PREPARING THE FAMILY FOR THE NEXT BABY

NEW YORK TIMES COLUMN: FAMILIES TODAY:
PREPARING THE FAMILY FOR THE NEXT BABY
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

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

Facing a second pregnancy is both thrilling and daunting. Parents will ask themselves: “What will this do to my older child? Can I manage with two? How could I ever love another child as much?”

When sibling rivalry arises, parents are bound to feel responsible, and guilty.

Later, they will find they need not divide their love, for they will love each child differently. But before the new baby arrives to help parents make this discovery, they may feel they must try not to grow attached to the new one, but instead must focus even more on the one they already have.

The fear of “deserting” the older child is inevitable. All parents wish they could eliminate the older child’s negative reactions to the new baby. This parental pressure makes the older child feel unacceptable as he is, and wonder if he really deserves to be replaced. Of course he knows that he both does and doesn’t want a new sibling.

Although these feelings are most prominent with the second pregnancy, they are likely to be present with any subsequent pregnancy. It can be a challenge to see each new baby as a “gift” to the family.

But parents needn’t feel that it is their role to protect their children from all the feelings – anger, jealousy and others – that they will experience with a new baby. Adjusting to a new sibling is a child’s opportunity to learn about these feelings and how to handle them. And parents can help.

When Do I Tell My First Child?

You never don’t tell him. As soon as you know a new baby is on the way, it can be discussed in the family openly. Your discussion is not so much an announcement as an acceptance of the baby as a future step for the whole family. But try not to overdo the information.

One couple told me that they had discussed the baby-to-be so much and so often that the older child was sick of it by the seventh month. He was tired of being prepared for so long.

Talking about the new baby coming into the family in an accepting way is different from excitedly preparing the older child for a major event. Parents can make it clear the family will “all deal with it together” without dramatizing that “everything will be different and you will have a big adjustment to make.”

Why Shouldn’t We Wait Until He Knows I’m Pregnant?

He may know almost as soon as you do.

Even a young child will notice. Leslie was 2 1/2 and and came to my office for a checkup. He was a handsome curly headed, dark-skinned toddler – the adored child of his lovely parents.

Every time he leaned over in my office, every time he’d lower himself to the floor, he’d let out a soft grunt. I thought that he might be hiding a bellyache or some problem in his joints. I felt his stomach more carefully. No tenderness. I examined his hips and legs. No problem. I watched him walk. Absolutely perfect, even graceful. I kept observing him. Each grunting sound made me more alert and more anxious. No physical signs.

Finally, out of the blue, I questioned his mother: “Are you pregnant?”

“No,” she assured me. A few days later, she called me to say, “I am pregnant. But I’m only eight weeks along. How did you know before I did?”

I was quick to answer: “I didn’t, really. But Leslie did.”

The job for parents is to give a name to the change the child senses, and gradually to make it seem real to the child. You might tell him, “You and Mommy and Daddy are going to have a baby. You can help us with the baby. You’ll be a big brother.”

Then, listen. Don’t keep telling him about the new baby. Wait for his questions. They’ll come.

When he passes a baby carriage, watch his eyes and his behavior change. He may say, “Can I help push the carriage?”

“Of course. You can be my best helper.”

He is already learning about giving. You are helping him discover its rewards. This is, of course, one of the most important lessons a sibling can ever learn.

How Will My Toddler React?

Everyone is talking about the changes that will occur. Of course, an older sibling has his questions: “When?” “Why?” (Aren’t I good enough?) “Will he be like me? Who will take care of me?”

All these questions deserve answers. As you answer, you’ll demonstrate your caring, and help your child “become a big brother.”

What you say may not matter as much as your being available. Your responsiveness is most important. This is a good time for each parent to start planning a regular “date” with the older child. Talk about it all week: “You and I will have our time together later this week. You can ask me all your questions and we can be together by ourselves. You are my big boy now and you’ll always be my first love.”

Labor and Delivery and the Older Child

As the delivery approaches, talk about going to the hospital to help the baby come “out.” Let your child know exactly who will stay with him at home, and who will take him to visit his mother and the new baby at the hospital.

It is a wonderful time for a father or a grandparent to point out that he or she will be there for the older child. One of the most rewarding experiences for me as a father was the opportunity to be completely available for my older daughters – and to have them all to myself!

Toward the end, be ready for the older child to build up excitement, as does the rest of the family. Tantrums, whining, sleep setbacks, food refusal and bedwetting can all be expected. These will arise from his confusion about all the intense anticipation as well as from his awareness of your heightened vulnerability.

The more he does now to share his distress, the easier it may be for him later.

When labor begins, and you must leave for the hospital, be sure to say goodbye. Tell him again that you’re going to the hospital for a few days. Remind him that he can call you, and come to visit. Reassure him again about who will be with him.

Tell him when you expect to come home. Show him on the calendar. All this preparation leaves him with a known structure and expectation. This can protect him from his deepest fear – that she’s “gone off to have the baby” and leave him. This fear is predictable for a young child, but parents can help allay it.

Reclaiming the Crib, and the ‘Big Boy’s Bed’

When parents are expecting a second child, they are often tempted to reclaim the first child’s crib to ready it for the new baby. Don’t.

If the older child is still in the crib during the pregnancy, don’t make him move unless you absolutely have to (for example, if he weighs too much for the crib, or is climbing out and at risk of being hurt). He’s already feeling displaced, and he will only feel more so once the baby is here.

Instead, you’ll have to get another crib for the baby and then wait until the older child really feels proud of being “a big brother.”


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.

CONCERN ABOUT LOW BIRTH WEIGHT

NEW YORK TIMES COLUMN: FAMILIES TODAY:
CONCERN ABOUT LOW BIRTH WEIGHT
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Please help. I am trying to find information on the causes of my grandchild’s low birth weight. She was full term and weighed 4 pounds 7 ounces. I am concerned about the consequences for her growth and development.

Should my daughter be concerned about the outcome of future pregnancies?

A. There are many causes for low birth weight. Some may predict future pregnancies resulting in low birth weight babies, or at least suggest some increased risk for more small babies, while others may be more likely to be once-only occurrences.

Among the possible causes: cigarette smoking during pregnancy, elevated blood pressure, problems with the placenta (which brings nutrition to the fetus’ blood stream from the mother’s), and inadequate maternal weight gain during pregnancy.

The impact of a mother’s health on her pregnancy and her baby’s future is one reason why prenatal care is so important. High blood pressure can develop for the first time during pregnancy in women with no prior history of it, and can be effectively treated, so blood pressure monitoring is a cornerstone of prenatal care.

But since some health issues are evident before a pregnancy and will take more than nine months to address, access to health care for all women of childbearing age is critical for healthy pregnancies and healthy babies.

It will also save a bundle in health care and educational expenses that many premature and very low birth weight babies will need. Six billion dollars per year of our health care costs are spent on neonatal intensive care for premature infants, to say nothing of the costs for special education and other services that premature infants are more likely to need later on. A health care system that fails to care for all women of childbearing age will cost us all more in the long run.

Significant stress during pregnancy has been found to be associated with premature births, and may also be associated with low birth weight in full-term babies since stress in the expectant mother can increase her stress hormones, which in turn can constrict the uterine artery which supplies nutrients through the placenta to the fetus.

A recent study found that mothers who took time off during the last three months of pregnancy were less likely to have premature babies. With only three months of unpaid maternity leave, few working expectant mothers can afford this luxury. Paid maternity leave during the last trimester could reduce the risks – and the costs – of prematurity and low birth weight.

Your daughter’s obstetrician may be able to tell her whether there was any evidence of problems with the placenta or other troubles during this pregnancy, and whether they are of the sort that might be more likely to occur again.

The pediatrician may also be able to help out here. A baby’s length in proportion to her weight may indicate whether low weight is more likely a result of a placental problem late in pregnancy or, instead, whether genetic or other less common causes are involved.

A long, skinny baby (normal length, low weight) is more likely to be the result of a problem with the placenta late in pregnancy: Often they look wizened and worried, and may be irritable and more difficult to soothe. A very “small all over” baby (low weight and length) may have experienced a problem earlier in the pregnancy, for example an infection, or again a problem with the placenta beginning earlier on.

Genetics may also play a role – especially in a baby whose height and weight are low – as a cause for a disorder in the child of which low birth weight is only one feature. In this case there would be other, more specific signs of such a disorder as well. Your daughter can ask the baby’s pediatrician if the low birth weight is a standalone issue or part of a larger syndrome.

As for these and other possible causes of concern for a low birth weight baby’s growth and development, we would hate to see you and your daughter worry about all the possibilities and would instead urge you to ask the pediatrician to review the pregnancy with the obstetrician, and then to watch carefully over her growth and development with you.

If your daughter’s pregnancy was entirely normal and your grandchild is entirely healthy, then chances are good that her growth and development will proceed normally too. But urge the pediatrician to follow closely. Let him or her know that if the baby does need help catching up, you all are ready to get going, the sooner the better.

You may be concerned about the “fetal programming” hypothesis put forward by David Barker which states that conditions during pregnancy can have lifelong effects for the fetus’ future health, and correlates low birth weight due to malnutrition during pregnancy with future health problems. However, it is important to remember that research like Barker’s examines statistical probabilities for very large population samples, and can’t really tell you much about your grandchild. These large studies that predict the chance of one outcome or another in large groups of people can’t tell us which way the coin will flip for any single individual.

Fortunately, you are there to vigilantly watch over this baby’s growth and development, and to help your daughter respond if the pediatrician finds any cause for concern.

Development is such a powerful force, especially in the first years of life. The human brain never again grows and changes as dramatically as it does in infants. In this period it is remarkably adaptive, developing new circuits and pathways to bypass and overcome specific areas that are not able to keep up.

Early intervention – before a child turns 3 years of age – provided by specially trained professionals (speech and language therapists, occupational therapists and physical therapists, for example) can help make the most of the astounding capacity of the very young human brain to recover and grow.


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.

BATH TIME FEARS AND TEARS FOR A 3-YEAR-OLD

NEW YORK TIMES COLUMN: FAMILIES TODAY:
BATH TIME FEARS AND TEARS FOR A 3-YEAR-OLD
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Our answer to a letter about bath time fears and tears has stirred up sympathy, salutary suggestions, and speculation in readers across the country.

Q. The 3-year-old who fears baths and showers might be willing to sit in a baby bath tub and get clean or to sit in a sink. Also, he might like to have a small inflatable swimming pool brought into the house or if the family lives in a warm climate have a bath outside in the small swimming pool.

Is the child afraid of taking off his clothes? Children are so exposed to mass media today it is almost impossible to isolate the source of fear but I find that asking a child to tell you what should be changed for him/her to like doing something sometimes works.

A. What great suggestions!

If the child slipped or swallowed water or had a traumatic shampoo in the “big” bath tub, simply switching bathing to another location might help. And a smaller place to bathe like the baby bathtub, sink or blow-up pool you suggest might also be less overwhelming to a small child to whom a “grown-up” tub might seem like a vast and gaping ocean.

Introducing water and the bath slowly, in small amounts, and on the child’s terms all make sense. Best of all, we like your idea of including the child in figuring out the solution and giving him some control. This way he might be more likely to tell you what the fear is all about, including whether it all started with some scary TV show.

We wondered what kind of media exposure you thought might prompt a child to fear taking his clothes off. When children are exposed to overstimulating adult sexual behavior, they are more likely to imitate it and act it out. When children are exposed to violence that makes them worry about the safety of their own bodies, they may spend more time inspecting themselves to be sure “everything is still there.” We certainly have seen children who have been sexually abused fear taking their clothes off. They do seem to see their clothes as a kind of protection, and staying dressed as a way of fending off unwanted memories of the trauma. (Often, though, other changes in behavior and mood are present too.)

Perhaps some of our readers have seen similar behavior in children who have been traumatized by media exposure without having actually been sexually abused.

Q. I read with interest your possible explanations for why a child would suddenly develop a fear of bathing. All of your possible reasons were valid. However, may I suggest a more ominous one?

Often children who have been sexually molested develop fears of being vulnerable as one is in the bathtub. Perhaps this child should be gently questioned regarding if anyone has frightened him in any way of was he touched by someone who made him feel uncomfortable.

Hope you find the cause of the problem and hopefully it is not as serious as I suggest.

A. We couldn’t agree with you more that this possibility is one to consider, although we would caution against scaring either the parents or the child in doing so. We appreciate your recommendation that the questions be gentle, and would underscore that they must not be leading, since the resulting replies would be harder to know how to interpret. Such questioning is best conducted by a professional trained to address such issues with young children.

We agree with your emphasis on the traumatized child’s fear of feeling vulnerable, and would add to this the fear of activities that contain some reminder of the traumatic event.

The original text of our answer to the  “fear of bathing” question did close with the following paragraph which was eventually cut due to space limitations:

Children who have been sexually molested may also appear fearful at bath time. But this is not likely to appear as the only symptom. Instead, other activities involving their bodies — using the toilet, getting undressed — also often stir up fear and attempts to avoid them.

This is a possible but unlikely cause in a child who shows no other changes in behavior. There are so many more common reasons for a child this age to become afraid of the bath.


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.

CRITICISM AND PRAISE

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

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

All children are hungry for their parents’ approval. As a result, parents know they can use criticism to curb unwanted behaviors, and praise to encourage others.

With siblings the dynamic of criticism and praise becomes more complex. Parents may not always realize just how seriously a child takes each criticism, each encouraging word. When other siblings become an audience, parents’ words take on even more power. Praising one child can feel like a criticism of another; similarly, criticizing one can certainly seem like praise to another.

When there is an imbalance over time – more criticism for one child, more praise for the other – the criticized child is likely to give up and behave as “bad” as everyone seems to think she is. The child who must bear the brunt of parents’ continual criticism also becomes the brunt of a sibling’s: “You’re a loser.” A sibling will rub it in, glad not to be the brunt himself.

Praise, too, can be uncomfortable for the sibling who receives it, especially if the others are around. The praised sibling’s successes then seem to come at the expense of the others. If a child such as this feels guilty, or is the target of jealousy and resentment, she might even stop trying so hard, preferring to be less special and more like the others.

Praise from a parent can easily be overdone. The child knows when it’s phony. Too much praise from a parent can interfere with a child’s learning to take satisfaction in his successes on his own. Yet praise can be a boost, particularly if it is fair and comes out of the blue. From a parent it is valued, but even more from a sibling.

When an older sibling can praise a younger one and say, for example, “You did such a good job. You worked and worked at it” – think how proud both will feel. A younger sibling is likely to praise his older sister with his eyes, and with imitation. Is it wise to comment on their praise and take it away from them?

If you must criticize, avoid words such as “always” and “never.” Rather than negative generalizations such as “You’re never ready on time,” focus on what’s happening now: “You’re late. We need to get going.”

Teaching Self-Criticism and Self-Praise

Be careful about using praise or criticism as a way of controlling behavior. Either one can quickly feel like a weapon to a child. Your long-term goal is not this kind of power. Instead, it is to help your child learn to face his own strengths and weaknesses, to praise and criticize himself as he learns to monitor his own behavior. Instead of saying, “Great job!” there may be a chance to ask “How do you feel about how you did?” Your smile and warm voice tell her how proud you are, but you leave your child room to find her own pride. The added benefit of this approach is that siblings are less likely to feel that your approval of this child takes away from your approval of them.

The same goes for criticism. Of course there are times when a child needs to be told very clearly that she’s made a mistake. But look for opportunities to ask her what she thinks she’s done wrong, what she thinks she could have done better. A conversation like this is best carried out when the other children aren’t around to add to her embarrassment.

Whenever possible, reserve criticism and sanctions for private times with a child. If the others ask, “How come you didn’t punish her?” a parent can answer, “That’s up to me, and it’s between your sister and me.” When the other children are present, stick to clear expectations and instructions that apply to all.

When siblings, or siblings and friends get out of control, there’s no need to single one out. Tell the whole group, “You need to settle down.” The others may protest: “But Susie started it!” Simply answer, “I’m not interested in who did it. I’m asking you all to help out.” They’ll get the message. Singling out a child for public humiliation, on the other hand, strikes terror in the hearts of children. But it won’t win you their respect. To protect themselves from it, they’re likely to turn against you.

Often, you may not know what really happened, or who started it. But when only some are guilty, all can still be helped to face their responsibility. This approach sustains a parent’s authority while encouraging the children to recognize their interdependence. They may all turn against one sibling, but over time they’ll learn to stick up for each other – an important goal for the whole family.


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.

BIRTH ORDER’S IMPACT

NEW YORK TIMES COLUMN: FAMILIES TODAY:
BIRTH ORDER’S IMPACT
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

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

Birth order is often used – both by children and by parents – to explain siblings’ different personalities. Of course, being the first, last or in the middle will influence each child’s behavior.

But it is harder to use birth order to predict who a child will become than some may think. So many other factors determine personality, too – the years between siblings, gender, each child’s temperament and the whole range of life experiences. No wonder different birth order researchers seem to come up with different results.

OLDEST CHILD

Everyone expects the oldest to grow up quickly. The other children treat her with respect but also expect her to be more generous, more helpful than she may want to be.

When she grows tired of her “oldest child role,” she may turn on them. “Leave me alone. Stop bugging me.” This may feel like a desertion if the younger sibling is used to being nurtured and cared for by her.

An oldest child may be expected to be an athlete or a “brain.” “Help me with my homework. You’ve already learned how to do it.” She may feel flattered by this kind of adoration, and she’ll do her best – for a while.

But she may also feel the pressure of this role, and rebel. She may turn on a younger sibling and treat him mercilessly. She may even take out on him the anger she feels about her parents’ pressure for her to be the “oldest and most responsible.” For example, when she’s asked to baby-sit, she may find a way to dodge the role. Or she may make a sibling’s life so miserable that she isn’t asked again.

No matter how the oldest child behaves, she is likely to be a role model for younger siblings. Watch a toddler become hooked on an older child’s ball throwing. He’ll shape his hands in imitation, even if he must still throw with both hands. His eyes and his adoration show how much he values the older child as a teacher.

A younger sibling follows the oldest one around like a puppy dog. Often, this behavior is carried to extremes, and it is not appreciated. “Mom, don’t let that little squirt come out of the house when my friends come over.”

And yet, an oldest girl is expected to be a second mother, a boy a second father and teacher. That’s a mixed blessing and a mixed role for the eldest, and a lot of responsibility, whether she likes it or not.

HELPING THE OLDEST CHILD HANDLE RESPONSIBILITY

  • Try not to expect the oldest to be “too” responsible. Watch for signs of needing relief from the role. Praise the older child for the responsibility she demonstrates at times when you have not requested it. But be aware that too much praise represents pressure.
  • Let the oldest be a baby, too, when she needs to. Pushing an older child too soon to give up sucking her thumb, or carrying her blanket everywhere, or other “babyish” behaviors is bound to backfire. Expect her to fall back on these under pressure, and let her know that such temporary backsliding is okay.
  • Try to free the older child up from her siblings enough to have friends of her own, outside the family.

MIDDLE CHILD

A middle child starts out as the youngest sibling, and was the oldest child’s “baby.” He has worked hard to find his niche in the family, both wooing and competing with the older child. Suddenly, another baby comes along. Everyone is ecstatic. Everyone except him.

All of them concentrate on this new baby – including the older child. The middle child is deserted by everyone, including his rival, whom he can no longer even provoke into a squabble.

The second child is now a “middle child.” To him, being in the middle feels like being forgotten. He may try to provoke, to show off, to cry out for someone – anyone. Unless a parent hears this cry, he continues to be without a sounding board, without a reliable advocate. Some middle children learn to turn their wish to be cared for into caring for others – later.

A middle child may try to make up for his loneliness with friends. But he may seem irritable, and depressed. Parents will ask, “Why are you so upset? Isn’t she a cute baby? Look at her watch you, adoring you.” Of course, she looks at everybody that way because they all adore her. The eyes and the winning smile everyone saves for the baby makes the middle child “want to puke.” How could he ever like her?

In time, the middle child may start to mother the baby. But when the baby screeches, he wants to swat her over the head. But he doesn’t, and soon he may find that he can woo the baby from his older sister. Not often, but just enough to make it worth the effort. When he fails, he’ll battle with the little one.

The myth of the “middle child,” and parents’ worries about it, may be more powerful than its reality. My middle daughter can always get at me when she says, “You treat me like a middle child!” Do I? I don’t think so, until she accuses me of it.

The “book end” children do have special places, but maybe the middle is a special place as well. A middle child isn’t as likely to be as overwhelmed as the first child, nor as overprotected as the baby. It may be a freer spot to be in. One can always just disappear in a crisis. Some middle children even figure out how to use this position in the family to ensure that no one expects as much of them.

Some middle children find they have unique creative gifts that allow them to distinguish themselves from the firstborn in their families. Others will learn to be the peacemakers; they will mediate conflicts and feel responsible for everyone’s well-being. They feel the pressure, but also the rewards of being in the middle.

HELPING THE MIDDLE CHILD FEEL VALUED

  • Remind a middle child of his talents. Praise him for his resilience, in adjusting to the baby and finding his own role.
  • Let the middle child groan and complain, even blow up about how hard he works to be a contributing member of the family. As he feels heard, he will learn a lot about himself.
  • Face whatever bias you may have about a middle child.
  • Don’t feel sorry for him. Pity will only push a child to focus on the negative aspects of his situation. Every position in the family has its rewards and burdens. The give-and-take demanded of each child is the cement that makes the family strong.

THE LAST CHILD -THE “BABY”

Everyone loves the baby – as long as he is the baby. He gets used to being adored. He knows when to dodge the sibling just above. The rest of the family makes allowances for the youngest child.

Then, all of a sudden, he begins to grow up. No longer do his babyish wiles help. When he battles over something he wants, suddenly everyone labels him as “spoiled.” His older siblings desert him. (They’ve waited patiently.)

Being cute doesn’t cut it any more. The pressure to leave the “baby” role behind often weighs more heavily on boys than on girls; in girls, appeals of being “fragile” and “helpless” are still more likely to be tolerated.

In search of a niche, the youngest child may become a rebel, or an unexpected performer. He may not fit in with the rest of the family’s patterns. He can be unique and surprising. But if less has always been expected of him, he may learn to expect less of himself.

If the youngest regresses to baby-like behavior at home, it is still likely to draw his parents in. But he will pay the price of being the butt of his siblings’ disapproval. He may then resort to bravado or rebellion. But when his siblings accept him, he blossoms. He will have learned a great deal about adapting to his more grown-up role, and about giving up his babyish one for new rewards.

HOW TO HELP THE YOUNGEST CHILD GROW UP

  • Value his struggle to keep up with older siblings.
  • Comfort him when he needs it. But remember that the role of a baby cannot last. He needs to value the new abilities he can develop.
  • Remind yourself how much you love having a baby and how you may be prolonging his baby role.
  • Be ready for his accusation: “You always treat me like a baby.” You probably do. Apologize, and let him know that you’ll try to stop, though you may not always succeed.

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.

MENTAL ILLNESS AND ITS CONSEQUENCES FOR A FAMILY

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
MENTAL ILLNESS AND ITS CONSEQUENCES FOR A FAMILY
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Four years ago my son had a nervous breakdown. He has since been diagnosed with bipolar disorder. His wife divorced him because he became physically abusive during an argument. They have a 5-year-old son, who has not been allowed to see his dad for the last three years, due to a restraining order by the mother, which included my grandson (although he has never been abused). My former daughter-in-law is financially stable and has a good lawyer, while my son is still barely able to support himself and cannot afford a lawyer.

My grandson is restless, angry and is already having problems in kindergarten. He can’t sit still and pay attention. He yells at his mother and does exactly what he wants to do, like going to bed at 9:30 on a school night. She loves him very much and wants him to have everything he wants in life. I feel her behavior is causing him to be insecure, and his actions are a call for help.

I tried to continue to be involved in his life, but have not seen him as much as I did (my husband as well) because his mother always makes it difficult by making excuses not to schedule visits — not enough notice, he’s going to a friend’s party, etc. I have told her how important it is to keep our relationship. She always says she understands and wants him to have a relationship with us, but does nothing to help us.

We have told her that we feel it’s vital to our grandson’s mental health that he see his father, and have offered to supervise any and all visits so our grandson would feel safe and be in a familiar setting. Nothing we say or do is working. We are sick about this and honestly feel the stress and heartache is wearing us down to the point that maybe we would all be better off if we gave in to her and stopped seeing him and stopped trying to reunite him and his father.

She says she doesn’t feel her son is safe with us (although when they were married he was with us at least once a week) and she says our son is too unstable and hasn’t changed enough that she wants him to see their son. I have told her he can’t change — this is a mental health problem that’s not going away (although he is getting help). I have told her all we want is for their son to have the best life possible, to be included as part of our family and to have a relationship with his father. She can’t see that her son is suffering silently and now overtly. What more can we do?

A. You are all suffering, and you’d all like it to stop. So you try to understand what is causing the pain and the problems. Inevitably, you end up blaming yourselves, and each other. But finding fault just leads to bitterness, misunderstanding and more pain. Deep down you all know that if anything is to blame, it is your son’s serious mental illness. That, of course, is no one’s fault.

If you could all forgive yourselves and each other, you might have a better chance of developing the kind of communication and teamwork that you know you all need. (When there are tough decisions to make that threaten to pit you against each other, a neutral third party such as a court appointed guardian ad litem for the child who would independently represent the child’s best interest might also help settle down the understandable tensions.)

Of course it would be best for your grandson for family ties to be preserved and strengthened, even while squarely facing whatever limits there must be to your son’s interactions with his son when he is unstable. Repairing your relationship with your ex-daughter-in-law will have to come first, before any hope of influencing your grandson’s life more directly.

You have been so strong and brave to face the realities of your son’s illness. No wonder you may need your own time to heal before you can understand his ex-wife’s reactions. Until then, see if you can hold off on attributing the child’s “bad” behavior to her parenting. She’s unlikely to feel that he’ll be safe with you as long as she has to worry that you are judging her critically, which may subtly undermine the authority she needs as a parent.

Of course the boy needs limits, and he may need more limits than he is getting. But the sadness and fear that sets in when a marriage ends often drains parents’ ability to tune into their children’s needs until they’ve had a chance to heal. Can you help her to heal as a critical first step to helping your grandson? She might feel that you could understand her side better if you could consider the possibility that her boy might be hard to handle for a number of reasons beyond late bedtimes and lack of limits.

How could he not be thrown off by his father’s violent behavior (even if it was never directed at him), the divorce and all of the family’s stormy feelings that have resulted? Or he might be showing early signs of threats to his own mental health, especially since these are sometimes transmitted genetically.

You sound big-hearted and generous, as if you can acknowledge his mother’s challenges. Can you take it a step further to let her know you can see and appreciate what she is doing right by her boy? She’s been violated and traumatized. So have you — by your son’s terrible illness. She’s lost her love, marriage and dreams for her future with her life’s partner.

You may feel that you’ve lost your son — at least temporarily — to the delusions and distortions of acute manic episodes. Are your feelings about this something you can share with her? Only once she believes that you understand what she’s been through, that you know she has the child’s best interests at heart, that you will support her as a parent rather than blame her, will she begin to feel safe enough with you herself to entrust your grandson to you.

We understand how close you feel to giving up, but we hope you won’t. We hope you have others in your family you can turn to so that you won’t have to turn away, and so that this little boy can have all the family he needs too. You sound like you have been such a critical support for your son — facing adversity together is the true test of family.


This article is not intended as a substitute for medical or psychiatric evaluation, diagnosis and treatment. Because of the rapid pace of research and new clinical findings, the information it contains is subject to change. If you are concerned about your child, consult your pediatrician, who can refer you to a mental health professional.

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.

HOW CAN WE IMPROVE OUR KIDS’ NUTRITION

NEW YORK TIMES COLUMN: FAMILIES TODAY:
HOW CAN WE IMPROVE OUR KIDS’ NUTRITION?
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Please comment about how much vitamin D children need as they are growing up. Also, does the location of where a child lives make it necessary to supplement vitamin D? My husband and I, in our early 60s, take supplemental vitamin D per the advice of our rheumatologist.

A. Last month the American Academy of Pediatrics (www.aap.org) doubled its recommended amount of vitamin D – necessary for bone absorption of calcium – to 400 International Units, for infants, children and adolescents:

“Breastfed and partially breastfed infants should be supplemented with 400 IU a day of vitamin D beginning in the first few days of life.”

“All non-breastfed infants, as well as older children, who are consuming less than one quart per day of vitamin D-fortified formula or milk, should receive a vitamin D supplement of 400 IU a day.”

“Adolescents who do not obtain 400 IU of vitamin D per day through foods should receive a supplement containing that amount.”

“Children with increased risk of vitamin D deficiency, such as those taking certain medications, may need higher doses of vitamin D.”

“Given the growing evidence that adequate vitamin D status during pregnancy is important for fetal development, the AAP also recommends that providers who care for pregnant women consider measuring vitamin D levels in this population.” For babies, formula should be fortified with vitamin D, but breast milk may not contain enough, even though it contains all kinds of important ingredients for health that are not in formula: antibodies, digestive enzymes, and just the right kinds and amounts of fats. Parents should ask their pediatrician to advise them about vitamin D drops for their breast-fed infants.”

As your question suggests, vitamin D requirements vary with exposure to sunlight, since sunlight is required to convert vitamin D to its active form. Children living in northern regions, who are dark skinned, or who spend every daylight hour swaddled from head to toe are more likely to need supplements.

Good dietary sources of vitamin D include fortified milk, eggs and fish. Vitamin D is sometimes added to orange juice, but dairy products other than milk are usually not fortified with vitamin D.

Vitamin D supplementation has reduced the incidence of rickets – weak, bowed bones due to poor calcium absorption that can occur with a Vitamin D deficiency – a great example of the power of prevention.

Q. Is it really at all healthy to limit fats and other caloric nutrients in otherwise healthy and growing young children?

A. Children under the age of 2 years (or 3, according to some experts) actually need the fats contained in whole milk for the rapid brain development that occurs in the first years of life. Some pediatricians are adjusting this recommendation to switch to 2 percent milk after 1 year of age when a child is already overweight or if there are risk factors for obesity, for example, overweight parents.

Calories are not bad, but necessary, in the right amounts. Children have specific caloric needs that depend on their age, size and activity level. The word “calories” is just a measure of the energy a food contains. However, foods that offer only calories and have no other nutritional value are best avoided since they run the risk of filling a child up with “empty” calories before all of her nutritional needs have been met.

Q. Are young children (age 10 and below) at risk from a high cholesterol diet – for example, from eating lots of egg and cheese sandwiches and similar foods?

A. Cholesterol and triglycerides can be a problem for children, especially if their diet is high in saturated fats, if they are obese, or if there is a family history of coronary artery disease or high triglycerides.

Eating habits and preferences do not begin in adulthood. Why start and reinforce unhealthy eating in childhood and then struggle to undo it later?


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 3-YEAR-OLD REACTS TO THE BIRTH OF A SIBLING

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
A 3-YEAR OLD REACTS TO THE BIRTH OF A SIBLING
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I’ve read Dr. Brazelton’s book (“Understanding Sibling Rivalry,” Da Capo, 2005) but I need additional information about how to help an older child (3 years old) transition with the birth of a sibling. Our daughter is having major separation anxiety.

A. Often, when a child is experiencing separation anxiety, a parent is, too. I can make any mother cry when she announces a second pregnancy to me. All I have to say is what she is feeling but can’t quite face: “You will be deserting that older child.”

She’ll start weeping, but as we talk, she realizes that she must face these feelings if she is to be able to help the first child put this new family member into perspective.

On some level, the mother-to-be may identify with the older child’s feelings: “How could you do this to me?” translates into “How could I impose a second child on the first?”

But until she is able to answer this question for herself, she will find it difficult to answer if for the child. As long as she doubts this decision, and fears that she really is “harming” the first child, then this is the unnerving message that child is likely to receive. The child isn’t likely to forgive the mother for this “abandonment” until she can stop seeing it this way, until she can forgive herself.

Parents always worry in second or later pregnancies, “Will I have enough to go around for another child?” But of course they will. Children learn to adjust to new siblings as they come along. This adjustment can teach them important lessons that they will need to get along in the world later on, for example, that the world does not revolve around them.

Siblings get so much from each other – in the way of learning (learning how to compete, how to resent a sibling and yet to love the other anyway). They learn to share, and to care for each other.

Just watch the younger one imitate the older one in learning a new developmental step. The younger one will watch and watch, then put the whole step together – all from imitation and from modeling on the older one: “visual learning.”

Giving a child a sibling is like giving him a gift. But don’t expect the older child to thank you when you bring your new baby home. She won’t recognize the gift of this unique new relationship until much later on.

Preparation for the new baby while you are pregnant will help you and your first child face the “separation.” For you the “separation” from her will be an emotional one – so much of your energy will be called up to focus on the new baby. Already your 3-year-old can feel the family’s attention begin to shift away from her.

But you can involve her in this new family event too: “Feel mommy’s tummy. Can you feel the baby you and I will take care of? This will be your baby as well as mine.”

Play out the nurturing with a toy or a doll. Show the older child how to cuddle and feed a beloved baby doll beforehand. She may even want to diaper it. “Now you know how to love the baby like your doll or your truck. You can help me when we have a baby.”

For your 3-year-old, though, the separation she is most worried about is the time when you will go to the hospital. It’s all so mysterious, and so hard to explain.

What will happen? Will you be OK? Will you come back? To help prepare her, you must let your daughter know who will be with her while you are giving birth to the new baby. Encourage her to talk with that important person – her father, a grandparent – beforehand, to plan it all out. Then, when you come home, let your daughter help with the new baby as you’ve rehearsed.

You might also take a new special “lovey” – a stuffed animal or a doll – home with the new baby so that 3-year-old can nurture it, imitating you with the new baby.

But don’t expect your oldest child to share your enthusiasm for the new baby right away. Even if she does at first, the novelty will soon fade. Sulking, temper tantrums and the temporary re-emergence of other old behaviors are predictable.

Don’t pressure her to be a “big” sister, and don’t overdo the praise when she does try to nurture the new baby. Instead, let her know that she will always be your first baby, and that if she feels like being a baby sometimes now too, that’s OK with you. She’s far more likely to step into these big new shoes if you let her step into them herself, when she’s ready.


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.