FamiliesToday

FEEDING A PICKY EATER

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

Q. My 3-year-old son is a very picky eater. As we weaned him from baby food and bottles around age 1, he refused to eat anything other than yogurt and crackers. I assumed it was just a transition issue that would sort itself out as he grew older.
He is now almost 4 and refuses even yogurt, sticking only to Cheerios, crackers, apples, applesauce and milk. He takes a daily multivitamin. He continues to grow taller and gain weight at a normal rate.

I’ve encouraged him to try new foods but I haven’t pressured him too much because he can be very determined when he makes a decision. Am I doing the right thing to wait it out?

A. You don’t have much choice. You can’t force a child to eat.

You’re doing the right thing by giving your son a daily multivitamin (be sure it also contains iron), taking him to the pediatrician for regular growth checks – and, hardest of all, not pressuring him too much. We urge you to see if you can make the move to not pressuring him at all.

Why? Every time he senses your attention to what he’s eating, you’re giving him power over you. The power struggle may distract him from the pleasures of eating. Even a little pressure can turn the dinner table into a battlefield. Parental hovering can be counterproductive whether it’s pressure (“just one bite”) or praise (“you tried the broccoli – good job”). Cajoling and bribing may backfire.

Let eating be his issue, not yours. Holding back can be difficult when you fear you may not be fulfilling one of your most important responsibilities as a parent – making sure your child is well fed. Yet you may help him get closer to this goal when you turn it over to him.

Your job is to present him with the food, whether or not he eats it. At each meal, you can add to his standard fare a small amount of a new food he hasn’t tried, just enough so that if you have to throw it away you won’t feel frustrated or discouraged – which he’s bound to notice.

Many children need to be presented with a small amount of the same kind of food at 15 successive meals before they’ll give it a try. Children’s taste buds mature over time. Tastes that bother them at an earlier age are easier for them to accept later.
For some children, specific food textures may be troublesome. So as you pick a new food to introduce, start with ones that aren’t too different in taste and texture from those he likes.

Since milk seems to be his only source of protein, you might try adding protein-rich food to his diet – for example, ground meat, egg, beans or nuts. Perhaps you can spread a teaspoonful on the crackers he likes.

Your other job is to keep mealtimes relaxed and fun. You may need to take a deep breath and accept that your son will only eat what he decides to put in his mouth. Regular checks from a pediatrician can reassure you. A consultation with a nutritionist may help, too.

When mealtimes are sociable rather than stressful, the positive associations of being together and enjoying each other’s company are likely to make the food on his plate seem tastier – but not if he gets even the slightest inkling of your strategy.

(For more information: “Feeding: The Brazelton Way,” by T. Berry Brazelton, M.D., and Joshua Sparrow, M.D. Da Capo Press.)

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.

LEARNING TO BE A ‘BIG BROTHER’

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
LEARNING TO BE A `BIG BROTHER’
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D

The new baby has come home and suddenly the older sibling doesn’t get the same attention as before. The newcomer is ever more demanding of their mother, whose energy may not yet have returned.

The older brother’s demands increase, too. It’s almost as if he must test to be sure that his mother will recover and that she can still care for him. Teasing and testing, refusing bedtime and waking up each time the baby does – all are to be expected.

Sometimes an older child will take on the helping role of “big brother” or “big sister,” but don’t be fooled. Along with pride in helping, and his discovery that he is more “grown-up,” he’ll still resent the baby and feel sad about losing you.

You can make it clear that there are times when he can help, and times when he can be a baby, too. He’s telling you, “Why did you need her? I can do anything she can. I can still be your baby and please you.” He is facing one of life’s crises and learning how to cope with it in the safety of your loving care.

Expect the older child to lose ground again at some point. Usually it’s in the developmental area he’s just mastered. If he has begun speaking, he may resort to baby talk. If he’s feeding himself, sleeping through the night, becoming toilet-trained or conquering fears of strangers – count on a slide backward. This is what we call a touchpoint, a temporary falling apart that anticipates a new step ahead. He is learning how to be a big brother.

Think what it means to the older child when a 2-month-old baby fusses every afternoon and parents rush to attend to her. You can help him understand his feelings. He’s working so hard to understand the new baby, and to imitate her. “Of course you want to talk like the baby: Everyone pays so much attention to her right now.” Or, “Don’t worry about wetting the bed. Once you get used to having a baby sister, it’ll stop.”

Your understanding will be far more effective than getting annoyed or pressuring him to be a “big boy.” These responses are bound to backfire into even more dramatic bids for you to let him be your baby again.

Some children seem to sail through these first months. They are compliant, even helpful. But this interlude won’t last. The price of such a challenging new role for a child may have to be paid at a later touchpoint, or in reaction to one of the baby’s own touchpoints.

Each of his steps backward is an opportunity for you and the child to learn together to master the next stage of development.

An older sibling who is 5 or 6 years old may not express his resentment and frustration through tantrums or meltdowns; instead, he may devise ways to attract your attention by spilling things, falling, or needing your help with homework. Or he may come to your side as if to help, only to drag around and get sassy with you. But he needs the same understanding as a younger child. He will be better able to tell you how he feels than his sibling, and more able to help in a useful way once he feels understood.

DISCIPLINING THE OLDER CHILD

  • Stop him firmly but quietly.
  • Hold him, or use a time-out if he’s ready to comply.
  • Pick him up to hug and love him. “It’s tough having a baby sister, isn’t it? But I can’t let you do that and you know it. I must be here to stop you until you can stop yourself.” Watch his face and his eyes take it in and soften.
  • After you’ve made contact with him and are feeling close again, let him help you with the baby. In that way, he’ll begin to sense the goal of discipline and to feel like a “big brother.”

(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.)

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.

14-MONTH-OLD, EARLY TO BED AND EARLY TO RISE

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
14-MONTH-OLD, EARLY TO BED AND EARLY TO RISE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My 14-month-old is an excellent sleeper – he has slept through the night since he was 2 months old. However, he goes to bed early and wakes up early (typically 7:15 p.m. to 5 a.m.)

I have tried shifting bedtime a little later but it hasn’t affected wake-up time; instead he is cranky and tired until his morning nap, which shifts earlier.

I don’t want to mess with a full night’s sleep, even if it’s not on my preferred schedule. But I find it hard to make evening plans with the rest of the family.

Do you have suggestions for (a) shifting to a later bedtime and/or (2) explaining to relatives and friends why it’s so important either to turn down invitations or to leave early to keep his sleep schedule?

A. At 14 months, 10 hours of nighttime sleep is about average. A child this age would also need another hour or two of sleep during the day. (Of course, many children are not average, so sleep requirements vary.)

An early-to-bed early riser’s sleep schedule is healthy so long as the child gets the sleep he needs. If you want to try to change his sleep schedule, you will need to shift every sleep-related event – naps, bedtime and mealtimes – in each 24-hour cycle.

And you must maintain the pattern consistently, advancing by 10 to 15 minutes each day. The process is like adjusting to a new time zone.

At first, your child probably won’t wake up later and may be tired and cranky. But if you continue this schedule for a few weeks, chances are he eventually will start waking up later in the morning.

At that point you would not advance his bedtimes, naptimes and mealtimes any further. He should still obtain the same amount of sleep at night and during naps. If not, you may need to go back by 15 minutes or so, settling on a new schedule that works best for him.

None of this is necessary unless his current schedule bothers the family enough to make the effort. You may indeed prefer not to “mess” with a good night’s sleep.

You don’t tell us whether your child appears well rested and wide-awake when he is up: important signs of a healthy sleep pattern.

As for the pressure to make your baby conform to others’ schedules, you are his parent. Decisions like these are up to you. You may deflect criticism by making it clear that this is a matter of the child’s biology, not a lack of parental backbone. Assert your authority: “He’s an early bird. Some people just are, and we intend to respect that.”

Others’ opinions will bother you less once you feel confident about your stance on your child’s sleep.

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

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

A CHILD’S ‘SENSORY PROCESSING DISORDER’

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
A CHILD’S ‘SENSORY PROCESSING DISORDER’
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. What is your opinion of “sensory integration dysfunction?” My 3-year-old has been diagnosed with this condition and is in occupational therapy to address it. Is this a new fad or something real? Does occupational therapy help?

A. Sensory integration dysfunction, now called sensory processing disorder, is not a fad.

The occupational therapist and developmental psychologist A. Jean Ayres first wrote about sensory integration almost 40 years ago.

I knew Ayres was onto something. My observations showed me that each newborn has a different tolerance for sensory stimulation. Such differences help make a unique individual – but they can be disabling.

For example, premature babies often are often so hypersensitive to sight, sound or touch that when overstimulated they register changes in their vital signs. As children grow, differences in their experience of their senses can affect their behavior and learning.

During the past decade, science has affirmed the disorder. The Sensory Processing Disorder Foundation (www.sinetwork.org) features research as well as information for parents.

To make sense of our world, we must put together what we see, hear, smell, feel and touch, and we start learning to do this at the beginning of life.

Some children are more – or less – sensitive than others to sensation. The differences show up in how children react to, and understand, the information their senses detect.

We now think of sensory processing disorder as a large diagnostic category with three subtypes: sensory modulation disorder, sensory discrimination disorder and sensory-based motor disorder.

All involve some kind of disruption in learning. As a result, children may have trouble understanding about their world. They may react to it in ways that are hard to fathom until the specific challenges are identified.

For example, a child who is hypersensitive to loud noises may have tantrums in response to them. Nobody else may even hear the noises, but everybody notices the tantrum. Another child may not correctly process information that her joints and muscles send about her body’s location in space. As a result, she may be clumsy, bump into things and avoid sports.

For some children, a day with the usual barrage of stimulation from the environment can feel uncomfortable, even traumatizing. They and their parents may be immensely relieved just knowing the source of the problem.

Occupational therapists can help identify the differences in how children’s senses work and how their brain processes information from their senses. The therapists can also help children learn how to avoid problem situations and how to cope with those that can’t be avoided.

For more information: “The Out-of-Sync Child,” by Carol Stock Kranowitz. Perigree 2005.

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 5-YEAR OLD WITH TROUBLED SLEEP

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
A 5-YEAR OLD WITH TROUBLED SLEEP
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My almost 5-year-old son is very tired during the day, even though he gets 10 hours of sleep most nights. He is in school now, so he can’t take daily naps. I’ve noticed that he kicks a lot during the night. Should I look into another cause, like periodic limb movement disorder?

A. By age 5, most children no longer need naps, so not napping is unlikely to explain the fatigue. Ten hours of sleep is enough for most children his age although the necessary amount varies from child to child.

So sleep quality may indeed be the problem. A number of disorders can disturb a good night’s sleep, including narcolepsy and obstructive sleep apnea, which is commonly caused by allergies, asthma and obesity.

Period limb movement disorder is another cause to consider when a child (or adult) kicks or moves his legs while asleep and is tired during the day. (Certain kinds of seizures can also cause unusual movement during sleep.)

Child sleep experts Judy Owens, M.D., and Jodi Mindell, Ph.D., note that PLMD is often missed because the symptoms are not reported. Also, many doctors don’t know about of this condition. PLMD is relatively common in adults, especially as they age. But not until recently has the condition, been recognized in children.

Your pediatrician could refer you a pediatric sleep specialist who can conduct a sleep study, make a diagnosis and recommend treatment.

Such a study is carried out in a sleep lab (usually in a hospital), where the child spends the night – and where a parent should be encouraged to stay too.

The lab monitors and records the child’s heart rate, blood pressure, breathing rate, movements and brain waves through the night.

A child with PLMD may also have Restless Legs Syndrome. A child with PLMD isn’t aware he’s kicking. RLS, however, involves an uncomfortable sensation in the legs, often described as a tingling, or the need to move.

Children with RLS will resist going to bed at night because lying down brings on the distressing sensations at their worst.

Both RLS and PLMD seem more common in children with Attention Deficit
Hyperactivity Disorder. Some scientists think that similar brain chemicals may be involved in the conditions.

Sleep disorders often lead to irritability and other behavioral problems at school, with related trouble in concentrating and remembering. But these problems often clear up when sleep quality improves.

PLMD’s cause is unclear, but the condition appears to run in families. It may be associated with iron and folate deficiencies. Sometimes, if the deficiencies are treated, the condition abates. (PLMD is also more common in children with leukemia, but most children with the disorder do not have leukemia.)

Usually, however , PLMD persists. Medication may effectively treat it. Avoid caffeine, present in many soft drinks, and be sure that the child devotes an adequate amount of time to sleep. Some doctors think that moderate exercise a few hours before bedtime may help.

(For more information, see “Take Charge of Your Child’s Sleep,” by Judith A. Owens, M.D., and Jodi A. Mindell, Ph.D, published by Marlowe & Co.)

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.

MULTIVITAMINS AND A BABY

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
MULTIVITAMINS AND A BABY
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D

Q. Is it true that a baby’s multivitamin intake should be stopped after age 3 months to prevent vitamin dependency?

A. We all depend on vitamins – molecules by which our bodies carry out chemical reactions that keep us healthy. Ordinarily the necessary vitamins come from a balanced diet and a little sunshine (five to 15 minutes three times a week) to activate vitamin D.

Some diseases and medications interfere with the absorption and metabolism of vitamins. A few rare hereditary diseases also cause vitamin deficiencies, despite a healthy diet; among the potentially affected vitamins are B6, B12 and D.

Children with these diseases may need to take regular supplements of the deficient vitamin to overcome their body’s inability to absorb or metabolize it.

We have never heard about multivitamins’ causing vitamin dependency. Multivitamin supplements aren’t necessary if a child eats a balanced diet. But many children don’t eat such a diet, especially in the first few years, and multivitamins can help them get the vitamins they need.

During the first year or two, iron and vitamin D are likely to be in short supply. In the first weeks of a baby’s life, we recommend that parents discuss iron and vitamin D supplements with their pediatrician.

Although breast milk is the best source of nutrition for babies, breast-fed infants often don’t get enough vitamin D, nor do babies who take in less than a quart a day of formula, which is usually fortified with vitamin D. The American Academy of Pediatrics recommends that infants take in 400 international units of vitamin D per day. Your pediatrician can guide you to the proper dose for your baby.

Depending on a mother’s diet, breast milk may not contain enough iron, though iron in breast milk is better absorbed than the iron in fortified formula. Your pediatrician can also determine your baby’s need for iron supplements.

Inadequate amounts can cause iron-deficiency anemia. During the first years of life, when the brain is growing faster than at any other time, inadequate iron intake has also been linked to learning disabilities that may only become evident later. Paying attention to nutritional needs from the beginning can make a big difference.

Between about 12 and 36 months, many children struggle to control what they eat and often limit their food intake to a few familiar items that may not contain the nutrients they need.

Many children take time to adjust to new tastes and textures. Often a parent may have to introduce a small amount of the same new food up to 15 times before a child will even try it. The process goes more smoothly if a parent simply places the new food on the plate without comment or pressure. Even gentle cajoling leads to more resistance. If you only offer a tiny taste each time, it will be less overwhelming for the child – and a little easier for you to put up with her refusal.

Multivitamins and regular visits to the pediatrician can reassure parents that a child’s growth is on track. Then parents may be less tempted to wage food battles with their children – which parents will surely lose.

There is no way to make a child eat something against her will. Repeated struggles over food are likely to lead to more struggles and perhaps even more serious eating problems 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 SIMPLE TEST OF A BABY’S DEVELOPMENT

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
A SIMPLE TEST OF A BABY’S DEVELOPMENT
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I am an infant-toddler teacher and first-time mother. I’m reading your book, “Touchpoints: Birth to Three,” and I want to learn more about the assessment you use to evaluate a 9-month-old’s belief in his or her own success or failure.

A. Careful observation is the key. I like to watch a 9-month-old take on a challenge. There is so much to learn from seeing how a child tries something new. I have a simple test that teaches about temperament, and I think it can also be a window into a child’s self-esteem.

I give a 9-month-old a wooden block, small enough to fit in his hand but too big to swallow. If he expects to succeed, this sequence often follows:

He reaches out to grab the block. He looks at it. Then he looks at me as if to say, “What do you want me to do?”

At this age, babies already know that information is written all over our faces, and they know how to read it. If I smile encouragingly, he looks back at the block, turning it around in his fingers.

Meanwhile I bang another block on the table. Ready to imitate, he bangs his block on the table, too. If I bang once, he bangs once. If I bang twice, he bangs twice.

If I tap his block with mine, he does the same thing – and then he looks up at me and smiles. Already, we are friends. Then he brings his block to his mouth and rubs it around – his way of getting to know it better.

A baby who expects to fail may not even reach for the block I offer to him. If he does, he’s likely to take it from me limply and then may let it drop. He may not bother to look back at me to see what I think. If he does, and if I smile my encouragement, he may not display the same curiosity or seem to care about pleasing me.

When I bang my block on the table, it gets his attention. But he watches passively instead of trying it for himself. Already he seems afraid of getting it wrong. Yet children can’t learn if they don’t dare make mistakes.

Next, I hold out a second wooden block. The 9-month-old who expects to succeed clutches the first one tightly, and extends his other hand for the new block. Then he studies it with the same curiosity he showed for the first one. While doing so, he may even forget about the first one and drop it.

But when I take my two blocks and slowly show him how I bang them together, he picks up his first block again and tries his hardest to imitate me. When he succeeds, he looks up at me as if to say, “I did it. I did it all by myself. Aren’t I great?”

The 9-month-old who expects to fail may not reach for the second block, having given up on himself with the first. I make it more enticing by turning it around In my fingers so he can look at it, or by banging it gently on the table. Then I put it down next to him – he’s likely to ignore it or just handle it briefly.

When I show him how to bang two blocks together, the response is a half-hearted try. He picks up a block with each hand, or I may need to hand them to him again. He may make a brief swipe to try to bring them together. But he misses and looks at me briefly, then at the ground. He won’t try again.

Hitting two blocks together is an item from the Denver Developmental Assessment. But when I’m watching to see if a child expects to succeed or fail, I’m not interested in whether he succeeds – but in how he approaches the task, and how he responds to his own success or failure.

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 BACK-AND-FORTH ON BITING (follow up)

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From the NEW YORK TIMES COLUMN: FAMILIES TODAY

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

In a recent column a grandmother recommended her solution to the problem of children biting: Bite back. We demurred. Now another mother lobbies for the fight-fire-with-fire approach.

Q. This is in support of the politically incorrect biting mother and grandmother. There is nothing like experience to teach us, and I’m talking about biting toddlers. We can talk a blue streak, and it’s all abstract to a toddler; they need to learn that if they cause pain, it comes back at them.

These are my biting stories from the trenches. I was nursing my baby and his teeth were starting to come in. After having toyed with the idea for some time, he finally bit me while nursing. I let out a very loud bellow out of proportion to the pain, because I was not going to have that happen again. The poor baby got quite traumatized by my loud scream, but he never bit me again.

When he was a toddler, I took him to a day care where there was a hyperactive boy who was a frequent biter. Nothing the parents or day-care provider tried changed anything. Finally the day-care provider’s toddler took matters into his own hands and bit him back. End of biting.

When my boy was a toddler, he kicked my leg. Like the politically incorrect grandma, I very carefully placed a kick on his leg (I was so scared of hurting him that the first attempts were air kicks). He never kicked anybody again. I must add that this boy is now 14 and a joy (besides the fact that, being a teenager, he counters everything his parents say).

A. Small children’s biting certainly creates a red flag for everyone. Yet it is such a universal response in late infancy and toddlerhood that it deserves all its eminence.

Starting out as an exploratory and often loving response when a nursing baby bites the breast of his mother, it gathers drama from the surprised, angry and even frightened response, “Have I lost my baby? Do I deserve this negative hurtful response when I’m giving him everything I can? Will he turn out to be a monster?”

For him, it is likely to mean that when he suddenly raised such a dramatic response, “Should I try it again when I need to get her attention?” Then, he may begin to fall back on it when he is tired or overwhelmed or doesn’t know any other way to get the attention of someone he craves. He tries it out on a peer toddler. The world blows up. Everyone overreacts. “Wow! This is more important than I thought. I’d better shove this behavior way down underneath. I’ve learned there are certain behaviors that I don’t dare to express. They mean something terrible to other people, even though that’s not what I meant when I tried them. I’d better be more inhibited than I was.”

Inhibitions can be expensive in the long run. Your method of retaliation has surely worked. But what has it meant to the baby or toddler? “I’m bad, or she wouldn’t have hurt me, and I’m not sure why. But I guess I’m just a bad kid.” Is that what you meant to teach him by your response?

Meanwhile, seeing it from the standpoint of the baby’s development, it has been a missed opportunity. Each behavior which becomes an intrusive or painful one presents the child the chance for him to learn about how to control himself.

A child who learns self-control is already way ahead of a child who must rely on an adult’s presence to be controlled by force or by retaliation. Learning self-control is a major goal for childhood in our present out-of-control society. Discipline (teaching) is the second most important gift we as parents can give a child. Love first, but discipline that says, “I shall have to stop you until you can stop yourself.” That’s a much longer goal in time than just teaching him to suppress his responses and his feelings.

Everything we know from research in child development demonstrates that suppressing angry, hurt feelings just postpones them. For a parent or a teacher or any caring adult, each episode needs to be understood from the child’s standpoint. We can use his hurtful behavior, share the idea of self-control rather than just shutting it off. “I can’t let you bite. It hurts and no one likes to be hurt. Let’s find another way for you to say what you’re trying to say.”

The story you tell of the child’s learning from another child how biting hurts and how necessary it was to control himself was on a different level. Children learn so much more from each other than they do from an adult. It’s fascinating to watch two toddlers as they reproduce by imitation hunks of behavior from each other.

I have recommended putting two 2-year-old biters together. One would bite the other. They’d look at each other with a startled look. “That hurt.” And they wouldn’t bite again. This is an almost sure cure, but maybe one to be used sparingly, in case it could get out of hand. When it works, one can see on the biter’s face that he recognizes the fact that he’d hurt him. “I never knew what I was doing could hurt someone. I can’t do that again.” He will have learned (at 2) how to experience what another is feeling – a major step toward empathy for others.

When an adult bites him back, his reactions are hurt and anger. He may not have meant to be aggressive in the first place. Now, biting could become loaded with angry feelings. Certainly, it has not been a learning experience except to stop the biting – but not the anger that being bitten has generated.

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.

IN TOILET TRAINING, A PREMIUM ON PATIENCE

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
IN TOILET TRAINING, A PREMIUM ON PATIENCE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Problems in toilet training nearly always arise because of an imbalance in the parent-child relationship. Children usually show signs of readiness between age 2 and 3. When parents can’t wait until then, and impose toilet training as their idea, the child will feel the pressure as an invasion.

All parents, of course, want their child to grow up and cross this threshold. Preschools often insist that a child be “trained” before he comes to school.

Other parents may offer advice and condescending comfort when their children are already trained. Grandparents may imply that toilet training is a measure of effective parenting and of a child’s overall competence. Some families may see the child’s entire second year as preparation for success in this area.

A toddler for whom independence is a passionate issue anyway will have his own struggles. He may stand in front of a potty, screaming with indecision. Or, he may crawl into a corner to hide as he performs a bowel movement, watching his parents out of the corner of his eye.

It’s a rare parent who won’t feel that such a child needs help to get his priorities straight.

When a parent steps in to sort out the guilt and confusion, the child’s yearning for autonomy becomes a power struggle between them. Then the scene is set for failure.

In bedwetting, as in many of the problems encountered with toilet training, a child’s need to become independent at his own speed is at stake. When a child’s need for control is neglected, he may see himself as a failure: immature, guilty and hopeless. The effect of this damaged self-image on his future will be greater than the symptoms themselves.

Given that toilet training is a developmental process that the child will ultimately master at his own speed, why do parents feel they must control it? My experience has led me to the conclusion that it’s very hard for parents to be objective about toilet training.

The child becomes a pawn – to be “trained.” It may take us another generation before we can see toilet training as the child’s own learning process – to be achieved by him in accord with the maturation of his own bladder and central nervous system.

When Problems Exist:

A.) Discuss the problem openly with your child. Apologize and admit you’ve been too involved.

B.) Remember your own struggles, and your eventual successes, so that you can let the child see that there is hope ahead.

C.) State clearly that toilet training is up to the child. “We’ll stay out of it. You’re just great, and you’ll do it when you’re ready.”

D.) Let the child know that many children are late in gaining control, for good reasons. Then, let him alone. Don’t mention it again.

E.) Keep the child in diapers or protective clothing, not as a punishment, but to take away the fuss and anxiety.

F.) Don’t have a child under age 5 tested unless the pediatrician sees signs of a physical problem. A urinalysis can be done harmlessly, but invasive tests and procedures – enemas, catheters, X-rays and so on – should be reserved for children who clearly need them.

G.) Make clear to the child that when he achieves control, it will be his own success and not yours.

(This article is adapted from “Touchpoints: Birth to Three,” 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.

Prior to Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

THE PACIFIER PROBLEM

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

Q. My almost 4-year-old refuses to give up her pacifier and I am concerned about her teeth. Since her sister was born 10 months ago, she seems to be using it much more. Do you recommend we get rid of it cold-turkey as some pediatricians have recommended? Will the pacifier cause long-term damage to her palate and/or teeth?

A. Some studies associate pacifier use with orthodontic problems, especially as children get older. Such findings don’t mean that any child who uses a pacifier will need orthodontic treatment, but treatment appears to be necessary more often with pacifier use.

We know of no studies that link cold-turkey termination of the pacifier with significant psychological problems later. Concerns arise from the notion that interfering with a young child’s need for oral soothing may lead to overeating and other problems.

The practical challenge in stopping pacifier use is that there’s no sure way to do it. Often, when a parent tries, the child just clings harder to the pacifier.

You mention that a baby sister came along 10 months ago.

Children often suck their thumbs, fingers or pacifiers to reduce stress. They’re bound to feel more anxious when the whole family is.

When a new baby is brought home, parents are understandably preoccupied, worn out and less available to the older child. She may wonder why her parents had to go to all that trouble for this crying, demanding, inert little creature who won’t be much fun for a long time. The question may vaguely cross her mind, “Is the new baby here because I wasn’t enough to satisfy them?”

As she tries to adapt to her new role of older sister, and learns to wait until her parents have time for her, she’s likely to feel upset. As the baby grows, there will be new challenges for the older child – when the baby says her first words, or begins to crawl or walk and get into all of the older child’s toys. A thumb, finger or pacifier can be a welcome refuge.

It may help to offer this child other strategies for soothing herself – a “lovey” such as a soft blanket to stroke and cuddle, or a stuffed animal to squeeze tight. There’s no need for lots of dolls and animals – too many will just distract her. Instead, she’ll need to become attached to a single special one. Hand it to her when she’s distressed, tired or has scraped an elbow or knee, and tell her to hug it hard to help her feel better.

After a new baby is born, the older child feels the need to be a baby, too. The baby just seems to suck up all the time and get all the parents’ attention – so why wouldn’t an older child try the same thing?

Parents often think they can help the older child adjust by praising her for being such a “good big sister.” But the older child also needs reassurance that she can be a baby again when she needs to. The more her need to regress is openly expressed and accepted, the less she’s likely to do so.

Family life is especially busy with a 10-month-old, but the older child might need some extra time to cuddle with you. Don’t say a word about it, and don’t make it an issue, but try to give her some gentle one-on-one time when she doesn’t have her pacifier. Thus she’ll learn – through actions rather than words – that there are even more rewarding places for her to find the comfort she seeks.

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.

Prior to Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.