FamiliesToday

CRITICISM AND PRAISE

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

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

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

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

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

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

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

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

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

Teaching Self-Criticism and Self-Praise

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

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

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

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

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

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

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

Reprinted with permission from the authors.

AGE 4 AND THE DAWN OF CONSCIENCE

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
AGE 4 AND THE DAWN OF CONSCIENCE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

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

A 4-year-old knows that she matters. She no longer needs her earlier defiance. She can handle her feelings with less effort now, and can more easily make her needs known. Now that she is less focused on herself, she is curious about the world. She can only understand it, though, in terms of her own experience. But she can look more deeply now, and sustain her interest for longer.

More aware of others, the 4-year-old is watchful, almost on guard, as she monitors those around her for their reactions. At 4, a child is developing the ability to imagine the thoughts and feelings of others. She can begin to see, now, her ability to affect them: “If I hit her, she won’t want to play with me. If I take her toy, she’ll scream and Mommy will blame me.”

Now a child can judge the effects of her behavior with a better understanding of its consequences, a new sense of right and wrong. With this awareness comes the dawn of a conscience. Guilty feelings are new, too. They can be a powerful motivator.

A 4-year-old has also begun to be aware of her own feelings and to pay attention to them. She has more words to describe them. As she learns to name her feelings as they well up inside her, she has a chance to think about them, what they are telling her, why she is having them, and what she can do about them. This is the beginning of an important new ability that some psychologists have called “emotional intelligence.” It is also critical to learning to handle her aggressive urges.

Now that she is beginning to be aware of her aggressive feelings, and of their consequences, the 4-year-old may be frightened of herself. Her aggressive acts carry a new cost! As she tries them out, she is fearful. She knows she’s wrong, and she expects to be punished.

At night, when her defenses are down, when she is regressing to a helpless sleep state, fears and nightmares begin to surface. “Is that a witch under my bed? Is there a monster in the closet?” In her nightmares, they may be coming after her to punish her for her “bad” behavior. Or they may be aggressive in all the ways she’d like to be but knows she shouldn’t.

Fears that are near the surface — of being “bad” and hurtful, of deserving punishment — will be called up during the day by any frightening event, even a dog barking or an ambulance’s siren. Thunder and lightning terrify a child of this age. To her it sounds like an angry scolding from someone who sees and hears all the “bad” things she’s done. At night, fears like these overwhelm her. She is aware of her ability to hurt others. She is frightened of her own fantasies of being more powerful than she really is. At this age, losing control is more frightening than ever. Conscience and being aware of other’s feelings have made it seem more dangerous.

HELPING A CHILD WITH NIGHTMARES

  • During the day, look for monsters and witches under the bed and in the closet with your child. This is one way to show that you can take her worries seriously without reinforcing them.
  • At bedtime, read stories that help children understand nightmares, such as “There’s a Monster in My Closet.” You can also read stories about dreams – such as “In the Night Kitchen” – because they help children understand that dreams come from the worries and other feelings we store up during the day.
  • Show your child where the nightlight is. Shut off all the other lights and let her look around while you are still there.
  • Reassure her that you’ll be in your room while she’s in hers.
  • If she does wake up with a nightmare, go to her. Sit by her bed. Let her tell you about it. (My mother used to say that if you tell someone about your nightmare, it won’t come back. I think she was right.)

HELPING A CHILD WITH FEARS

  • Don’t put off facing a fear. Waiting will only make the child think that there really is something to worry about.
  • Make a list with your child of all the ways she’s learned to make herself feel better when she is scared: for example, holding your hand, talking together, trying to think of something different, or of times when facing the fear has helped. These are self-comforting strategies.
  • Then, make a list of all the things that are scary about the feared object or event, and rank them from most scary to the least: for example, “I hate when the dog barks, I hate just seeing the dog _ especially when she shows her teeth, I hate seeing her dog bone in the yard when she’s not there, I even hate just thinking about her.”
  • Now your child is ready to face her fear. She can think first about the least scary aspect of the feared object or event and then practice all her self-comforting strategies. Once she can calm herself while thinking about the least frightening part of the fear, she’s ready to move on to the next. Step by step, she’ll be able to conquer her fear.

(This article is adapted from “Mastering Anger & Aggression: 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.

BIRTH ORDER’S IMPACT

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

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

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

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

OLDEST CHILD

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

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

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

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

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

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

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

HELPING THE OLDEST CHILD HANDLE RESPONSIBILITY

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

MIDDLE CHILD

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

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

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

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

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

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

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

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

HELPING THE MIDDLE CHILD FEEL VALUED

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

THE LAST CHILD -THE “BABY”

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

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

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

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

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

HOW TO HELP THE YOUNGEST CHILD GROW UP

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

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

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

Reprinted with permission from the authors.

MENTAL ILLNESS AND ITS CONSEQUENCES FOR A FAMILY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reprinted with permission from the authors.

HOW CAN WE IMPROVE OUR KIDS’ NUTRITION

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reprinted with permission from the authors.

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Reprinted with permission from the authors.

SLEEPING SAFELY IN A CRIB

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
SLEEPING SAFELY IN A CRIB
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. With the new precautions for SIDS in the crib, how do I help my infant learn to comfort himself? We follow the current thinking to keep a crib uncluttered with pillows and blankets.

In your books you suggest a “lovey” or a blanket for transition time. My son hasn’t yet found such an attachment.

We’ve gotten him to sleep in his crib at night, but he resists bedtime and is inconsolable at nap time. Instead, I continue to lie next to him on our bed, which isn’t safe if I leave the room.

A. The Back to Sleep campaign, sponsored by the National Institute of Child Health and Human Development, nichd.nih.gov/sids, has reduced the incidence of SIDS (Sudden Infant Death Syndrome), also known as “crib death.”

We should all stick with the campaign. Back to Sleep recommends placing babies on their backs to sleep. But we are still learning about the impact of altering infants’ spontaneous sleep positions and of giving up traditional ways to help them stay asleep.

Many parents find that their infants have trouble settling into a restful state when placed on their backs to sleep. In this position, babies can’t easily curl up into the more familiar fetal position or get their hands to their mouths to suck and soothe. Swaddling can help babies settle down to sleep. Swaddling’s pressure may feel like the womb’s support.

We agree with you that infants must learn to console and comfort themselves. The ability to experience distress, and to overcome it, is developed early and lasts a lifetime. The ability starts with a parent or other caregiver’s soothing a baby, who gradually learns to imitate and then internalize it.

Infants discover how to comfort themselves – sucking a thumb or finger, or stroking their cheeks or a blanket’s soft satin border. You can introduce your baby to his thumb, or to a small stuffed animal or a piece of soft cloth – be sure that there’s no possibility it could obstruct his nose or mouth.

Hold the object close while you lie with your baby so he connects the comforting feeling of your skin, warmth, breath and heartbeat with something small and safe that may even take on your familiar smell. Try a soft piece of one of your own old shirts. Other ways to make a crib more welcoming: Record yourself singing your baby’s favorite lullaby and play it softly as he goes to sleep. Or try a CD of lullabies by others.

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 PARENTS DIVORCE

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NEW YORK TIMES COLUMN:  FAMILIES TODAY:
WHEN PARENTS DIVORCE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

From TOUCHPOINTS: BIRTH TO THREE: YOUR CHILD’S EMOTIONAL AND BEHAVIORAL DEVELOPMENT, by T. Berry Brazelton, M.D., and Joshua D. Sparrow, M.D., published by Da Capo Press, a member of The Perseus Books Group.

Parents whose marriages seem to be failing have a major obligation to protect their children as much as they can, whether this means trying to work things out or deciding to divorce. This is a lot to ask of parents who are already overwhelmed with their own feelings.

In the aftermath of divorce, it is very hard for parents who may not only be angry, but also frightened, anxious and grieving the loss of their relationship, to focus on the needs of their children.

But there is no other choice. In the first years after a divorce, a child blames himself for his parents’ breakup and dreams of having his two parents to himself again, even though the original family may have been stressed and stressful. While everyone in the family suffers during a divorce, and during the first year or so that follows, the long-term effects of divorce vary depending on a wide range of protective and risk factors, including how parents handle the divorce and how well they recover from its immediate effects to become effective parents again. Over time, it turns out, many other individual characteristics of the child and parents, as well as life events, play a bigger role than a past divorce in a child’s well-being and healthy development.

As a result, there is no need to label the children of divorce with a self-fulfilling prophecy or to burden their parents with more guilt and anxiety than they may already feel.

The most serious harm to children is done by placing them in the middle of parents’ animosity – using them as a football. Angry parents all too readily take out their feelings on each other by using the child. That is sure to hurt the child. Her capacity to make solid relationships with other adults in the future is likely to be impaired by this insensitivity on the part of divorcing parents.

At first, children may continue to wish for the “old family.” They will feel deserted by the nonresident parent and will fear desertion by the resident parent, reasoning, “If one can leave me, why won’t the other?” Short-term separations become magnified in the child’s mind. Every time a parent leaves, the child must wonder, “Will she be gone for good? Will she remember to come back? Who will take care of me?” Or she may wonder, “Why does he leave me? Am I bad, and no one will want me?”

Before every separation, parents must prepare a child as carefully as possible. After they return, they must say, “I missed you. Did you miss me? Remember I told you I’d be back at (such and such a time), and here I am. You worry, don’t you?” Then, the parent needs to be ready for the child’s feelings about being deserted. Every time the child has a chance to air them, the adult has a chance to demonstrate that desertion is not in the nature of all relationships.

The nonresident parent has a parallel responsibility. Visitation should be clear, dependable and on time. Even a 15-minute wait is an eternity for a small child. Visits from the absent parent offer reassurance about what he fears most – desertion.

A child takes everything personally. No matter how often she is told that a separation or a divorce is not her fault, she will continue to blame herself.

A child will fear that the reason the absent parent has gone is because he or she doesn’t love her, because she’s been “bad.” Later, children dare to put their fears into words: “I knew if I’d been a better kid, they’d never have split up.”

Small children are less able to express it, but they also feel responsible for the split. Both parents must be ready to reiterate over and over and over: “We love you and we never wanted to leave you. We grown-ups couldn’t live together, but we both want to be with you. Nothing you do could ever change that for us.”

A divorced parent must remember that demonstrating any animosity to the ex-spouse in the child’s presence will frighten her. She will take it personally. “If Dad and Mom can fight with each other, they can hate me, too. I must be a perfect child, or I’ll be in for it.”

Parents can help reassure a child that she needn’t try to be perfect. She may need constant reassurance about this, for she is likely to regress with the trauma of the divorce.

Most children regress in the area of the last achievement. If she has just become dry at night, she may begin to wet all over again. If she has been talking well before, she may begin to stutter. Her behavior may be either too good or too provocative. A sensitive parent will accept this and discuss it with the child so that she, too, understands it as normal and expectable. The usual limits should apply, however, and are more important than ever. Limits reassure the child that someone is still in control.

The presence of a sibling can lessen the fear of separation. Sibling relationships can become closer than they were before. Although rivalry will still surface, taking it too seriously can make relationships in the split-up family seem more fragile than they really are.

Grandparents, aunts, uncles and cousins can become important supports for children during and after a divorce. Not only can they give the child help in understanding the split-up, but they also fill her need for reliable, caring people who remain constant in her life.

Resident parents need to reconcile their own feelings about their in-laws in order to respect the child’s need for family. During a divorce, grandparents are likely to “spoil” the children in the family. They may let down all discipline. The resident parent may feel threatened by the lack of rules at Grandma’s. The child will use this: “Grandma gives me what I want. You’re mean and you don’t realize what I’m going through.”

Since you are feeling pretty raw and deprived yourself, this criticism hits below the belt. You bristle. If these are your in-laws, you will feel even angrier at this undermining of your household rules.

If you can, discuss this with your in-laws. Ask them to back you up in your effort to support the child with firm rules and discipline. If relations are too tense for such discussions, simply tell the child, “Grandma does things her way at her house, we do them our way here.” Respectful discipline becomes a source of security.

Try not to overprotect the child. Let her make her own adjustment, and from time to time, point out how well she is doing. When a child can master the stress and change, she can take pride in this demonstration of her competence. Your continued love, respect and discipline can be shown without hovering.

AFTER THE DIVORCE, IF YOU BEGIN DATING

  • If you begin dating, be careful about introducing new people of the opposite sex to your children. Wait until you are pretty sure the child can rely on the relationship. A child of divorce will make new relationships with adults of the same gender as the missing parent all too easily, and she will be deeply disappointed if it doesn’t work.
  • When you do form a lasting relationship, point out that “friends” and stepparents are different from parents, but having two of each can be great.
  • Talk about the child’s fears of your desertion of her. Tell her that you aren’t going to leave her under any circumstance.
  • Find BOOKS about divorced families, or introduce your child to other children whose parents have gone through a divorce. These days, children of divorce are not a small minority, but it still helps a child going through one to know other children who are adjusting to divorce.

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.