PREPARING THE FAMILY FOR THE NEXT BABY

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

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.

BIRTH ORDER’S IMPACT

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

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

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

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

OLDEST CHILD

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

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

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

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

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

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

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

HELPING THE OLDEST CHILD HANDLE RESPONSIBILITY

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

MIDDLE CHILD

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

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

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

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

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

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

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

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

HELPING THE MIDDLE CHILD FEEL VALUED

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

THE LAST CHILD -THE “BABY”

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

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

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

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

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

HOW TO HELP THE YOUNGEST CHILD GROW UP

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

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

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

Reprinted with permission from the authors.