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RAISING YOUR ONE AND ONLY

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
RAISING YOUR ONE AND ONLY
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I have an only child. What’s your best advice for raising one?

A. Raising an only child brings special challenges and rewards.

An only child is always a “first child.” Parents may feel that no other child can compare. But they may also be at a loss because they don’t have the experience with other children to help them understand this one.

In a larger family, a child must learn to share – and fight to hold on to what is his, right from the start. An only child needn’t share his parents.

So don’t shower him with excessive praise, rewards and attention. He doesn’t benefit from having too much of everything just because he’s the focus.

Siblings also help to spread out a parent’s protective instincts. Go easy on hovering. Like all children, “onlies” need to try things out for themselves, fail (temporarily), get upset, pick themselves up and try again. Otherwise they may become overly dependent on their parents and lack the self-reliance to separate from them.

If your child is upset, wait a few moments before rushing in to soothe her. See if she can settle herself. Thus she learns to handle her strong feelings. Then she’ll know she can count on herself rather than her parents.

Siblings teach, inspire and entertain one another. Research has shown that babies as young as 7 months of age study each other carefully and respond to each other’s facial expressions, gestures, coos and cries.

Therefore, put extra effort into introducing your only child to other children. Close friends are especially important. Make regular play dates. Whenever possible, let your child get to know her cousins, or the children of your closest friends, to give her the feeling of belonging to a family or community.

Some parents of only children express the concern that their kids miss out on “just being kids” and “grow up too soon” because they are surrounded by adults.

But if parents balance adult-like conversations and expectations by paying close attention to their only child’s cues, they will reinforce the child’s playful side – and rediscover, enjoy and share their own.

Parents of only children find deep satisfaction in the close relationships they share. And only children tell us that they “turned out just fine” and that they treasure the families and childhood memories they have. They speak of connecting with plenty of other children in their extended families, neighborhoods and schools.

Whatever the challenges of being an only child (or raising one), that child will feel like No. 1 from the start, and forever.

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.

CHILD RAISING IN A TIME OF MULTITASKING

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
CHILD RAISING IN A TIME OF MULTITASKING
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

In these challenging times, we risk losing our sense of balance. Technology and global competition have changed how we work. Multitasking has been glorified while new stresses on working parents sap more energy. Yet the most important jobs – like child raising – can’t be done without our full attention.

Working parents are less productive when they worry about their child care arrangements or about their co-workers’ resentment of parental time off when a child is ill.

Families suffer when parents – tethered to smart phones and laptops – bring work home. They may be home, but their jobs are their focus. They may be less engaged with their families, less available to them emotionally.

Yet that availability is critical for child development and strong family relationships.

Children and parents need protected time together to focus on each other, to watch, listen and respond with a minimum of intrusions.

From the start, babies and parents are learning to understand each other and themselves.

Since newborns have been listening to their parents’ voices for several months before birth, I like to help parents discover how much they and their babies already matter to each other.

I hold a newborn with his head in one hand and his bottom in the other. I ask the mother to stand on one side and to talk to her baby in one ear while I talk in the other.

Of course, most every newborn turns his head to his mother. And every mother grabs her baby, kisses him and says, “You know me already!” Then I do the same thing for the fathers. Eight in 10 babies turn their heads to their father’s voice instead of mine. With the other two, I tip their heads toward their fathers – to establish the “conversation.” The fathers react just like the mothers.

In our research, we found that 2-month-olds are already “conversing” with their parents. Sometimes a baby leads; sometimes he follows. He is learning that he can act on his world, and that he will be heard.

Babies and parents are working hard to get to know each other. They are already sharing emotions.

In another experiment, researcher Ed Tronick and I ask mothers to interact normally with their 2-month-olds – and then to turn away. When the mother turns back, we ask her to be unresponsive, expressionless: the “still face.”

Within 11 seconds the baby realizes that something is not right. Then he’ll try 15 different behaviors – smiling, crinkling his eyelids and cooing – to try to win back his mother’s attention.

The baby’s response changes if the mother is depressed. In the “still face” experiment, the baby gives up after only three tries.

Since we can detect maternal depression early and know how to treat it, we have an opportunity to protect children and families.

We used this research on Capitol Hill to advocate for the Family and Medical Leave Act (passed in 1993), which mandates job-protected leave for up to 12 weeks a year, although it is unpaid.

Parents need time with their new babies before returning to work. But these crucial interactions do not end after the first three months.

Workplaces can encourage strong families (and boost productivity, too) when job and family life are in balance.

Families also depend on strong communities where parents can find and share emotional support, practical advice and resources.

For many families, the workplace is their community. Workplaces must learn from strong communities about how to support healthy families. We must all put families first to keep our nation strong.

For more information on family and workplace:

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 “BIG EMOTIONS”

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
A CHILD’S “BIG EMOTIONS”
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. How do I help an almost-6-year-old learn to handle disappointment and frustration? This is a child with big emotions, both positive and negative. Nearly every time he doesn’t get his way, he instantly gives in to his impulse to stomp, throw something, cry, scream, and sometimes hit and push.

He is always apologetic and remorseful, and even berates himself, which I find disturbing (he says he is “stupid,” a word we don’t allow in our home).

A. At nearly 6, your son can learn to manage his strong feelings. The work may be hard now, but it will be much harder later.

It is good that his behavior bothers him, which may motivate him to change. But if he is feeling hopeless, he will need your reassurance that he will someday learn to control himself. He will need to know that physical aggression is unacceptable, and that you will do everything you can to keep him under control until he can manage on his own.

He sounds like he is scared of himself, and he needs to know that he can count on you until he can count on himself. Help from you will be far more effective if he can keep reminding himself that he, most of all, is the one who wants to learn.

In calm times, help him make a list of the triggers for his tantrums. Some triggers will be avoidable, others not. You can strategize together about how to handle both.

For example, when he can’t have what he wants right away, he could focus on when he can have it and what he can do while he is waiting. Instead of pushing someone when he is mad, he can stop and think about what he is feeling, and why. Rather than getting physical, he can say, “I’m mad because I wanted to go first. If you won’t let me go first, then I’m not going to play with you.”

Of course he won’t be able to substitute these reasonable responses for the pushing and hitting right away. Tell him he’ll need to be patient with himself.

Look at the list and help him to identify any triggers that have warning signs. You can agree on a special code that you’ll both use, such as, “Looks like it’s time to cool down.” But then he’ll need to know how. Ask him to think about what helps him relax when he’s feeling upset. Share with him what you’ve noticed, and give him some ideas to try.

For example, leaving the scene to go to his room, not as a punishment but just to cool down, can make a big difference. Does he have a teddy bear to squeeze really hard? Would it help him to wrap himself in his bed covers? Listen to music? Take a shower? Have a cold drink? Or scribble furiously (on paper) until eventually he feels like making drawings or writing about what bothers him?

If these strategies don’t work, you may need more help. Has your child always had “big emotions,” or is this a recent development? Have there been major changes in his life or in your family’s situation that may have gotten under his skin? Have other family members had problems with “big emotions”?

If so, we suggest you consult your pediatrician, who can refer you to a mental health professional skilled in working with young children.

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 TODDLER RESISTS NAPS

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
A TODDLER RESISTS NAPS
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My 3-year-old son now resists a nap until late afternoon. Of course that affects his behavior. (We also have a 5-month-old baby boy, which is part of the problem.) If our 3-year-old eventually puts himself down for a nap in late afternoon, bedtime is a nightmare.

How hard should we try to get him to nap? I don’t think he is ready to drop it, based on his mood on days when he doesn’t get one.

A. Most children start dropping their afternoon nap after age 3. Ready or not, your son seems to be moving in that direction.

His new baby brother may be a reason to stay awake. Five-month-olds are much more exciting for young children than newborns. Everybody else is captivated by babies at this stage, too. Your son doesn’t want to miss out on anything – especially if his brother is in on it.

You’re right that a late afternoon nap postpones bedtime. Instead of a nap, might you set up an early afternoon “quiet time”? Don’t call it a nap. You might even avoid using the bed where he usually naps.

Set up a regular time and place for him to cuddle with you, and for you to read stories together. Or ask him to stay quietly in one spot – a mat or a few cushions – for 30 to 45 minutes. He may surprise you and fall asleep. If not, at least this quiet time may keep him from falling apart later.

Also consider moving his bedtime a half hour or so earlier. Think of this new schedule as a combination of nap and nighttime sleep. You may find that even if he goes to bed a little earlier, he wakes up in the morning at the same time as before.

On average, 3-year-olds need 10 or 11 hours of sleep each night and an hour’s nap. Children who don’t get enough rest in a 24-hour period often have trouble falling asleep, and their sleep is disrupted at night.

But even if you can’t get your son to nap, he may soon be able to get all the sleep he needs at night.

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 TODDLER’S VERBAL CHALLENGES

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
A TODDLER’S VERBAL CHALLENGES
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My son is 2-and-1/2. He speaks in sentences but his verbal exchanges are more descriptive than interactive – almost like a running commentary.

He also has problems “naming” things. He doesn’t seem to grasp the concept. He is sweet and affectionate. He plays well with his younger sister and often interacts with her: He scolds her, brings her toys, tells her what to do, and makes her laugh.

Should I worry?

A. Your child seems bright and engaging, which is reassuring. But those qualities might cause others to overlook the subtle differences you detect. It’s noteworthy when a child who speaks in sentences isn’t naming objects.

When children are learning to speak, they point to things to find out what to call them, to practice naming them or to share their excitement about the words they already know. As you describe it, your son’s approach to expressing himself doesn’t involve the back-and-forth that most children this age can manage.

Perhaps he truly engages in free-flowing conversation with his sister – or she is more tolerant of one-way communication than older children and adults.

Any parent with a lingering concern about a child deserves to have that concern addressed. Mention your observations to your pediatrician. Not every pediatrician, however, has the training to pick up subtle differences in language development. A careful evaluation by a speech and language therapist who is experienced in working with children can help you understand the significance, if any, of the differences you observe.

Some pediatricians might suggest you wait to see if your son will “grow out of it.” But if he needs help, starting early can make an enormous difference.

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.

POTTY TRAINING AROUND THE CLOCK

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NEW YORK TIMES COLUMN:  FAMILIES TODAY:
POTTY TRAINING AROUND THE CLOCK
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Our 2-year-and-9-month-old son was potty-trained for daytime fairly easily at 2 and 1/2. At night he is still in a diaper, and he wakes up very wet. How do we help him to stay dry at night?

A. Your son is following the usual pattern for toilet training. Learning to use the potty during the day at 2 and 1/2 should reassure you. Use the same approach for nighttime: Keep things smooth and easy.

Staying dry at night often takes more time. Many children sleep so deeply at this age that they don’t sense when their bladders are full. As sleep cycles change, most children grow out of this problem. It is far too early to worry about enuresis, or persistent bedwetting. Most pediatricians won’t make such a diagnosis until a child is at least 5.

For children who have been dry at night for several months and then wet the bed, other causes should be considered – for example, a urinary tract infection.

The wait for nighttime dryness can be frustrating. Changing the sheets is no fun, and success seems so close once a child uses the potty during the day. Yet a parent’s overreaction may lead to resistance.

If you can avoid drawing attention to it, have your child limit his liquid intake after supper. Before he goes to bed, he can use the potty not once, but twice – in between, you two could read a story together. Then, let him bring his potty to his bed so he can learn to use it on his own when he wakes up at night. Decorate the potty with glow- in-the-dark stickers to help him find it.

Many parents have told me they have succeeded in night training by gently waking their child to use the toilet a few hours after lights out – usually just before the parents go to bed.

It’s important to keep things low-key. If your son wakes up wet in the morning, don’t make an issue of it. Just respond with an encouraging tone: “Don’t worry. When you’re ready, you’ll be able to stay dry at night.” And he will.

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.

A 1-YEAR-OLD WHO RESISTS HER CAR SEAT — AND HER MEALS

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
A 1-YEAR-OLD WHO RESISTS HER CAR SEAT — AND HER MEALS
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I’m the proud father of a 1-year-old baby girl.

Every time we put her into her car seat for a drive (5 to 20 minutes long), she seems fine and playful for the first few minutes but within no time, she’s crying for attention. She’ll do the cry-stop-cry-stop for as long as 20 minutes.

She’ll reach a point where she’ll just burst into continuous tears. My wife and I have tried toys, Cheerios, cookies, singing and even ignoring her to see if she would stop. The toys, food and singing work just for a minute or two but that’s about it.

We’ve reached the point where we dread going for drives. We know that she’s OK because her diaper is dry, she’s well fed and she’s not tired (when she is tired, a pacifier puts her to sleep in no time).

There is another issue as well. Our daughter is a great eater when it comes to formula and Cheerios (sometimes some cookies). However, we’ve been working on trying to give her solids but with no success.

You’ve said that milk is fine until age 3 but you also recommend the child having bread, yogurt, orange juice, etc. Our daughter will have minimal to no solids – I mean like two to three pea-sized pieces of chicken/tomato/cucumber, etc., MAX!

It seems that all the other kids her age are eating quite well. As you’ve mentioned, we tried giving her solids before her regular feeds (when she’s hungry) but haven’t gotten anywhere.

Also, when she’s in the highchair, we’ll immediately take her out if she starts throwing the food onto the floor. I must mention that from 6 months of age till 9 months, she was eating oatmeal baby cereal once a day. She then reached a point where she didn’t even want to see the spoon coming toward her.

People tell us that she isn’t eating her solids because we started solid feeding too late. They all think we should have started at four months instead of us starting at six months.

A.    A two-fer!

First the car seat:

You are not alone. Nor is your 1-year-old. Babies were not designed to be in car seats, no matter how well car seats were designed to protect them. Many 1-year-olds hate them. Their energy is likely to be focused on getting up and getting going. Whether they’re already walking or not, at this age, children are intent on moving, practicing their moves, strengthening their muscles, learning to balance and to experience the world around them. So of course your baby is bound to protest until she can get going again.

You say she’s crying for attention, but it sounds like when you give it to her, it doesn’t help. So it may be that she’s just letting you know that she hates being restrained, and can’t wait to get out. Don’t let her until you’ve arrived at your destination. But don’t worry. When she’s older, and takes walking for granted, she won’t mind sitting still as much as she does now.

In the meantime, she might be more likely to settle if one of you can sit next to her and soothe her. You’ll miss out on being together as a couple on your drives during this period, but it doesn’t sound like you could be having much fun anyway with all that screaming. (And of course this won’t work when you’re all alone to drive her.)

The other possibility is that she may be motion sick – that could be why she seems fine for the first few minutes. Does it make a difference if you drive more gently, taking it easy on the accelerator and the brakes, and slowly around the curves? You might try a bottle for her to suck on to see if this helps to settle.

Next, the picky eating:

It sounds as if the advice and criticism from books and friends are making you doubt yourself. Yet what you describe can be right on track for many children, as long as their growth and health are. (And we don’t think you need to worry about having started solids at six months.)

You say you could spoon-feed her cereal from 6 to 9 months – and then, nothing doing. Nine months is the age when many infants seem to announce to their parents that they are ready to take over. They’ll start grabbing for the spoon, and now that they can, they’ll pick up food between finger and thumb and throw it on the floor. It is time to start involving them in their own feeding. At this age give them a spoon, and let them try to shovel in their food themselves. Or try one spoon for each hand, so that you can use a third one to feed her while her hands are busy.

But at 1, or a few months later, many children start making a fuss about feeding. If you try to force them, you’ll lose. You are right about the pea-sized pieces of food. Just put a few of these on her table at a time. That way, she won’t be overwhelmed, and when she hurls them overboard, you can just start again. Many children need to be introduced to the same new food over and over before they’ll give it a try and many more times before they can accept the taste and texture.

If your pediatrician can check her out, and offer vitamin and iron supplements, you’ll be able to relax, and avoid the struggles that tend to just make the picky eating worse. You and she are lucky that she still likes her milk! (See our book “Feeding Your Child: the Brazelton Way,” Da Capo 2003, for more suggestions, and information on children’s nutritional needs.)

The best part – that no matter what, you are a proud father! Congratulations.

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

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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

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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

by
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.