PROTEINS IN A BABY’S DIET

NEW YORK TIMES COLUMN: FAMILIES TODAY:
PROTEINS IN A BABY’S DIET
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Is there any risk in not feeding beef or pork to our nearly 8-month-old son as he gets older? He is still on vegetables, fruits and oatmeal, but one of these days, we need to introduce proteins.

A. You started proteins almost eight months ago! Breast milk and formula, mainstays of a baby’s first-year diet, both contain lots of protein. Fish, dairy products and eggs will eventually also be good sources. Egg whites should not be given to children under age 1 since they may cause allergies.

Proteins come from plants, too. Important sources include soy foods, (for example, tofu and tempeh – staples of many Asian diets), soy milk, legumes (peas, beans, lentils, peanuts), nuts and seeds.

Cooked and strained peas and beans are early solids with protein. They can be mixed with blander-tasting foods like soupy corn or rice cereals for children who initially resist the taste.

To reduce allergy risk and to prevent choking, children under 2 should not be given peanut butter. In children or families with lots of allergies, it’s better to wait until 3. Whole peanuts, which can block small airways, should not be fed to children under 3.

As children grow, their nutritional needs change, varying with gender and activity level. Children also absorb, digest and metabolize nutrients differently.

All of us need certain amino acids – the building blocks of proteins – to survive and thrive. Essential amino acids are those that we can’t make on our own and that our diet must provide. Two additional amino acids – cystine and tyrosine – are essential for young babies, whose ability to make them doesn’t mature until later in the first year.

Breast milk contains the amino acids required in the first year. But when babies start eating solids and drinking less milk, the balance can be tricky.

Dairy products, eggs, fish, poultry and meat contain a wide range of essential amino acids, as do legumes and soy foods and milks. Other sources are foods made from quinoa, an ancient South American grain-like food, or from hemp seeds (hemp milk and even ice cream are now available).

Corn, rice, wheat and other grains also contain proteins but with fewer of the necessary amino acids. If animal protein is not part of a child’s diet, a variety of different plant-derived foods is important. With all these options, omitting red meat needn’t interfere with adequate protein intake.

The daily protein requirement should be spread out in feedings over the course of the day since babies’ bodies can’t store extra protein. They break down the proteins into amino acids that stimulate tissue growth. Spreading out protein across the day will stimulate growth several times daily.

Nutrients other than protein need special attention, too: iron and vitamin D and, for babies and children who are not given any milk or animal-based foods, vitamin B-12. Vitamin D supplements are recommended for all infants who are breast-fed (baby formula is fortified with vitamin D). Iron is found in plant foods as well as in meats, but is not as readily absorbed, so the daily requirements are higher for children and adults who eat no meat.

Check with your pediatrician about iron supplementation, since too much iron is not healthy. Vitamin B-12 is found only in animal-based foods and foods contaminated with B-12-producing microorganisms. Poultry, fish and eggs contain plenty of B-12 – so, again, red meat isn’t essential.


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.

SOURCES OF A CHILD’S AGGRESSION

NEW YORK TIMES COLUMN: FAMILIES TODAY:
SOURCES OF A CHILD’S AGGRESSION
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Sometimes a child at age 2 to 3 can seem so serious. Her frowns and determined pace let you know she’s trying hard to figure out her world.

She decides what she wants and worries that she may have to struggle to get it. She tries to maneuver around her parents’ commands. But she is torn between her hunger for their affection and her need to assert herself. Among the challenges:

Toilet Training

The child may be excited about identifying with the world of grown-ups. But children who have been pushed to be toilet-trained may not see it as a chance for more independence. For them, using the potty may seem like “giving in.”

Parents may not realize how much they challenge a child when they push her to be toilet-trained. What a request! Why wouldn’t a feisty child resist?

Parents may beg, “Just sit here a little bit. Do it for Mommy.” They may bargain and persuade, “Mommy can’t bring you to preschool if you’re in a diaper.”

If you’ve had a struggle, try apologizing to your child for the pressure. Let her know it’s up to her to decide when she’s ready. Then she can set her own timing and live up to her decision. It will be her achievement.

Tantrums

A child will have a tantrum to show you how important it is to her to make her own choices: “I want the orange shirt, not the green one.” You’ll have to pick your battles. Don’t be surprised if she melts down when you say, “No, you can’t go out in your shirt and socks. It’s raining.” A 3-year-old may still fall down screaming.

But the tantrums have a new element. As she throws herself on the ground, she may seem to do so with a dramatic flair. A tantrum is a communication. The child will look her parents straight in the eye. With a new defiance, she asserts her ability to subject them to a tantrum that only she can control.

But tantrums are no more fun for the child than for her parents. She resorts to them when she doesn’t know how else to get her way. A parent’s job is to help the child learn other means of expressing her needs.

Let her make her own decisions and feel in control but only when you can. “No, we’re not buying soda or chips. But you can decide if we should get pears or apples. Both? OK.”

Don’t take tantrums personally. You’ll just make them more powerful. Instead, stay cool and, by your lack of response, disarm her. Let her know: “Your tantrum won’t get you what you want.” Stick to your position. Then, if it’s safe, walk away. If not, stay nearby and keep an eye on her but don’t interact. Your resolve will be a relief to her. Afterward, pick her up and comfort her.

New Expectations

A child at 2 or 3 has learned so many new ways to show control over her world, but now there are new expectations too.

Pulling the cat’s tail, pinching Daddy or kicking Mommy may once have seemed playful. Now, though, the child is expected to understand that these actions are hurtful and that she will be held responsible because everyone thinks she should know better.

She needs these new expectations, which show respect for her strong wish to be in control.

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


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

Dr. Brazelton, 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.

THE CHALLENGES OF TOILET TRAINING

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
THE CHALLENGES OF TOILET TRAINING
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Our 2-year-9-month-old son was potty trained relatively easy during the day at 2 and 1/2 years old. However, he is still in a diaper at night. He wet his bed for several days in a row when we tried to put him in underwear at night, and now he awakes with a very wet diaper since we’ve switched him back into a diaper at night. How do we try to help him stay dry at night, or wake up to go to the bathroom at night?

A. He may not be ready – yet. Patience and time may be what he needs most for now. But the “very wet diaper” makes us wonder how much he is drinking in the evening before going to bed. As long as he is getting enough fluids during the day, you can cut back on fluids after supper. If he doesn’t mind, ask him to try urinating once at bedtime and then one extra time before going to bed. If he does mind, don’t bother – the struggle will do more harm than good. In my practice, I found that some children would stop wetting at night if their parents roused them at about 10 p.m. just enough to urinate before returning immediately back to bed.

The most important thing you can do right now, though, is to back off, avoid making a big deal of it (which includes holding off on any unwelcome “help”) and let him know that when he’s ready, he’ll manage just fine. (See our book, “Toilet Training: The Brazelton Way,” Da Capo Press, 2004, for more information.)

Q. My 5 and 1/2 year old daughter constantly forgets to wipe, wash, and flush. What advice do you have?

A. Is this a new problem, or is this something she’s never yet mastered? If this is a change in her behavior, we would wonder about what might have prompted it – for example, some physical condition such as a rash or infection that might make wiping painful, or some experience that has frightened her and led her to try to avoid this area as much as possible. In this case, we would encourage you to bring this up with your child’s pediatrician.

If this is the way it’s always been, and otherwise her development has been entirely typical, our guess would be that she will learn to master this – when she is ready and when this really begins to matter to her. In the meantime, if this is one small expression of her overall temperament – a little girl who is under a head of steam, often in a rush, only halfway through one activity and then she’s on to the next before – you’re likely to do better by accepting this and helping her to accept her own temperament. This will help her to know she can turn to you to understand herself and for help when she begins to be bothered by some of her own shortcomings and is ready to work on them. (If she has difficulty following through with a much wider range of tasks in a number of different settings, it might be worth looking into what might be distracting her. Your pediatrician could help.)

She’s already shown you that reminders won’t work. Do they feel like nagging to her? They’re bound to if she hasn’t asked for them. And she won’t until she is able to recognize and accept that she needs help, and that you can offer it to her without embarrassing her. Of course you don’t mean to. But she’ll be more comfortable with your help when she’s ready for it. You might try sitting down with her in a calm moment when this isn’t the immediate issue. Let her know that you know you’ve been bugging her with your reminders and that they haven’t helped. Ask her if she would like your help. If she says no, then let her know you’ll be ready to offer it when she’s ready to ask for it. Then, drop it. If she says yes, then ask her what kind of help would work better for her than your reminders.

Some parents may feel that this approach gives a child too much control – but in areas where no parent can control a child, the best a parent can do is to help a child discover her own motivation, and to harness that motivation for her to be in control of herself. Others might suggest a reward system – some little token for every flush. There’s probably not much harm in that, except that it could still easily become your issue, rather than hers – a setup for struggles that might just reinforce the problem.


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.

IS MY BABY GETTING ENOUGH IRON?

NEW YORK TIMES COLUMN: FAMILIES TODAY:
IS MY BABY GETTING ENOUGH IRON?
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. How can I ensure that my breast-fed 7-month-old consumes adequate iron? I give her a daily serving of iron-fortified cereal, but I’m lucky if she eats one tablespoon (she’s also started pureed vegetables). My pediatrician has expressed concern about her intake since breast milk doesn’t contain much iron. So far she’s been growing well.

A. Breast milk is the best food for babies during the first year, with just the right balance of fats and amino acids as well as antibodies that protect against infection. Breast milk may not always provide adequate amounts of iron. But iron in breast milk is more easily absorbed than in iron-fortified baby formulas.

Iron is an essential mineral for hemoglobin, the molecule in red blood cells that allows the blood to absorb oxygen in the lungs and transfer it to the body’s tissues. Iron has other important roles, too. Iron deficiency in the first years can be related to learning disabilities.

Low iron levels can also increase the risk of lead poisoning in babies. A child with iron deficiency may absorb five times more lead than a well-nourished child. Pediatricians usually test a baby’s blood for lead levels at nine or 12 months and may repeat the test yearly until age 5. For mild cases of lead poisoning, pediatricians often prescribe iron supplementation.

During the first four months, babies generally can rely on the iron in the red blood cells acquired from their mother’s circulation before birth, unless maternal iron levels were too low during pregnancy. Nutrition during pregnancy, including adequate iron, affects a baby’s health and development long after birth.

For breast-feeding babies, the American Academy of Pediatrics (www.aap.org) recommends daily iron-drop supplementation between four months and the age at which you introduce iron-rich solids. Because too much iron can be as bad as too little, it is important to follow your baby’s doctor’s advice on dosage.

Babies can start on solids between four and six months. Some of the first solids – infant rice cereals, for example – are often iron-fortified. Iron that occurs naturally in food is better absorbed than the artificial kind.

Iron sources include soft, strained, pureed cooked meats such as beef, turkey and chicken. Cooked and strained peas and green beans are also good, although their iron is less readily absorbed than via meats.

Cooked, strained fruits are other early solids. Sometimes citrus fruits cause rashes in children under age 1. Apricots, peaches and prunes are worthy choices until then.

Pediatricians usually test a baby’s concentration of hemoglobin in red blood cells at nine or 12 months and again between 15 and 18 months. This test is not perfect, so an iron-rich diet is important even if the test result is normal. If iron levels are low at this time, iron drops may be prescribed, along with a recommendation for more iron in the diet.

Young children also need adequate supplies of calcium, but calcium interferes with iron absorption. Try serving high-iron foods at meals or in snacks, separate from breast-milk feedings. Cow’s milk should not be given to babies under age 1 because it can irritate their intestines and prevent iron absorption.


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.

THE OLDEST CHILD

NEW YORK TIMES COLUMN: FAMILIES TODAY:
THE OLDEST CHILD
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

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

When she grows tired of her “older child role,” she may turn on her siblings. “Leave me alone. Stop bugging me.”

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. And anyway, you’re the smart one in the family.” She may feel flattered by this kind of adoration, and she’ll do her best for a while.

But if she feels pressured, she may 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’ reliance on her to be the “oldest and most responsible.”

For example, when she’s asked to babysit, 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. Often this behavior is carried to extremes and not appreciated. “Mom, don’t let that little squirt come out of the house when my friends come over. He always ruins our games.” And, yet, at other times, the older child teaches her siblings the games she plays with her friends. This is a mixed blessing and a mixed role for the eldest, and a lot of responsibility, whether she likes it or not.

An oldest girl is expected to be a second mother; a boy, a second father and teacher. When the oldest tries to fight off this role, everyone is shocked. The oldest feels surprised and guilty. The younger ones feel abandoned. Predictably, the older child’s teaching and helping will be rebuffed, at other times, by the younger child: “I don’t need you. I can do it myself.”

Helping the Oldest Child Handle the Role of Responsibility

  • Try not to expect the oldest to be “too” responsible. Watch for signs of needing relief. Even if there is a large age gap, don’t expect the older one to do all the babysitting.
  • 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.
  • Value the older child for her uniqueness in the family, independent from any expectation for her to be the “oldest and the most responsible.” “I love it when you come in to sit on my bed and tell me about your day. It’s just like you were my little girl again when we used to cuddle and talk over everything you’d done.”
  • Let the oldest be a baby, too, when she needs to. Pushing too soon for an older child to give up “babyish” behavior like sucking her thumb or carrying her blanket everywhere is bound to backfire. Expect her to fall back on this behavior under pressure, and let her know that temporary backsliding is OK.
  • Try to free the older child from her siblings enough to have friends of her own, outside the family.

(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.

LEARNING TO BE A ‘BIG BROTHER’

NEW YORK TIMES COLUMN: FAMILIES TODAY:
LEARNING TO BE A `BIG BROTHER’
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D

The new baby has come home and suddenly the older sibling doesn’t get the same attention as before. The newcomer is ever more demanding of their mother, whose energy may not yet have returned.

The older brother’s demands increase, too. It’s almost as if he must test to be sure that his mother will recover and that she can still care for him. Teasing and testing, refusing bedtime and waking up each time the baby does – all are to be expected.

Sometimes an older child will take on the helping role of “big brother” or “big sister,” but don’t be fooled. Along with pride in helping, and his discovery that he is more “grown-up,” he’ll still resent the baby and feel sad about losing you.

You can make it clear that there are times when he can help, and times when he can be a baby, too. He’s telling you, “Why did you need her? I can do anything she can. I can still be your baby and please you.” He is facing one of life’s crises and learning how to cope with it in the safety of your loving care.

Expect the older child to lose ground again at some point. Usually it’s in the developmental area he’s just mastered. If he has begun speaking, he may resort to baby talk. If he’s feeding himself, sleeping through the night, becoming toilet-trained or conquering fears of strangers – count on a slide backward. This is what we call a touchpoint, a temporary falling apart that anticipates a new step ahead. He is learning how to be a big brother.

Think what it means to the older child when a 2-month-old baby fusses every afternoon and parents rush to attend to her. You can help him understand his feelings. He’s working so hard to understand the new baby, and to imitate her. “Of course you want to talk like the baby: Everyone pays so much attention to her right now.” Or, “Don’t worry about wetting the bed. Once you get used to having a baby sister, it’ll stop.”

Your understanding will be far more effective than getting annoyed or pressuring him to be a “big boy.” These responses are bound to backfire into even more dramatic bids for you to let him be your baby again.

Some children seem to sail through these first months. They are compliant, even helpful. But this interlude won’t last. The price of such a challenging new role for a child may have to be paid at a later touchpoint, or in reaction to one of the baby’s own touchpoints.

Each of his steps backward is an opportunity for you and the child to learn together to master the next stage of development.

An older sibling who is 5 or 6 years old may not express his resentment and frustration through tantrums or meltdowns; instead, he may devise ways to attract your attention by spilling things, falling, or needing your help with homework. Or he may come to your side as if to help, only to drag around and get sassy with you. But he needs the same understanding as a younger child. He will be better able to tell you how he feels than his sibling, and more able to help in a useful way once he feels understood.

DISCIPLINING THE OLDER CHILD

  • Stop him firmly but quietly.
  • Hold him, or use a time-out if he’s ready to comply.
  • Pick him up to hug and love him. “It’s tough having a baby sister, isn’t it? But I can’t let you do that and you know it. I must be here to stop you until you can stop yourself.” Watch his face and his eyes take it in and soften.
  • After you’ve made contact with him and are feeling close again, let him help you with the baby. In that way, he’ll begin to sense the goal of discipline and to feel like a “big brother.”

(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.

9 MONTH OLD AND NAPTIME RESISTANCE

NEW YORK TIMES COLUMN: FAMILIES TODAY:
9 MONTH OLD AND NAPTIME RESISTANCE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Our healthy 9-month-old son has started to resist going down for his naps. We have tried every method in the book (quiet time, reading, rocking, dark room) but he still cries/wails before each nap.

On good days, he takes two one-hour naps; on bad days (more often lately), one or two 45-minute naps. He goes to sleep easily at night without nursing and sleeps through for about 10 hours.

A. Most 9-months-olds require about 12 hours of sleep during each 24-hour period – including nighttime sleep and naps. Sleep needs vary among babies. The range for 9-month-olds is from 11 to 13 hours per day, according to pediatric sleep specialist Richard Ferber, M.D. So on “good days” your son is within the average.

Many children resist naps, even when they need them. Up until 6 months, most babies take three naps a day – one in the morning, one midday or early afternoon and one later in the afternoon.

At around 6 months, one nap is dropped. At around 12 months, babies often drop one of the two remaining naps. A little ahead of schedule, your baby may be getting ready to switch from two naps to one.

When a baby is on the verge of dropping a nap, a period of back-and-forth may follow for a few weeks. This transition is typical of what we call a touchpoint, when an area of development such as sleep becomes briefly disorganized to reorganize into a more mature pattern.

One day, your baby may take one nap and skip the other, or he may have trouble falling asleep before both. He’ll also be cranky and tired when he has had fewer or shorter naps. Falling asleep at night may be harder, also.

When one nap replaces two, naptime also shifts – between the old morning and afternoon naps. The remaining nap’s length may be longer, or the baby may sleep a little longer at night. At 12 months, the sleep total is only about 30-45 minutes less than at 9 months, so the single remaining nap may be longer than before.

Can a parent help this transition? Try to be sure that the baby is getting enough sleep over each 24-hour period. Inadequate sleep can interfere with falling asleep and sleeping restfully.

Help your baby consolidate his two naps into one by putting him down for his morning nap a little later. Put him to bed later, too, which might lead him to sleep longer – thus easing the shift to consolidate morning and afternoon naps.

The transition will happen anyway in a few months, if not sooner. You may be just as glad for him to keep napping twice a day for a while longer, even if he struggles to get himself to sleep and the naps are shorter.

If he gets tired and cranky, encourage quiet time for cuddling and reading together so that he can get a little rest and comfort even if he can’t sleep then.

(For more information, see “Solve Your Child’s Sleep Problems,” by Richard Ferber, M.D. published by Simon & Schuster.)


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.