A 5-YEAR-OLD’S SUDDEN CHANGE OF HEART

NEW YORK TIMES COLUMN: FAMILIES TODAY:
A 5-YEAR-OLD’S SUDDEN CHANGE OF HEART
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My 5-year-old granddaughter has taken ice-skating lessons for a little more than a year.

A couple of months ago she started crying before her lesson, saying she didn’t like it and didn’t want to go. She was told to give it another try because she had liked it (and the lessons were paid for).

Then she started crying before her dance lessons. But when she gets home, she says what a great time she had.

Now she’s starting crying before school and having bad days at school. She was always so excited to go to school and telling us all about her day.

What could be going on? Is she just “playing around” to see how far she can go? What can we do to help?

A. Five-year-olds who have complied with activities that their parents choose for them may suddenly realize, “I want to decide what I’m going to do – all by myself!” This wish to be in control can be a healthy sign of growing self-esteem: “I’m going to decide what I do now because I know what I’m doing!”

To help her open up, commend her for wanting to have a say. Then, if she can tell you what she doesn’t like about these activities, she may be able to focus on what she likes about them. Her parents could make an agreement with her to remind her that she says she enjoys these activities.

If a child complains about one activity, she may need help to figure out why. Is it too hard, frustrating or lonely without friends in that class? Is she too tired or hungry at that time of day? Perhaps something frightening happened there? A traumatic experience in one setting can lead a child to be fearful of others.

If you had told us that she was crying most of the time, and if you hadn’t said that after class she realizes she’s had fun there, we might have wondered if she could be depressed. If the crying is limited to these times, and if she is bright and cheerful at home and with friends during less structured activities, that’s reassuring.

It is concerning that she is also having “bad days” at school. You need more information about these bad days, about what is going on in school and her behavior there. Her parents could ask her teacher how she is handling the everyday school challenges. Her teacher may have ideas about how to help her enjoy school more. The teacher might even let her parents observe her in the classroom.

Another possible reason for the crying might be trouble with transitions. Many children this age become so absorbed in one activity that they can’t stop and switch to a different one. Reminders 15, 10 and five minutes before it is time to get ready to go can help. Another possibility is that her busy schedule may overtax her parents. If they’re frazzled, she’s bound to feel that way too.

When a child is more insistent on staying home or with a parent than avoiding a specific activity, separation may be her challenge. Such anxiety is common at this age, especially after a loss such as the death of a grandparent, or a move, or when a parent has been ill or preoccupied – by stress at work, financial worries or marital tensions. Five-year-olds may also insist on staying home after a new baby is born, as if to reassure themselves that they will not lose their place in the family.

For some children, dance and skating and other classes can just be too much. Your grandchild is only 5. Perhaps she’s trying to tell you that she needs a different pace, a few more breaks during the day, or more time for learning on her own – through play and with her friends. She may not know how to make friends yet – another reason to be miserable at school and in other group settings. Setting up play dates would then be an important first step.

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.

MOTIVATING A CHILD

NEW YORK TIMES COLUMN: FAMILIES TODAY:
MOTIVATING A CHILD
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. How can a parent help cultivate a child’s motivation in balance with complete acceptance of a child? What are the differences between “boundaries” and “unconditional acceptance”?

A. Parents can’t choose between boundaries and unconditional acceptance. The goal is to work toward balancing the two.

Children’s motivation partly depends on their feeling that they matter to others. From infancy, that feeling helps them believe in themselves. Why would any child be motivated to take on a new challenge if she sees herself as a failure?

Motivation begins at birth. Parents start the process by loving their baby, holding her, cooing, singing and rocking, setting up rhythms of smiling, vocalizing and touching that make her feel cared-about.

Within this cocoon of attachment, your baby begins to reach out for you. When you respond to her laughter with yours, she is learning – even in the first months of life – that things happen when she takes action. These exchanges are the beginning of motivation. She reaches out for others, and then for the world.

If she gets no response to her first coos and babbles, a baby doesn’t see much point to trying to make an effort.

As your baby grows into a toddler, your job gets more complicated. You have to set boundaries to be sure that her environment is safe to explore as she learns the motor skills – cruising, scooting, crawling and walking – that give her a new independence. When she’s just begun to toddle, you set the limit – no climbing up the stairs unless you’re right there to help her practice.

You can foster motivation even when you need to balance it with limits: “You can try climbing the stairs when I’m here to hold your hand.” But you also have to install safety gates, since a toddler can’t be expected to remember the limits when her own motivation tips the balance.

She tests you. She scrambles toward the stairs, then looks back to see if you really mean that she not climb them. Once you let her know you’re in earnest, you need to pick her up and stop her if she can’t stop herself.

Many parents worry that when they set limits they no longer unconditionally accept their child. Nothing could be further from the truth.

Setting limits is an act of love – it’s not always easy, and you wouldn’t bother if you didn’t really care. A child needs grown-ups who love her to clarify the rules and to protect her from hurting herself as she follows her motivation to learn about the world.

As a child becomes more independent, she finds new ways to resist your authority – temper tantrums in the second and third years, and often, at ages 3, 4 and 5, lying, cheating and stealing.

Boundaries help improve the child’s ability to achieve what she wants, as long as they are respectful and she understands the reason for them. Setting limits makes it clear that you unconditionally accept her but not all her actions.

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.

YOUNGEST IN HIS CLASS

NEW YORK TIMES COLUMN: FAMILIES TODAY:
YOUNGEST IN HIS CLASS
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Our only son was born in August, which means that in most schools he will be the youngest or nearly the youngest in classes. Many teachers and schools imply that always being the youngest will make things harder for him throughout the school years. True?

A. Chronological age doesn’t do justice to individual differences in development. Children of the same age show a wide range in height, weight and abilities.

Even within a single child, some kinds of development may move more rapidly than others. For example, a child may be bigger and taller than other children of the same age but clumsier and no more mature. I call this situation the “big child” syndrome – a problem because everyone expects more than is reasonable and the child suffers because of inappropriate developmental expectations.

While you can’t know the outcome for sure, taking a look at your child’s development and pace of growth may help guide your decision about whether to hold him back until the next school year.

If he is smaller than children his age, that may be an added disadvantage for him as the youngest child in the class. Height and weight are easy information to obtain, and growth curves over time are fairly predictable, at least until puberty.

It would be helpful to know about your son’s social maturity relative to his peers’. The preschool teacher should have a good perspective, using the other children in his class as points of reference.

If he is immature when compared with children with similar birthdays, that might affect your decision – even though a child can rather suddenly catch up in this area.

Also, you’ll want to consider how the school and the parents in your community handle this issue. If all the other parents of the youngest children retain them so that they can be the oldest in the following year, then your child is likelier to be isolated as the youngest unless you do the same.

Recently more parents have delayed their children’s entry into kindergarten, often with the hope that they are giving them a competitive edge, particularly in later years.

Many children have little to lose and perhaps much to gain from such a delay. In response to standardized statewide testing, many schools are introducing academic curricula originally designed for older grades that are inappropriate for younger children. These may turn them off from learning and interfere with how younger children learn.

Yet for truly gifted children – children who are cognitively ahead of their own chronological age – delaying entry to kindergarten may exact a price.

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.

CONCERN ABOUT AN UNORTHODOX CRADLE

NEW YORK TIMES COLUMN: FAMILIES TODAY:
CONCERN ABOUT AN UNORTHODOX CRADLE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. During a recent visit to a cousin’s home in another state, I was very troubled by a sleeping arrangement for a 14-week-old. Perhaps I’m not aware of common practices today for encouraging newborns to sleep through the night.

The baby is swaddled in a garment designed for newborns, then fed and put into a car seat, which is placed on the floor in a small bathroom – without windows. The fan is turned on to provide white noise, and the door is closed. A blanket outside the door blocks external noise. No monitors are used.

The baby has been sleeping for 10 to 12 hours at night. He appears to be healthy and happy.

But I’m concerned about his being in a sensory-deprived situation, unattended. The parents go to him when he cries, but the entire procedure seems wrong.

I would appreciate your input since I’m expecting a baby in a few months.

A. We share your concerns. This arrangement may interfere with the baby’s safety and development.

With all the measures to block out sound, the baby’s parents may not be able to hear him when he needs them. Adequate ventilation is another basic requirement.

Safe ways of swaddling can help babies settle for sleep and get back to sleep when they awaken during the night. But babies also need a chance to move their limbs to develop their muscle tone and strength.

We would ask whether all this protection against light and sound will interfere with the baby’s developing the capacity to filter them out on his own.

What kind of transition are the parents expecting from such a highly controlled environment to a more natural one, and when?

It would be helpful to know why the parents feel their baby needs these special measures. Was the baby hypersensitive at birth to noise or light? At birth, babies have different levels of tolerance and sensitivity to touch, sounds and sights. Some have little trouble tuning out useless information such as the sound of the dishwasher or a slice of light from a street lamp. Others may be sensitive only to sights, or to sounds, or to touch.
Such differences contribute to each individual’s unique temperament from the very beginning of life. Even infants who start out hypersensitive may become at least a little less so over the years by learning to cope.

We could imagine that without practice at shutting out unwanted stimulation, some infants could become overly sensitive. Later on they might even have trouble focusing their attention in the face of everyday distractions.

Sometimes technology can improve on nature, but there are plenty of examples, such as infant formula, where this just isn’t the case. Often we don’t fully understand the benefits of nature’s design until we’ve tried to substitute our own.

For all we know, human babies and parents may have evolved ways to communicate with each other, such as pheromones, that would require more contact than this closed-in arrangement allows – perhaps even through the night.

In any event, we see no reason why you need to follow your cousin’s example when your own baby is born.

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.

FEEDING A TODDLER

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

At age 2 and 3, a child begins to be not only independent but also aware of himself and of other’s feelings.

In the first year, feeding is established as an important form of communication between child and parent. But feeding also becomes a time for play, which is the young child’s most important way of learning about his world.

A child’s passion to learn is so strong it overshadows hunger. Parents are equally passionate about nourishing their child. But in this arena the parents should avoid setting up any battles.

Food Play

When a 3-year-old calls your attention to the “picture” he has made out of carrots and green beans, he is using food to test his new skills. To a parent the “picture” feels like teasing or making a mess with important, hard-earned ingredients.

Parents may remind children about starving children elsewhere in the world. The child senses the pressure, and the message can complicate a child’s attitude toward eating. My parents were second-generation Texas settlers, steeped in their parents’ struggles to make a living in this new land. I remember my mother’s stern face when I left food on my plate. I found I couldn’t avoid replaying my mother’s strong feelings with my own children.

When they seemed to be “playing with their food,” I had to learn not to comment on it. Should a parent give in to the child’s need to play with food, and let him tease? No. Parents can make it clear that food is for eating, not play. But making an issue of it won’t work.

When a child begins to play with his food, simply remove his plate and tell him, “All done” or “It looks like you’ve finished eating. Did you like it?” Then, remove him from the table and let him settle down to play on his own. Stopping the behavior firmly but gently is far more effective than criticizing or punishing it.

Eventually he will understand that staying at the table with the family depends on his learning to feed himself as everyone else does. He will be far more motivated to imitate adult table manners if punishments are not associated with mealtimes. Manners come later – at age 4 and 5.

Maintain your patience and perspective. A study that documented toddlers who were allowed to choose their own foods over several months showed that the children balanced their diet with all the ingredients necessary for optimal growth.

Strategies for Feeding

  • Consider feeding a toddler separately – not in isolation, but at a time and place where food and his choices are not the focus. You and others who won’t comment on his eating can keep him company so that he can learn to look forward to meals as a time to enjoy being together.
  • Don’t make special foods for him if you will be disappointed when he refuses them or plays with them.
  • Start with the more nourishing food while he likeliest to be hungry.
  • Offer two bits of food at a time, then two more, until he begins to drop them or throw them.
  • Don’t expect him to be excited by new or different foods.
  • Decide beforehand about the limits you’ll set. Then, without excitement, say, “That’s the end of the meal” and put him down.
  • Ignore his requests for grazing between meals.
  • Relax about a “balanced diet” if the child is healthy and growing.

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

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

Dr. Brazelton 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.

PREVENTING A VICIOUS CYCLE OF ANOREXIA

NEW YORK TIMES COLUMN: FAMILIES TODAY:
PREVENTING A VICIOUS CYCLE OF ANOREXIA
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I dealt with anorexia nervosa for 10 years. Though I am now healthy, I still consider myself a recovering anorexic. I’m terrified there may be some truth to the idea that eating disorders can be inherited. My mother has also struggled with her weight. How can I protect my 14-month-old daughter from this legacy?

A. Perhaps you can think of yourself not as a recovering anorexic but as a person recovering from anorexia.

Anorexia nervosa can seem to take over your life. By reaffirming your identity, you may help your daughter discover and assert her own.

Young adolescents with anorexia often seem to have a fragile sense of who they are. They may focus on attending to everyone’s needs except their own.

In the movie “Black Swan,” Natalie Portman’s character, Nina, is scripted to follow this pattern – she lives her tortured life as a dancer to fulfill her mother’s unrealized dreams. Sometimes people with anorexia discover that as children they felt pressured to sacrifice the development of their own identities for a parent’s sake. Their parents didn’t mean to pressure them. But sensitive children may pick up on parental needs and problems, misunderstand them and hold themselves responsible.

Awareness of a parent’s fragility can turn into self-deprivation, self-punishment and self-hatred: “I don’t deserve to eat or to enjoy eating. I am fat and greedy and need to stop eating so that everyone else can have what they need – everyone but me.”

If this pattern has passed down from one generation to the next, psychotherapy can help. A new mother recovering from anorexia can learn to free herself from her own past and leave room for her baby to become her own person.

Psychotherapy can help stop a vicious cycle when parents worry that their problems may affect their young children. Parents may unwittingly urge their children to appear happy – thus reassuring themselves they have done no harm. This pressure can keep children from experiencing all their own emotions, including sadness and anger. As a result, the pattern continues.

Under the weight of pressures from one generation, the next one fails to develop fully. Nobody is at fault. But the pattern is hard to see and hard to stop – without help. Studies have shown that anorexia nervosa may be inherited. However, despite the increased likelihood, many children whose parents have struggled with this disease will not inherit it.

A hallmark of anorexia is loss of pleasure in eating. Studies have focused on how mothers with a history of anorexia feed their babies. These mothers seem to be more anxious and to take less pleasure in the feeding process than other mothers.

Psychotherapy can help them to relax and to attend to their babies’ cues about feeding and to enjoy these interactions.

Pleasure is a powerful motivator and an important part of the feeding experience throughout life. By the end of the first year, parents can help their babies start taking pleasure in feeding themselves. The babies will soon want to take over. At that point, avoiding struggles over food can help prevent bigger struggles 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 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.

TEACHING IMPULSE CONTROL TO A TODDLER

NEW YORK TIMES COLUMN: FAMILIES TODAY:
TEACHING IMPULSE CONTROL TO A TODDLER
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

The toddler grabs the glass paperweight.

“Put it back on the desk.”

Entranced with the object, the child appears oblivious to his father’s words. Wisely, the father extracts the paperweight from the small fingers. The child falls in a heap on the floor.

“You can’t have it. It might break.” More sobs. “I’m sorry I had to take it away from you. But when you can’t stop yourself, I need to help you.”

After a violent heave of the child’s chest, the sobs begin to space out.

“It could break so easily. That would make you sad too.” The child looks up at his father through his tears. “Would you like a hug?” The child holds out both arms. He’s forgotten about the paperweight.

Sometime during his second year, a toddler discovers cause and effect. I drop the paperweight. It breaks. I climb on the coffee table. I fall down and hurt myself.

Until this understanding is achieved, a parent must always be present to counteract the toddler’s lack of judgment. Even then, the child will have trouble using his knowledge of cause and effect to guide his behavior when his impulses hold sway.

Discipline at this age is the gradual teaching of control to this young bundle of impulses. Impulse control is not learned instantly. Parents of toddlers know that such episodes are bound to repeat themselves countless times every day.

The parent with the paperweight tested the child’s response to words alone and quickly realized that words were not enough. Had he repeated the request several times, it would have been increasingly unclear to the child that his father meant it. The words would have lost their potential to stand alone, as they will more often in the next year or so. As soon as the spoken instructions went unheeded, the father moved in and retrieved the paperweight.

Had he stopped there, he would simply have demonstrated that he had more control over the situation than his son did. Instead, he explained why he had to take over. Then he gave his son a moment to relax before helping him to imagine his own feelings had the precious object been damaged. Most important, he left his son with the feeling that one day he would be able to control himself.

Self-discipline means that a child is motivated to control himself because it matters to him, not just to others. Having learned self-discipline, a child can then balance his own and others’ needs. You are laying the groundwork for learning for years to come.

Guidelines for Impulse Control:

  • First get your child’s attention. Look him in the eye to be sure he is focusing on your message.
  • Make clear that he can’t act on the impulse.
  • If necessary, physically stop him from doing what you have forbidden.
  • When possible, offer the child an alternative. “You can have this instead.” This is one way to teach problem-solving. Make the alternative a take-it-or-leave-it offer, not a negotiation.
  • Sympathize with the child’s frustration or disappointment. “It feels terrible when you can’t have what you want.” You’re not teaching the child to give up all his wishes and dreams, only to hold back on those that can’t be acted on. You are not trying to teach him to like all the rules, just to manage his negative feelings about them so they don’t overwhelm him.
  • Help him understand why – in simple terms – his wish can’t come true.
  • Comfort him, and offer him your faith that he can learn, little by little, to control himself.
  • When a day is filled with “no’s,” find something to which you can say “yes.” This helps a child to see discipline as an act of love, not as a response to something “bad” in him.
  • Don’t take your child’s misbehavior personally, especially the repeated testings. If you see them as a personal attack, you are bound to respond in kind. Instead, look for what he is trying to learn with his misbehavior, so that you can respond with the teaching he needs.
  • Share this responsibility for discipline, and for teaching, with the other adults in your child’s life.

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.

AN 18-MONTH-OLD WHO LASHES OUT

NEW YORK TIMES COLUMN: FAMILIES TODAY:
AN 18-MONTH-OLD WHO LASHES OUT
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My 18-month-old boy is healthy, and our doctor says he is bright. He has a single-word vocabulary of more than 25 words but appears to be verbally frustrated. He imitates everything I do; understands everything I say; repeats words with the appropriate sounds even if the words are too advanced for him to say; and has a wonderful memory.

My question: Why does my son hit people or throw things at them? He’s getting into repeated time-outs at day care that don’t seem to stop him.

My doctor feels he is simply verbally frustrated, but this behavior is unacceptable and worrisome. At home the aggression happens much less often but when it does, I sternly redirect him and explain how hitting hurts. He’s normally loving and affectionate but has frequent outbursts, especially when he’s tired.

A. In young children, limited language often leads to the frustration that boils over into hitting and tantrums.

The pace of language development varies among children. Some 18-month-olds who are exposed to very verbal adults may deploy up to 100 vocabulary words. So your child may indeed be frustrated with the number of words at his command now.

A limited vocabulary may not be the whole story. Along with having too few words to express all their wants and feelings, toddlers have too little impulse control and too few problem-solving and social skills not to explode occasionally.

Over time, you and his child-care providers can help him learn to get along. Time-outs aren’t likely to work if they are offered as punishments: They may teach him to believe he’s a “bad boy,” increasing the chances he’ll act like one – well into the future.

Time-outs that are presented as a chance to take a break, rest and feel better can help a child master the self-control we all need when we can’t make ourselves understood or get our way.

We know one child care teacher who doesn’t give time-outs to her children. Instead, she has a comfy couch for them to sit on when they start to sizzle. When she can, she comes over to cuddle with them. She is not rewarding them for bad behavior. She’ll say, “It’s so tough when you can’t figure out how to play with a friend” or “It isn’t easy to learn you can’t always get what you want.”

Thus she encourages them to work toward the goals of self-control and cooperation.

At 18 months, children want what they want – now. To them, “later” seems so far into the future that it barely exists and is awfully hard to wait for. Often they want one thing and the opposite, all at once. The only solution is a meltdown.

They want to play with other children and to make friends. But they don’t know how to attract another child’s interest, how to tune into the other child or how to take turns, share and compromise. Plenty of adults aren’t terrific at these skills, either. Also, some child care centers may not be realistic in their expectations for toddlers. Undue pressure can trigger hitting and blow-ups.

Some very young children may be hampered by developmental delays. Any interference with processing information can lead to problems.

Subtle difficulties in seeing and hearing may lead to overstimulation and a tendency to tantrums. These difficulties may also interfere with picking up social cues. Missing these cues may cause the child to feel threatened or limit his ability to interact appropriately.

Delays or differences in motor development can be an issue, too. For example, a child with poor muscle tone who has to work harder to hold his head and body straight may make inadequate eye contact with other children, leading to misunderstandings.

These differences may go unnoticed by parents, teachers and pediatricians. But a child under age 3 whose behavioral challenges stand out from his peers should be referred to a specialist for an early-intervention evaluation.

There is little to lose, even if it turns out that development is proceeding on track – and much to gain by starting early to address a challenge.

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.