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 heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at 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

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.

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 heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

MEDICATED KIDS: A PARENT’S GUIDE, PART 2

More than 6 million children in the United States are taking psychiatric drugs — the result of a dramatic recent increase in the number of children being diagnosed with serious psychiatric disorders. The drugs, which are often not fully assessed in children, can cause serious side effects, and little is known about their long-term impact. Reporting on the phenomenon, the PBS program FRONTLINE aired “The Medicated Child” to help families sort through a range of medication-related issues and to team up with their children, doctors, and teachers to face these issues, Frontline asked Joshua Sparrow, M.D., a child psychiatrist at Children’s Hospital, Boston, and an assistant professor at Harvard Medical School, to contribute to a Viewer’s Guide to accompany the program. The Viewer’s Guide is posted at www.pbs.org/frontline/medicatedchild. This article, adapted from that guide, was the first of two parts in successive weeks in the FAMILIES TODAY column.

This article, adapted from that guide, was the second of two parts in successive weeks in the FAMILIES TODAY column. (This article, the second of a two-part series, accompanies “The Medicated Child,” that aired on Frontline on PBS. A more extensive version of the article appears in the Viewer’s Guide posted at www.pbs.org/frontline/medicatedchild, where the program itself may also be seen online.)

When a child is troubled and needs help, it is crucial that parents, the child, doctors and teachers work together as a team. An unfortunate but avoidable consequence of diagnostic labels and medication treatment is that these may lead children to believe that their future is no longer in their hands. But they can be helped to understand that even though their struggles are not their fault, their actions remain their responsibility.

This can be presented to the child not as more pressure, but as a form of respect that will help them fight for their own role in their recovery. Parents too may feel that as they entrust their child’s psychiatric care to a professional they themselves can do little to help.

Yet of course parents remain children’s most important caregivers and advocates. To play this role effectively, parents can take several steps:

  1. Pay attention to your questions and doubts about your child, and to the fears, feelings and memories that these may stir up in you. Parents may be haunted by their own pasts and the family’s history, or their worst fears for the future, and not dare to speak them.
  2. Talk about your concerns with the professional caring for your child, or, if it is more comfortable, with friends and family members. Many parents find relief and renewed strength when they meet other parents experiencing similar ordeals. Often they set up their own support groups to face challenges and share resources together.
  3. Stay connected with friends and family who care. Find allies who can help, even if just with daily routines. The symptoms of a psychiatric disorder in a child can overwhelm a family and derail its usual ways.
  4. Become an expert on your child’s condition. Expect that doctors and counselors will answer your questions, and that they acknowledge when and what they don’t know. Talk with other parents, teachers and school counselors, read, and use — with caution – the Internet.
  5. Trust your instincts. You know your child better than anyone.
  6. Involve your child in the process. Far too often children are not respected as partners in working to understand their challenges, and learning to manage them.
    Listen to your child. Try to understand and value his perspective. Ask your child how he understands his struggles and what he thinks will help. Help him find ways to describe the problem that preserve his self-image and give him hope for the future: “Sometimes your feelings just get too strong for you to handle, but we can work on this together so that you’re back in control.”

You may be referred to a child psychiatrist by your child’s pediatrician, or a school guidance counselor, or, if he’s already receiving treatment from a non-medical mental health professional (a social worker or psychologist) who isn’t trained and licensed to prescribe medications.

If you decide to pursue this recommendation, prepare for your visit by gathering together medical information, reports you have about your child’s behavior and notes from your own observations.

You can expect that the psychiatrist will do the following

  1. Take a thorough history, including allergies and medications, along with the child’s other medical and/and or psychiatric conditions and the family history of medical and/or psychiatric conditions.
  2. Carefully consider and rule out possible medical and neurological causes of the child’s symptoms before settling on a psychiatric diagnosis.
  3. Ensure that you and your child understand his or her views on the problem and what to do about it, and that he or she understands yours.
  4. Plan for regular monitoring and follow-up. Children should be seen at regular intervals by the prescribing physician to monitor medication response, side effects, and to assess whether the drug is still needed.
  5. Take a conservative approach. The psychiatrist should help you weigh the risks and benefits of medication, and of not using medication. The lowest effective dose possible should be used, and, whenever possible, the use of more
    than one drug at a time should be avoided to decrease the risk of side effects.
  6. Inform you about side effects. Before your child starts on medication, the doctor should explain what to look for to know that it is working. He or she should also point out possible side effects and what to do about them, and when
    to call the doctor or to go to the emergency room.
  7. Provide holistic and carefully coordinated treatment. All appropriate non-drug treatments should also be considered. The psychiatrist should collaborate with your child’s pediatrician and other professionals (teachers, and when other treatments are needed, with psychologists or social workers providing counseling or psychotherapy, speech and language therapists, physical and occupational therapists).
  8. Be compassionate. The physician should be ready to respond to the most pressing question that many parents ask: “What would you do if this was your child?”
  9. Treat your child with respect. The physician should include the child in the process of understanding his struggles. He or she also should take great care to show you all that the child’s strengths and potential are appreciated, and that his psychiatric disorder does not define him.

Partnering with your child’s school can also make a big difference. The school ought to offer plenty of opportunities for him to learn about himself, to discover his strengths, to compensate for his vulnerabilities, and to experience success
as the reward for his efforts.

School can also be a useful resource to help you assess, observe and monitor your child’s behavior. Often, a teacher might be the first person to alert you to potential trouble. That news may be painful to hear — but this is the time to preserve and strengthen your relationship with teachers and other school personnel:

  1. When you disagree with teachers about their judgments or recommendations, or when you are first informed of an upsetting behavioral problem, try to keep your initial reactions to yourself until you’ve had a chance to gather your thoughts, and to strategize about how to best respond so that everyone will be on your child’s side. Start with positive, appreciative comments about some aspect of teachers’ efforts, even if you disagree with others.
  2. Show you understand the need for classroom rules and expectations so that the child’s teacher will be more inclined to balance these with your child’s individual needs.
  3. Invite teachers to describe your child’s behavior, and show them that you are listening carefully, even when you disagree. Then start with your observations rather than your conclusions so that consensus on a more complete picture of the child’s behavior can emerge.
  4. Instead of criticizing teachers for how they’ve handled your child’s struggles in the past – which is bound to make them defensive, focus on working together to avoid such problems in the future. Ask them to share with you their ideas about what is causing the behavior, and then concentrate your efforts on the causes that you all can do something about.

Work with teachers to recognize that you all need a plan of action for your child that you can agree on. It is easier for children to relax and understand what is expected of them when parents and teachers can show that they know how to work together as a team, share the same expectations, and give the same messages.

  1. With the school as your partner, you can ask teachers and other personnel to:
  2. Describe their understanding of the child’s problems, and of the behaviors that lead to their concerns.
  3. Agree to put aside terminology that labels a child and instead provide carefully
    articulated, nonjudgmental descriptions of what they observe.
  4. Acknowledge what they don’t know, and when they need help from you, your child, or from other professionals to understand your child and how to work with him. For example, a psychologist may be needed to test for a learning disability (that often underlies a child’s frustration and explosive behavior) and recommend strategies to overcome it.
  5. Respect your decisions, even if they may disagree with them.
  6. Try to see the situation from your perspective.
  7. Show compassion to you, and care about your child.

ONLINE RESOURCES

As you would in gathering any information on the Internet, stick to trustworthy sources. The American Academy of Child and Adolescent Psychiatry (www.aacap.org) offers parents extensive, widely respected information on psychiatric conditions and treatment in childhood.

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 heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

MEDICATED KIDS: A PARENT’S GUIDE, PART 1

By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

More than 6 million children in the United States are taking psychiatric drugs — the result of a dramatic recent increase in the number of children being diagnosed with serious psychiatric disorders. The drugs, which are often not fully assessed in children, can cause serious side effects, and little is known about their long-term impact. Reporting on the phenomenon, the PBS program FRONTLINE aired “The Medicated Child” to help families sort through a range of medication-related issues and to team up with their children, doctors, and teachers to face these issues, Frontline asked Joshua Sparrow, M.D., a child psychiatrist at Children’s Hospital, Boston, and an assistant professor at Harvard Medical School, to contribute to a Viewer’s Guide to accompany the program. The Viewer’s Guide is posted at www.pbs.org/frontline/medicatedchild. This article, adapted from that guide, was the first of two parts in successive weeks in the FAMILIES TODAY column.

(This article, the first of a two-part series, accompanies “The Medicated Child,” that aired on Frontline on PBS. A more extensive version of the article appears in the Viewer’s Guide posted at www.pbs.org/frontline/medicatedchild, where the program itself may also be seen online.)

Psychiatric medication can rescue a child from a desperate future, and sometimes even save a child’s life. But such medication’s effects on children’s developing minds and bodies are largely unknown. Most psychiatric drugs aren’t approved by the Federal Drug Administration for use in children. Even the diagnosis that may occasion the drugs is challenging since “normal” behavior in
children varies widely. Symptoms like impulsivity or hyperactivity may suggest a host of diagnoses.

Parents are bound to wonder whether psychiatric drugs will really help. Many parents also wonder whether such drugs are used to control developmentally “normal” but “unacceptable” behavior. For example, hyperactivity in a child can interfere with learning and maturing — but sometimes it simply means that too much sitting-still is being demanded of the child. Even when a psychiatric diagnosis is appropriate, parents worry about the price the child
will pay. Identity and self-esteem take form in the vulnerable childhood years but last a lifetime. Taking psychiatric drugs is a tangible symbol of a diagnosis that children often misunderstand to mean they are defective. However, when treatment helps children manage more effectively at home and school, it can
bolster fragile self-esteem. In some instances, cognitive behavioral therapy or other nondrug treatments may replace medication or reduce the amount needed.

Adjustments of the school and home environment to the child’s needs may also help. Parents often can sense when psychiatric attention is warranted. The following are a few of the warning signs that parents are usually right to worry about when the signs persist and pervade — though none indicates a specific condition, nor that medication will necessarily help.

  • You spend more time being angry or upset with your child, or trying to control her behavior, than having fun together.
  • You realize that you are not enjoying your child, and worry that you have fallen “out of love.”
  • You feel worn out or worried by your child’s behavior.
  • People in the family are arguing about the child.
  • You feel like you don’t know or understand your child anymore.
  • Your child’s behavior changes suddenly — for example, activity level or choice of friends.
  • Your child spends prolonged periods withdrawn or in isolation,
  • She rarely smiles or seems happy. Her emotions seem limited mostly to anger or irritability.
  • Your child’s reactions are out of proportion to the situation.
  • Other children don’t like your child, keep their distance, think she’s odd or are afraid of her.

If you have concerns about your child, you deserve honest answers to your questions. Start with your pediatrician, who can refer you to a mental health professional if your child needs this kind of help.

UNDERSTANDING YOUR CHILD’S BEHAVIOR WHEN IT SEEMS ‘OUT OF CONTROL’

When parents are concerned about a child, catchall terms like “angry outburst,” “temper tantrum,” “meltdown” or “out-of-control” are bound to come to mind. But careful observation and detailed descriptions of the behavior will be more useful to parents, children, and mental health professionals as they work together to understand the behavior and then determine how they can help.

Try keeping a journal of your descriptions, and note the following:

Warning signs
Can you tell that your child is on the verge of an “episode”? Can he tell? Can he ask for help before it’s “too late”? Is he especially vulnerable when tired, hungry or anxious, or stressed?

Triggers
What seems to set the behavior off? Sometimes there is no apparent trigger — yet there still may be one that isn’t easily recognized. Was the child’s reaction out of proportion with the trigger’s severity? Ask your child if he thought something happened that made him upset, and get a sense from him of his perception of its seriousness relative to his reaction. But try not to make him feel that you are criticizing him for reacting the way he did, since that will only make it harder for him to team up with you to work on regaining control.

Contexts, settings
Is there a pattern to when and where the troublesome behavior occurs? Always before leaving for school? When there is a transition? Separations? Only with certain friends? Only in private?

Symptoms
What does your child do and say during an “episode? How would you describe his mood? If he’s angry, is there some basis in reality to his concerns? Can he continue to converse? Can he be reasoned with? Does he settle down quickly if something happens that he cares about, like a friend’s visit or call? How long does the episode usually last? How often does it occur? How have you tried to help him settle down? How does he calm himself? What makes the episode worse?

Aftermath
Does he go right back to “normal” after an episode? Or does he seem tired or moody for a prolonged period? Can he remember what happened? Can he talk about it? How does he feel about it? Ashamed? Remorseful? Indifferent?
Does he want help? Or has he given up? Can you plan together to watch out for the warning signs and work together to prevent other episodes or to settle them sooner?

The price you and the child pay
How do your child’s symptoms affect him and the family? Have you had to change the way you and other family members live your lives? Do you all feel that you are “‘held hostage”‘ by the child’s behavior? Has the child’s performance at school or relationships with friends been affected? Does he feel that he can no longer understand or like himself?

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 heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

WHEN A PARENT IS CALLED TO WAR

Q. My soldier son has just deployed to Iraq for his second tour of duty. His wife and three sons, ages 9 to 2 1/2, live at Ft. Hood, Texas. I want to add something that has helped our family: Web cams and computer speakers. We gave them to our daughter-in-law and our son during his last tour of duty and we have sent him a new set for this deployment. As soon as our son has his set up and running, they will be able to see and talk to each other via the Internet.

This makes a tremendous difference for spouses and children caught up in this war. The 2 1/2 year-old cries more for his dad that the others because he doesn’t understand what has happened. He just knows that his dad flew away in a plane with other soldiers. We tell him that his dad will come back. He does understand that.

A. Thank you for your great ideas and for the help they will be for all families with loved ones deployed overseas. Certainly Web cams and the Internet can be a great help in keeping families in touch. Maybe you can even record some of these special moments so that the children can go over and over them.

I have recommended leaving several DVDs or videotapes of parents reading bedtime stories so that children can be lulled to sleep by parents who are too far away to tuck them in. Your youngest grandchild may find comfort in a piece of Daddy’s clothing as a “lovey” to cuddle and to fall back on when he’s upset or frightened. Even his smell may be comforting at such a time. He is certainly old enough to sense the distress his mother must feel — another reason for his tears.

Of course a worried family member can’t hide such feelings. Instead they can be explained simply in terms that very young children can understand: “Mommy misses Daddy. I know you do too.”

The older children can be suffering because they do understand too well the separation issues as well as the dangers. Although they may seem under control on the surface, they deserve special times with their mother to unload their feelings, their questions, and to share her sadness. They also certainly need to have a chance for their own concerns to be heard. They will be relieved to speak openly but may also feel proud that through this sharing they are helping her. For the most mature children, and for adults, the terror of losing a military family member is all the worse with the current uncertainty about what this war could possibly accomplish and how it will ever end.

Family meals become even more important now. The family can pray together for their father’s safety and quick return. Then, too, they can share their feelings as a family, “We all miss him terribly and need to see his face and hear his voice.” Meanwhile, each of the boys will learn most from the mother’s strengths and her ability to share those — and her moments of vulnerability — with them.

If we can give anything to children who must suffer in this dreadful war, it will be the sense of having made it through the trauma of separation and loss and of learning how to be resilient. We pray with you that your son returns safely, and wish that all of our brave men and women could.

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 heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

A 4-YEAR-OLD CHILD OF DIVORCE, BESET BY CONFLICTS

By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I am writing on behalf of my friend in India. He and his wife were divorced, and the mother was given custody. The father could visit the child once every 15 days for not more than 24 hours.

The child is a 4-year-old boy. The father has noticed that the child speaks bad language and also uses dirty remarks on people, especially females. The father suspects that the child, being with the driver and the watchman most of the time, has picked up this habit and the father is really concerned. The mother is busy in her own life and most probably hasn’t paid any attention to this problem. The father on the other hand has tried communicating about this to his father and his ex-father-in-law but no one seems to be taking any steps. Since the father meets the child once in 15 days, he doesn’t want to scold him all the time they are together, but has spoken to the child about it, and he is just not improving.

The boy’s parents are not in contact at all. I have asked my friend to speak to his ex- wife about it, but he says he has tried and her family doesn’t let him keep any contacts with her. He is really very worried and his work is suffering a lot because of it too.

A. Your friend is right not to want to spend all of his precious time with his son scolding him, nor would this be likely to have any effect on the child’s use of “bad language.” This would not set the tone of a relationship that the boy might value and want to look forward to. Instead, I would suggest that he use that time to become close and try to become a model for him — one that the boy might want to know better and emulate to over time. He and the boy can do cozy things that bring them closer, tell stories and dream together.

This would be the most effective way to help him learn about the power of words and to care about being respectful of others. The attitude your friend shows towards the boy’s mother is bound to be a potent influence in shaping his behavior with women.

Although he can listen to the child’s complaints and empathize with him, it won’t help for the father to criticize the mother. Any criticism would be bound to get back to the mother, prolonging the painful period during which all contact is cut off. It would also leave the child feeling torn between the two parents, and leave him worried about the security of the home he does have. The boy can’t help but feel protective of his mother and her supports or they might “vanish” as his father no doubt seemed to, and leave him all alone — the most frightening thing a child that age can conceive of. The most destructive thing a child of divorce can experience is anger and tension between his divorced parents. Of course this is inevitable, and can’t be hidden from children, but children needn’t be drawn into it, or made to feel that they must choose one parent over the other.

When parents can support each other for the child’s sake and keep the intensity of their conflicts to themselves, the child will worry less about the usual preoccupations that burden so many children of divorced or estranged parents:

  1. “Was it my fault?” A child may really feel it might have been, and conclude, “I have to be perfect now. Maybe then I `ll be able to bring them back together.”
  2. Any “badness” (such as language) is extra-threatening. Yet, the child is often compelled to try it out to see whether his bad behavior or dirty words will bring on the doom he is so fearful of. Testing a father with dirty words about females may be a way of checking whether the father can be pushed to criticize the child’s mother. “If my Daddy will leave me, my mommy might too and then I’d be all alone. What a terrifying possibility! Will my dirty words bring that on?”
  3. When trying to be perfect seems impossible, or pointless, a child may give up. When a child in this situation is enticed into the usual testing children engage in, for example, trying out “dirty words,” he may conclude that he has failed to be perfect, failed to reunite his parents. Then, he’ll give up.

For such a child, even a slight transgression may lead him to decide he really is a bad kid after all, that the family’s dissolution is all his fault, and that he might as well be “bad.” This is compounded by the expectable preoccupation of parents with their own wounds and fears, leaving the child to feel “no one really wants me anyway.”

As for the foul language, many 4-year-olds try out dirty words in order to learn what they mean and why they stir up such strong reactions. When a child says one, watch his face. Isn’t he watching you carefully to see what effect he’s having on you? It’s a sign of his new awareness that words matter, and that he can create excitement and dominance in his world by throwing around a dirty word. The quickest way to shut down his experimentation would either be to ignore it completely (which is very hard for a short-term parent), or to react as little as possible. A parent might say quietly and calmly, “I don’t like words like that and I don’t use them, as you know.” Then, change the subject without making a big deal. “Let’s go back to dreaming together. I look forward to these times so much and I want to be with you as much as I can. You don’t need to test me to see if I love you or will leave you completely. Nothing would ever make me do that.”

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 heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

STORM FEARS; AND TREATING A CHILD LIKE A BABY

By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

The aftermath of Hurricane Katrina continues to inspire readers to share their experiences about children’s fear of storms. We can’t resist sharing one more letter:

Q. When my boy was about 4 years old, I recall there was a sudden thunderstorm, so I picked him up and went to our enclosed front porch. I told him that the clouds were rolling around in the sky and when they bumped into each other they made a lot of noise, which is the thunder. When the clouds collided really hard, they made sparks, which we call lightning.

When my boy was 12, we left for vacation before sunrise. He was riding in the front seat with his dad, and I was in the back. In the distance, lightning appeared. The boy and his father were pointing out the sharp, jagged lightning strikes. At one particularly spectacular strike, my son said, “Mom, did you see that one?” I replied, “No, my eyes are closed.” “Are you afraid of lightning?” he asked. “Yes,” I replied. After a moment he said, “Thanks for not making me afraid.”

A. As a parent, who could ask for a more rewarding outcome? Our children mostly tell us about our mistakes. Rarely do we receive their approval. What a nice kid, and how appreciative of you! Your success shows how important rituals and stories — even if untrue — can be.

Although even as a young child he may have seen through your fanciful explanation, the fact that you shared your story with him let him know that you were not afraid. You showed him that you understood his fear, and took him seriously enough to reassure him that you were there to protect him.

Frightening events are more disturbing when they are out of our control, and beyond our understanding. Any explanation for events like these, no matter how far-fetched, seems better than the unknown. All 4-year-olds are prone to fears _ being alone at night, loud sounds, dogs who may bite. But giving your child an explanation for his fear rather than pooh-poohing it must have been very comforting. What an example of great communication with a child at a vulnerable time! No wonder he has never forgotten it.

Q. I share custody of my 5-year-old daughter with her father. When he is at work, his mother watches her. My daughter is potty-trained and doesn’t wet the bed at my house. But her grandmother still gives my daughter a spill proof cup and puts diapers on her. I feel she is stunting my child’s progress toward independence.

On the first day of school her grandmother even wanted to follow the school bus. When I protested, she called me out in front of my daughter. And the father won’t listen to me. He just follows his mother’s orders.

Am I wrong to be annoyed? What can I do to fix this situation?
Frazzled and annoyed

A. Of course you are annoyed. You know your child has grown beyond spill proof cups and diapers. And you know that no child likes to be treated as a baby. From what you say it sounds as if the infantilizing you describe hasn’t led the child to regress. But the tension in the adult relationships in this situation could make it harder for her to stand her ground. Can you manage to control your feelings and present a calm, neutral approach to her grandmother’s behavior?

If she doesn’t feel caught between her loyalties to each of the adults, or pressured to protect one from the other, you daughter is more likely to be freed up to make her own decisions about it.

I can almost promise you then that she will resist her grandmother’s babying of her. If you and her father are not stirred up to get into the act, she will put up her own resistance. This will work better with her grandmother than just about anything else you can do.

If the child begins to show persistent, delayed problem behavior you may have to enlist a court advocate (for example, a court appointed guardian ad litem for the child) to try to intervene with the grandmother, but it would certainly be better if your daughter could handle it herself.

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 heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

A DIALOGUE ON TANTRUMS AND TOILET TRAINING

From the NEW YORK TIMES COLUMN: FAMILIES TODAY

By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. You wrote a long article on tantrums — mine will be short.

When our granddaughter was six years old, she and her brother were visiting us. One lunchtime, I decided to clean up some leftovers. My husband asked for more spaghetti. When I reminded him that he was trying to lose some weight, he pretended to cry.

While my back was turned, Shanta said, “It won’t work.” So he “cried” some more. I could hear Shanta sigh, then repeat, “It won’t work, Granddad. I tried it once.”

Volumes have been written on this subject by brilliant scholars. It took a 6-year-old only eight words. When I see a child having a tantrum in a store, my sympathy is with the child, who has been “programmed” to do this — and is not a happy child.

A. What a wonderful story! What a lovely way for your granddaughter to try to help her grandfather learn the lesson she’s learned from your clear, firm messages: that he should respect your clear authority. When parents or grandparents are not clear, a child on the edge of an inner conflict is thrown into more confusion, and a temper tantrum is a likely response.

Tantrums at different ages are the result of different conflicts. In the second and third years, they are normal and are a reflection of the child’s wish to make her own decision, “Do I or don’t I? Will I or won’t I?” For an older child, the reasons may be quite different — such as wanting to get attention or wanting her own way in the face of an undecided parent. This is a time when firm but friendly discipline, such as “Of course you want to go, but the answer is clearly and decidedly no.” By 6 or 7, tantrums should be less common and when they involve physical aggression, we may be well beyond the run-of-the-mill tantrums for which your advice is so pertinent. A child having repeated tantrums, especially at older ages, is surely an unhappy one crying out for help. Your granddaughter sounds wonderful — clear about when it’s no longer her decision or her grandfather’s

Toilet Training

Opinions on toilet-training are forcefully held. Here’s another contribution to the continuing dialogue, prompted by our recent column on the topic. Thanks to the many of you who have offered your creative ideas to help children decide: “I’m ready!”

Q. When my daughter didn’t quite get the hang of the potty, my father thought she could do it if she just gave it a little more effort. He knew she wanted to take ballet classes, so he bought her a leotard and told her that they didn’t make a style that would fit over a diaper. He told her to try out the leotard, and if she could wear it for a day without her diaper, remembering to always go to the potty, then she would be “big enough” to go to dancing school. It worked! She never wore a diaper again.

A. A fascinating strategy! We hope our readers can appreciate the difference between this approach, which leaves the child to discover her own motivation and to decide that she is ready, as opposed to those that put parents in the position of doling out rewards, or punishments.

To a young child just think how different it sounds to be told “you can’t take ballet unless you use the potty” as opposed to what your father almost seemed to be saying: “If they made leotards to fit over diapers, then you could keep wearing them, but since they don’t there may be a way for you to manage without them.”

Part of the secret of success of a strategy like this is that it does not pit the parent against the child — instead, both work together to face a shared challenge. Then, the child needn’t hold onto her diapers to prove that she can resist a parent’s pressure.

There are so many daily conflicts with children that can be turned into opportunities for learning rather than just another struggle when parents can join children in seeing their common goals. “The leotard may help you figure out whether you are ready to make your own decision to be ‘grown up.’ ” Not pressure, but a goal for her grown up achievement. Bravo!


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 heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.