PREVENTING CHILD ABUSE: SOURCES OF STRENGTH

NEW YORK TIMES COLUMN: FAMILIES TODAY:
PREVENTING CHILD ABUSE: SOURCES OF STRENGTH
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Although written several years ago by Dr. Brazelton and Dr. Sparrow for the Families Today column, the content of this article remains relevant today.

(This is the second of a two-part series on child abuse. Last week, Part 1 outlined the problem’s national scope.)

At a conference in Washington last week, reports on child abuse and neglect in the United States revealed a national crisis.

In 2007, an estimated 1,760 children died from abuse and neglect – up 35 percent from 2001, according to federal statistics. In that same year, service agencies received nearly 3.2 million reports of maltreatment.

The deaths are preventable, according to Every Child Matters, a nonprofit advocacy group that issued the report, “Stretched Too Thin: Child Abuse and Neglect in America.”

Much is known about the risks and how to reduce them.

Child abuse and neglect occur in every socioeconomic group, but poverty is a major factor.

A child living in a family with an annual income of $15,000 or less is 22 times more likely to be abused than one in a family with an income of $30,000 or more. One in five American children, more than 14 million, lives in poverty.

Of course, quality education and health care can go a long way toward reducing poverty.

Alcoholism and substance abuse are present in 50 percent or more of child-abuse and neglect cases. Access to drug and alcohol treatment can make all the difference, yet many parents lack that access. Infants and young children are most at risk.

Here are some danger points where parents need extra support:

  1. Colic, or unexplained-end-of-the-day crying, occurs in the majority of infants, and it peaks at eight weeks. Three hours of daily crying that is unresponsive to consolation is hard for any parent, much less one on the edge.
  2. When babies start to crawl and walk, they require a great deal of supervision; overextended parents could blow a fuse during this time.
  3. Toilet training, if feelings of failure and desperation mount on all sides, is another trying time. During these brief intervals of difficult behavior, young children will cry more, cling more, and seek more attention and physical contact from their mothers. If the mother’s relations with her partner are tense, the baby’s crying and clinging may stir up frustration and resentment, which can boil over into abuse. Professionals working with families can help anticipate such challenges and reassure them that no one is to blame. Among the programs that help mothers and fathers become the kind of parents they would like to be: the Parenting Journey, Strengthening Families, and the Nurse Family Partnership.

We have the knowledge to protect children, but we haven’t dedicated adequate resources to putting that knowledge to work.

Family, friends and community also are vitally important in helping at-risk parents to weather the storms of child development. Parents who have someone to talk to are more likely to vent their frustration in that forum rather than taking it out on their children. Caring support can give parents the help they need before they lose control.

(This article was prepared with materials provided by and used with the permission of Every Child Matters, everychildmatters.org.)

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

Dr. Brazelton heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

PREVENTING CHILD ABUSE: WE CAN DO BETTER

NEW YORK TIMES COLUMN: FAMILIES TODAY:
PREVENTING CHILD ABUSE: WE CAN DO BETTER
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Although written several years ago by Dr. Brazelton and Dr. Sparrow for the Families Today column, the content of this article remains relevant today.

(This is the first in a two-part series on child abuse. Part 2, which will be available next week, outlines warning signs and sources of strength for families.)

Child abuse and neglect exist on a scale more massive than many of us realize.

From 2001 to 2007, more than 10,000 children died from abuse and neglect, according to a new report released today by the nonprofit advocacy group, Every Child Matters.

More than 20 million reports of child maltreatment have been made so far this decade to government agencies.

In 2007, about 75 percent of children who died of abuse or neglect were 4 or younger. Almost half the deaths were among babies who had not yet reached their first birthday.

The crisis in our health care system aggravates the threat. Children with special needs may be at higher risk, yet medical treatment for them is out of the reach of many families, adding another layer of stress.

Mental health and substance misuse problems among parents are also risk factors for child abuse and neglect. Treatment, however, is often inaccessible or inadequately insured, and many families have no coverage at all.

These factors can push vulnerable families to the brink. With access to quality care, families would get a healthier start.

The U.S. child-abuse death rate is three times higher than Canada and 11 times higher than Italy.

Why? These countries invest more per capita in families. Affordable child care, universal health Insurance, paid parental leave and visiting-nurse programs address many risk factors for child maltreatment.

These countries’ rates for teen pregnancy, violent crime, imprisonment and poverty are much lower than the United States, which, by comparison, invests modestly in preventive measures.

Many states’ resources are stretched thin.

Some states spend as much as 12 times per capita more than others. In 2007, the child abuse and neglect fatality rate in the most dangerous state for children was 16 times that of the safest state.

The recession has already weakened under-funded child protection systems.

Differences among the states can translate directly into whether children live or die.

States that spend more are likelier to investigate a higher proportion of abuse and neglect reports because social workers have more manageable caseloads. Children fall through the cracks when social workers have too many families under their care.

In some districts, a social worker may be responsible for 60 or more families, though national standards recommend 12 or fewer per worker.

Child protection work is difficult and emotionally draining. Child protection workers must often make harrowing decisions – like leaving a child in harm’s way or terminating parental custody.

The preventable deaths of children demand the attention of policy makers and elected officials.

While direct responsibility remains with local and state child protection agencies, law enforcement and courts, the challenge is national. Local efforts must be strengthened by expanded federal planning, coordination and funding.

Federal funding provides nearly half the needs of the child welfare system, and much of the legal framework.

The federal government is required to assess each state’s child protection performance and to recommend improvements, but neither federal funding nor oversight is at levels sufficient to protect all children.

President Obama and the 111th Congress have shown strong interest in child well-being in their early policy and budget decisions. Now they must intensify federal involvement in what Every Child Matters calls “homeland insecurity” for thousands of our country’s most vulnerable citizens.

Pressure on policy makers can start with parents, grandparents and other citizens who want to stop child abuse. Community leaders and legislators respond when they hear from constituents who speak up for those who don’t have a voice or who are too young or too frightened to speak for themselves.

(This article was prepared with materials provided by and used with the permission of Every Child Matters, everychildmatters.org.)

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

Dr. Brazelton heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

ADJUSTING A CHILD’S SLEEP SCHEDULE

NEW YORK TIMES COLUMN: FAMILIES TODAY:
ADJUSTING A CHILD’S SLEEP SCHEDULE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

One of our children never succeeded in getting more than eight hours of sleep at night. As a young toddler, she was very cooperative about going to bed, but she woke early and began to rock in her bed.

We knew she was awake by 5 a.m., but we weren’t eager to get up with her. I often went to her to offer a safe toy. When she was 3, we’d call out to her to talk with her teddy bear until we could come in to see her.

Early-morning awakening can be difficult for parents. By 6 a.m., many children have had enough nighttime sleep (10-12 hours between age 6 months and 6 years).

If your child is awakening before 6 a.m., he may in fact need slightly less sleep. But surprising as it may seem, early awakening can occur when a child isn’t getting enough sleep – which can make it hard for a child to sleep normally.

Early awakening may also occur when a child is getting enough sleep, but at the wrong times.

To understand a child’s early awakening, it can help to re-examine the child’s sleep patterns. How many hours of sleep is he getting at night? And during the day?

What time do his naps begin and end? When does he go to bed at night? Does he go to sleep easily? Does he usually seem well-rested when he wakes? Is he fairly good-humored and able to remain alert during most of his waking hours?

The answers to these questions should help you determine what sleep he needs: a little less, a little more, or the same amount but at different times.

For the well-rested child who needs a little less sleep or only a readjustment in his sleep schedule:

  • Re-examine his daytime sleep.
  • Consider delaying, shortening or eliminating a morning nap if he is also napping in the afternoon.
  • Be sure his afternoon nap doesn’t continue after 3 p.m.
  • Give him a later supper.
  • Put him to bed a bit later in an effort to readjust his clock.
  • Wake him before you go to bed to rock him and sing to him, and to interrupt his rhythms. Many children will sleep through from 10 p.m. to 6 a.m. if you interrupt their cycle.

For the tired child whose poor sleep leads to more poor sleep, including early awakening, you may need to lengthen naps and set earlier bedtimes. As your child catches up on his sleep, he’ll be better able to sleep normally for the roughly 10-12 hours he needs at night.

All this transition takes time but helps him gradually adjust to your rhythms.

For any child who wakens too early, be sure that his room remains quiet and dark as the sun comes up and the day begins. Some children are easily roused from the light sleep of early morning by any sunlight that gets past the blinds, or by noises in the house or neighborhood. Try dark shades and curtains that fully cover the windows.

He may need his windows shut, or even a white-noise machine – though he may soon become dependent on the machine.

If you go in to play with him when he wakes up in the early morning, he’ll surely wake up at the same time, or earlier, the next day to have more time with you. Children learn early to “set their alarms” for the things they care about.

(This article is adapted from “Sleep: 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 heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

OUTGROWING THE PACIFIER

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

Q. My nearly 3-year-old daughter still uses a pacifier to fall asleep for her naps and at night. Otherwise she doesn’t use it. I’ve gotten conflicting advice about whether this will cause orthodontic problems in the future. I’m loath to take the pacifier away from her since it’s such a limited use and it really does soothe her and help her fall asleep.

A. Many orthodontic problems are genetic, and the development of a child’s teeth, bite and facial bone structure changes over time. It may be impossible to know whether a misaligned bite would have emerged even if a child hadn’t used a pacifier.

Sometimes, stopping pacifier use appears to correct bite problems. You can have your child’s pediatric dentist take a look, but it may be tough to predict the future of problems identified now unless they’re severe.

Researchers compare groups of children who use pacifiers to those who don’t. Studies rely on parents’ reports and must track the children over years. Results may be complicated by habits that aren’t always reported – for example, children’s finger- and thumb-sucking.

Many studies report that bite misalignments are more common in children who use pacifiers, and that some problems (particularly posterior cross bites) are likelier with longer duration of pacifier use, markedly so after age 4.

Along with research limitations, deep-seated prejudices also come into play. Sometimes pacifiers seem to be misused as “plugs” to keep a child quiet.

When the pacifier becomes a kind of panacea for a child’s distress, there is cause for concern. The pacifier may keep parents from learning to offer a broader range of responses. It may interfere with the child’s learning other ways to soothe herself and even to understand and express her own discomfort.

Some adults may be troubled to see young children soothe themselves. Sucking a pacifier may seem “babyish” and lead to fears that the child will never stop. It is reassuring to see a child move ahead on her developmental pathway and discouraging to watch her hold onto or even revert to an old behavior.

Adults may worry that pacifiers, thumbs, bedraggled blankets and beloved stuffed animals are “crutches.” Children are often pushed to give up such habits before they’re ready – before they’ve mastered other ways of handling feelings of distress.

One simple guideline: If you try to take away a pacifier, or stop a child from sucking her thumb or fingers, you are likelier to reinforce the behavior. Instead, you can make the pacifier available as little as possible, and only for those very specific and common times when a child needs a self-soothing measure to settle down for sleep.

Once your 3-year-old is sound asleep, you may be able to ease the pacifier out of her mouth.

Occasionally we hear about a parent who gets away with “just losing” the pacifier, and who sympathizes with the child’s sense of loss while taking as much time as possible to replace it.

But we wouldn’t recommend this ploy. Instead, introduce a “lovey,” a soft bit of cloth or favorite doll that she can hold and stroke as she goes to sleep – while she sucks on her pacifier. This will help her learn to rely less on the pacifier, and may help her give up the pacifier sooner.

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

Dr. Brazelton heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

IS A CHILD READY FOR TOILET TRAINING?

NEW YORK TIMES COLUMN: FAMILIES TODAY:
IS A CHILD READY FOR TOILET TRAINING?
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Around her second birthday, a child may show initial interest in the potty or training seat. Often this interest soon vanishes, especially if eager parents seize on it. Don’t be fooled by these early indications. Let the first steps be the child’s.

Before age 2, your child isn’t likely to be ready for toilet training. But it’s time to watch for seven new behaviors – usually not all present until then – as the earliest expressions of a child’s readiness.

When one or two signs appear, parents are bound to want to start toilet training. But they need to wait for the others to appear.

  1. She’s not as excited about walking and being on her feet all the time. At 18 months (and often older), she’s ready to sit still and learn a new task, like using her fingers for complex activities.
  2. She has “receptive language” – the ability to understand the words she hears: for example, a parent’s wishes. She can remember what she is told and translate it into action. She can even carry out a two-step command: “Go to your bedroom and bring me a book for us to read together.” And she’s so proud of herself when she succeeds.
  3. She can say, “No!” Don’t push her before she knows how to tell you whether she’s ready. She needs to decide for herself. A child may comply with toilet training for a while, as if to please the parent. Then she may stop, as if she’s realized, “This wasn’t my idea.” Once she can protest with words, she can make toilet training her own job.
  4. She starts putting things where they belong. She may even begin to pick up her toys. Some children this age amuse themselves by lining up toy cars or doll furniture. I’m always amazed at this orderliness that crops up sometime after a second birthday. She is getting ready to use her potty as an appropriate place for her “products.”
  5. She imitates your behavior. A girl wants to wear her mother’s shoes. A boy puts his father’s tie around his neck. This urge to imitate is a precious incentive for a child to use the toilet – “like mommy and daddy.” Children this age are already pressuring themselves to live up to their parents’ behavior. Pressure from parents can make the challenge seem hopeless.
  6. The child starts to urinate and move her bowels more predictably. Her urinary and digestive systems are maturing. She may remain dry for up to two hours at a time. Toward the end of this year, a child may even be dry throughout a nap. These patterns are a real tease for waiting parents who may mistake them as a sign of readiness.
  7. She becomes aware of her body. She points to her wet diaper. She grunts when she’s trying to have a bowel movement. Her awareness helps her train herself. She also starts labeling her body parts and functions. Your own words, or hers, are probably the best. All can alert her to her bodily functions.

When I share these developmental steps with parents, they say, “But this process may take forever!” I assure them that these skills come in a predictable way, and that toilet training is much easier and more successful if they wait for all the signs.

(This article is adapted from “Toilet Training: 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 heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

HITTING, KICKING AND SCRATCHING

NEW YORK TIMES COLUMN: FAMILIES TODAY:
HITTING, KICKING AND SCRATCHING
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Most children go through a period of hitting, kicking and scratching in the second year. Parents are often the first victims.

For a child, parents are the primary source of comfort and sustenance, so when something goes wrong, they’re the first to be blamed.

But when a child is about 7 or 8 months old, parents will find themselves pressed into denying or frustrating his new demands. At that age, he can express his wants more clearly, begin to move around on his own and try to do things he can’t. Be ready for him to take his frustration out on you!

By around 9 months, he has also learned how to test limits. He’ll see whether you always mean what you say. When the answer is ”No!” he’s bound to fall apart and lash out. Suddenly, without thinking, he’ll scratch his fingernails across your face. What a shock!

Make a stern face, and just as sternly say, ”No. Don’t hit. It hurts.” But don’t get too excited, or he’ll think it’s a game and want to try again. Put him down, or turn away from him.

Parents’ first task is to stay in control of themselves. He may make you so angry that you want to smack him. Don’t. He needs you to model for him what he must learn.

Hitting, kicking and scratching are also a last resort for children when the demands of a situation exceed their social skills or their ability to use words to express themselves. They may also hit when they feel belittled, or when they want to assert their dominance in a schoolyard pecking order or with their siblings.

When a child feels frightened and without protection – for example, if the adults around him use physical aggression, or threaten to – he may become physically aggressive himself.

If your child repeatedly fights with peers, talk to his teacher and his pediatrician. If necessary, they can help you find specialists such as a speech pathologist or a psychologist.

Sometimes preschool children just collide, get hurt, lose control, and then flail back in retaliation. They’re still learning to balance, and to plan how they’ll move, but they can’t always anticipate the results. They’ll also attack when they want to play with a toy made more exciting because it’s in another child’s hands; when they want their turn now, not later; or when they’re losing but want to win.

Preschool children hit, kick and scratch because they’re still working on important skills:

  • making friends
  • paying attention to other people’s needs
  • sharing
  • taking turns
  • losing gracefully
  • apologizing, and meaning it
  • negotiating relationships
  • resolving conflicts, solving problems
  • anticipating, understanding, and caring about the feelings of others

The second and third years are the appropriate times for children to begin to learn these social skills. When adults stop to consider how much preschoolers have to learn, it’s easy to see why they still often resort to simpler, blunter tools.

How to respond to hitting, kicking and scratching:

  1. Reestablish safety: ”Stop hitting right now.” If the children don’t respond at once, separate them.
  2. Comfort the victim and the attacker: Strong feelings between them – hurt, fear, guilt, or a longing for revenge – will make it harder for each child to face what has happened and to repair their relationship.
  3. Set limits: ”It’s wrong to hit, and it won’t be allowed.” Say it like you mean it, and make sure you look like you do. Be sure, too, that other adults back you up.
  4. State consequences: ”If you hit someone else like that, you’ll have to stay by yourself until you’re ready to play without hitting. I can’t let anybody get hurt. And I can’t let you hit.” Explain the natural consequences of aggressive behavior: ”If you hurt people, they won’t want to play with you or be your friend.”
  5. Model empathy: When one child grabs a toy from another, help the grabber step into the other child’s shoes: ”Can you imagine how you would feel if someone grabbed a toy away from you? How do you think she felt when you took it from her?” You’ll do better if you ask these important questions with more patience than exasperation.
  6. Resolve the conflict. To the grabber, a parent can say, ”You’ll need to give back the toy. And say you’re sorry. But you could ask her to let you play with it when she’s finished. Or you could ask her to trade it with one of your toys.”

(This article is adapted from “Mastering Anger & 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 heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

BULLYING AND TEASING: THE PLAYGROUND ROOTS

NEW YORK TIMES COLUMN: FAMILIES TODAY:
BULLYING AND TEASING: THE PLAYGROUND ROOTS
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

The wave of suicides among adolescents and young adults who have been mercilessly bullied on the Internet is a national tragedy.

The roots of bullying begin much earlier – at age 4 and 5, when children become aware of their differences and comment on them openly as they work to understand them.

At this age, children are learning about right and wrong, good and bad. They’re bound to feel that everything must go into one category or another.

Differences can call up a child’s insecurity – the basis for taunts and teasing. By the fifth year, a child learns she can use words to hurt, “Your skin’s dark. You’re fat.” The other child senses the scorn in the first child’s voice and winces. The teaser feels powerful. Underneath, she may be frightened of the power of teasing and of her own aggression.

Gender is one of the first differences that children recognize. Boys tease girls. Girls tease boys. Each teases his own gender for seeming like the other. Underneath the teasing is a question: “Is it OK for me to be the way I am? And to like her as she is?”

Skin color is another difference. If it weren’t for adult prejudices, children would be unlikely to see different skin colors, facial features or hair textures in positive and negative terms. Children learn racism from the adults around them.

It’s not useful to pretend that we’re all the same. We’re not, and 4- and 5-year-olds realize this. Can they understand that we can be equal even though we’re different?

Rather than telling children what to think, encourage them to think carefully about their assumptions, “OK. So her eyes are different from yours. His skin is different from yours. What do you think that means?” Give your child a chance to ponder the question. Then, you might ask, “How can you tell if someone is a friend? By what they look like? By how they act? By what’s on the outside, or what’s on the inside?”

HELP FOR THE BULLIED AND THE TEASED

Safety comes first. Parents will need to find out whether the bullied or teased child is in danger. They may have to escort him to school and be more of a presence in places where the bullying occurs, such as the playground. They can also discuss the situation with teachers and other parents.

Although more adult supervision can help, if it conveys the impression that the victimized child is receiving special treatment, it may backfire and lead to more teasing when adults aren’t around. More adult protection than necessary can also leave the victimized child feeling even more helpless and vulnerable. Teasing and bullying are more effectively addressed when the rules are spelled out and consistently enforced for all the children.

The victimized child will need help to learn to protect himself. Parents can share the child’s feelings with him, “It feels awful when someone is so mean.” Talk it out with him. Remind him of his strengths. Offer him other ways of looking at himself and his tormentors so that he doesn’t have to take the teasing to heart. He can be helped to see that he has power over whether he lets these taunts get under his skin.

As my mother used to say, “When other kids tease you, just picture them without their clothes on. But don’t tell them it’s your secret weapon!”

A child who is bullied may find it helpful to take a self-defense class so he can project an air of self-confidence. Such classes are available for children as young as 3.

The victims of bullying and teasing will need help in learning to value and feel proud of their differences so they can’t be used as weapons against them. Parents can help by accepting them as they are and valuing their differences as strengths.

If a child continues to be victimized, over and over, he may need a fresh start in a new, more protected peer group. Children who consistently flounder in social situations may have a more serious disorder that interferes with understanding body language and other important but subtle aspects of communication. Your pediatrician can refer you to a child psychiatrist, psychologist, and/or a speech and language pathologist.

HELP FOR THE BULLIES AND TEASERS

A bully is an insecure, unhappy child. Peers shun him. He may attack when he feels threatened by signs of vulnerability in another child that remind him of his own. He may use intimidation to keep others from threatening him.

Often an aggressive child has been the victim of aggression. Has he been made to feel small and weak by an older sibling or peer? Is he vaguely aware of his own immaturity – perhaps in the area of language or social skills – and does he compensate by teasing his peers?

Bullies and teasers can be helped to feel certain enough of their own competence so they are less threatened by other children’s displays of weakness. They can also learn to face their own vulnerability as a sign of strength and a source of pride.

If their bullying persists, damaging their relationships, they, too, may need help from a child mental health specialist.

(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 heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

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.

Dr. Brazelton heads the Brazelton Touchpoints Project, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is Director of Strategy, Planning and Program Development at the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

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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 moreANNUAL CONFERENCE 2018