also in Zero to Three [1993], focuses on Interoception2, a “sixth sense” response to internal physiological cues. Both social and internal inputs are linked via the vagus nerve to multiple response systems. The multiple roles of this nerve and its contribution to Social Engagement Systems of parents and infants are elaborated within a Polyvagal Theory of stress response3.

Basically, polyvagal theory refers to (1-6):

  1. the general variety of inputs and outputs of the ventral (front) and dorsal (back) branches of the vagus nerve in the parasympathetic Autonomic Nervous System (ANS),
  2. the involvement of the ventral branch of the vagus in communicating (receiving and expressing) cues of safety and threat within interactions in the Social Engagement (i.e. Safe to Friend 4) System.
    In conditions of safety, the ventral vagus regulates the ups and downs of:
  3. mobilization without fear for action (waking, food gathering, defense, etc) by inhibiting and disinhibiting the sympathetic arousal branch of the ANS, especially heart function, and
  4. immobilization without fear for physical maintenance (sleeping, digesting, lactation, intimacy, illness recovery, etc.) by dorsal branch of the vagus and release of oxytocin.
    In conditions of significant or life-threatening stress:
  5. mobilization with anger/fear leading to dominance of ventral vagus by sympathetic arousal and limbic system overriding cortex (“losing your head”), i.e. Fight/Flight systems OR
  6. immobilization with fear involving physical shutdown by dorsal branch of vagus nerve, i.e. Freeze/Faint systems, going into shock, loss of blood pressure, etc.

In other words, with safety the parasympathetic ventral vagus nerve regulates both the sympathetic ANS and the parasympathetic dorsal vagus, as it balances waking and sleeping, gathering food and digesting it, engaging socially and withdrawing for reflection, energetic sexual activity and safe intimacy, child protection and lactation, etc. When this homeostatic balance is overwhelmed and sympathetic ANS or dorsal vagus is unregulated, an individual is vulnerable to physical and/or mental health problems.

Health and resilience involve accurate sensitivity to threat cues and flexibility in response. Problems result when persons see threat in safe situations and miss threat in stressful situations and/or when their mobilization or immobilization with anger or fear is chronic and less flexible. Polyvagal theory adds another lens to viewing current problems in self- and social-regulation: the importance of safety, the role of social engagement system in communicating and managing safety, and dysregulation that follows lack of safety.

The Social Engagement System develops within the attachment relationship between infant and parent and continues through adult interactions. Social engagement involves muscles of face and head, available in infancy, before development of extremities.

Following are some of the highlights:

Social Engagement

with Safety

(higher vagal tone, more flexibility)
• Make eye contact
• Display contingent facial expressions
• Vocalize with appealing inflection and rhythm
• Modulate middle-ear muscles to distinguish human voice more efficiently
• Problem solve
• Safe Touch, Massage
• All the above contribute to Attachment and to Soothing stress before it becomes toxic

Disengagement

with Danger

(lower vagal tone, less variability)
• Eyelids droop
• Positive facial expressions dwindle
• Voice loses inflection
• Awareness of human voice is less acute
• Sensitivity to others’ social engagement behaviors decreases
• Chest (crisis) breathing

Porges (2004)

There is a YouTube video that depicts the role of social engagement system in soothing stress and relationship development https://www.youtube.com/watch? v=zcz2Towvf8A. Spoiler alert: It portrays a father attempting to comfort the cries of his infant daughter. Their facial expressions mirror as he becomes stressed and she continues to fuss. He contacts her mother by cellphone where she is shopping in a grocery store and mother tries a variety of attempts to connect with and entertain her daughter via the cellphone screen, unsuccessfully. A grandmotherly figure in the grocery store appears to wonder, “What is going on here? How ridiculous to think technology could replace human interaction.” Nothing works.

The father then picks up his daughter with safe touch, brings her up to make eye contact with his safe face; all of which soothes her upset and catches her interest, and they eventually calm and connect. Its poignancy brings tears to mother’s eyes, perhaps gratified to see father and daughter’s capacity to join her in parenting. Both father and daughter were able to utilize their social engagement systems. Although it’s not clear that the producers of the video clip were thinking beyond “Technology will never replace love”, it seemed to me to illustrate social engagement well.

Polyvagal theory adds another lens to viewing current problems in self- and social-regulation. Heart Rate Variability (HRV) is a measurable biomarker of flexibility in ventral vagal regulation of heart function. Heart rate rises and falls with respiration. I won’t attempt to go into detail about this, beyond noting that it is one of the ways of studying the tone (high or low flexibility) of the ventral vagus in a variety of physical and mental health problems. Porges (2004) proposes that faulty neuroception (ability to switch effectively from defensive to social engagement strategies) may contribute to autism, schizophrenia, anxiety disorders, depression, and Reactive Attachment Disorder. Infants may learn defensive behaviors with frightened or frightening caregivers, which may then be ineffective or costly within safe environments.

For example, in infants exposed prenatally to substances and experiencing withdrawal symptoms as neonates, sympathetic arousal may be dominant, resulting in difficulty with parasympathetic functions of eating and sleeping and being comforted.5 Caregiving within the Eat, Sleep, Console program6assists in regaining sympathetic/parasympathetic balance, supported by medication to manage sympathetic arousal. Massage has been helpful in vagal tone of premature infants, enabling better weight gain. 7

The social interaction and communication challenges associated with autism spectrum difficulties8 are another area of research on polyvagal theory where intervention increases eye contact, vocalization, and anxiety; sensitivity to stimulation, etc. It doesn’t cure autism, but addresses some of the challenges, which might lead to a vicious cycle of withdrawal, behavioral difficulties, etc.

Turning to the parental role in the social engagement system involves parents being able to regulate their own emotional state and sense of safety, in order to be a safe partner interacting with their child. After ensuring that the child’s “alert system” is not hyper- (“wired”) or hypo- (“tired”) aroused and that the child’s “alarm system” is not activated by internal (interoception) or psychosocial (neuroception) threats, a parent can communicate safety within the parent-child social engagement relationship by providing nonverbal (right brain) relationship cues and utilizing developmentally appropriate language (left brain).9 Synchrony in the parent and child social engagement systems supports resilience. As the child develops beyond infancy, neuroception of safety is needed for verbal communication or executive functioning to be successful. Infant mental health interventions can model and provide safe social engagement by therapists to support safe parent and child interaction.

Parallel to the experience of parents, providers of healthcare and social services experience both vulnerability and opportunities for resilience, managing exposure to stress, utilizing professional coping strategies, practicing personal self-care, and experiencing organizational support. In particular, social engagement through teamwork and mutual support can help maintain resilience and reduce feelings of unmanageable threat. Unfortunately, this has been limited during COVID, in which distancing and masking undermine social engagement opportunities. When such social connection is not available, individual practices can help ‘jump start’ vagal tone through a variety of portals to the ventral vagus nerve. These include:

  1. Confident (diaphragmatic) “belly-button-breathing” (e.g. four count inhalation and six count exhalation), which is an alternative to crisis (chest, up-and-down) breathing.
  2. Massage, safe touch, which renews vagal tone.
  3. Vocalization (e.g. singing, chanting), which can engage the cranial nerve regulating the trachea and, together with diaphragmatic breathing, stimulate the ventral vagus nerve.
  4. Auditory stimulation which renews the balance in sensitivity to voice frequencies that can be dysregulated after exposure to danger frequencies, e.g. with soothing music in the range of voice frequencies (e.g. classical stringed instruments) or specially programmed music (Safe and Sound Protocol10) to stimulate middle ear functioning and flexibility.

Using such vagal stimulation strategies to achieve or renew a parasympathetic state of Safe to Friend provides a foundation for confidence and other cognitive coping strategies. This is built into a series of “Resilience Stretches”, which help recover from, manage, and prepare for psychosocial stress; like physical stretches prepare for physical activity.11

Research into these areas is still at early stages in many respects, at promising to evidence-based levels. As polyvagal theory has gained popularity12 , interpreters (myself included) may stray from science or evidence base, promoting short cuts to social engagement with oxytocin, vagus nerve stimulation, quick fixes, etc. I recommend sticking close to the source and staying up to date with the evidence base.

Take Home / Take to Work points:

  • In addition to Fight/Flight and Freeze/Faint responses to
  • Adverse Experiences, there is a Safe To Friend system of social engagement to manage stress with resilience.
  • This system is ready to begin from birth and is developed within safe, stable, supportive attachment interactions and relationships.
  • Vulnerabilities in the Social Engagement System may contribute to a variety of physical and psychosocial health problems.
  • There are multiple portals to renew safety at a personal level of neuroception and interoception and at a social level of protective factors for parents and professionals
  • With professional/personal/organizational resources, Infant mental health specialists can bring their own social engagement systems to safe, healing, growthful, interactions with parents and children.
  • Ongoing research will contribute to better understanding of the potential and limits of the preceding points

  1.  Porges, SW. (2004) Neuroception: A Subconscious System for Detecting Threats and Safety.  Zero to Three, 24:5,19-24.  (Downloadable from www.stephenporges.com )
  2.  Porges, SW. (1993) The Infant’s Sixth Sense: Consciousness and Regulation of Bodily Processes. Zero to Three 14(2), 12-16. (Downloadable from www.stephenporges.com )
  3.  Porges SW (2017). The Pocket Guide to the Polyvagal Theory: The Transformative Power of Feeling Safe. New York: WW Norton.
  4.  There are a variety of abbreviations for describing the Social Engagement System in contrast to “Fight/Flight, Freeze/Faint” systems, e.g. Tend and Befriend, Rest and Refresh, Friend, etc.  I am proposing “Safe to Friend” as a psychophysiological state, which an individual may reach through social interaction or personal activities.
  5.  Jansson, LM, DiPiero, JA, Elko, A and Velez, M. (2010) Infant Autonomic Functioning and Neonatal Abstinence Syndrome. Drug Alcohol Depend. 109(1-3): 198-204.
  6.  Grisham, L. et al. Eat, Sleep, Console Approach: A Family-Centered Model for the Treatment of Neonatal Abstinence Syndrome. Adv Neonatal Care. 19(2):138-144.
  7.  Field, T. (2019). Pediatric Massage Therapy Research: A Narrative Review. Children (Basel), 6(6): 78.
  8.  Porges SW, Bazhenova OV, Bal E, Carlson N, Sorokin Y, Heilman KJ, Cook KH, Lewis GF. (2014). Reducing Auditory Hypersensitivities in Autistic Spectrum Disorder: Preliminary Findings Evaluating the Listening Project Protocol. Frontiers in Pediatrics. Doi:10.3389/fped.2014.00080
  9.  Rains, M. Contact mainerains@gmail.com for handout. Brief video illustrating Brain in Palm of Hand    https://www.youtube.com/watch?v=evikiqovSVw
  10. https://integratedlistening.com/ssp-safe-sound-protocol/
  11.  Rains, M. 2022. “Resilience Stretches” Contact mainerains@gmail.com for copy.
  12.  Porges SW & Dana D (2018).  Clinical Applications of the Polyvagal Theory: The Emergence of Polyvagal-Informed Therapies. New York: WW Norton.
  13.  See also a wide variety of YouTube videos featuring Stephen Porges.