WHEN A 2-YEAR OLD WON’T STAY IN BED

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
WHEN A 2-YEAR OLD WON’T STAY IN BED
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. How can we keep our 2-and-a-half-year-old daughter in bed? Two weeks ago she climbed out of her crib and never looked back. However, I don’t feel that she is developmentally ready to stay in bed.

We are patting her back until she falls asleep, but this goes against all the parenting I’ve done with my other kids. I would like her to rest and sleep in her own bed, by herself.

A. We’d love to know what else happened two weeks ago. Has an important change or event affected the family – a move, illness or death, a pregnancy, a parent’s job loss? When children this age experience a new stress, the first sign may be a change in sleep patterns.

Parents sometimes assume that a child is “too young” to realize that something’s up, which is appealing when a change is hard to face and parents wish they could protect a child from knowing. At such moments, though, young children need parents’ help to understand what is happening, and how the family will manage. What young children can’t put into words they may translate into actions, like refusing to stay in bed.

Another potential cause may be allergies, asthma or even a cold. Check with your pediatrician.

If your child had been sleeping through the night, she’s mastered how to settle herself down at bedtime. But going to bed means she must temporarily separate from parents and surrender to being alone – unless she is sharing a room.

Separation can be tougher when a child’s world seems less predictable. She needs to believe you will still be there, and respond as always, in the morning.

Another sleep-disrupting event can occur within the child – a developmental threshold we call a touchpoint. At age 3 or 4, children become newly aware of their emotions and of the moral judgments that go with them. They realize they can feel angry or vengeful or jealous. Such emotions may frighten them or make them feel guilty. Often this awareness surfaces as fear about monsters and witches, and in nightmares of angry, vengeful, hurtful creatures.

Parents can help to ease this stress by talking gently about the full range of emotions (their own and their children’s) and by reading children’s books that deal with them – for example, “Where the Wild Things Are” by Maurice Sendak, or “There’s a Nightmare in My Closet” by Mercer Mayer.

When children know their parents can help them handle emotions so they won’t act in scary ways, the fears and nightmares will subside.
(See our book, “Touchpoints: 3 to 6: Your Child’s Emotional and Behavioral Development.” Da Capo, 2006)


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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

DEVELOPING A SENSE OF SELF ESTEEM

NEW YORK TIMES COLUMN: FAMILIES TODAY:
DEVELOPING A SENSE OF SELF ESTEEM
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D

Q. I would like to hear your thoughts on how to raise a child to have a strong sense of self-esteem.

A. The word “self-esteem” has been so overused that its meaning has been lost and sometimes confused with “selfishness.” But these are entirely different. Thank you for your question and this opportunity to clear up the confusion.

Self-esteem does not refer to an inflated view of one’s self. Instead, it is the capacity to hold onto a basically hopeful view of one’s self while facing and integrating experiences that challenge this view.

The development of healthy self-esteem in a child allows her to confront her mistakes without taking apart her positive feelings about herself, so that she can mobilize these positive feelings (confidence, faith in her potential, etc.) to find the courage to learn from and overcome her mistakes. The result is not a skewed view of one’s self, but a realistic one in which both strengths and weaknesses can be acknowledged and accepted.

How to help a young child develop healthy self-esteem? Here, too, there’s been a great deal of misunderstanding.

Overpraising a child (“Yay!” for every least little utterance or gesture) can interfere with a child’s learning to motivate herself, to praise herself when she deserves it, and to face her failures so that she can work to overcome them. I have seen 5-year-olds in Kenya care competently for younger siblings without anybody cheering them on, yet radiating a quiet confidence in their own abilities.

In some upper-middle-class communities in this country, I have seen some children who seem to lack the inner motivation to challenge themselves, and who have become dependent on external sources of praise – over which they have a different kind of control.

Abundant opportunities for small successes and an environment rich with developmentally calibrated challenges are important, but total protection from small failures deprives a child of the experience of facing mistakes, feeling the feelings that go with this, getting these feelings under control, and then developing the resolve to try again.

Perhaps most important of all for the development of healthy self-esteem in a child is a parent’s unconditional acceptance – entirely independent of performance – of a child not for what she does, but for who she is. Feeling loved no matter what does not fill us with illusions about how wonderful we are, but helps us to tolerate our imperfections. When we can do this, we are more likely to learn to live with the imperfections of others. This is why self-esteem is such an important first step in learning to get along with others.

Q. I am writing to appreciate you for being such a fine pediatrician who cares as much about the parents as you do about our children … I felt you were like a friendly grandfatherly type of doctor sitting by my side as I faced each developmental phase. I’ve always felt my daughter is my teacher, and with your guidance, I learned to listen and observe her better so I could support her to develop her potential.

A. It is good to hear that I was able to get across to you what I truly believe, that parents need support at least as much as they need advice, and that their best teachers are not the “experts” but their children, if only parents can really watch and listen, as you have been able to.


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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

BABIES WHO WANT TO WALK; AND BEDWETTING

NEW YORK TIMES COLUMN: FAMILIES TODAY:
BABIES WHO WANT TO WALK; AND BEDWETTING
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Are there any studies about babies who develop learning disabilities if they never crawl? Or, is this an old wives’ tale? A friend’s baby is almost 11 months old and he will not crawl. He is trying to walk but will not crawl.

A. I am not aware of any studies on the long-term development of children who don’t learn to crawl before walking, but I have known many children who skipped crawling entirely, went straight on to walking and never developed any learning disabilities that anyone was ever aware of.

I don’t think it helps parents to scare them about unknown or improbable risks that they can’t do anything about. On the other hand, if there is already other evidence that this 11-month-old is not developing on target in any way (leaving out crawling on the way to walking as an isolated finding is not evidence), then early identification and intervention can make an enormous difference in optimizing the child’s ultimate progress.

If your friend is worried, she should start with her pediatrician, who should be able to provide an initial developmental assessment. See our newly revised “Touchpoints Birth to 3: Your Child’s Emotional and Behavioral Development” (Da Capo 2006) for information on the range of behaviors a healthily developing 11-month-old can be expected to display: They are so much fun!

Q. I have a daughter who outgrew bedwetting years ago. This year she started sixth grade and has now resumed wetting the bed every night.

My daughter and I agree that the bedwetting must be due to stress. But she is doing well in school, with good grades and new friends. There are no big negative stress factors — just the newness of sixth grade.

What can I do to help her stop this problem?

A. Bedwetting in a child who has been dry for six months or more is altogether different from bedwetting that has never ceased. When a child this age who has been dry for years starts bedwetting, it is concerning. I would look for possible causes for this sudden change, for example, a urinary tract infection, or diabetes and other less common medical or neurological causes. Check on it with her pediatrician.

In this situation, stress can only be settled upon as a cause after medical ones have been ruled out. After you have determined that there is no medical reason for her bedwetting, then you and she can face together any new stress that she may feel about entering sixth grade.

Sixth grade can be a time of great change and great anticipation. If they didn’t start in fourth or fifth grade, boys and girls are likely to start showing new nervousness and excitement about each other now. Some girls have already had their first period and the others ought to know their time is coming.

Sixth or seventh grade may be the start of middle school– what a terrible time to lump together so many children undergoing such drastic upheaval, without the pressure to act grown up from older students (9 -12 high schools), or the opportunities to feel grown up provided by younger ones (K-8 elementary schools)! No longer nurtured by a single teacher, students may already be moving from class to class, teacher to teacher, and feeling much more like they must fend for themselves.

For many children this age, it seems like time to say goodbye to childhood, and to prepare for the unknown. As much as they may act as if they were eager to forge ahead, many sixth graders struggle with mixed feelings about the end of this somewhat more carefree period of their lives.

I am impressed that your daughter is so open and eager to work on her problem with you Rather than feeling so ashamed that she wants to hide it. Her close relationship with you is the single most important protective factor against whatever you and she may fear about the adolescent years ahead!


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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

STRATEGIES FOR LIBERATION FROM THE PACIFIER

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
STRATEGIES FOR LIBERATION FROM THE PACIFIER
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. We have a very bright, active and affectionate 3-and-1/2-year-old boy, who is wonderful in every way.

My question concerns the use of a pacifier. Our child still sleeps with one, and occasionally (rarely) asks for it “to calm down.” It is something he uses only at home. The dilemma is that our pediatrician, who is a wonderful child advocate, says it is fine and that we should let him give it up when he is ready.

My dentist (who has not yet examined the child), however, says in no uncertain terms that will deform his palate and we should take it away.

We’ve decided not to nag him about it, but think we should make a decision about it soon. I myself sucked my thumb until I started school.

A. Does your child use the pacifier just to soothe himself to sleep at bedtime, or does he suck on it all night long? If he only uses it briefly as he falls asleep and occasionally “to calm down”: for short periods, then trying to take it away may not be worth the struggle. If he uses it more often than this, he’s even less likely to give into nagging.

Either way, attempts to stop thumb sucking or pacifier use are bound to backfire unless the child is offered and successfully learns alternative strategies for self-calming. Without other ways to relax and calm down, a child will cling to a pacifier even harder when a parent tries to interfere with its use, since this struggle creates a new source of stress while threatening to take away a major way of handling it.

Instead, without ever mentioning the long-term goal of replacing the pacifier, watch your child for other things he does to calm himself down. Does he talk or sing to himself, squeeze a teddy bear, curl up under the covers, or come to you for a hug, a lullaby, or reassurance?

Whenever he does use his pacifier, encourage him to fall back on one of his other ways of soothing himself too. You can also introduce new ones. If he has a favorite (small) stuffed animal, doll, or toy, offer it to him when he is upset, and ask him to stroke and hug it until he’s feeling better again. Take it with you wherever you go as you do the pacifier, so that you can offer both.

Little by little he’ll learn to feel nearly the same comfort from his specially treasured toy or doll as he has from the pacifier, and will begin to let go of the latter – when he is ready.

The key is to keep any sense of urgency to yourself, for this will only make him anxious, and more in need of his pacifier. Let him lose interest in the pacifier, at his own pace. Sooner or later he will. As may have been true for you when you stopped sucking your thumb as you began school, many children make up their minds to give these soothers up when being accepted by their peers becomes even more important.

Strategies that simply stop pacifier use or thumb sucking in the short term may come at some cost. For example, simply taking away something this important to a child may lead some children to feel less secure, and some to become more focused on seeking comfort by putting things in their mouths, fingers, thumbs, other objects, or more food than is healthy.

Turning the pacifier into a negative experience, for example, by scolding or mocking the child when he uses it, or punishing him when he does, may stop the behavior in the short term, but there may also be a price later to pay for it.

Unfortunately, too many sources of information for parents try to reduce child rearing into a few quick tips and simple steps. Although some of these may “just work” in the here and now, they may not be good for a child’s future development. To raise a child is not always simple or easy. It wouldn’t be as rewarding as it usually is if it were. Often parents are caught between conflicting recommendations from professionals. Perhaps you might ask your pediatrician and dentist to talk with each other. If they do decide together to recommend stopping the pacifier, it is reasonable to expect that they would also help you figure out how to do it. Just ordering parents to make a child change a hard-to-change behavior without any other help won’t do.

Perhaps our readers can help too.


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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

TODDLERS AND VEGETABLES

NEW YORK TIMES COLUMN: FAMILIES TODAY:
TODDLERS AND VEGETABLES
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My 3-and-1/2-year-old son will not eat vegetables at all, except (very occasionally) a couple of baby carrots. He has thus far defeated every one of the strategies I’ve used to sneak in veggies. He will eat certain kinds of fresh fruit, so I give him those whenever possible.

We also avoid sweets and use whole grains rather than refined flour. But I worry that he’s getting poor nutrition – his diet is so heavy on meat, cheese, pasta and bread (in addition to whatever fruit he will eat, the current favorites being cantaloupe and red grapes).

For his age, he’s only in the 25th percentile for height, while 50th for weight. Our pediatrician said he didn’t need a multivitamin and she didn’t see any cause for worry about weight. What do you think?

A. Vegetables! I hated them as a child – and I still hate them. My younger brother hated them more. As I watched my mother hover over him for hours trying to shovel vegetables into him, while completely ignoring me, I began to hate my brother even more than vegetables. Now you know why I became a pediatrician – to stamp out vegetables, and to overcome my guilt at wanting to kill my brother!

When I turned 50, I began to get along with my brother – of course we both had to wait for this moment until our mother had died. But I’ve never forgiven her for vegetables. So every time I am asked about young children and vegetables (and in the course of 50 years of practice, I have discovered that my mother was not the only mother who cared so deeply about vegetables), I tell mothers, and grandmothers, “Forget about vegetables.”

They turn pale. Open their eyes wide. Feel faint. I offer them a seat, and repeat, “Forget about vegetables.”

As they gasp for breath, I continue, “When a young child struggles with you over food, you won’t win. The more you struggle, the more he’ll hate whatever you’re trying to shovel into him. Back off. Apologize. Let him know that you know that only he can swallow the stuff you prepare for him.”

As they begin to recover, they stammer, “Really? No vegetables? No green vegetables? No yellow vegetables?”

“Really,” I say. “You can cover them with a multivitamin during this temporary period – usually between 2 and 3 years old – when any battle over food will backfire into even worse nutrition. They’ll make it through this with enough milk, meat, eggs, grains and fruit.”

As a pediatrician, I would carefully monitor for growth and general health. Height and weight need to be considered not only separately, but together, and not just at one single moment in time, but over time. The context of a child’s overall health, eating habits and activity level, and his parents’ height and weight, also need to be factored in. Any parent who is concerned about a child’s weight, height or eating certainly deserves to have this taken seriously by the child’s pediatrician.

Of course, the truth is that science is still working to identify all the active ingredients of vegetables, and how they promote health – and not all of these are contained in multivitamins. Yet even once this has all been fully worked out, there still will be certain basic bodily functions – such as eating and breathing – that we can’t take over or control for children.

Jessica Seinfeld has written an intriguingly entitled book, “Deceptively Delicious,” in which she whips up a number of child-friendly disguises for vegetables. If you try this kind of maneuver, try not to make an issue of it, or to take your stealthy nutritional missions too seriously.

Instead, keep mealtimes relaxing and enjoyable, and focus talk on fun things, but not on food.

Many children take time to acquire tastes for new foods, and their taste-sensing equipment actually matures with age. So in the meantime, you can introduce a vegetable over and over, in very small amounts, so that there is no pressure to try it. The tiny bit of new and different food should just repeatedly appear – without commentary, without pressure, without monitoring of or reaction to whether or not it is consumed. On the sixteenth time, you may be surprised to see the child give it a try, and you may be disappointed as you watch him spit it out. In the meantime, if you avoid processed sweets, and salty and fried foods, your child’s palate will not become overwhelmed with and addicted to these easy-reach taste blasts, and will be more likely to welcome the more subtle tastes of – vegetables.


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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.
www.touchpoints.org.

Reprinted with permission from the authors.

HOW MUCH SHOULD TODDLERS SLEEP – AND NAP?

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
HOW MUCH SHOULD TODDLERS SLEEP — AND NAP?
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. How much sleep does an 18-month-old really need? My son sleeps 10 hours at night (waking several times) and takes a 1 hour nap during the day – well below what the books (and common sense!) say he needs. However, he seems rested and energetic and is developing normally. What do you think?

A. What the books say about the amount of sleep children need at different ages is usually limited to averages. Individual children, though, may fall at one end of the range or the other. (The average at this age would be about 12 hours at night plus 1 to 3 hours of napping.) We think that your observations that he is rested, energetic and developing normally are reassuring.

However, you also mention that he wakes up several times at night. Does he just briefly rouse, never becoming fully awake, and quickly settle down to sleep? Or does he become fully awake, and if so for how long, and what does it take for him to get back to sleep?

Has this only begun to occur recently? If so, and if it rapidly resolves itself, it may mean that he is responding to some minor stress, or even to the stress of development – the temporary backslide in one area of development just as a new developmental skill is coming together – a touchpoint.

But if this has been going on for some time, or persists, then we would suggest that you bring this to the attention of your child’s pediatrician. There are a wide range of readily treatable causes of sleep disturbances that you wouldn’t want to miss. If the waking at night is a regular bother for you or for him, then it is a sleep problem worth addressing. (See our book “Sleep: The Brazelton Way,” DaCapo Press, 2003, for more information.)

Q. I have a 3-year-old son who is becoming terribly resistant to taking naps until late in the afternoon, which of course impacts on his behavior (and we have a 5-month-old baby boy in the family now as well, which is a part of this as well).

If he does eventually put himself down for a nap in the late afternoon, bedtime is a nightmare as well. How hard should we try to get him to take a nap? I really do not think he is ready to completely drop his nap, based on his mood on days he doesn’t get one. I just don’t know how much of an issue I should make it. Any advice would be much appreciated.

A. It does sound as if he may be beginning the transition away from the afternoon nap – not a struggle you want to fight, nor one you’re going to win. We’d bet that he wants to be up and around as much as possible so as not to miss out on all the fun his baby brother is having.

Why not put him down for a “rest” early enough to prevent the bedtime “nightmares?” If he sleeps, fine; but if he doesn’t, don’t bother with a nap too late to help. Instead, when he doesn’t nap in the afternoon, try moving up his bedtime a little earlier. Some children who aren’t getting enough sleep actually start sleeping less and less, or sleep less restfully. If he really isn’t ready to give up his afternoon nap, he may show you this by sleeping more at night – if given the opportunity. (Three-year-olds average about 11 hours of sleep each night and an hour’s nap each day, but the range varies from one child to another).

If you can break away from the 5-month-old briefly in the early afternoon, this could be your special time to cuddle and relax together with your older child. Maybe this will help with his moods. As you say, sharing you with his new brother is bound to affect his moods and his sleep.


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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

THE ANCIENT PRACTICE OF SWADDLING

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
THE ANCIENT PRACTICE OF SWADDLING
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Are there any negative side effects to swaddling with the baby’s arms down along the sides of the body?

A. Swaddling – snugly wrapping your baby in a blanket – is an age-old, nearly universal strategy for comforting young infants. It seems to have fallen out of favor a few hundred years ago in many cultures, but not in the Middle East, and not among many Native American tribes.

Many Native American peoples have long used cradle boards – a flat board to which cloth or animal skin was attached – to keep their babies snug, warm, easily carried and out of harm’s way.

Many cradle boards have “bumpers” at the top ingeniously extending beyond the baby’s head so that it is fully protected. In some tribes they were positioned at a gentle angle for feeding or upright so that the babies in them could watch other family members at work and begin to learn about their world.

In fact, we would expect that these babies would be able to muster up more energy for visual learning since the cradle boards kept their little bodies at ease and under control.

Recently, swaddling seems to have been making a comeback, in the United States, the United Kingdom and other European countries. This may be because now that we understand the advantages of positioning babies on their backs for sleep to decrease the risk of Sudden Infant Death Syndrome, we need a way to help babies fall asleep and stay asleep in that less comfortable position.

Swaddling has many obvious benefits, helping to keep babies warm, calm and comfortable. Swaddled babies will rouse less and sleep longer. At the beginning of life, the snugly fastened wraps recreate the womb’s supportive fit, cutting down on a newborn’s startles and jerks – motor reflexes that otherwise make the baby feel uncomfortable and often start to cry.

Modern science has established numerous other benefits of swaddling, and special circumstances in which it is particularly helpful. One study has even shown that premature infants may have improved neuromuscular development when regularly swaddled.

But you ask about negative effects. A recent study showed that Hopi infants raised in cradle boards did not start walking any later than those raised without them. There are, though, studies that link swaddling to early hip problems (hip dysplasia and dislocation), but the risk may be the result of the specific position of the legs under the swaddles. These studies suggest that it is important to avoid fully extending the legs, or rotating hips outward when swaddling a baby. Swaddling babies so that their hips and knees are bent and with enough slack to allow movement appears to be safer for their hips.

In warm climates or over-heated buildings, care must be taken not to let an infant’s body temperature rise dangerously high when tightly wrapped. There are a few studies that have found that babies swaddled from head to toe all day long for several months may be more likely to be deficient in Vitamin D, presumably because swaddling cuts down on their exposure to sunlight, which is needed to activate Vitamin D.

Other studies suggest that very tight swaddling may slightly increase a baby’s vulnerability to respiratory infections, perhaps because it limits the normal expansion of chest and lungs. These studies seem to suggest avoiding prolonged swaddling, swaddling from head to toe, and overly tight swaddling. This shouldn’t interfere with the containment and comfort that swaddling still can offer, and many pediatricians feel that swaddling a baby for 12 to 20 hours a day in the first weeks is perfectly fine, and that it can be gradually decreased after a month or two depending on a baby’s comfort without it.

As for swaddling the arms alongside the body, we have not found any studies to suggest that this is a problem. However, it is important to leave the arms free often enough that babies can discover their fingers and thumbs, so that they can learn to use them to comfort themselves by fondling the soft edges of their blankets, their own soft cheeks, or by sucking on them.

Swaddled or not, it is critical to position babies on their backs when asleep, or likely to fall asleep so that they are at less risk for SIDS. It is also critical that when awake all babies are given plenty of time to play while on their tummies so that they can strengthen their arm, shoulder and back muscles. This has become a major concern for babies who spend much of their awake time in car seat-like baby carriers. We did once encounter an 8-month-old with delayed motor milestones, not yet sitting on his own. He had been a fussy baby, and his mother had religiously adhered to an intensive regimen of swaddling that some pediatricians recommend for such babies. Swaddling does seem to reduce crying and can even soothe pain. We had no way of knowing whether he’d had too much swaddling for his own good, but we’ll always wonder.


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.

Before Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center.  Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

IN TOILET TRAINING, A PREMIUM ON PATIENCE

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

Problems in toilet training nearly always arise because of an imbalance in the parent-child relationship. Children usually show signs of readiness between age 2 and 3. When parents can’t wait until then, and impose toilet training as their idea, the child will feel the pressure as an invasion.

All parents, of course, want their child to grow up and cross this threshold. Preschools often insist that a child be “trained” before he comes to school.

Other parents may offer advice and condescending comfort when their children are already trained. Grandparents may imply that toilet training is a measure of effective parenting and of a child’s overall competence. Some families may see the child’s entire second year as preparation for success in this area.

A toddler for whom independence is a passionate issue anyway will have his own struggles. He may stand in front of a potty, screaming with indecision. Or, he may crawl into a corner to hide as he performs a bowel movement, watching his parents out of the corner of his eye.

It’s a rare parent who won’t feel that such a child needs help to get his priorities straight.

When a parent steps in to sort out the guilt and confusion, the child’s yearning for autonomy becomes a power struggle between them. Then the scene is set for failure.

In bedwetting, as in many of the problems encountered with toilet training, a child’s need to become independent at his own speed is at stake. When a child’s need for control is neglected, he may see himself as a failure: immature, guilty and hopeless. The effect of this damaged self-image on his future will be greater than the symptoms themselves.

Given that toilet training is a developmental process that the child will ultimately master at his own speed, why do parents feel they must control it? My experience has led me to the conclusion that it’s very hard for parents to be objective about toilet training.

The child becomes a pawn – to be “trained.” It may take us another generation before we can see toilet training as the child’s own learning process – to be achieved by him in accord with the maturation of his own bladder and central nervous system.

When Problems Exist:

A.) Discuss the problem openly with your child. Apologize and admit you’ve been too involved.

B.) Remember your own struggles, and your eventual successes, so that you can let the child see that there is hope ahead.

C.) State clearly that toilet training is up to the child. “We’ll stay out of it. You’re just great, and you’ll do it when you’re ready.”

D.) Let the child know that many children are late in gaining control, for good reasons. Then, let him alone. Don’t mention it again.

E.) Keep the child in diapers or protective clothing, not as a punishment, but to take away the fuss and anxiety.

F.) Don’t have a child under age 5 tested unless the pediatrician sees signs of a physical problem. A urinalysis can be done harmlessly, but invasive tests and procedures – enemas, catheters, X-rays and so on – should be reserved for children who clearly need them.

G.) Make clear to the child that when he achieves control, it will be his own success and not yours.

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


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

Prior to Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

THE PACIFIER PROBLEM

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

Q. My almost 4-year-old refuses to give up her pacifier and I am concerned about her teeth. Since her sister was born 10 months ago, she seems to be using it much more. Do you recommend we get rid of it cold-turkey as some pediatricians have recommended? Will the pacifier cause long-term damage to her palate and/or teeth?

A. Some studies associate pacifier use with orthodontic problems, especially as children get older. Such findings don’t mean that any child who uses a pacifier will need orthodontic treatment, but treatment appears to be necessary more often with pacifier use.

We know of no studies that link cold-turkey termination of the pacifier with significant psychological problems later. Concerns arise from the notion that interfering with a young child’s need for oral soothing may lead to overeating and other problems.

The practical challenge in stopping pacifier use is that there’s no sure way to do it. Often, when a parent tries, the child just clings harder to the pacifier.

You mention that a baby sister came along 10 months ago.

Children often suck their thumbs, fingers or pacifiers to reduce stress. They’re bound to feel more anxious when the whole family is.

When a new baby is brought home, parents are understandably preoccupied, worn out and less available to the older child. She may wonder why her parents had to go to all that trouble for this crying, demanding, inert little creature who won’t be much fun for a long time. The question may vaguely cross her mind, “Is the new baby here because I wasn’t enough to satisfy them?”

As she tries to adapt to her new role of older sister, and learns to wait until her parents have time for her, she’s likely to feel upset. As the baby grows, there will be new challenges for the older child – when the baby says her first words, or begins to crawl or walk and get into all of the older child’s toys. A thumb, finger or pacifier can be a welcome refuge.

It may help to offer this child other strategies for soothing herself – a “lovey” such as a soft blanket to stroke and cuddle, or a stuffed animal to squeeze tight. There’s no need for lots of dolls and animals – too many will just distract her. Instead, she’ll need to become attached to a single special one. Hand it to her when she’s distressed, tired or has scraped an elbow or knee, and tell her to hug it hard to help her feel better.

After a new baby is born, the older child feels the need to be a baby, too. The baby just seems to suck up all the time and get all the parents’ attention – so why wouldn’t an older child try the same thing?

Parents often think they can help the older child adjust by praising her for being such a “good big sister.” But the older child also needs reassurance that she can be a baby again when she needs to. The more her need to regress is openly expressed and accepted, the less she’s likely to do so.

Family life is especially busy with a 10-month-old, but the older child might need some extra time to cuddle with you. Don’t say a word about it, and don’t make it an issue, but try to give her some gentle one-on-one time when she doesn’t have her pacifier. Thus she’ll learn – through actions rather than words – that there are even more rewarding places for her to find the comfort she seeks.


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

Prior to Dr. Brazelton’s passing in 2018, he was the founder and director of the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is now the director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

ANNUAL CONFERENCE 2018

Event Phone: 207-375-8184

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  • MeAIMH Annual Conference 2018
    May 18, 2018
    8:15 am - 4:00 pm

MeAIMH Annual Training Conference REGISTRATION IS NOW OPEN For our 31st Annual Conference May 18, 2018 8:15 AM – 4:00 PM Hilton Garden Inn Freeport Downtown 5 Park St., Freeport, Maine Finding the Hope and Strengths In Substance-Exposed Young Families Featuring: Jayne Singer, PhD Developmental Medicine Center, Boston Children’s Hospital Faculty & Founder Early Care Read more