A 3-YEAR-OLD’S DISTRACTION ON THE POTTY

NEW YORK TIMES COLUMN: FAMILIES TODAY:
A 3-YEAR-OLD’S DISTRACTION ON THE POTTY
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I have a 3-year-old grandson who is pretty much potty trained. The problem is he likes to sit on the potty and play with his penis. When I tell him he should finish his business he tells me he is not finished. I have to distract him to get him off the potty. Will he outgrow this or what?

A. Children this age who are just getting out of diapers are always fascinated to discover what’s been hidden underneath them. Already their genitals are sensitive and physically responsive, and the fact that these have been so inaccessible heightens toddlers’ interest.

At these ages children are scientists and explorers, working hard to conquer the exciting new worlds opening up to them. So it is both common and natural to turn their curious investigations to their own bodies as well.

Three-year-olds are bound to inspect themselves with their eyes and hands as they work to understand themselves and how they’re put together. They’ll also be using their eyes to look with astonishment at parents’ and siblings’ private parts as they struggle to understand differences and figure out whether their own bodies are OK just they way they are.

When boys discover that girls don’t have penises they often think that they must have fallen off and worry that theirs will do the same!

Rarely, a child will become preoccupied with the sensations provoked by this kind of self-exploration so much that this begins to take over and drain the child’s energy and interest for other activities.

When a young child’s masturbation takes on a compulsive quality, persists even with efforts to distract and engage in other activities that ought to be appealing, and goes on for long enough most days to significantly cut into a child’s time from engaging in play and interactions with friends and family, there is cause for concern.

This may occur when a child has been sexually molested, although it sometimes arises in the absence of this kind of trauma. Sexual molestation often produces other changes in a child’s behavior too.

For example, the child may engage in more adult-like sexual behaviors rather than simply just touching his genitals. He may become irritable and angry, or frightened and withdrawn, and he may appear fearful whenever he undresses, use the toilet, or takes a bath, or must separate from a trusted caregiver.

Other causes for persistent, compulsive masturbation remain unclear, although some researchers have suggested that for some children this may be an attempt to make up for a lack of other kinds of stimulation (play, social interaction) or a lack of normal physical stimulation – hugging and cuddling, or for some abnormality in the way touch sensations are experienced and processed. Sometimes referred to as “infantile gratification disorder,” this remains a controversial and poorly understood area of child behavior.

As is often the case, the answer to the question about how much to worry about one behavior in a young child can be found by looking closely at whether other behaviors are thrown off. The child’s pediatrician should be able to help his parents sort through this kind of information.

A 3-year-old is just beginning to learn about other people, what they think, how they react, and the social conventions and expectations that must guide his behavior. Children who touch their genitalia in public can be gently told that their private parts are private. Usually their motivation to please, fit in and win over the important people in their world is even more powerful than the gratification of fondling their own genitals.

Any strong reaction or attempt to change this behavior runs the risk of setting it up as a more deeply engrained habit that is more likely to take on a life of its own. As long as the genital touching is restricted to a private place like the bathroom, the best approach is to try to relax, let it be, and trust that this, and the bowel movements, will eventually pass.

There’s no need to stop the touching or to comment on it. You could try distracting him with conversation or with a book to read or something else to fiddle with while sitting on the potty, but only because this might interfere less with focusing on moving his bowels.

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.

BATH TIME FEARS AND TEARS FOR A 3-YEAR-OLD

NEW YORK TIMES COLUMN: FAMILIES TODAY:
BATH TIME FEARS AND TEARS FOR A 3-YEAR-OLD
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Our answer to a letter about bath time fears and tears has stirred up sympathy, salutary suggestions, and speculation in readers across the country.

Q. The 3-year-old who fears baths and showers might be willing to sit in a baby bath tub and get clean or to sit in a sink. Also, he might like to have a small inflatable swimming pool brought into the house or if the family lives in a warm climate have a bath outside in the small swimming pool.

Is the child afraid of taking off his clothes? Children are so exposed to mass media today it is almost impossible to isolate the source of fear but I find that asking a child to tell you what should be changed for him/her to like doing something sometimes works.

A. What great suggestions!

If the child slipped or swallowed water or had a traumatic shampoo in the “big” bath tub, simply switching bathing to another location might help. And a smaller place to bathe like the baby bathtub, sink or blow-up pool you suggest might also be less overwhelming to a small child to whom a “grown-up” tub might seem like a vast and gaping ocean.

Introducing water and the bath slowly, in small amounts, and on the child’s terms all make sense. Best of all, we like your idea of including the child in figuring out the solution and giving him some control. This way he might be more likely to tell you what the fear is all about, including whether it all started with some scary TV show.

We wondered what kind of media exposure you thought might prompt a child to fear taking his clothes off. When children are exposed to overstimulating adult sexual behavior, they are more likely to imitate it and act it out. When children are exposed to violence that makes them worry about the safety of their own bodies, they may spend more time inspecting themselves to be sure “everything is still there.” We certainly have seen children who have been sexually abused fear taking their clothes off. They do seem to see their clothes as a kind of protection, and staying dressed as a way of fending off unwanted memories of the trauma. (Often, though, other changes in behavior and mood are present too.)

Perhaps some of our readers have seen similar behavior in children who have been traumatized by media exposure without having actually been sexually abused.

Q. I read with interest your possible explanations for why a child would suddenly develop a fear of bathing. All of your possible reasons were valid. However, may I suggest a more ominous one?

Often children who have been sexually molested develop fears of being vulnerable as one is in the bathtub. Perhaps this child should be gently questioned regarding if anyone has frightened him in any way of was he touched by someone who made him feel uncomfortable.

Hope you find the cause of the problem and hopefully it is not as serious as I suggest.

A. We couldn’t agree with you more that this possibility is one to consider, although we would caution against scaring either the parents or the child in doing so. We appreciate your recommendation that the questions be gentle, and would underscore that they must not be leading, since the resulting replies would be harder to know how to interpret. Such questioning is best conducted by a professional trained to address such issues with young children.

We agree with your emphasis on the traumatized child’s fear of feeling vulnerable, and would add to this the fear of activities that contain some reminder of the traumatic event.

The original text of our answer to the “fear of bathing” question did close with the following paragraph which was eventually cut due to space limitations:

Children who have been sexually molested may also appear fearful at bath time. But this is not likely to appear as the only symptom. Instead, other activities involving their bodies — using the toilet, getting undressed — also often stir up fear and attempts to avoid them.

This is a possible but unlikely cause in a child who shows no other changes in behavior. There are so many more common reasons for a child this age to become afraid of the bath.

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.

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 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.