WHEN A 2-YEAR OLD WON’T STAY IN BED

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
WHEN A 2-YEAR OLD WON’T STAY IN BED
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. How can we keep our 2-and-a-half-year-old daughter in bed? Two weeks ago she climbed out of her crib and never looked back. However, I don’t feel that she is developmentally ready to stay in bed.

We are patting her back until she falls asleep, but this goes against all the parenting I’ve done with my other kids. I would like her to rest and sleep in her own bed, by herself.

A. We’d love to know what else happened two weeks ago. Has an important change or event affected the family – a move, illness or death, a pregnancy, a parent’s job loss? When children this age experience a new stress, the first sign may be a change in sleep patterns.

Parents sometimes assume that a child is “too young” to realize that something’s up, which is appealing when a change is hard to face and parents wish they could protect a child from knowing. At such moments, though, young children need parents’ help to understand what is happening, and how the family will manage. What young children can’t put into words they may translate into actions, like refusing to stay in bed.

Another potential cause may be allergies, asthma or even a cold. Check with your pediatrician.

If your child had been sleeping through the night, she’s mastered how to settle herself down at bedtime. But going to bed means she must temporarily separate from parents and surrender to being alone – unless she is sharing a room.

Separation can be tougher when a child’s world seems less predictable. She needs to believe you will still be there, and respond as always, in the morning.

Another sleep-disrupting event can occur within the child – a developmental threshold we call a touchpoint. At age 3 or 4, children become newly aware of their emotions and of the moral judgments that go with them. They realize they can feel angry or vengeful or jealous. Such emotions may frighten them or make them feel guilty. Often this awareness surfaces as fear about monsters and witches, and in nightmares of angry, vengeful, hurtful creatures.

Parents can help to ease this stress by talking gently about the full range of emotions (their own and their children’s) and by reading children’s books that deal with them – for example, “Where the Wild Things Are” by Maurice Sendak, or “There’s a Nightmare in My Closet” by Mercer Mayer.

When children know their parents can help them handle emotions so they won’t act in scary ways, the fears and nightmares will subside.
(See our book, “Touchpoints: 3 to 6: Your Child’s Emotional and Behavioral Development.” Da Capo, 2006)


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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, 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 now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

DEVELOPING A SENSE OF SELF ESTEEM

NEW YORK TIMES COLUMN: FAMILIES TODAY:
DEVELOPING A SENSE OF SELF ESTEEM
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D

Q. I would like to hear your thoughts on how to raise a child to have a strong sense of self-esteem.

A. The word “self-esteem” has been so overused that its meaning has been lost and sometimes confused with “selfishness.” But these are entirely different. Thank you for your question and this opportunity to clear up the confusion.

Self-esteem does not refer to an inflated view of one’s self. Instead, it is the capacity to hold onto a basically hopeful view of one’s self while facing and integrating experiences that challenge this view.

The development of healthy self-esteem in a child allows her to confront her mistakes without taking apart her positive feelings about herself, so that she can mobilize these positive feelings (confidence, faith in her potential, etc.) to find the courage to learn from and overcome her mistakes. The result is not a skewed view of one’s self, but a realistic one in which both strengths and weaknesses can be acknowledged and accepted.

How to help a young child develop healthy self-esteem? Here, too, there’s been a great deal of misunderstanding.

Overpraising a child (“Yay!” for every least little utterance or gesture) can interfere with a child’s learning to motivate herself, to praise herself when she deserves it, and to face her failures so that she can work to overcome them. I have seen 5-year-olds in Kenya care competently for younger siblings without anybody cheering them on, yet radiating a quiet confidence in their own abilities.

In some upper-middle-class communities in this country, I have seen some children who seem to lack the inner motivation to challenge themselves, and who have become dependent on external sources of praise – over which they have a different kind of control.

Abundant opportunities for small successes and an environment rich with developmentally calibrated challenges are important, but total protection from small failures deprives a child of the experience of facing mistakes, feeling the feelings that go with this, getting these feelings under control, and then developing the resolve to try again.

Perhaps most important of all for the development of healthy self-esteem in a child is a parent’s unconditional acceptance – entirely independent of performance – of a child not for what she does, but for who she is. Feeling loved no matter what does not fill us with illusions about how wonderful we are, but helps us to tolerate our imperfections. When we can do this, we are more likely to learn to live with the imperfections of others. This is why self-esteem is such an important first step in learning to get along with others.

Q. I am writing to appreciate you for being such a fine pediatrician who cares as much about the parents as you do about our children … I felt you were like a friendly grandfatherly type of doctor sitting by my side as I faced each developmental phase. I’ve always felt my daughter is my teacher, and with your guidance, I learned to listen and observe her better so I could support her to develop her potential.

A. It is good to hear that I was able to get across to you what I truly believe, that parents need support at least as much as they need advice, and that their best teachers are not the “experts” but their children, if only parents can really watch and listen, as you have been able to.


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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, 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 now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

BABIES WHO WANT TO WALK; AND BEDWETTING

NEW YORK TIMES COLUMN: FAMILIES TODAY:
BABIES WHO WANT TO WALK; AND BEDWETTING
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Are there any studies about babies who develop learning disabilities if they never crawl? Or, is this an old wives’ tale? A friend’s baby is almost 11 months old and he will not crawl. He is trying to walk but will not crawl.

A. I am not aware of any studies on the long-term development of children who don’t learn to crawl before walking, but I have known many children who skipped crawling entirely, went straight on to walking and never developed any learning disabilities that anyone was ever aware of.

I don’t think it helps parents to scare them about unknown or improbable risks that they can’t do anything about. On the other hand, if there is already other evidence that this 11-month-old is not developing on target in any way (leaving out crawling on the way to walking as an isolated finding is not evidence), then early identification and intervention can make an enormous difference in optimizing the child’s ultimate progress.

If your friend is worried, she should start with her pediatrician, who should be able to provide an initial developmental assessment. See our newly revised “Touchpoints Birth to 3: Your Child’s Emotional and Behavioral Development” (Da Capo 2006) for information on the range of behaviors a healthily developing 11-month-old can be expected to display: They are so much fun!

Q. I have a daughter who outgrew bedwetting years ago. This year she started sixth grade and has now resumed wetting the bed every night.

My daughter and I agree that the bedwetting must be due to stress. But she is doing well in school, with good grades and new friends. There are no big negative stress factors — just the newness of sixth grade.

What can I do to help her stop this problem?

A. Bedwetting in a child who has been dry for six months or more is altogether different from bedwetting that has never ceased. When a child this age who has been dry for years starts bedwetting, it is concerning. I would look for possible causes for this sudden change, for example, a urinary tract infection, or diabetes and other less common medical or neurological causes. Check on it with her pediatrician.

In this situation, stress can only be settled upon as a cause after medical ones have been ruled out. After you have determined that there is no medical reason for her bedwetting, then you and she can face together any new stress that she may feel about entering sixth grade.

Sixth grade can be a time of great change and great anticipation. If they didn’t start in fourth or fifth grade, boys and girls are likely to start showing new nervousness and excitement about each other now. Some girls have already had their first period and the others ought to know their time is coming.

Sixth or seventh grade may be the start of middle school– what a terrible time to lump together so many children undergoing such drastic upheaval, without the pressure to act grown up from older students (9 -12 high schools), or the opportunities to feel grown up provided by younger ones (K-8 elementary schools)! No longer nurtured by a single teacher, students may already be moving from class to class, teacher to teacher, and feeling much more like they must fend for themselves.

For many children this age, it seems like time to say goodbye to childhood, and to prepare for the unknown. As much as they may act as if they were eager to forge ahead, many sixth graders struggle with mixed feelings about the end of this somewhat more carefree period of their lives.

I am impressed that your daughter is so open and eager to work on her problem with you Rather than feeling so ashamed that she wants to hide it. Her close relationship with you is the single most important protective factor against whatever you and she may fear about the adolescent years ahead!


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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, 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 now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

STRATEGIES FOR LIBERATION FROM THE PACIFIER

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
STRATEGIES FOR LIBERATION FROM THE PACIFIER
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. We have a very bright, active and affectionate 3-and-1/2-year-old boy, who is wonderful in every way.

My question concerns the use of a pacifier. Our child still sleeps with one, and occasionally (rarely) asks for it “to calm down.” It is something he uses only at home. The dilemma is that our pediatrician, who is a wonderful child advocate, says it is fine and that we should let him give it up when he is ready.

My dentist (who has not yet examined the child), however, says in no uncertain terms that will deform his palate and we should take it away.

We’ve decided not to nag him about it, but think we should make a decision about it soon. I myself sucked my thumb until I started school.

A. Does your child use the pacifier just to soothe himself to sleep at bedtime, or does he suck on it all night long? If he only uses it briefly as he falls asleep and occasionally “to calm down”: for short periods, then trying to take it away may not be worth the struggle. If he uses it more often than this, he’s even less likely to give into nagging.

Either way, attempts to stop thumb sucking or pacifier use are bound to backfire unless the child is offered and successfully learns alternative strategies for self-calming. Without other ways to relax and calm down, a child will cling to a pacifier even harder when a parent tries to interfere with its use, since this struggle creates a new source of stress while threatening to take away a major way of handling it.

Instead, without ever mentioning the long-term goal of replacing the pacifier, watch your child for other things he does to calm himself down. Does he talk or sing to himself, squeeze a teddy bear, curl up under the covers, or come to you for a hug, a lullaby, or reassurance?

Whenever he does use his pacifier, encourage him to fall back on one of his other ways of soothing himself too. You can also introduce new ones. If he has a favorite (small) stuffed animal, doll, or toy, offer it to him when he is upset, and ask him to stroke and hug it until he’s feeling better again. Take it with you wherever you go as you do the pacifier, so that you can offer both.

Little by little he’ll learn to feel nearly the same comfort from his specially treasured toy or doll as he has from the pacifier, and will begin to let go of the latter – when he is ready.

The key is to keep any sense of urgency to yourself, for this will only make him anxious, and more in need of his pacifier. Let him lose interest in the pacifier, at his own pace. Sooner or later he will. As may have been true for you when you stopped sucking your thumb as you began school, many children make up their minds to give these soothers up when being accepted by their peers becomes even more important.

Strategies that simply stop pacifier use or thumb sucking in the short term may come at some cost. For example, simply taking away something this important to a child may lead some children to feel less secure, and some to become more focused on seeking comfort by putting things in their mouths, fingers, thumbs, other objects, or more food than is healthy.

Turning the pacifier into a negative experience, for example, by scolding or mocking the child when he uses it, or punishing him when he does, may stop the behavior in the short term, but there may also be a price later to pay for it.

Unfortunately, too many sources of information for parents try to reduce child rearing into a few quick tips and simple steps. Although some of these may “just work” in the here and now, they may not be good for a child’s future development. To raise a child is not always simple or easy. It wouldn’t be as rewarding as it usually is if it were. Often parents are caught between conflicting recommendations from professionals. Perhaps you might ask your pediatrician and dentist to talk with each other. If they do decide together to recommend stopping the pacifier, it is reasonable to expect that they would also help you figure out how to do it. Just ordering parents to make a child change a hard-to-change behavior without any other help won’t do.

Perhaps our readers can help too.


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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, 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 now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

TODDLERS AND VEGETABLES

NEW YORK TIMES COLUMN: FAMILIES TODAY:
TODDLERS AND VEGETABLES
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My 3-and-1/2-year-old son will not eat vegetables at all, except (very occasionally) a couple of baby carrots. He has thus far defeated every one of the strategies I’ve used to sneak in veggies. He will eat certain kinds of fresh fruit, so I give him those whenever possible.

We also avoid sweets and use whole grains rather than refined flour. But I worry that he’s getting poor nutrition – his diet is so heavy on meat, cheese, pasta and bread (in addition to whatever fruit he will eat, the current favorites being cantaloupe and red grapes).

For his age, he’s only in the 25th percentile for height, while 50th for weight. Our pediatrician said he didn’t need a multivitamin and she didn’t see any cause for worry about weight. What do you think?

A. Vegetables! I hated them as a child – and I still hate them. My younger brother hated them more. As I watched my mother hover over him for hours trying to shovel vegetables into him, while completely ignoring me, I began to hate my brother even more than vegetables. Now you know why I became a pediatrician – to stamp out vegetables, and to overcome my guilt at wanting to kill my brother!

When I turned 50, I began to get along with my brother – of course we both had to wait for this moment until our mother had died. But I’ve never forgiven her for vegetables. So every time I am asked about young children and vegetables (and in the course of 50 years of practice, I have discovered that my mother was not the only mother who cared so deeply about vegetables), I tell mothers, and grandmothers, “Forget about vegetables.”

They turn pale. Open their eyes wide. Feel faint. I offer them a seat, and repeat, “Forget about vegetables.”

As they gasp for breath, I continue, “When a young child struggles with you over food, you won’t win. The more you struggle, the more he’ll hate whatever you’re trying to shovel into him. Back off. Apologize. Let him know that you know that only he can swallow the stuff you prepare for him.”

As they begin to recover, they stammer, “Really? No vegetables? No green vegetables? No yellow vegetables?”

“Really,” I say. “You can cover them with a multivitamin during this temporary period – usually between 2 and 3 years old – when any battle over food will backfire into even worse nutrition. They’ll make it through this with enough milk, meat, eggs, grains and fruit.”

As a pediatrician, I would carefully monitor for growth and general health. Height and weight need to be considered not only separately, but together, and not just at one single moment in time, but over time. The context of a child’s overall health, eating habits and activity level, and his parents’ height and weight, also need to be factored in. Any parent who is concerned about a child’s weight, height or eating certainly deserves to have this taken seriously by the child’s pediatrician.

Of course, the truth is that science is still working to identify all the active ingredients of vegetables, and how they promote health – and not all of these are contained in multivitamins. Yet even once this has all been fully worked out, there still will be certain basic bodily functions – such as eating and breathing – that we can’t take over or control for children.

Jessica Seinfeld has written an intriguingly entitled book, “Deceptively Delicious,” in which she whips up a number of child-friendly disguises for vegetables. If you try this kind of maneuver, try not to make an issue of it, or to take your stealthy nutritional missions too seriously.

Instead, keep mealtimes relaxing and enjoyable, and focus talk on fun things, but not on food.

Many children take time to acquire tastes for new foods, and their taste-sensing equipment actually matures with age. So in the meantime, you can introduce a vegetable over and over, in very small amounts, so that there is no pressure to try it. The tiny bit of new and different food should just repeatedly appear – without commentary, without pressure, without monitoring of or reaction to whether or not it is consumed. On the sixteenth time, you may be surprised to see the child give it a try, and you may be disappointed as you watch him spit it out. In the meantime, if you avoid processed sweets, and salty and fried foods, your child’s palate will not become overwhelmed with and addicted to these easy-reach taste blasts, and will be more likely to welcome the more subtle tastes of – vegetables.


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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, 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 now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.
www.touchpoints.org.

Reprinted with permission from the authors.

HOW MUCH SHOULD TODDLERS SLEEP – AND NAP?

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
HOW MUCH SHOULD TODDLERS SLEEP — AND NAP?
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. How much sleep does an 18-month-old really need? My son sleeps 10 hours at night (waking several times) and takes a 1 hour nap during the day – well below what the books (and common sense!) say he needs. However, he seems rested and energetic and is developing normally. What do you think?

A. What the books say about the amount of sleep children need at different ages is usually limited to averages. Individual children, though, may fall at one end of the range or the other. (The average at this age would be about 12 hours at night plus 1 to 3 hours of napping.) We think that your observations that he is rested, energetic and developing normally are reassuring.

However, you also mention that he wakes up several times at night. Does he just briefly rouse, never becoming fully awake, and quickly settle down to sleep? Or does he become fully awake, and if so for how long, and what does it take for him to get back to sleep?

Has this only begun to occur recently? If so, and if it rapidly resolves itself, it may mean that he is responding to some minor stress, or even to the stress of development – the temporary backslide in one area of development just as a new developmental skill is coming together – a touchpoint.

But if this has been going on for some time, or persists, then we would suggest that you bring this to the attention of your child’s pediatrician. There are a wide range of readily treatable causes of sleep disturbances that you wouldn’t want to miss. If the waking at night is a regular bother for you or for him, then it is a sleep problem worth addressing. (See our book “Sleep: The Brazelton Way,” DaCapo Press, 2003, for more information.)

Q. I have a 3-year-old son who is becoming terribly resistant to taking naps until late in the afternoon, which of course impacts on his behavior (and we have a 5-month-old baby boy in the family now as well, which is a part of this as well).

If he does eventually put himself down for a nap in the late afternoon, bedtime is a nightmare as well. How hard should we try to get him to take a nap? I really do not think he is ready to completely drop his nap, based on his mood on days he doesn’t get one. I just don’t know how much of an issue I should make it. Any advice would be much appreciated.

A. It does sound as if he may be beginning the transition away from the afternoon nap – not a struggle you want to fight, nor one you’re going to win. We’d bet that he wants to be up and around as much as possible so as not to miss out on all the fun his baby brother is having.

Why not put him down for a “rest” early enough to prevent the bedtime “nightmares?” If he sleeps, fine; but if he doesn’t, don’t bother with a nap too late to help. Instead, when he doesn’t nap in the afternoon, try moving up his bedtime a little earlier. Some children who aren’t getting enough sleep actually start sleeping less and less, or sleep less restfully. If he really isn’t ready to give up his afternoon nap, he may show you this by sleeping more at night – if given the opportunity. (Three-year-olds average about 11 hours of sleep each night and an hour’s nap each day, but the range varies from one child to another).

If you can break away from the 5-month-old briefly in the early afternoon, this could be your special time to cuddle and relax together with your older child. Maybe this will help with his moods. As you say, sharing you with his new brother is bound to affect his moods and his 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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, 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 now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

THE ANCIENT PRACTICE OF SWADDLING

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
THE ANCIENT PRACTICE OF SWADDLING
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Are there any negative side effects to swaddling with the baby’s arms down along the sides of the body?

A. Swaddling – snugly wrapping your baby in a blanket – is an age-old, nearly universal strategy for comforting young infants. It seems to have fallen out of favor a few hundred years ago in many cultures, but not in the Middle East, and not among many Native American tribes.

Many Native American peoples have long used cradle boards – a flat board to which cloth or animal skin was attached – to keep their babies snug, warm, easily carried and out of harm’s way.

Many cradle boards have “bumpers” at the top ingeniously extending beyond the baby’s head so that it is fully protected. In some tribes they were positioned at a gentle angle for feeding or upright so that the babies in them could watch other family members at work and begin to learn about their world.

In fact, we would expect that these babies would be able to muster up more energy for visual learning since the cradle boards kept their little bodies at ease and under control.

Recently, swaddling seems to have been making a comeback, in the United States, the United Kingdom and other European countries. This may be because now that we understand the advantages of positioning babies on their backs for sleep to decrease the risk of Sudden Infant Death Syndrome, we need a way to help babies fall asleep and stay asleep in that less comfortable position.

Swaddling has many obvious benefits, helping to keep babies warm, calm and comfortable. Swaddled babies will rouse less and sleep longer. At the beginning of life, the snugly fastened wraps recreate the womb’s supportive fit, cutting down on a newborn’s startles and jerks – motor reflexes that otherwise make the baby feel uncomfortable and often start to cry.

Modern science has established numerous other benefits of swaddling, and special circumstances in which it is particularly helpful. One study has even shown that premature infants may have improved neuromuscular development when regularly swaddled.

But you ask about negative effects. A recent study showed that Hopi infants raised in cradle boards did not start walking any later than those raised without them. There are, though, studies that link swaddling to early hip problems (hip dysplasia and dislocation), but the risk may be the result of the specific position of the legs under the swaddles. These studies suggest that it is important to avoid fully extending the legs, or rotating hips outward when swaddling a baby. Swaddling babies so that their hips and knees are bent and with enough slack to allow movement appears to be safer for their hips.

In warm climates or over-heated buildings, care must be taken not to let an infant’s body temperature rise dangerously high when tightly wrapped. There are a few studies that have found that babies swaddled from head to toe all day long for several months may be more likely to be deficient in Vitamin D, presumably because swaddling cuts down on their exposure to sunlight, which is needed to activate Vitamin D.

Other studies suggest that very tight swaddling may slightly increase a baby’s vulnerability to respiratory infections, perhaps because it limits the normal expansion of chest and lungs. These studies seem to suggest avoiding prolonged swaddling, swaddling from head to toe, and overly tight swaddling. This shouldn’t interfere with the containment and comfort that swaddling still can offer, and many pediatricians feel that swaddling a baby for 12 to 20 hours a day in the first weeks is perfectly fine, and that it can be gradually decreased after a month or two depending on a baby’s comfort without it.

As for swaddling the arms alongside the body, we have not found any studies to suggest that this is a problem. However, it is important to leave the arms free often enough that babies can discover their fingers and thumbs, so that they can learn to use them to comfort themselves by fondling the soft edges of their blankets, their own soft cheeks, or by sucking on them.

Swaddled or not, it is critical to position babies on their backs when asleep, or likely to fall asleep so that they are at less risk for SIDS. It is also critical that when awake all babies are given plenty of time to play while on their tummies so that they can strengthen their arm, shoulder and back muscles. This has become a major concern for babies who spend much of their awake time in car seat-like baby carriers. We did once encounter an 8-month-old with delayed motor milestones, not yet sitting on his own. He had been a fussy baby, and his mother had religiously adhered to an intensive regimen of swaddling that some pediatricians recommend for such babies. Swaddling does seem to reduce crying and can even soothe pain. We had no way of knowing whether he’d had too much swaddling for his own good, but we’ll always wonder.


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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, 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 now 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.