Brazelton Method

A HYPERACTIVE KINDERGARTNER CHALLENGES A TEACHER

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NEW YORK TIMES COLUMN:  FAMILIES TODAY:
A HYPERACTIVE KINDERGARTNER CHALLENGES A TEACHER
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I am an educator and I’m currently working with a kindergartner with what could best be described as extreme ADHD.

She is currently on Ritalin which has allowed her to increase her attention span. However, it seems the medication makes her moody, tired and melancholy.
Ritalin also seems to greatly alter her personality. She seems almost depressed when she is on the drug.

Are there any interventions that would be helpful in such a case? Her parents seem receptive to advice and would really love to help this little girl.

A. We certainly can’t offer diagnoses or treatment recommendations from such a distance, but can offer some general information in response to your observations, questions and concerns that will no doubt resonate with educators and parents across the country.

Because there still is no definitive objective test for diagnosing Attention Deficit Hyperactivity Disorder (ADHD), doctors making this diagnosis must rely on careful observation of children’s behavior in their offices as well as thorough reports from teachers and parents.

ADHD is probably over-diagnosed in some settings, and under-diagnosed in others, but either way, there is clearly room for error. There is good evidence that stimulant medication is an effective treatment for ADHD, but when it is not, it is important to go back to the drawing board to be sure that ADHD is the correct diagnosis, and whether or not it is the only one.

Many children are very, very active without tipping over into hyperactivity. This distinction can be difficult to make unless the hyperactivity is truly extreme.

In young children, there is a wide range in the ability to sit still and concentrate in the classroom setting, and indeed, we are asking more and more compliance with traditional academic demands at earlier and earlier ages, despite the fact that there is no reason to believe that children’s capacities to handle these have started developing at earlier ages. (In fact, there may be some conditions in our world today that make it harder for some children to attend and focus. For example, one study found a correlation between long hours of television watching in children under age 3 with symptoms of attention difficulties at age 7, although a cause and effect link could not be made by the researchers.)

Excessive physical activity, fidgeting and restlessness, trouble concentrating, being easily distracted and impulsive behavior all are symptoms of ADHD. Yet they also can be more general signs of distress in young children. Just as fever suggests an infection without telling us what the cause of the infection is, these behaviors in young children may signal a range of other conditions, including anxiety, a mood disorder or even post traumatic stress in a child who has been abused or traumatized in some other way.

Stimulants such as Ritalin (methylphenidate) can bring about clear improvements, noticeably increasing attention and concentration, and decreasing hyperactivity. Sometimes, though, a child does begin to appear down, or even depressed when taking these medications.

They can interfere with sleep, which might also be a cause for sleepiness and moodiness during the day. A switch to a different preparation (short or long-acting, for example) or kind of stimulant (dexedrine, for example, rather than methylphenidate) sometimes can help with either of these side effects, although there are some children who just won’t be able to tolerate these medications.

If the Ritalin is stopped and the melancholy moodiness continues, there may be another problem that needs careful assessment. If parents express concerns that line up with yours, they may accept your suggestion to turn to a child psychiatrist, if they haven’t done so already, to address these specific questions about possible side effects, other treatment options and diagnostic reassessment.

While there now are studies that show that medication alone can be more effective than cognitive-behavioral treatments alone for ADHD, there are also a number of other measures to try that may be helpful. In the classroom, a child who is easily distracted and has trouble attending should be seated close to the teacher, and positioned so that all of the other children wiggling and jiggling are out of her line of sight. This must be done without making her feel singled out or humiliated – self-esteem all too often suffers in children with ADHD. It is also helpful to give such children regular, gentle reminders to tune back in again: The teacher can work out a private signal with the child that helps the child to feel special and valued rather than to stand out as the “trouble” child.

Reminders and disciplines should be framed positively and with hope, since these children often need so many that they will soon tune out anything that sounds like nagging to protect themselves from feeling worse and worse about themselves. Special chores that allow them to work off steam, like getting up to sharpen the pencils, or pass out supplies, or to deliver the attendance list to the principal’s office can also help honor such children’s need for extra activity. These children often need frequent encouragement, praise and rewards, as it can be as hard for them to sustain their own motivation and keep themselves on track independently.

Careful and respectful back and forth sharing between parents and teachers can help create a more seamless experience of rewards and reminders for the child as she adapts each day to transitions between school and home. The long-term goal is for the child to understand and accept herself so that she can become increasingly independent in coping with and overcoming her challenges. For parents and teachers to help with this, they too will need to understand and accept.

For more information:
Children and Adults with Attention Deficit/Hyperactivity Disorder
The American Academy of Child and Adolescent Psychiatry’s website

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.

FAMILIES READY FOR CHANGE

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NEW YORK TIMES COLUMN:  FAMILIES TODAY:
FAMILIES READY FOR CHANGE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Things are so tough these days that most of us are ready to do our part to make our country strong again.

Everyone’s worried about the economy, health care, the environment, and safety in a dangerous world. With unemployment and the economic crisis in our homes and around the corner, we can’t hide adult fears and struggles from our children, but we can show them what we can do, what they can do to help.

THE ECONOMY: Our current problems are complicated, but we know that greed, selfishness, irresponsibility and wasteful self-indulgence have not helped.

Young children struggle with conflicting wishes to hoard all the goodies for themselves, and to share them with those they care about. We adults can model a different set of values and behaviors: being thankful for what we have and for being able to share it with those who have less; spending a little less now to save a little more; going along with what’s fair even if there’s no one to catch us if we don’t. Opportunities for learning these simple but important lessons occur every day and in family rituals:

Once a week, each family member can give something to someone who needs it more, by helping out an elderly neighbor, inviting a family going through unemployment over for dinner, volunteering in a shelter or soup kitchen, or putting a dime or quarter in a jar to save up for a cause the whole family cares about. (See donorschoose.org or habitat.org for ways your family can make a difference in your community, or around the country.)

Allowances: Even though money is tight, a regular allowance – no matter how small (a nickel a week gives the same message as a dollar) – can help children learn to make smart decisions about limited resources, and to save now and be glad they did later.

THE ENVIRONMENT: It’s bigger than all of us, and may seem too big to a child to be able to doing anything about. Yet there are small ways that each of us can help.

As a family, start saving up now for a tree to plant. Learn about the kind of trees that are best suited for your neighborhood, those that absorb the most excess carbon in the air while using the least amount of water. When it’s time, you can pick it out and plant it together.

Help your children remember that they can save water by turning off the faucet each time that they brush their teeth. (See charitywater.org for other ways you can help.)

HEALTH CARE: Our nation’s health care crisis is also too big for any of us to solve alone. But each of us can do our part by doing our best to stay healthy, the earlier the better. A healthy diet, plenty of exercise, simple safety precautions (like seat belts and bike helmets), and balancing out stress with family times to laugh and relax together can make a big difference.

Healthy nutrition can be simple:

  • Eat more vegetables.
  • Eat less processed food, fried food, fast food, and soft drinks.
  • Enjoy what you eat, and take the time to savor it slowly while enjoying being together as a family.
  • Keep the TV off at mealtimes.
  • No grazing between meals, no eating in cars or on your feet.

EXERCISE: Limit TV to an hour a day, and computer time to an hour a day (except for homework). Walk or bike whenever you can, or use public transportation. This can be your family’s contribution to saving our planet’s health too.

SAFETY PRECAUTIONS: See the safekids.org to help keep your children safe, and to protect yourselves, for their sake and yours.

Safety in a dangerous world is another challenge that may seem too big for children to tackle. But adults may have something to learn from them.

Recently, a preschool teacher asked each child at circle time what he or she had done for winter vacation, but skipped the child sitting closest to her. The children took this seriously, and reminded her not to leave anybody out. One child asked, “What about Remy? He’s sick today. We’ll have to ask him too.”

Very young children naturally work to include each other, to help children with special challenges find their roles, and belong.

Much violence comes from hatred passed across generations, and fear that scarce survival resources like food and water will not be fairly shared. What can parents and children do?

Look at a globe and pick out one country, one your children have never heard of. Go to the library or on the Internet to learn about its people. Is there some small way that you all can get to know them? Is there a school, hospital, or orphanage that you can get to know?

See if you can find a trustworthy organization that you can support to provide clean water, food, medical care, teachers. (You might want to check out Amigos de las Americas, Mil Milagros, Oxfam, Partners in Health, Peace is Loud, Save the Children, Unicef and others. We’re sure many of our readers are involved with terrific organizations that help other families here and abroad. We’d love to hear about them.)

Children can become pen pals, or send drawings when language is a barrier. They can help bring peace one friendship at a time.

All of these problems and solutions are interconnected. What each of us can do may seem small, but when we act together as a nation, we are powerful. We can model values that will endure through the bubbles and bursts. We can keep ourselves healthy and strong, saving health care resources for illness that can’t be prevented. We can protect our planet so that we can be sure to have enough energy, water, and food for all of us.

Times are tough, but we can teach our children to do their part for change.

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.

WHEN A PARENT IS CALLED TO WAR

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From the NEW YORK TIMES COLUMN: FAMILIES TODAY

By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My soldier son has just deployed to Iraq for his second tour of duty. His wife and three sons, ages 9 to 2 1/2, live at Ft. Hood, Texas. I want to add something that has helped our family: Web cams and computer speakers. We gave them to our daughter-in-law and our son during his last tour of duty and we have sent him a new set for this deployment. As soon as our son has his set up and running, they will be able to see and talk to each other via the Internet.

This makes a tremendous difference for spouses and children caught up in this war. The 2 1/2 year-old cries more for his dad that the others because he doesn’t understand what has happened. He just knows that his dad flew away in a plane with other soldiers. We tell him that his dad will come back. He does understand that.

A. Thank you for your great ideas and for the help they will be for all families with loved ones deployed overseas. Certainly Web cams and the Internet can be a great help in keeping families in touch. Maybe you can even record some of these special moments so that the children can go over and over them.

I have recommended leaving several DVDs or videotapes of parents reading bedtime stories so that children can be lulled to sleep by parents who are too far away to tuck them in. Your youngest grandchild may find comfort in a piece of Daddy’s clothing as a “lovey” to cuddle and to fall back on when he’s upset or frightened. Even his smell may be comforting at such a time. He is certainly old enough to sense the distress his mother must feel — another reason for his tears.

Of course a worried family member can’t hide such feelings. Instead they can be explained simply in terms that very young children can understand: “Mommy misses Daddy. I know you do too.”

The older children can be suffering because they do understand too well the separation issues as well as the dangers. Although they may seem under control on the surface, they deserve special times with their mother to unload their feelings, their questions, and to share her sadness. They also certainly need to have a chance for their own concerns to be heard. They will be relieved to speak openly but may also feel proud that through this sharing they are helping her. For the most mature children, and for adults, the terror of losing a military family member is all the worse with the current uncertainty about what this war could possibly accomplish and how it will ever end.

Family meals become even more important now. The family can pray together for their father’s safety and quick return. Then, too, they can share their feelings as a family, “We all miss him terribly and need to see his face and hear his voice.” Meanwhile, each of the boys will learn most from the mother’s strengths and her ability to share those — and her moments of vulnerability — with them.

If we can give anything to children who must suffer in this dreadful war, it will be the sense of having made it through the trauma of separation and loss and of learning how to be resilient. We pray with you that your son returns safely, and wish that all of our brave men and women could.

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 4-YEAR-OLD CHILD OF DIVORCE, BESET BY CONFLICTS

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From the NEW YORK TIMES COLUMN: FAMILIES TODAY

By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I am writing on behalf of my friend in India. He and his wife were divorced, and the mother was given custody. The father could visit the child once every 15 days for not more than 24 hours.

The child is a 4-year-old boy. The father has noticed that the child speaks bad language and also uses dirty remarks on people, especially females. The father suspects that the child, being with the driver and the watchman most of the time, has picked up this habit and the father is really concerned. The mother is busy in her own life and most probably hasn’t paid any attention to this problem. The father on the other hand has tried communicating about this to his father and his ex-father-in-law but no one seems to be taking any steps. Since the father meets the child once in 15 days, he doesn’t want to scold him all the time they are together, but has spoken to the child about it, and he is just not improving.

The boy’s parents are not in contact at all. I have asked my friend to speak to his ex- wife about it, but he says he has tried and her family doesn’t let him keep any contacts with her. He is really very worried and his work is suffering a lot because of it too.

A. Your friend is right not to want to spend all of his precious time with his son scolding him, nor would this be likely to have any effect on the child’s use of “bad language.” This would not set the tone of a relationship that the boy might value and want to look forward to. Instead, I would suggest that he use that time to become close and try to become a model for him — one that the boy might want to know better and emulate to over time. He and the boy can do cozy things that bring them closer, tell stories and dream together.

This would be the most effective way to help him learn about the power of words and to care about being respectful of others. The attitude your friend shows towards the boy’s mother is bound to be a potent influence in shaping his behavior with women.

Although he can listen to the child’s complaints and empathize with him, it won’t help for the father to criticize the mother. Any criticism would be bound to get back to the mother, prolonging the painful period during which all contact is cut off. It would also leave the child feeling torn between the two parents, and leave him worried about the security of the home he does have. The boy can’t help but feel protective of his mother and her supports or they might “vanish” as his father no doubt seemed to, and leave him all alone — the most frightening thing a child that age can conceive of. The most destructive thing a child of divorce can experience is anger and tension between his divorced parents. Of course this is inevitable, and can’t be hidden from children, but children needn’t be drawn into it, or made to feel that they must choose one parent over the other.

When parents can support each other for the child’s sake and keep the intensity of their conflicts to themselves, the child will worry less about the usual preoccupations that burden so many children of divorced or estranged parents:

  1. “Was it my fault?” A child may really feel it might have been, and conclude, “I have to be perfect now. Maybe then I’ll be able to bring them back together.”
  2. Any “badness” (such as language) is extra-threatening. Yet, the child is often compelled to try it out to see whether his bad behavior or dirty words will bring on the doom he is so fearful of. Testing a father with dirty words about females may be a way of checking whether the father can be pushed to criticize the child’s mother. “If my Daddy will leave me, my mommy might too and then I’d be all alone. What a terrifying possibility! Will my dirty words bring that on?”
  3. When trying to be perfect seems impossible, or pointless, a child may give up. When a child in this situation is enticed into the usual testing children engage in, for example, trying out “dirty words,” he may conclude that he has failed to be perfect, failed to reunite his parents. Then, he’ll give up.

For such a child, even a slight transgression may lead him to decide he really is a bad kid after all, that the family’s dissolution is all his fault, and that he might as well be “bad.” This is compounded by the expectable preoccupation of parents with their own wounds and fears, leaving the child to feel “no one really wants me anyway.”

As for the foul language, many 4-year-olds try out dirty words in order to learn what they mean and why they stir up such strong reactions. When a child says one, watch his face. Isn’t he watching you carefully to see what effect he’s having on you? It’s a sign of his new awareness that words matter, and that he can create excitement and dominance in his world by throwing around a dirty word. The quickest way to shut down his experimentation would either be to ignore it completely (which is very hard for a short-term parent), or to react as little as possible. A parent might say quietly and calmly, “I don’t like words like that and I don’t use them, as you know.” Then, change the subject without making a big deal. “Let’s go back to dreaming together. I look forward to these times so much and I want to be with you as much as I can. You don’t need to test me to see if I love you or will leave you completely. Nothing would ever make me do that.”

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.

STORM FEARS; AND TREATING A CHILD LIKE A BABY

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From the NEW YORK TIMES COLUMN: FAMILIES TODAY

By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

The aftermath of Hurricane Katrina continues to inspire readers to share their experiences about children’s fear of storms. We can’t resist sharing one more letter:

Q. When my boy was about 4 years old, I recall there was a sudden thunderstorm, so I picked him up and went to our enclosed front porch. I told him that the clouds were rolling around in the sky and when they bumped into each other they made a lot of noise, which is the thunder. When the clouds collided really hard, they made sparks, which we call lightning.

When my boy was 12, we left for vacation before sunrise. He was riding in the front seat with his dad, and I was in the back. In the distance, lightning appeared. The boy and his father were pointing out the sharp, jagged lightning strikes. At one particularly spectacular strike, my son said, “Mom, did you see that one?” I replied, “No, my eyes are closed.” “Are you afraid of lightning?” he asked. “Yes,” I replied. After a moment he said, “Thanks for not making me afraid.”

A. As a parent, who could ask for a more rewarding outcome? Our children mostly tell us about our mistakes. Rarely do we receive their approval. What a nice kid, and how appreciative of you! Your success shows how important rituals and stories — even if untrue — can be.

Although even as a young child he may have seen through your fanciful explanation, the fact that you shared your story with him let him know that you were not afraid. You showed him that you understood his fear, and took him seriously enough to reassure him that you were there to protect him.

Frightening events are more disturbing when they are out of our control, and beyond our understanding. Any explanation for events like these, no matter how far-fetched, seems better than the unknown. All 4-year-olds are prone to fears – being alone at night, loud sounds, dogs who may bite. But giving your child an explanation for his fear rather than pooh-poohing it must have been very comforting. What an example of great communication with a child at a vulnerable time! No wonder he has never forgotten it.

Q. I share custody of my 5-year-old daughter with her father. When he is at work, his mother watches her. My daughter is potty-trained and doesn’t wet the bed at my house. But her grandmother still gives my daughter a spill proof cup and puts diapers on her. I feel she is stunting my child’s progress toward independence.

On the first day of school her grandmother even wanted to follow the school bus. When I protested, she called me out in front of my daughter. And the father won’t listen to me. He just follows his mother’s orders.

Am I wrong to be annoyed? What can I do to fix this situation?
Frazzled and annoyed

A. Of course you are annoyed. You know your child has grown beyond spill proof cups and diapers. And you know that no child likes to be treated as a baby. From what you say it sounds as if the infantilizing you describe hasn’t led the child to regress. But the tension in the adult relationships in this situation could make it harder for her to stand her ground. Can you manage to control your feelings and present a calm, neutral approach to her grandmother’s behavior?

If she doesn’t feel caught between her loyalties to each of the adults, or pressured to protect one from the other, you daughter is more likely to be freed up to make her own decisions about it.

I can almost promise you then that she will resist her grandmother’s babying of her. If you and her father are not stirred up to get into the act, she will put up her own resistance. This will work better with her grandmother than just about anything else you can do.

If the child begins to show persistent, delayed problem behavior you may have to enlist a court advocate (for example, a court appointed guardian ad litem for the child) to try to intervene with the grandmother, but it would certainly be better if your daughter could handle it herself.

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 DIALOGUE ON TANTRUMS AND TOILET TRAINING

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From the NEW YORK TIMES COLUMN: FAMILIES TODAY

By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. You wrote a long article on tantrums — mine will be short.

When our granddaughter was six years old, she and her brother were visiting us. One lunchtime, I decided to clean up some leftovers. My husband asked for more spaghetti. When I reminded him that he was trying to lose some weight, he pretended to cry.

While my back was turned, Shanta said, “It won’t work.” So he “cried” some more. I could hear Shanta sigh, then repeat, “It won’t work, Granddad. I tried it once.”

Volumes have been written on this subject by brilliant scholars. It took a 6-year-old only eight words. When I see a child having a tantrum in a store, my sympathy is with the child, who has been “programmed” to do this — and is not a happy child.

A. What a wonderful story! What a lovely way for your granddaughter to try to help her grandfather learn the lesson she’s learned from your clear, firm messages: that he should respect your clear authority. When parents or grandparents are not clear, a child on the edge of an inner conflict is thrown into more confusion, and a temper tantrum is a likely response.

Tantrums at different ages are the result of different conflicts. In the second and third years, they are normal and are a reflection of the child’s wish to make her own decision, “Do I or don’t I? Will I or won’t I?” For an older child, the reasons may be quite different — such as wanting to get attention or wanting her own way in the face of an undecided parent. This is a time when firm but friendly discipline, such as “Of course you want to go, but the answer is clearly and decidedly no.” By 6 or 7, tantrums should be less common and when they involve physical aggression, we may be well beyond the run-of-the-mill tantrums for which your advice is so pertinent. A child having repeated tantrums, especially at older ages, is surely an unhappy one crying out for help. Your granddaughter sounds wonderful — clear about when it’s no longer her decision or her grandfather’s

Toilet Training

Opinions on toilet-training are forcefully held. Here’s another contribution to the continuing dialogue, prompted by our recent column on the topic. Thanks to the many of you who have offered your creative ideas to help children decide: “I’m ready!”

Q. When my daughter didn’t quite get the hang of the potty, my father thought she could do it if she just gave it a little more effort. He knew she wanted to take ballet classes, so he bought her a leotard and told her that they didn’t make a style that would fit over a diaper. He told her to try out the leotard, and if she could wear it for a day without her diaper, remembering to always go to the potty, then she would be “big enough” to go to dancing school. It worked! She never wore a diaper again.

A. A fascinating strategy! We hope our readers can appreciate the difference between this approach, which leaves the child to discover her own motivation and to decide that she is ready, as opposed to those that put parents in the position of doling out rewards, or punishments.

To a young child just think how different it sounds to be told “you can’t take ballet unless you use the potty” as opposed to what your father almost seemed to be saying: “If they made leotards to fit over diapers, then you could keep wearing them, but since they don’t there may be a way for you to manage without them.”

Part of the secret of success of a strategy like this is that it does not pit the parent against the child — instead, both work together to face a shared challenge. Then, the child needn’t hold onto her diapers to prove that she can resist a parent’s pressure.

There are so many daily conflicts with children that can be turned into opportunities for learning rather than just another struggle when parents can join children in seeing their common goals. “The leotard may help you figure out whether you are ready to make your own decision to be ‘grown up.’ ” Not pressure, but a goal for her grown up achievement. Bravo!

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 4-YEAR-OLD REACTS BADLY TO BABY

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From the NEW YORK TIMES COLUMN: FAMILIES TODAY

By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I am writing for advice about my 4 1/2-year-old grandson. Very recently, my son and his wife welcomed their second child, a girl, to the family. They very diligently included their son in all the preparations beforehand, and he seemed to be handling everything very well. His parents even allowed him to stay at the hospital overnight with them.

Now that the baby is 3 weeks old, my grandson is beginning to act out at preschool, not even wanting to attend, but when there, has done things no one ever thought he would do. He’s even been sent out of the class because of disruptive behavior.

How can you get a 4-year-old to voice his feelings when he himself probably doesn’t know why he’s behaving negatively? What approach might his parents take in addressing this problem?

A. Your thoughtful questions show how much you and his parents have tried to do everything you could to prepare him for the new baby. The last question about “voicing his feelings when he doesn’t know why he’s behaving negatively” is so respectful of what it’s really like to be 4 years old. Knowing what he’s feeling, and knowing how to say it is a very big project – even for many adult-aged children!

You’ve prepared him in every way. I’m sure you’ve talked about the baby in mommy’s tummy, how he could help take care of his little sister when she comes (as if he asked for her, as if it were up to him). He even stayed overnight at the hospital so he wouldn’t feel abandoned by his concerned parents.
Everyone has reassured him that he’ll never be deserted because of her. You probably even brought him home a teddy bear or a truck to nurture when his mother is nurturing her new baby. This may help keep him from feeling displaced by the fascinating new baby.

So why shouldn’t he handle everything well, or even near perfectly?

Despite all best efforts, he still feels angry and displaced. Of course, you and his parents feel let down by his behavior. You feel so badly for him and may blame yourselves, wondering what else you could have done that would have made it easier for him. Yet it sounds as if you all have done everything you possibly could have to smooth over this big transition for him. Except perhaps to leave room for him to protest. To let him know that no one expects him to enjoy being a “big brother,” all the time. To allow him to be “a baby” too without feeling that he is letting anybody down. And to reassure him that sooner or later most big brothers ask about sending the new baby back to the hospital, or stowing her permanently back in the mother’s “stomach.”

He is upset; upset enough to act out at preschool. Not yet at home, although that may come yet. Over time, he may come closer to understanding his feelings, and then to controlling them, if the adults around him can identify the specific aspects of this natural catastrophe that are most disturbing to him.

Of course his parents have less time for him. Of course the baby is lavished with nurturing that stirs up longing – both embarrassing and irresistible – for such nurturing in him. Can he be encouraged to nurse and change his baby doll alongside his parents as a way of pulling together this flood of feelings? Are his parents too tired, too busy, and too preoccupied for their old games and rituals with him? Which ones does he miss the most? Are there a few rituals that they could manage to keep going while he is wondering if they even remember who he is, if they even know he’s there? Can they sit down with him and simply talk out some of the hard parts and show them that they understand and that they care? “It’s so upsetting when people come over with gifts for the baby, and they barely even say hello to you. Of course it hurts your feelings!” Or is he under so much pressure to be praised for being such a good big brother that he doesn’t dare regress – as he will need to -to ask to be your baby again?

But it sounds as if he wants to protect his parents and his baby from his feelings, so he “blows up” at pre-school where it is safer, and where the teachers will protect him from his understandable angry and naturally destructive feelings. He must feel safe with them, and I recommend that you and his parents thank his preschool teachers for the environment they have created where he can feel safe and protected from his out-of-control feelings. Their discipline must be reassuring to him at such a time.

These feelings of displacement and jealousy are inevitable. One of the most precious gifts you can give as parents to a first child is to guide him through his feelings about being displaced to the point where he can accept and control his jealousy. Then he can get on to the important job of caring for his little sister.
For competition with a sibling is one side of the same coin as caring deeply about that sibling later on. But you must be patient and wait for caring to come later.

Meanwhile, to allow him his negative feelings about her, and to face these angry feelings, can be a real gift to him. He won’t have to suppress them. In time, he can feel in control of them so he can move on. My mother always expected me to “love my little brother” so I never got a chance to face my feelings openly. I disliked him until he was 50 and then we became best friends. The pressure to be perfect instead of real was finally off.

It is interesting that he begins to be aware of and to show these feelings after she is 3 weeks old. Just at the time when she’s beginning to smile, and coo, and to fuss at the end of the day – more beguiling but also more demanding. He picks up his family’s turmoil and reacts at preschool. I would predict that he’ll “blow” in some way at each of her new developmental steps – most older siblings do. I call these developmental steps Touchpoints (See our book, “Touchpoints: Birth to Three.”).

Before each new step in her development, she will regress and be more demanding. This will throw the family into turmoil. Your grandson is likely to react at these predictable times. For example, when she begins to crawl, or to walk. Don’t be surprised, and if you and his parents can help him express himself safely (with limits on how far he can go) each Touchpoint becomes an opportunity for him to express these negative feelings. Eventually he can become aware of his protective and caring ones for her. Good for you to want to help him connect his feelings with his actions!

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 PRECOCIOUS TODDLER’S REPLY TO A PASSERBY

by

From the NEW YORK TIMES COLUMN: FAMILIES TODAY

By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

The topic of thumb-sucking continues to prompt responses from readers.

Q. My “children” are now 32 and 24. Your column reminded me of my favorite thumb-sucking story.

A friend and her toddler son were shopping. He was sitting in a child’s seat in the shopping cart, happily sucking his thumb, when a woman approached and said to him and his mother, “Imagine a child that age still sucking his thumb.” My friend’s child took his thumb out of his mouth, looked directly at her and replied, Hurts you?”

I’d love to meet that young man now. He was a wise soul already almost 30 years ago.

A. Your friend’s toddler’s reply to a judgmental busybody is quite a hoot! How does a child just old enough to make two word sentences come up with something like that? A toddler might have sensed this intruder’s negative emotion without fully understanding it. At 2 years or less, a child certainly wouldn’t have known that it was none of her business. And at his tender age, he may not yet have encountered the disapproval of thumb sucking that often is reserved for older children. Toddlers do already know that people have feelings, and by 2 and 1/2 years or so are already hard at work trying to understand what causes them. (This child must have been a little precocious.) Their range of understanding of feelings, and their explanations for other people’s feelings, of course, can only come from their close-at-hand experiences. This child was too young to understand the very abstract notions of persnickety value judgments, or competitive parenting. (His mother may have felt that this woman was saying, “I’d certainly do better than that!)

A child this age would be likely to think that he’d caused her emotions, and would be bound to translate “condescending” or “judgmental” into “hurt” or “mad.” Why would a lady in the store sound upset and mad while looking in the toddler’s general direction? From a toddler’s perspective, this might very well be because he hurt her! This poor child sucking his thumb might even think that he’d caused her distress by sucking too hard, or using his teeth! This may have been the best explanation he could come up with for her arching eyebrows and turned up nose, but it sounds as if it seemed a little implausible even to him!

What a wonderful story! The profound truths of young children’s words let us into their world – one that we have long since left behind, and so often fail to understand.

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.