FamiliesToday

WHEN A CHILD LACKS DEXTERITY

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

Q. My 4-year-old son is within the chart for normal growth and development. He speaks well for his age and is fine at preschool.

But I have this nagging observation about his lack of dexterity and confidence in motor skills such as broad jumping, catching a ball or climbing. He sometimes still holds the pen with the wrong grip and finds it challenging to tear a piece of paper along a straight line.

His 20-month-old brother has shown dexterity and motor skills ahead of his age.

A. A child’s feelings can be a first tipoff to a delay. Is your son frustrated by a lack of dexterity, or does he avoid physical activities? Frustration or lack of confidence may hamper the child more than the delay itself. Comparison with a sibling is hard, too. Even the impact of a minor delay on a child’s self-esteem can be aggravated by the growing pressure on children to perform in ways that, until recently, weren’t expected so young.

You might start by talking to your pediatrician, who can check for illness and help to sort out whether it’s an issue of muscle strength, tone or coordination.

If needed, the pediatrician can refer your son to an occupational therapist for assessment. Often a minor delay shows no root cause, but treatment and time for developmental catch-up can make a big difference.

Specific exercises and activities to solve the issue can be similar to play, making a child want to join wholeheartedly. If the treatment is made to seem like it’s for a problem, a child could resist help.

Often parents, and even professionals, forget to talk with young children about the reasons for tests and treatments. Talking about problems and solutions helps children to feel less alone and afraid, and more hopeful.

The discussion can focus on issues that bother a child: “You know how sometimes you get mad at yourself when you can’t jump as far as some of the other kids?” Or a parent might ask, “What are the things you can do that you are really proud of?” Then: “What would you like to improve?”

Some children may not be able to answer, but if they’ve already noticed their delay, it’s reassuring to know you want to help.

Once a challenge has been acknowledged, put it in perspective: “It’s not a big problem, but it bothers you – and that’s a good reason to work on it, especially since it can improve.”

Progress comes when children are motivated. They may have their own reasons to hold back, such as feeling self-conscious or fearing that other children will know what’s up (though they needn’t).

Or a child may feel so badly about the delay he denies it altogether. Such a child may accept help if he is offered chances to succeed in other areas, and recognized for his strengths.

When he agrees to treatment, let the successes be his. Someday he’ll understand that even if he remains less dexterous, he deserves far more recognition for the courage to face his challenges and the tenacity to overcome them.

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.

 

ENCOURAGING OUR CHILDREN TO EAT HEALTHY

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
ENCOURAGING OUR CHILDREN TO EAT HEALTHY
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I’m saddened by the increase in childhood obesity. But I find it difficult to be the parent of a thin, healthy child bombarded with low-fat advertising. Is it right to limit fats and other caloric nutrients in healthy children?

A. The U.S. childhood obesity rate is staggering, with all the associated risks for diabetes, heart disease, cancer and other health problems.

Often we blame the victims. It is assumed that people who are obese just need to change their behavior – which they would if only they had the right information about food.

But many studies have shown that information alone can’t affect some of the factors that influence what we eat. For example, childhood obesity disproportionately hits people living in poverty, and hits them harder.

The food industry skillfully produces unhealthy, filling “foods” that cost much less than healthy kinds. Fresh produce is much more expensive, calorie for calorie, than junk food.

Information can’t change the fundamental inequality of access to healthy foods that is driving our obesity epidemic. A generation is at risk, and part of the cost will be a new spiral of health care expenses.

Nutrient labels only go so far. Science is still debating how much protein, fat and carbohydrates are needed, and what balance is healthy.

Not all fats are bad and some are critical to health. For example, the fat in whole milk is needed in the first years of life for brain development.

We share your concern about overemphasis on nutritional constituents and their potential for distorting healthy eating habits – ours and our children’s. Many of us have been victimized by the flip-flopping fads of high-carb/low-fat and low-carb/high-fat diets.

Healthy eating isn’t simply this much protein or that much fat. We need to research what kinds of protein and fat and carbohydrates, in what proportions, eaten at what times of day, in combination with what other foods, and perhaps even in what order.

How do these factors interact for good health?

We may even learn that physical activities and their timing – such as preparing food before eating it, or relaxing and chatting after meals – play a role in how our bodies make use of what we eat. Here are a few things to rely on:

First, stick to what nature offers us, like more leafy vegetables than fatty animals. Trust traditional ethnic diets. Refined over the generations, they generally produce healthier outcomes than the diets put together by the food industry in our time. Also, in many traditional cultures, eating takes place only at meals (rather than “grazing” throughout the day) and is a relaxed social event that makes less food and healthier food seem more satisfying.

Give up the sweet, fat and salty excesses of junk food. Be guided by your taste buds and your own sensations of hunger, fullness and satisfaction. Heeding these important signals helps us respond healthily.

We need to start children on this path from the very beginning of life.

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

Dr. Brazelton, 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 BACKTRACKS ON TOILET TRAINING

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

Q. Our 3-and-1/2-year-old girl finally used the toilet for pooping, after several months of comfortably urinating by herself.

It happened after a weekend away with a 4-year-old who she watched, and was evidently encouraged to try it at home. She pooped again the next day. We showed her a lot of praise and joy at her accomplishment.

She had previously showed little interest in giving up her diapers to go poop, and admitted she was scared of making a poop in the toilet.

Then she stopped, and we are back where we were. She runs and gets her own diaper when it’s time. Sometimes she will “try,” which means sitting on the toilet for a few minutes, then getting up to find a diaper.

She has said things like, “I really like making poo in the potty!” and “Maybe later I will make poo in the potty,” but never really pushes herself to do it again.

We are just a little confused that she started, then stopped. We don’t want to push her, but we do feel like she likes the ease of grabbing a diaper, going, then having dad and mom quickly take it off and clean her up. We (and she) know she is capable, but she has a routine which works for her and she obviously doesn’t feel like pushing herself.

Should we nudge her along? Go “cold turkey” with all diapers gone from the house? Not say a thing about it?

A. No wonder you are confused. Your daughter does demonstrate many of the signs of readiness.

She can feel her readiness to “poo” coming on, she can tell you, and can hold on long enough to get herself to where she needs to go, or get herself a diaper. She even showed you that she could “poo” in the toilet.

But she isn’t fully ready, since she hasn’t mastered her fears, and perhaps doesn’t fully feel that this achievement is her own.

Perhaps all the praise when she imitated her 4-year-old friend was a little too much – too much excitement, and perhaps too much of your sense of victory interfering with her sense that this was her own.

Do you know what she is afraid of? Some children are afraid of the noise that a flushing toilet makes. Or that they’ll fall in. And many are quite troubled by the fact that once their b.m.’s are flushed down the toilet they disappear for ever. What happens to them? Where do they go? Where does she think they go? These are important questions for young children since they think of their b.m.’s as a part of their own bodies, as a precious product of themselves.

Pushing her isn’t likely to help. She seems quite motivated to imitate and be like older children and is bound to tire of diapers, which distinguish her from them.

Once a child who is developing healthily in all respects has had a chance to fully explore her questions, conquer her fears and feel that pooping in the toilet is her own achievement, rather than one that has been taken away from her, she’ll be fully ready to show herself that she can be successful.

Should she give up her diaper? I wouldn’t recommend it. Instead, tell her that it is up to her to decide when and where she will use it. You will be ready to help her when she asks for it. Let her know that you know that when she’s ready to “poo” in the toilet, she will, and that there’s no need for her to reassure you about “later” or “really liking it.”

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.

INTERPRETING A NEWBORN’S CRIES

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
INTERPRETING A NEWBORN’S CRIES
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I am the grandfather of a 4-week-old girl, the first child of our daughter and her husband. How accurately can a newborn’s cries be interpreted?

A. Like all families, you wonder what your new addition is “saying.” Mothers, fathers and grandparents jockey over interpreting the new baby:. Does she want to be held? Or has she been held too much? Is she hungry or wet or weary? And who knows best?

Scientists have analyzed infants’ cries by pitch, tone, volume and rhythm. Infants indeed make cries that correlate to hunger, fatigue, discomfort, pain, a bid for interaction – or to letting off steam at the end of the day.

Feed a baby crying in one way, and she will guzzle appreciatively. A baby crying in another way will just turn her head and keep crying.

Parents may interpret their baby’s cries too narrowly. For example, they may think she is asking to be fed with each cry. Overfeeding, though, may confuse a baby into believing that feeding helps with other discomforts, like boredom or loneliness. Parents need a few weeks to learn to distinguish their baby’s cries. They may not be right each time, but they can narrow the possibilities.

A baby whose cry says “pick me up and love me” will quiet simply by being held. If she keeps crying, she may be asking for something else – to have a diaper changed, or to be swaddled more firmly for sleep.

As parents ponder a baby’s cries, she too is learning to distinguish different sensations, and to soothe herself when distressed. These will become skills of great importance.

If a baby is crying, it’s best for parents to go to her – but usually they needn’t rush to resolve the issue in seconds. Unless the baby is ill, in danger, or too fragile to tolerate her distress – as can happen for pre-term infants – you have time to prepare a feeding, check a diaper, cuddle and coo together, or help the baby soothe herself with a thumb to suck or a piece of soft cloth to touch.

Parents respond more sensitively to a baby’s cries as they learn more about her. Some babies are clearer than others in their communications.

Ultimately, all parents learn by trial and error, encouraged by family members and other parental cheerleaders who help them to feel OK about not always getting it right the first time.

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.

PREPARING THE FAMILY FOR THE NEXT BABY

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
PREPARING THE FAMILY FOR THE NEXT BABY
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.)

Facing a second pregnancy is both thrilling and daunting. Parents will ask themselves: “What will this do to my older child? Can I manage with two? How could I ever love another child as much?”

When sibling rivalry arises, parents are bound to feel responsible, and guilty.

Later, they will find they need not divide their love, for they will love each child differently. But before the new baby arrives to help parents make this discovery, they may feel they must try not to grow attached to the new one, but instead must focus even more on the one they already have.

The fear of “deserting” the older child is inevitable. All parents wish they could eliminate the older child’s negative reactions to the new baby. This parental pressure makes the older child feel unacceptable as he is, and wonder if he really deserves to be replaced. Of course he knows that he both does and doesn’t want a new sibling.

Although these feelings are most prominent with the second pregnancy, they are likely to be present with any subsequent pregnancy. It can be a challenge to see each new baby as a “gift” to the family.

But parents needn’t feel that it is their role to protect their children from all the feelings – anger, jealousy and others – that they will experience with a new baby. Adjusting to a new sibling is a child’s opportunity to learn about these feelings and how to handle them. And parents can help.

When Do I Tell My First Child?

You never don’t tell him. As soon as you know a new baby is on the way, it can be discussed in the family openly. Your discussion is not so much an announcement as an acceptance of the baby as a future step for the whole family. But try not to overdo the information.

One couple told me that they had discussed the baby-to-be so much and so often that the older child was sick of it by the seventh month. He was tired of being prepared for so long.

Talking about the new baby coming into the family in an accepting way is different from excitedly preparing the older child for a major event. Parents can make it clear the family will “all deal with it together” without dramatizing that “everything will be different and you will have a big adjustment to make.”

Why Shouldn’t We Wait Until He Knows I’m Pregnant?

He may know almost as soon as you do.

Even a young child will notice. Leslie was 2 1/2 and and came to my office for a checkup. He was a handsome curly headed, dark-skinned toddler – the adored child of his lovely parents.

Every time he leaned over in my office, every time he’d lower himself to the floor, he’d let out a soft grunt. I thought that he might be hiding a bellyache or some problem in his joints. I felt his stomach more carefully. No tenderness. I examined his hips and legs. No problem. I watched him walk. Absolutely perfect, even graceful. I kept observing him. Each grunting sound made me more alert and more anxious. No physical signs.

Finally, out of the blue, I questioned his mother: “Are you pregnant?”

“No,” she assured me. A few days later, she called me to say, “I am pregnant. But I’m only eight weeks along. How did you know before I did?”

I was quick to answer: “I didn’t, really. But Leslie did.”

The job for parents is to give a name to the change the child senses, and gradually to make it seem real to the child. You might tell him, “You and Mommy and Daddy are going to have a baby. You can help us with the baby. You’ll be a big brother.”

Then, listen. Don’t keep telling him about the new baby. Wait for his questions. They’ll come.

When he passes a baby carriage, watch his eyes and his behavior change. He may say, “Can I help push the carriage?”

“Of course. You can be my best helper.”

He is already learning about giving. You are helping him discover its rewards. This is, of course, one of the most important lessons a sibling can ever learn.

How Will My Toddler React?

Everyone is talking about the changes that will occur. Of course, an older sibling has his questions: “When?” “Why?” (Aren’t I good enough?) “Will he be like me? Who will take care of me?”

All these questions deserve answers. As you answer, you’ll demonstrate your caring, and help your child “become a big brother.”

What you say may not matter as much as your being available. Your responsiveness is most important. This is a good time for each parent to start planning a regular “date” with the older child. Talk about it all week: “You and I will have our time together later this week. You can ask me all your questions and we can be together by ourselves. You are my big boy now and you’ll always be my first love.”

Labor and Delivery and the Older Child

As the delivery approaches, talk about going to the hospital to help the baby come “out.” Let your child know exactly who will stay with him at home, and who will take him to visit his mother and the new baby at the hospital.

It is a wonderful time for a father or a grandparent to point out that he or she will be there for the older child. One of the most rewarding experiences for me as a father was the opportunity to be completely available for my older daughters – and to have them all to myself!

Toward the end, be ready for the older child to build up excitement, as does the rest of the family. Tantrums, whining, sleep setbacks, food refusal and bedwetting can all be expected. These will arise from his confusion about all the intense anticipation as well as from his awareness of your heightened vulnerability.

The more he does now to share his distress, the easier it may be for him later.

When labor begins, and you must leave for the hospital, be sure to say goodbye. Tell him again that you’re going to the hospital for a few days. Remind him that he can call you, and come to visit. Reassure him again about who will be with him.

Tell him when you expect to come home. Show him on the calendar. All this preparation leaves him with a known structure and expectation. This can protect him from his deepest fear – that she’s “gone off to have the baby” and leave him. This fear is predictable for a young child, but parents can help allay it.

Reclaiming the Crib, and the ‘Big Boy’s Bed’

When parents are expecting a second child, they are often tempted to reclaim the first child’s crib to ready it for the new baby. Don’t.

If the older child is still in the crib during the pregnancy, don’t make him move unless you absolutely have to (for example, if he weighs too much for the crib, or is climbing out and at risk of being hurt). He’s already feeling displaced, and he will only feel more so once the baby is here.

Instead, you’ll have to get another crib for the baby and then wait until the older child really feels proud of being “a big brother.”

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.

CONCERN ABOUT LOW BIRTH WEIGHT

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NEW YORK TIMES COLUMN: FAMILIES TODAY:
CONCERN ABOUT LOW BIRTH WEIGHT
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Please help. I am trying to find information on the causes of my grandchild’s low birth weight. She was full term and weighed 4 pounds 7 ounces. I am concerned about the consequences for her growth and development.

Should my daughter be concerned about the outcome of future pregnancies?

A. There are many causes for low birth weight. Some may predict future pregnancies resulting in low birth weight babies, or at least suggest some increased risk for more small babies, while others may be more likely to be once-only occurrences.

Among the possible causes: cigarette smoking during pregnancy, elevated blood pressure, problems with the placenta (which brings nutrition to the fetus’ blood stream from the mother’s), and inadequate maternal weight gain during pregnancy.

The impact of a mother’s health on her pregnancy and her baby’s future is one reason why prenatal care is so important. High blood pressure can develop for the first time during pregnancy in women with no prior history of it, and can be effectively treated, so blood pressure monitoring is a cornerstone of prenatal care.

But since some health issues are evident before a pregnancy and will take more than nine months to address, access to health care for all women of childbearing age is critical for healthy pregnancies and healthy babies.

It will also save a bundle in health care and educational expenses that many premature and very low birth weight babies will need. Six billion dollars per year of our health care costs are spent on neonatal intensive care for premature infants, to say nothing of the costs for special education and other services that premature infants are more likely to need later on. A health care system that fails to care for all women of childbearing age will cost us all more in the long run.

Significant stress during pregnancy has been found to be associated with premature births, and may also be associated with low birth weight in full-term babies since stress in the expectant mother can increase her stress hormones, which in turn can constrict the uterine artery which supplies nutrients through the placenta to the fetus.

A recent study found that mothers who took time off during the last three months of pregnancy were less likely to have premature babies. With only three months of unpaid maternity leave, few working expectant mothers can afford this luxury. Paid maternity leave during the last trimester could reduce the risks – and the costs – of prematurity and low birth weight.

Your daughter’s obstetrician may be able to tell her whether there was any evidence of problems with the placenta or other troubles during this pregnancy, and whether they are of the sort that might be more likely to occur again.

The pediatrician may also be able to help out here. A baby’s length in proportion to her weight may indicate whether low weight is more likely a result of a placental problem late in pregnancy or, instead, whether genetic or other less common causes are involved.

A long, skinny baby (normal length, low weight) is more likely to be the result of a problem with the placenta late in pregnancy: Often they look wizened and worried, and may be irritable and more difficult to soothe. A very “small all over” baby (low weight and length) may have experienced a problem earlier in the pregnancy, for example an infection, or again a problem with the placenta beginning earlier on.

Genetics may also play a role – especially in a baby whose height and weight are low – as a cause for a disorder in the child of which low birth weight is only one feature. In this case there would be other, more specific signs of such a disorder as well. Your daughter can ask the baby’s pediatrician if the low birth weight is a standalone issue or part of a larger syndrome.

As for these and other possible causes of concern for a low birth weight baby’s growth and development, we would hate to see you and your daughter worry about all the possibilities and would instead urge you to ask the pediatrician to review the pregnancy with the obstetrician, and then to watch carefully over her growth and development with you.

If your daughter’s pregnancy was entirely normal and your grandchild is entirely healthy, then chances are good that her growth and development will proceed normally too. But urge the pediatrician to follow closely. Let him or her know that if the baby does need help catching up, you all are ready to get going, the sooner the better.

You may be concerned about the “fetal programming” hypothesis put forward by David Barker which states that conditions during pregnancy can have lifelong effects for the fetus’ future health, and correlates low birth weight due to malnutrition during pregnancy with future health problems. However, it is important to remember that research like Barker’s examines statistical probabilities for very large population samples, and can’t really tell you much about your grandchild. These large studies that predict the chance of one outcome or another in large groups of people can’t tell us which way the coin will flip for any single individual.

Fortunately, you are there to vigilantly watch over this baby’s growth and development, and to help your daughter respond if the pediatrician finds any cause for concern.

Development is such a powerful force, especially in the first years of life. The human brain never again grows and changes as dramatically as it does in infants. In this period it is remarkably adaptive, developing new circuits and pathways to bypass and overcome specific areas that are not able to keep up.

Early intervention – before a child turns 3 years of age – provided by specially trained professionals (speech and language therapists, occupational therapists and physical therapists, for example) can help make the most of the astounding capacity of the very young human brain to recover and grow.

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.