A TODDLER’S VERBAL CHALLENGES

NEW YORK TIMES COLUMN: FAMILIES TODAY:
A TODDLER’S VERBAL CHALLENGES
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My son is 2-and-1/2. He speaks in sentences but his verbal exchanges are more descriptive than interactive – almost like a running commentary.

He also has problems “naming” things. He doesn’t seem to grasp the concept. He is sweet and affectionate. He plays well with his younger sister and often interacts with her: He scolds her, brings her toys, tells her what to do, and makes her laugh.

Should I worry?

A. Your child seems bright and engaging, which is reassuring. But those qualities might cause others to overlook the subtle differences you detect. It’s noteworthy when a child who speaks in sentences isn’t naming objects.

When children are learning to speak, they point to things to find out what to call them, to practice naming them or to share their excitement about the words they already know. As you describe it, your son’s approach to expressing himself doesn’t involve the back-and-forth that most children this age can manage.

Perhaps he truly engages in free-flowing conversation with his sister – or she is more tolerant of one-way communication than older children and adults.

Any parent with a lingering concern about a child deserves to have that concern addressed. Mention your observations to your pediatrician. Not every pediatrician, however, has the training to pick up subtle differences in language development. A careful evaluation by a speech and language therapist who is experienced in working with children can help you understand the significance, if any, of the differences you observe.

Some pediatricians might suggest you wait to see if your son will “grow out of it.” But if he needs help, starting early can make an enormous difference.


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.

POTTY TRAINING AROUND THE CLOCK

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
POTTY TRAINING AROUND THE CLOCK
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Our 2-year-and-9-month-old son was potty-trained for daytime fairly easily at 2 and 1/2. At night he is still in a diaper, and he wakes up very wet. How do we help him to stay dry at night?

A. Your son is following the usual pattern for toilet training. Learning to use the potty during the day at 2 and 1/2 should reassure you. Use the same approach for nighttime: Keep things smooth and easy.

Staying dry at night often takes more time. Many children sleep so deeply at this age that they don’t sense when their bladders are full. As sleep cycles change, most children grow out of this problem. It is far too early to worry about enuresis, or persistent bedwetting. Most pediatricians won’t make such a diagnosis until a child is at least 5.

For children who have been dry at night for several months and then wet the bed, other causes should be considered – for example, a urinary tract infection.

The wait for nighttime dryness can be frustrating. Changing the sheets is no fun, and success seems so close once a child uses the potty during the day. Yet a parent’s overreaction may lead to resistance.

If you can avoid drawing attention to it, have your child limit his liquid intake after supper. Before he goes to bed, he can use the potty not once, but twice – in between, you two could read a story together. Then, let him bring his potty to his bed so he can learn to use it on his own when he wakes up at night. Decorate the potty with glow- in-the-dark stickers to help him find it.

Many parents have told me they have succeeded in night training by gently waking their child to use the toilet a few hours after lights out – usually just before the parents go to bed.

It’s important to keep things low-key. If your son wakes up wet in the morning, don’t make an issue of it. Just respond with an encouraging tone: “Don’t worry. When you’re ready, you’ll be able to stay dry at night.” And he will.


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.

A 1-YEAR-OLD WHO RESISTS HER CAR SEAT — AND HER MEALS

NEW YORK TIMES COLUMN: FAMILIES TODAY:
A 1-YEAR-OLD WHO RESISTS HER CAR SEAT — AND HER MEALS
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I’m the proud father of a 1-year-old baby girl.

Every time we put her into her car seat for a drive (5 to 20 minutes long), she seems fine and playful for the first few minutes but within no time, she’s crying for attention. She’ll do the cry-stop-cry-stop for as long as 20 minutes.

She’ll reach a point where she’ll just burst into continuous tears. My wife and I have tried toys, Cheerios, cookies, singing and even ignoring her to see if she would stop. The toys, food and singing work just for a minute or two but that’s about it.

We’ve reached the point where we dread going for drives. We know that she’s OK because her diaper is dry, she’s well fed and she’s not tired (when she is tired, a pacifier puts her to sleep in no time).

There is another issue as well. Our daughter is a great eater when it comes to formula and Cheerios (sometimes some cookies). However, we’ve been working on trying to give her solids but with no success.

You’ve said that milk is fine until age 3 but you also recommend the child having bread, yogurt, orange juice, etc. Our daughter will have minimal to no solids – I mean like two to three pea-sized pieces of chicken/tomato/cucumber, etc., MAX!

It seems that all the other kids her age are eating quite well. As you’ve mentioned, we tried giving her solids before her regular feeds (when she’s hungry) but haven’t gotten anywhere.

Also, when she’s in the highchair, we’ll immediately take her out if she starts throwing the food onto the floor. I must mention that from 6 months of age till 9 months, she was eating oatmeal baby cereal once a day. She then reached a point where she didn’t even want to see the spoon coming toward her.

People tell us that she isn’t eating her solids because we started solid feeding too late. They all think we should have started at four months instead of us starting at six months.

A.    A two-fer!

First the car seat:

You are not alone. Nor is your 1-year-old. Babies were not designed to be in car seats, no matter how well car seats were designed to protect them. Many 1-year-olds hate them. Their energy is likely to be focused on getting up and getting going. Whether they’re already walking or not, at this age, children are intent on moving, practicing their moves, strengthening their muscles, learning to balance and to experience the world around them. So of course your baby is bound to protest until she can get going again.

You say she’s crying for attention, but it sounds like when you give it to her, it doesn’t help. So it may be that she’s just letting you know that she hates being restrained, and can’t wait to get out. Don’t let her until you’ve arrived at your destination. But don’t worry. When she’s older, and takes walking for granted, she won’t mind sitting still as much as she does now.

In the meantime, she might be more likely to settle if one of you can sit next to her and soothe her. You’ll miss out on being together as a couple on your drives during this period, but it doesn’t sound like you could be having much fun anyway with all that screaming. (And of course this won’t work when you’re all alone to drive her.)

The other possibility is that she may be motion sick – that could be why she seems fine for the first few minutes. Does it make a difference if you drive more gently, taking it easy on the accelerator and the brakes, and slowly around the curves? You might try a bottle for her to suck on to see if this helps to settle.

Next, the picky eating:

It sounds as if the advice and criticism from books and friends are making you doubt yourself. Yet what you describe can be right on track for many children, as long as their growth and health are. (And we don’t think you need to worry about having started solids at six months.)

You say you could spoon-feed her cereal from 6 to 9 months – and then, nothing doing. Nine months is the age when many infants seem to announce to their parents that they are ready to take over. They’ll start grabbing for the spoon, and now that they can, they’ll pick up food between finger and thumb and throw it on the floor. It is time to start involving them in their own feeding. At this age give them a spoon, and let them try to shovel in their food themselves. Or try one spoon for each hand, so that you can use a third one to feed her while her hands are busy.

But at 1, or a few months later, many children start making a fuss about feeding. If you try to force them, you’ll lose. You are right about the pea-sized pieces of food. Just put a few of these on her table at a time. That way, she won’t be overwhelmed, and when she hurls them overboard, you can just start again. Many children need to be introduced to the same new food over and over before they’ll give it a try and many more times before they can accept the taste and texture.

If your pediatrician can check her out, and offer vitamin and iron supplements, you’ll be able to relax, and avoid the struggles that tend to just make the picky eating worse. You and she are lucky that she still likes her milk! (See our book “Feeding Your Child: the Brazelton Way,” Da Capo 2003, for more suggestions, and information on children’s nutritional needs.)

The best part – that no matter what, you are a proud father! Congratulations.


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.

“WHERE DID I COME FROM?”

NEW YORK TIMES COLUMN: FAMILIES TODAY:
“WHERE DID I COME FROM?”
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My older daughter was conceived through IVF (in vitro fertilization). Shortly after her birth I began wondering when she might ask the inevitable question, “Where did I come from?” What would you say?

A. Children usually ask that question at age 4 or 5 when they begin to wonder about the differences between boys and girls’ bodies, and between their bodies and their parents’. This curiosity coincides with the time when children deeply want to imitate their parents and identify with them. They are becoming more aware of gender differences and seek to understand why they are different and how their bodies work.

The questions are perfectly natural: “Where did I come from?”, “How does the seed get to the egg?” and “How does the baby get out?”

So it’s a good idea to be ready when your child is approaching that age. Conception, pregnancy and birth are such miraculous feats that it is hard for any of us to fathom just how they all could happen. Add in the marvels of medical technology and it’s no wonder we struggle to answer children’s questions.

Fortunately, children only take in simple, clear answers aimed at their level of understanding. If you overshoot with details, eyes glaze over or the kids start fidgeting and change the subject.

Your reply to your child depends on a few specifics – including her age and her interest in bodies or babies. Your reply also depends on whether she was conceived with her mother’s egg or a donor’s.

The basic information is the same. Babies come from an egg from a woman and a kind of seed called sperm from a man that fertilizes the egg. These facts of life are already surprising and hard enough for a child to understand. You may not be adding much to spell out that sometimes the egg comes from the mommy and the sperm from the daddy, and sometimes they get it from another woman or another man if they need it to make the baby they both want so much to have.

By now, the child may have heard enough until the next conversation. If so, you can save this information for then: The fertilized egg grows inside the woman’s body, in her womb – a kind of pouch inside made especially for babies to grow in. The baby comes out through the mother’s birth canal, or she may need an operation to help the baby come out.

Parents love their children no matter where they come from, how they are conceived and born, or what the connection happens to be between biological parents and “real” parents in a family. This is what children need to know most of all.

For more information to answer children’s questions about their bodies, see Robie H. Harris’ books, including “It’s Perfectly Normal.”

How to talk about the birds and the bees? Tell the truth. If not, you may lose a child’s trust. You needn’t tell the whole truth all at once, just what the child can handle. Be open to a child’s questions and ready to answer, which will prepare the way for open communication all the way through adolescence. Let the child’s questions and behavior guide you. If you watch and listen you’ll know when you’ve given a little too much information.


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.

3-YEAR-OLD’S SEPARATION ANXIETY

NEW YORK TIMES COLUMN: FAMILIES TODAY:
SEPARATION ANXIETY
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I am a professional and a married mom with two wonderful boys, ages 3 and 1.

The 3-year-old struggles with severe separation anxiety every time I go to work. He wants me to be the person who does everything for him.

He throws a fit if his father or grandmother diapers him or helps him dress. Getting out of the house in the morning is so emotionally exhausting that it’s affecting my job.

We have a strong bond and spend one-on-one time together every day, but this aspect of parenting is so hard. Now my other boy is starting to behave the same way.

A. Is your 3-year-old close to the person who takes care of him while you are at work?

Your confidence in his caregiver can reassure him that everything will be OK until you return. If you have doubts, your boy will pick up on them.

If you give in to his tantrums, you are sending the message – even though unintentionally – that he’s right to want you and no one else.

At 3, your boy is old enough to understand that you still exist even when you are not in sight. But a reminder will help. Let him know where you are going. Describe your workplace so he can picture you there. Give him a photo of you, or an old small scarf of yours, and tell him to hug it tight or keep it in his pocket.

Does he have a favorite stuffed animal or doll? If not, let him pick one – just one – and encourage him to hold it close when he is feeling sad or frightened.

Remind him that you have always come back and that you always will. Show him examples of other things that go away and come back, like the sun and the moon and the stars, the day and the night.

Read him a book about young children who are either looking for their mothers (“Are You My Mother?” by P.D. Eastman) or running away from them (“The Runaway Bunny,” by Margaret Wise Brown) – the flip side of the same coin.


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.

CARRYING A TUNE

NEW YORK TIMES COLUMN: FAMILIES TODAY:
CARRYING A TUNE
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. My sons, who are 6 and 3, have been able to hum and sing on key since before they were 2. Why can’t my almost-5-year-old daughter carry a tune? Do most children grow to recognize pitch?

I don’t want to sign her up for singing lessons for fear it might squelch her delight, but it’s difficult to listen to her. I fear the day when peers tell her she’s off-key. For the record, my husband and I are musical, and I was able to sing harmony when I was 4.

A. Your 5-year-old may not be able to carry a tune, but that doesn’t mean she is tone-deaf. Amusia, the medical name for tone-deafness, is an impaired ability to discriminate between pitches. The brain pathway responsible for pitch perception doesn’t fully connect with parts of the brain involved in sound perception and production, according to a recent study. About one in 20 people are tone-deaf. Many who can’t carry a tune can still distinguish pitches, another study says.

Telling the difference between pitches is only part of singing on key, which also requires the ability to remember pitches and to reproduce them. Many off-key singers have another problem. They can differentiate pitches and remember them, and their voices work fine, but they can’t combine these skills. In effect, they lack the aural equivalent of hand-eye coordination.

Perfect or absolute pitch is the ability to identify individual pitches without a reference, like a pitch pipe or a piano. Only one in 10,000 people have absolute pitch. Relative pitch allows you to identify pitches after hearing them. Most people, including most musicians, have relative pitch.

Children’s rapidly developing brains are malleable; we bet that musical training at a young age can make a difference. We share your concern about spoiling your child’s musical joy. It’s hard to learn anything, or to overcome a personal obstacle, without hope.

We suggest you find a music teacher (perhaps with a background in speech and language pathology) who is experienced with young children, and who will take on this challenge with patience and respect.


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 BACK-AND-FORTH ON BITING (follow up)

From the NEW YORK TIMES COLUMN: FAMILIES TODAY

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

In a recent column a grandmother recommended her solution to the problem of children biting: Bite back. We demurred. Now another mother lobbies for the fight-fire-with-fire approach.

Q. This is in support of the politically incorrect biting mother and grandmother. There is nothing like experience to teach us, and I’m talking about biting toddlers. We can talk a blue streak, and it’s all abstract to a toddler; they need to learn that if they cause pain, it comes back at them.

These are my biting stories from the trenches. I was nursing my baby and his teeth were starting to come in. After having toyed with the idea for some time, he finally bit me while nursing. I let out a very loud bellow out of proportion to the pain, because I was not going to have that happen again. The poor baby got quite traumatized by my loud scream, but he never bit me again.

When he was a toddler, I took him to a day care where there was a hyperactive boy who was a frequent biter. Nothing the parents or day-care provider tried changed anything. Finally the day-care provider’s toddler took matters into his own hands and bit him back. End of biting.

When my boy was a toddler, he kicked my leg. Like the politically incorrect grandma, I very carefully placed a kick on his leg (I was so scared of hurting him that the first attempts were air kicks). He never kicked anybody again. I must add that this boy is now 14 and a joy (besides the fact that, being a teenager, he counters everything his parents say).

A. Small children’s biting certainly creates a red flag for everyone. Yet it is such a universal response in late infancy and toddlerhood that it deserves all its eminence.

Starting out as an exploratory and often loving response when a nursing baby bites the breast of his mother, it gathers drama from the surprised, angry and even frightened response, “Have I lost my baby? Do I deserve this negative hurtful response when I’m giving him everything I can? Will he turn out to be a monster?”

For him, it is likely to mean that when he suddenly raised such a dramatic response, “Should I try it again when I need to get her attention?” Then, he may begin to fall back on it when he is tired or overwhelmed or doesn’t know any other way to get the attention of someone he craves. He tries it out on a peer toddler. The world blows up. Everyone overreacts. “Wow! This is more important than I thought. I’d better shove this behavior way down underneath. I’ve learned there are certain behaviors that I don’t dare to express. They mean something terrible to other people, even though that’s not what I meant when I tried them. I’d better be more inhibited than I was.”

Inhibitions can be expensive in the long run. Your method of retaliation has surely worked. But what has it meant to the baby or toddler? “I’m bad, or she wouldn’t have hurt me, and I’m not sure why. But I guess I’m just a bad kid.” Is that what you meant to teach him by your response?

Meanwhile, seeing it from the standpoint of the baby’s development, it has been a missed opportunity. Each behavior which becomes an intrusive or painful one presents the child the chance for him to learn about how to control himself.

A child who learns self-control is already way ahead of a child who must rely on an adult’s presence to be controlled by force or by retaliation. Learning self-control is a major goal for childhood in our present out-of-control society. Discipline (teaching) is the second most important gift we as parents can give a child. Love first, but discipline that says, “I shall have to stop you until you can stop yourself.” That’s a much longer goal in time than just teaching him to suppress his responses and his feelings.

Everything we know from research in child development demonstrates that suppressing angry, hurt feelings just postpones them. For a parent or a teacher or any caring adult, each episode needs to be understood from the child’s standpoint. We can use his hurtful behavior, share the idea of self-control rather than just shutting it off. “I can’t let you bite. It hurts and no one likes to be hurt. Let’s find another way for you to say what you’re trying to say.”

The story you tell of the child’s learning from another child how biting hurts and how necessary it was to control himself was on a different level. Children learn so much more from each other than they do from an adult. It’s fascinating to watch two toddlers as they reproduce by imitation hunks of behavior from each other.

I have recommended putting two 2-year-old biters together. One would bite the other. They’d look at each other with a startled look. “That hurt.” And they wouldn’t bite again. This is an almost sure cure, but maybe one to be used sparingly, in case it could get out of hand. When it works, one can see on the biter’s face that he recognizes the fact that he’d hurt him. “I never knew what I was doing could hurt someone. I can’t do that again.” He will have learned (at 2) how to experience what another is feeling – a major step toward empathy for others.

When an adult bites him back, his reactions are hurt and anger. He may not have meant to be aggressive in the first place. Now, biting could become loaded with angry feelings. Certainly, it has not been a learning experience except to stop the biting – but not the anger that being bitten has generated.


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.

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.