FamiliesToday

WHERE DO PRESCHOOLERS LEARN MOST?

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NEW YORK TIMES COLUMN:  FAMILIES TODAY:
WHERE DO PRESCHOOLERS LEARN MOST?
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. What are your thoughts on preschool? Are very young children better off constantly interacting with a dedicated adult parent to stimulate their brain growth, or is there a benefit to socializing them with their peers at an early age? What’s the optimum balance of this for raising an intelligent yet independent and socially adept child?

A. How fortunate you are if you have a choice! And yet what a sense of responsibility!
Most parents in the United States today have no choice, and must work in order to be able to provide for their families. Because of the decline in real wages over the past decade, most single and two-parent families need all adults to bring in paychecks. While quality child care is hard to find and harder to pay for, it may be harder still to do without a parent’s salary. Some families find, though, that with two or more children under age 4, there’s no choice but for a parent to stay home. For others, friends and relatives are the only solution.

Early Head Start (for infants and children to age 3) and Head Start have been the salvation of many families, although for decades there have been no openings for the vast majority of eligible families. Finally new funding is on its way to make room for more children in these high-quality and proven programs.

To our knowledge, there are no actual studies that compare the brain development of children in preschool to children who spend their days at home with a dedicated adult parent. Such a study would be difficult to conduct both because the specific experiences in individual homes and preschools can vary so much and because there are so many other variables that influence brain development, including pregnancy, health, nutrition, air and water quality, and genetics.

What we do know is that high-quality early childhood education has been proven to save up to $17 for every dollar it costs because it leads to better academic success, fewer special education expenditures, greater chances for employment and productivity, and less risk of ending up in jail.

Quality criteria include a low child-teacher ratio, a high level of formal training in child development and education for teachers, positive relationships between teachers and parents, and meaningful parent involvement.

There is no evidence that such high-quality experiences can’t also be provided by dedicated and caring parents for children at home. Positive learning and growing may occur in either setting.

Since most parents don’t have a choice, and are either at home or at work because they must be, we’d hate to make them feel guilty about either option. What matters most is the quality of the child’s experience. Whether the child is at home or at preschool, parents and children need enough time together to continue to grow closer and to deepen their understanding and appreciation of one another. And children at home will still need abundant opportunities to be with peers to learn from them, with them and through their interactions.

Parents may feel overwhelmed by the responsibility that the “new brain science” may seem to impose on them to stimulate their children’s brain development – quick, in a hurry – before it is too late. The reality is that while the human brain never grows and develops more rapidly and dramatically than in the first three years of life, children’s most important learning experience will not come from videos or computer programs but from interactions with those who care about them most – parents, teachers, siblings and peers.

Parents are children’s first and most important teachers not because they teach the alphabet, shapes and colors but because they encourage and motivate children’s curiosity and enthusiasm to learn. Parents help children to take in as much as they can learn from their environment by gently buffering them from more stimulation than they can handle. Early on, children teach their parents how to read their cues so that together they can work toward this balance.

The foundations for learning are laid down before kindergarten in the context of children’s interactions with adults and with each other. We have known for decades that the key to school readiness and becoming a lifelong learner lies in the early experiences that help develop important qualities such as persistence, perseverance, curiosity, the capacity to tolerate frustration and the self-esteem to keep on trying even after making a mistake.

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.

WHEN A TODDLER SUDDENLY DEVELOPS SLEEP PROBLEMS

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NEW YORK TIMES COLUMN:  FAMILIES TODAY:
WHEN A TODDLER SUDDENLY DEVELOPS SLEEP PROBLEMS
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. We have read “Touchoints” cover to cover. We keep our tattered and torn copy on the coffee table for easy access, but we are at a loss.

Up until a week ago, our 25-month-old daughter was the “perfect child” – our pediatrician often asks to adopt her if we tire of her! She has always has been able to self-soothe and go to sleep on her own. She is not having any problems at nap time (noon-2 p.m.) She eats fairly well, is active and well ahead of the curve in her language skills.

Last week, she started a pattern of not being able to/wanting to go to sleep in the evening (7:45-8 p.m.). We keep a very regular schedule and bedtime routine (bath, brush teeth, books in the rocking chair and then bed).

Now, we are having to actually get her into a sound sleep and when we finally get her to sleep, she experiences long spells of night waking – anywhere from one to four hours of screaming, crying, pleading with us to rock her, hold her, take her to our bed, stay in her room, rub her back, etc.

She’s not waking regularly at 10 p.m., 2 a.m. and 6 a.m., but rather wakes once and can not/will not go back to sleep. She repeatedly is crawling out of her crib. It is almost more than we can take to allow her to be in such a state.

A. At what time of night do these awakenings occur? Night terrors usually occur during the first few hours of sleep, while nightmares tend to occur in the last hours of sleep, in the early morning.

During night terrors, children are not really awake or conscious. They’ll suddenly sit bolt upright in bed and let out blood-curdling shrieks. Inconsolable, they often become more agitated when parents try to talk to them or comfort them. The best bet is to stay out of their way, if they are safe, and let them fall back to sleep on their own. They’ll have no memory for the event, since they never really were awake, even though it seems as if they are.

Nightmares, on the other hand, really are dreams, and children usually can remember them, and when they’re old enough to speak, talk about them.

Does your child really keep screaming for 4 hours even if you do hold her, stay with her, or bring her into your bed? It does sound as if she is conscious – not having night terrors – if she is pleading with you to stay with her and comfort her.

At 25 months, she is a little young to be having the kinds of nightmares that 3- and 4-year olds have when they begin to become aware of their own aggressive feelings and begin to scare themselves.

It sounds as if this has only been going on for about a week, but if it has persisted, we would suggest you consult with your pediatrician, who might refer you to a pediatric sleep expert.

Have there been any recent changes or stressors for your family? Her new resistance to going to bed, and her new demands for you to stay close during the night, raise the possibility that something has happened that has frightened her and makes her more hesitant to separate from you.

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.

THE CHALLENGES OF TOILET TRAINING

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NEW YORK TIMES COLUMN:  FAMILIES TODAY:
THE CHALLENGES OF TOILET TRAINING
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Our 2-year-9-month-old son was potty trained relatively easy during the day at 2 and 1/2 years old. However, he is still in a diaper at night. He wet his bed for several days in a row when we tried to put him in underwear at night, and now he awakes with a very wet diaper since we’ve switched him back into a diaper at night. How do we try to help him stay dry at night, or wake up to go to the bathroom at night?

A. He may not be ready – yet. Patience and time may be what he needs most for now. But the “very wet diaper” makes us wonder how much he is drinking in the evening before going to bed. As long as he is getting enough fluids during the day, you can cut back on fluids after supper. If he doesn’t mind, ask him to try urinating once at bedtime and then one extra time before going to bed. If he does mind, don’t bother – the struggle will do more harm than good. In my practice, I found that some children would stop wetting at night if their parents roused them at about 10 p.m. just enough to urinate before returning immediately back to bed.

The most important thing you can do right now, though, is to back off, avoid making a big deal of it (which includes holding off on any unwelcome “help”) and let him know that when he’s ready, he’ll manage just fine. (See our book, “Toilet Training: The Brazelton Way,” Da Capo Press, 2004, for more information.)

Q. My 5 and 1/2 year old daughter constantly forgets to wipe, wash, and flush. What advice do you have?

A. Is this a new problem, or is this something she’s never yet mastered? If this is a change in her behavior, we would wonder about what might have prompted it – for example, some physical condition such as a rash or infection that might make wiping painful, or some experience that has frightened her and led her to try to avoid this area as much as possible. In this case, we would encourage you to bring this up with your child’s pediatrician.

If this is the way it’s always been, and otherwise her development has been entirely typical, our guess would be that she will learn to master this – when she is ready and when this really begins to matter to her. In the meantime, if this is one small expression of her overall temperament – a little girl who is under a head of steam, often in a rush, only halfway through one activity and then she’s on to the next before – you’re likely to do better by accepting this and helping her to accept her own temperament. This will help her to know she can turn to you to understand herself and for help when she begins to be bothered by some of her own shortcomings and is ready to work on them. (If she has difficulty following through with a much wider range of tasks in a number of different settings, it might be worth looking into what might be distracting her. Your pediatrician could help.)

She’s already shown you that reminders won’t work. Do they feel like nagging to her? They’re bound to if she hasn’t asked for them. And she won’t until she is able to recognize and accept that she needs help, and that you can offer it to her without embarrassing her. Of course you don’t mean to. But she’ll be more comfortable with your help when she’s ready for it. You might try sitting down with her in a calm moment when this isn’t the immediate issue. Let her know that you know you’ve been bugging her with your reminders and that they haven’t helped. Ask her if she would like your help. If she says no, then let her know you’ll be ready to offer it when she’s ready to ask for it. Then, drop it. If she says yes, then ask her what kind of help would work better for her than your reminders.

Some parents may feel that this approach gives a child too much control – but in areas where no parent can control a child, the best a parent can do is to help a child discover her own motivation, and to harness that motivation for her to be in control of herself. Others might suggest a reward system – some little token for every flush. There’s probably not much harm in that, except that it could still easily become your issue, rather than hers – a setup for struggles that might just reinforce the problem.

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 HYPERACTIVE KINDERGARTNER CHALLENGES A TEACHER

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NEW YORK TIMES COLUMN:  FAMILIES TODAY:
A HYPERACTIVE KINDERGARTNER CHALLENGES A TEACHER
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I am an educator and I’m currently working with a kindergartner with what could best be described as extreme ADHD.

She is currently on Ritalin which has allowed her to increase her attention span. However, it seems the medication makes her moody, tired and melancholy.
Ritalin also seems to greatly alter her personality. She seems almost depressed when she is on the drug.

Are there any interventions that would be helpful in such a case? Her parents seem receptive to advice and would really love to help this little girl.

A. We certainly can’t offer diagnoses or treatment recommendations from such a distance, but can offer some general information in response to your observations, questions and concerns that will no doubt resonate with educators and parents across the country.

Because there still is no definitive objective test for diagnosing Attention Deficit Hyperactivity Disorder (ADHD), doctors making this diagnosis must rely on careful observation of children’s behavior in their offices as well as thorough reports from teachers and parents.

ADHD is probably over-diagnosed in some settings, and under-diagnosed in others, but either way, there is clearly room for error. There is good evidence that stimulant medication is an effective treatment for ADHD, but when it is not, it is important to go back to the drawing board to be sure that ADHD is the correct diagnosis, and whether or not it is the only one.

Many children are very, very active without tipping over into hyperactivity. This distinction can be difficult to make unless the hyperactivity is truly extreme.

In young children, there is a wide range in the ability to sit still and concentrate in the classroom setting, and indeed, we are asking more and more compliance with traditional academic demands at earlier and earlier ages, despite the fact that there is no reason to believe that children’s capacities to handle these have started developing at earlier ages. (In fact, there may be some conditions in our world today that make it harder for some children to attend and focus. For example, one study found a correlation between long hours of television watching in children under age 3 with symptoms of attention difficulties at age 7, although a cause and effect link could not be made by the researchers.)

Excessive physical activity, fidgeting and restlessness, trouble concentrating, being easily distracted and impulsive behavior all are symptoms of ADHD. Yet they also can be more general signs of distress in young children. Just as fever suggests an infection without telling us what the cause of the infection is, these behaviors in young children may signal a range of other conditions, including anxiety, a mood disorder or even post traumatic stress in a child who has been abused or traumatized in some other way.

Stimulants such as Ritalin (methylphenidate) can bring about clear improvements, noticeably increasing attention and concentration, and decreasing hyperactivity. Sometimes, though, a child does begin to appear down, or even depressed when taking these medications.

They can interfere with sleep, which might also be a cause for sleepiness and moodiness during the day. A switch to a different preparation (short or long-acting, for example) or kind of stimulant (dexedrine, for example, rather than methylphenidate) sometimes can help with either of these side effects, although there are some children who just won’t be able to tolerate these medications.

If the Ritalin is stopped and the melancholy moodiness continues, there may be another problem that needs careful assessment. If parents express concerns that line up with yours, they may accept your suggestion to turn to a child psychiatrist, if they haven’t done so already, to address these specific questions about possible side effects, other treatment options and diagnostic reassessment.

While there now are studies that show that medication alone can be more effective than cognitive-behavioral treatments alone for ADHD, there are also a number of other measures to try that may be helpful. In the classroom, a child who is easily distracted and has trouble attending should be seated close to the teacher, and positioned so that all of the other children wiggling and jiggling are out of her line of sight. This must be done without making her feel singled out or humiliated – self-esteem all too often suffers in children with ADHD. It is also helpful to give such children regular, gentle reminders to tune back in again: The teacher can work out a private signal with the child that helps the child to feel special and valued rather than to stand out as the “trouble” child.

Reminders and disciplines should be framed positively and with hope, since these children often need so many that they will soon tune out anything that sounds like nagging to protect themselves from feeling worse and worse about themselves. Special chores that allow them to work off steam, like getting up to sharpen the pencils, or pass out supplies, or to deliver the attendance list to the principal’s office can also help honor such children’s need for extra activity. These children often need frequent encouragement, praise and rewards, as it can be as hard for them to sustain their own motivation and keep themselves on track independently.

Careful and respectful back and forth sharing between parents and teachers can help create a more seamless experience of rewards and reminders for the child as she adapts each day to transitions between school and home. The long-term goal is for the child to understand and accept herself so that she can become increasingly independent in coping with and overcoming her challenges. For parents and teachers to help with this, they too will need to understand and accept.

For more information:
Children and Adults with Attention Deficit/Hyperactivity Disorder
The American Academy of Child and Adolescent Psychiatry’s website

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.

FAMILIES READY FOR CHANGE

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NEW YORK TIMES COLUMN:  FAMILIES TODAY:
FAMILIES READY FOR CHANGE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Things are so tough these days that most of us are ready to do our part to make our country strong again.

Everyone’s worried about the economy, health care, the environment, and safety in a dangerous world. With unemployment and the economic crisis in our homes and around the corner, we can’t hide adult fears and struggles from our children, but we can show them what we can do, what they can do to help.

THE ECONOMY: Our current problems are complicated, but we know that greed, selfishness, irresponsibility and wasteful self-indulgence have not helped.

Young children struggle with conflicting wishes to hoard all the goodies for themselves, and to share them with those they care about. We adults can model a different set of values and behaviors: being thankful for what we have and for being able to share it with those who have less; spending a little less now to save a little more; going along with what’s fair even if there’s no one to catch us if we don’t. Opportunities for learning these simple but important lessons occur every day and in family rituals:

Once a week, each family member can give something to someone who needs it more, by helping out an elderly neighbor, inviting a family going through unemployment over for dinner, volunteering in a shelter or soup kitchen, or putting a dime or quarter in a jar to save up for a cause the whole family cares about. (See donorschoose.org or habitat.org for ways your family can make a difference in your community, or around the country.)

Allowances: Even though money is tight, a regular allowance – no matter how small (a nickel a week gives the same message as a dollar) – can help children learn to make smart decisions about limited resources, and to save now and be glad they did later.

THE ENVIRONMENT: It’s bigger than all of us, and may seem too big to a child to be able to doing anything about. Yet there are small ways that each of us can help.

As a family, start saving up now for a tree to plant. Learn about the kind of trees that are best suited for your neighborhood, those that absorb the most excess carbon in the air while using the least amount of water. When it’s time, you can pick it out and plant it together.

Help your children remember that they can save water by turning off the faucet each time that they brush their teeth. (See charitywater.org for other ways you can help.)

HEALTH CARE: Our nation’s health care crisis is also too big for any of us to solve alone. But each of us can do our part by doing our best to stay healthy, the earlier the better. A healthy diet, plenty of exercise, simple safety precautions (like seat belts and bike helmets), and balancing out stress with family times to laugh and relax together can make a big difference.

Healthy nutrition can be simple:

  • Eat more vegetables.
  • Eat less processed food, fried food, fast food, and soft drinks.
  • Enjoy what you eat, and take the time to savor it slowly while enjoying being together as a family.
  • Keep the TV off at mealtimes.
  • No grazing between meals, no eating in cars or on your feet.

EXERCISE: Limit TV to an hour a day, and computer time to an hour a day (except for homework). Walk or bike whenever you can, or use public transportation. This can be your family’s contribution to saving our planet’s health too.

SAFETY PRECAUTIONS: See the safekids.org to help keep your children safe, and to protect yourselves, for their sake and yours.

Safety in a dangerous world is another challenge that may seem too big for children to tackle. But adults may have something to learn from them.

Recently, a preschool teacher asked each child at circle time what he or she had done for winter vacation, but skipped the child sitting closest to her. The children took this seriously, and reminded her not to leave anybody out. One child asked, “What about Remy? He’s sick today. We’ll have to ask him too.”

Very young children naturally work to include each other, to help children with special challenges find their roles, and belong.

Much violence comes from hatred passed across generations, and fear that scarce survival resources like food and water will not be fairly shared. What can parents and children do?

Look at a globe and pick out one country, one your children have never heard of. Go to the library or on the Internet to learn about its people. Is there some small way that you all can get to know them? Is there a school, hospital, or orphanage that you can get to know?

See if you can find a trustworthy organization that you can support to provide clean water, food, medical care, teachers. (You might want to check out Amigos de las Americas, Mil Milagros, Oxfam, Partners in Health, Peace is Loud, Save the Children, Unicef and others. We’re sure many of our readers are involved with terrific organizations that help other families here and abroad. We’d love to hear about them.)

Children can become pen pals, or send drawings when language is a barrier. They can help bring peace one friendship at a time.

All of these problems and solutions are interconnected. What each of us can do may seem small, but when we act together as a nation, we are powerful. We can model values that will endure through the bubbles and bursts. We can keep ourselves healthy and strong, saving health care resources for illness that can’t be prevented. We can protect our planet so that we can be sure to have enough energy, water, and food for all of us.

Times are tough, but we can teach our children to do their part for change.

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.

WHEN A PARENT IS CALLED TO WAR

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From the NEW YORK TIMES COLUMN: FAMILIES TODAY

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

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, 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.