MULTIVITAMINS AND A BABY

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

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

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

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

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

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

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

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

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

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

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

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

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

There is no way to make a child eat something against her will. Repeated struggles over food are likely to lead to more struggles and perhaps even more serious eating problems later.


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

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

Reprinted with permission from the authors.

A TODDLER WHO BITES HIS MOTHER

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

Q. My 22-month-old son is delightful and energetic. However, he tends to bite me. This behavior began around 17 months and shows no signs of abating.

He doesn’t bite when he’s angry or frustrated; it’s mostly when we’re playing or when he’s excited. I’ve firmly said, “No!” – complaining of a boo-boo (which elicits a kiss from him) – and I’ve ignored the behavior completely (when possible).

He doesn’t bite his father, grandmother, day-care provider or other children. Also, much to his father’s chagrin, my son has been increasingly focused on me: Mama must read stories, give baths and prepare sippy cups. Are these behaviors connected?

A. For children this age, a bite is just a step away from a kiss.

For babies and young toddlers, love means feeling you are a part of each other. At 22 months, his sense of the two of you as separate has begun to emerge, but the awareness is tenuous and likely to confuse him. Biting you is a way of connecting.The focus on you helps balance his new drive to do everything “all by myself.” He also is beginning to recognize that when he is alone he is without you, and that he must share you – with his father.

The biting sounds like a display of affection and a bid to keep your attention. Clearly he can control his impulsive behavior with everyone else.

You are doing the right thing by saying, “Stop.That hurts. Would you like it if I bit you?”

Be sure that your tone and your expression match your words. It is important to be clear with a child this age that he has hurt you or that you are angry. Your reaction helps teach him about emotions and how his actions affect other people.

A friend or a relative may recommend that you bite the child in return. Please don’t. A parental bite will surprise and stop him at the moment. But the turnabout undermines your role as a model of predictability and trust.

I used to keep a list of parents with toddlers so they could get the kids together to learn about each other. Then I realized that some toddlers were hair-pullers, some were eye-scratchers, and some were biters.

So I suggested that parents pair their toddler with another who was up to the same behavior. When you put two biters together, sooner or later one bites the other. The victim looks astonished: “Why did you do that? It hurts!” And if he bites back, the first biter will ask the same question. Then both will stop biting and never do it again. They’ve understood their actions’ consequences.

Biting is normal in small children who are just learning to control themselves. So don’t worry. He will outgrow the biting. Meanwhile comfort him and love him – but if he bites, say, “I don’t like that. You can show me in other ways how you love me, and I’ll love you back.”


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.

PARENTS, UNITE

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

When two parents are raising a child, and a disciplinary dilemma arises, one parent may need to call a “time-out” to consult the other in private.

What makes it so difficult to wait to lay down the law until a spouse can share the decision? Both parents feel passionately about their child. The passion sets up competition between them that I call “gatekeeping.”

As they compete for the child’s heart, they recognize that the parent who gives in will be rewarded with intimacy – in the short run.

But children need adults to agree on the rules and the consequences for breaking them. Sometimes one parent may respond to a child’s behavior by setting a limit, only to find later that the other parent disagrees. It is almost always best to support the initial response and to plan to talk later about how to handle the situation in future.

When one parent undermines the other’s authority, the child feels confused, even guilty, and unsure that parental discipline can protect her from her own impulses. At times, parents may need to sacrifice the fine points of their individual views on discipline for the sake of working more closely together.

In disciplining a child, parents may be surprised to find themselves confronting their own pasts. They face the challenge of reconciling their childhood experiences and their current ideas about discipline.

Children sense disagreements and test them. A child who knows that one parent will side with her against the other will continue to misbehave. Often the consequence that a parent chooses for misbehavior is less important than that both parents back the choice.

One parent is likely to become the disciplinarian. But if that role isn’t shared, children may see one parent as “good” and the other as “bad.” Children need to know they can count on both parents for limits. When discipline is not shared, parents may unwittingly set up expectations that the children then carry into their adult relationships.

Discipline is even more complicated as children progress through the stage of favoring one parent while rebuffing the other. The 4-year-old boy who, for the moment, is entranced with his mother will want nothing to do with his father. How much harder it is for this child to hear his father tell him: “I’m going to have to take away that toy since you haven’t put it away” – all the more motivation to disobey!His mother may try to “protect” him from his father’s protests and legitimate limits. “Give him another chance. He’s just a little boy.” Then the child may see the father’s discipline as unjustified and even frightening. The child needs both parents to let him know when discipline is appropriate.

WHEN MISBEHAVIOR HAPPENS

1. Stop the action – use a time-out or instruct the child to go to her room.
2. Take a deep breath.
3. Consult your spouse and coordinate your response.
4. Set up consequences for the child that relate closely to the misbehavior and that aim at your larger goals such as learning to control impulses, respecting the feelings of others and distinguishing right from wrong.
5. Let the child know you need to discuss her behavior with her when she’s calmed down.

ISSUES WHERE UNITY IS BEST

Chores
Allowance
Bedtime and bedtime ritual
Between-meal snacks
Hitting and fighting
Television (time and programming)

(This article is adapted from “Discipline: 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, 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.

SIBLING RIVALRY WHEN A FIRSTBORN MEETS THE NEW BABY

NEW YORK TIMES COLUMN: FAMILIES TODAY:
SIBLING RIVALRY
WHEN A FIRSTBORN MEETS THE NEW BABY
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

When you arrive home with your new baby, I’d suggest that you have a special toy ready to give to your older child – preferably a “baby” of his own that he can feed and diaper as you attend to the newborn.

If he’s more interested in trucks, give him one that he can fuel and wash. Thus he has the chance to imitate your nurturing and learn from it.

Don’t be afraid to set limits on how much he can handle the new baby. Limits will reassure him as his feelings about her come to the surface.

If he wants to hold her “like you do,” ask him to sit in a chair. You will need to stay right by his side. Then he can learn to put one hand under her neck and head to protect her. He can learn to cuddle her, to give her a water bottle. He can begin to learn how to help diaper her and to talk to her as he does so. He will be learning how to be a big brother – with you nearby.

If the older child soon loses interest in being a big brother, don’t be surprised and don’t make too much of it. Though he may at times be proud of his new role, it’ll be a burden for him, too.

He may want to be your baby again. He may fall back on behavior you’d thought he’d outgrown. Don’t expect too much of him right now.

Many children who are just discovering what it means to be an older sibling begin to be cruel to the dog or cat. Stop your child firmly and let him know that you can’t allow this behavior.

Help him with his feelings by letting him know that his anger is understandable, even though he can’t take it out on the pet. It won’t help if these feelings go underground. An older child is likely to feel that the new baby has displaced him because he was not “good enough” or even “bad.”

A 3- or 4-year-old can often recall mischief that angered you and made you, in his mind, want to replace him. He is bound to feel that if he could have been all that you wanted, you’d not have needed a new baby.

A child who is 6 or 7 or older may just ignore the baby – and you. He may even seem to disappear because he’s spending more time with friends or dawdling on his way home from school.

Instead of being your companion as you get to know the baby, he seems to want to avoid you – to punish you. Time alone with you – and your willingness to listen and to answer questions – will become all the more important.

HELPING A CHILD ADJUST TO A NEW BABY

If you have just returned from a stay in the hospital, tell the older child how much you missed him while you were away.

Let him know that the baby has been added to the family and is not a replacement: “Now you have a brand-new baby sister. But nobody could ever be just like you.”

Hold him close and remind him of experiences you’ve shared and will share again.

If he pushes you to discipline him, remember that limits can be especially significant for him now. To him, limits mean that his parents “haven’t changed, still love me, and will stop me when I need it.”

Don’t urge him to be “a good big brother.” This job won’t always seem appealing. It will mean more when he finds his own motivation to fill the role.

Guard against wanting him to grow up too fast. He will grow up, when he’s ready. And his younger sibling is already pushing him enough.

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


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

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

Reprinted with permission from the authors.

FAMILY MEALTIMES WITH MORE FUN, LESS FUSS

NEW YORK TIMES COLUMN: FAMILIES TODAY:
FAMILY MEALTIMES WITH MORE FUN, LESS FUSS
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

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

For parents and their young children, family mealtimes can be valued as opportunities for sharing each other’s ideas and company. Meals are times for children to experience their own autonomy while being together as a family. Meals need to be fun, not a struggle. Too many choices lead to conflict. A child can eat what the family eats, or not eat at all. Food can all too easily become a destructive struggle that becomes rewarding in itself; food then comes second.

Food can be used as barter for affection: “Eat that just for me”; as coercion: “If you don’t eat that, you won’t get any dessert”; as a reward: “If you clean your plate for Mommy, you can have an M&M.” Bartering clouds the point of meals.

Food and the atmosphere around it are intimately tied together. Parents can provide the food, but they can’t force a child to eat it. If a child is to value food and to look forward to it, it must be associated with her own motivation, appetite and pleasure. Valuing her ability to make her own decisions about what she will eat or not is the surest way out of the struggle. All too often, parents struggle over refusals over which they have no control. Yet parents don’t need to jump to make substitutions. Sticking to a few limited choices, combined with the choice not to eat what is offered, say to the child that “eating is important, but we aren’t going to struggle over it.”

Starting with less than what she may want reduces pressure. Feeding is one of the first activities to express both a parent’s caring and a child’s need for autonomy; feelings, then, are likely to be intense, and struggles difficult to avoid. Both parent and child are too invested.

A caring parent must feel a responsibility to keep the child well-fed and to provide a “balanced diet.” The child struggles between dependence (being fed) and independence (feeding oneself). The tension between dependence and independence will be a recurring theme during a child’s development.

To structure mealtimes so they aren’t too full of conflict for parents and child, here are a few suggestions:

  • No feeding between meals and regular times for snacks.
  • No eating in front of the television or computers.
  • Limit eating to the kitchen (this will cut down on time spent cleaning, too) except for special occasions.
  • Let the answering machine or voice mail get phone messages during meals; these are times for the family to be together without interruption. (No cell phones or hand held devices at the table except in emergencies.)
  • Let the child help with planning the meal (although she may still need to rebel).
  • Each child is given a smaller amount of each item than she may want; she can always ask for a second helping.
  • At 3, allow a child to eat with her fingers or a spoon, but be realistic about manners; she’ll model herself on your expectations later.
  • If a child has strong feelings about a few items, these can be eliminated, but make no substitutions, because they open the door to struggles.
  • Whether the child is eating or not does not need to be discussed.
  • No punitive approaches! “Of course you’re still hungry. You didn’t eat your beans.” She’ll figure out that connection without you.
  • At the end of a leisurely meal, all food is cleared away. No bargains.
  • Dessert is the conclusion of a satisfying meal, not a reward for “eating what Mommy wants us to eat.”

That’s the ideal. Too often, family mealtimes can be hectic, or missed altogether. Family mealtimes are even more important as opportunities for togetherness in the stressed lives of single parents and dual-career families. Routines such as breakfast and dinner with conversation that shares experiences can compensate for a great deal of separation. Busy working families need to do all they can to maintain shared mealtimes as a way of strengthening stretched ties.

I recommend that working parents aim, at the very least, for shared breakfasts, not least for their nutritional value! You might try some of these approaches to a healthy, happy family breakfast:

  • Set the alarm half an hour earlier.
  • Lay out clothes the night before for the preschool child so arguments the next morning will be minimal.
  • Because low blood sugar (hypoglycemia) in the morning can lead to crankiness, why not put a glass of juice by the child’s bed for her to drink before she gets up and starts moving? She’ll be readier for breakfast if her blood sugar is adequate.
  • Encourage conversation that makes room for each family member. Meals are a social event, a time for communication.
  • Keep breakfast offerings to a minimum. Use routines such as, “We always have cereal. You can have this one or that one.” “Here’s your toast and milk.” Extensive choices are sure to lead to struggles.

Whether a child eats or not may not be worth a battle; you can always send her to school with the toast, fruit or dry cereal in a bag, and a drink. Most learning occurs in the morning.

Family breakfast also is a chance to learn about one another – and to look forward to the day together and prepare for separations as a 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.

PEACEKEEPING BETWEEN BROTHERS

NEW YORK TIMES COLUMN: FAMILIES TODAY:
PEACEKEEPING BETWEEN BROTHERS
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q: I need a strategy for curbing sibling rivalry. How can I keep the school-age boy from playing too rough with his baby/toddler brother?

The refrain of “Stop X. Don’t Y. Keep your hands to yourself, etc.” doesn’t work and makes the older sibling feel like he’s always scolded while the baby “never gets in trouble.” How old should the little one be before I can let them duke it out themselves without my intervening so much?

A: Parents can’t quell sibling rivalry, but they can avoid making it worse. The firstborn child has parents to himself until the second comes along. Then he must give you up every time his sibling needs you. He must look on as you admire his baby brother, and he wonders when it will ever be his turn again or if you still admire him at all.

As soon as the younger brother is old enough to scoot and crawl, the older one will have to fend him off when he comes to snatch one of his toys or knock down the block tower he has worked hard to balance.

Moreover, the older one must please you when you beseech him to be a “good big brother,” which often means giving up his special place in the family as firstborn. From birth, the second child has never known another position. He is grateful for whatever parental attention he gets, and as the baby of the family, he’ll get plenty.But soon he starts wishing he could do all the things his brother can. He falls apart whenever he fails to imitate him. Parents rush to scoop him up and coddle him – to his older brother’s disgust.

Over time, if parents stay out of their struggles, the older child will learn to take pleasure in the younger one’s admiration, and enjoy his role in helping him learn.To avoid reinforcing sibling rivalry, the first step is to accept that it is not a parent’s job to keep siblings from fighting. If you try, you’re likely to intensify the conflict by putting yourself in mid-battle.

Every time you tell the older one, “No,” “Don’t,” “Stop,” he is likely to feel even more resentful of his younger brother. He knows you are mad at him. It’s easy to see how in his mind your temporary loss of affection for him is the little one’s fault – all the more reason to torture him again.

An infant must not be left with an older sibling unsupervised. But I’ve never seen one sibling seriously injure another when parents leave it to the children to sort out their differences on their own.

When the youngest can fend for himself, make it clear you expect them both to straighten things out themselves. Don’t bother trying to figure out “who started it.” Most of the time, you’ll never know, and engaging in this inquiry just heightens their competition to be your favorite.

Instead, let them know that you don’t care who’s to blame. Tell them that you hold them both responsible for stopping their squabbling. And if you can manage it, give each of them regular separate times just to play with you.

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


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

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

Reprinted with permission from the authors.

A SIMPLE TEST OF A BABY’S DEVELOPMENT

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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


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

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

Reprinted with permission from the authors.

A TODDLER WHO BANGS HIS HEAD

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

Q. My 21-month-old son head-butts. He has been doing this since about 13 months. He bangs his head on the wall or ceramic floor and doesn’t cry. When told no, he does it again. Sometimes he bangs his head so hard he bruises his forehead.

My pediatrician says this is normal. My mother thinks this is abnormal and he should be checked out.

A. Many children bang their heads in the second year when they begin to have temper tantrums or meltdowns. Some also rock themselves forcefully in their cribs or on the floor.

These actions seem to be a child’s way to handle uncomfortable feelings – frustration, disappointment, tension, anger, boredom. But of course such behavior frightens parents.

Even though toddlers bang their heads hard, I have never heard of one who hurt himself. As a precaution, though, I recommend putting carpet or other “shock absorbers” on concrete floors, cinder block walls and other unyielding surfaces – without making a big deal of it.

I don’t think that telling him no will help. If he could stop himself, he probably would. Struggling with him over the issue might give him another reason to bang his head: It not only helps him soothe himself but also gets your attention.

Look for opportunities to engage him before he bangs his head. When he is playing quietly by himself, you can help him learn how to prolong his play so he wards off boredom.

Try to protect this quiet time by avoiding interruptions and cutting down on distractions. When he starts to lose interest or to become bored or frustrated, you can move in briefly to help him with what he’s doing or to introduce a different activity.

When he’s ready for a break, cuddle him before he gets to the point of head-banging. Look for sources of tension that you can control and try to minimize them. If you or other family members are under stress, take a break and let off steam.

Help your son focus on his other ways of calming himself, and teach him new ones. Does he like to cuddle with and talk to a stuffed animal? Look at a storybook? Scribble with crayons? Listen to calming music? Or suck his thumb?

At the first warning signs for head-banging, offer an alternative like cuddling or singing with you. If all else fails, you can’t do much more than sit nearby and say soothingly, “I am here and I would like to help but I can’t.”

If a child is otherwise healthy and developing on track, he’s likely to outgrow head-banging. If the behavior persists, there may be a more serious problem. If a parent is concerned that a child’s development is not on pace, it is important to alert the pediatrician as soon as possible. Early intervention can make a big difference for developmental delays and disabilities.


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.