child

A 4-YEAR-OLD REACTS BADLY TO BABY

by

From the NEW YORK TIMES COLUMN: FAMILIES TODAY

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

A PRECOCIOUS TODDLER’S REPLY TO A PASSERBY

by

From the NEW YORK TIMES COLUMN: FAMILIES TODAY

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

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

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

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

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

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

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

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

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

Dr. Brazelton, prior to his passing, was the founder and head of the Brazelton Touchpoints Center, which promotes and supports community initiatives that are collaborative, strength-based, prevention-focused sources of support for families raising children in our increasingly stressful world. Dr. Sparrow, a child psychiatrist, is currently the Director of the Brazelton Touchpoints Center. Learn more about the Center at www.touchpoints.org.

Reprinted with permission from the authors.

WHEN A 3-YEAR-OLD TOUCHES HERSELF TOO MUCH

by

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
WHEN A 3-YEAR-OLD TOUCHES HERSELF TOO MUCH
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. I have a 3-year-old daughter who I believe is masturbating. I have Dr. Brazelton’s book “Touchpoints” and I read about it in “Challenges to Development” and my husband and I have used his advice.

We even took her to the pediatrician to have her checked out and we didn’t get any help as to how to handle this. I have talked to her about it and she does it in inappropriate settings. I don’t know what to do. I think it has become a pattern. I want to take her to someone to be evaluated to see if she is hypersensitive as Dr. Brazelton mentions. I am a stay-at-home mother and she has only been watched by my mom and sister so molestation I think is not the problem. I need some professional help, but I want to make sure we take the right next step.

A. There are a number of reasons why children this age repeatedly touch their genital areas. They may have a urinary tract infection, a skin rash or even pinworms (which would lead them to scratch their behinds). Presumably your child’s pediatrician checked her for these kinds of causes. Any prolonged itching or discomfort in the genital area can set off this kind of behavior.

Even more common than these is the natural inclination of young children to explore their bodies, including the sensations that touching themselves stir up. This often begins when diapers come off, and rather suddenly children have more access to their genitals. Later, at age 3 or 4, they become interested and able to identify differences between their bodies and other peoples’ bodies.

At these ages, they may also start touching their genitals as a way of checking on themselves, understanding their differences: “Is that the way my body is supposed to be? Is everything there that is supposed to be there?” This kind of touching usually occurs at the normal times for being naked – bath time, bathroom time, getting dressed and undressed. It doesn’t interfere with other normal interests and activities.

For many young children, touching their own genitals can become a way of self-soothing, for example, relaxing when feeling anxious, or when trying to fall asleep. Gentle, neutral reminders should be enough to tell them that this is a private activity for alone times in their own rooms. The frequency of such self-touching may increase when a child is under great stress – for example when a new sibling is born, or when separated from parents.

Children who touch themselves repeatedly, as if preoccupied or driven, who appear unable to respond to such reminders, and who seem so compelled by this behavior that it competes with other activities, may be signaling that there is another kind of problem.

You mention the possibility of sexual molestation. Children who have been sexually abused, that is, touched in sexual ways by adults or children who are several years older than they, or shown pornographic material, may display sexual behaviors that appear preoccupying, that interfere with their play and their peer interactions, or that are adult-like in quality.

Obviously, adult-like sexual behaviors displayed by young children are stronger evidence of sexual abuse than self-touching, which is common and normal in young children.

Children who have been sexually abused may also appear fearful when with adults who remind them of the abuser, or near the place where it happened, or simply when they are separating from the adults who they can still trust. They may also appear distressed at bedtime and bath time, when they must confront the vulnerability of their own bodies. Or their behavior may suddenly and radically change – irritability and aggression are common examples, although they certainly aren’t specific to sexual molestation.

It is possible, as you seem to be thinking, that a young child simply becomes over-focused on touching her own genitals, far more focused than children just learning about themselves, or self-soothing at limited times, in limited situations.

Some experts have termed this behavior “infantile self-stimulation” or “gratification disorder,” although little is known about it, or its causes.

In some cases, it is thought, these children may lack other kinds of stimulation. For example, such behavior may begin at the time of weaning, or with the birth of a sibling, which decreased the child’s physical contact with parents.

Certainly, engaging such a child in ordinary kinds of physical play and normal cuddling, all of which is deeply involving and rewarding, may help. Avoid emotional reactions, too, since making a big deal of the behavior may inadvertently reinforce it. It is hard to tell from your question whether your child’s touching herself is within the normal range or not. Your observation that she does it in inappropriate places, and won’t stop when you ask her, are causes for concern.

We would urge you to return to the pediatrician to reconsider the possible causes and help determine whether the behavior requires more attention, or less.

If there are no other causes for self-touching that she can’t limit to alone times and that disrupts her other activities, then a cognitive-behavioral psychologist experienced in treating small children may be able to help you see how you can avoid reinforcing this behavior, and encourage other ones instead.

The idea is not to make her stop, but to help her get this behavior under control. But she mustn’t be made to feel bad about herself or her body with any approach that you take.

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 PURPOSE OF TIME-OUT

by

NEW YORK TIMES COLUMN:  FAMILIES TODAY:
THE PURPOSE OF TIME-OUT
By: T. Berry Brazelton, M.D., and Joshua Sparrow, M.D.

Q. Could you please send me guidelines for time-outs?

My son-in-law put my grandson, who is almost 5, in time-out for a couple of hours and when he ran an errand my daughter let him play and his daddy made him go back and sit.

He’s a sweet boy, and after we spank him or give him a time-out, he always apologizes.

Even the next day when we’re playing or watching a movie, out of the blue he says, “Mamaw, I’m sorry I upset you or threw a fit, etc.” He’s a very good boy. My sister and I and his grandmother tell him we love him even when he messes up. And that we have to correct him but that doesn’t mean he’s not a good kid.

A. Guidelines for time-outs? First, time-outs are not punishments, and should not be used as punishments. If they are, then of course the child will try to avoid them. This is one reason why some parents find they don’t work.

Time-outs require that a child actively cooperate to come to a quiet place to sit, calm down, think, get ready to apologize and come up with some better ways of handling himself or approaching a problem. This is an awful lot to ask a child to do if at the same time he is being made to feel that a time-out is bad, scary, uncomfortable and shameful.

Time-outs should not be presented as if the child were being banished forever to outer space. What child would ever go along with that? Instead, the child needs to be reassured that a time-out does not mean a rupture in the relationships with parents, just a quiet time to settle down and think things over before coming together again. If time-outs have come to mean punishment in your household, them it may be time to call them something different and to do them differently.

One family we know says “time to sit on the calming-down couch.” Stuffed animals and books are welcome there too.

Second, time-outs are for learning. Time-outs can be used when a child becomes overwhelmed by strong feelings – frustration, disappointment, anger, which have been expressed in misbehavior, for example yelling, hitting, talking back, being rude and disrespectful, and breaking things.

Children are not born knowing how to handle these feelings, and it is our job to help them learn. Once parents understand that time-outs are a special time in a quiet place for a child to learn to settle down and regain control, then they can help children understand their purpose.

At first, parents may need to help children calm themselves, offering them a cool washcloth to wet their faces, or their favorite stuffed animal to squeeze. These are not rewards for misbehavior. They are examples of strategies for learning how to get back in control. It can also help to remind the child of the ways he has successfully settled himself down in the past. “You might need to make a mad face and not talk to anybody for a little while. Let me know when you’re calmed down, and then we can talk.”

Once a child is calm, the next step is for him to work on recognizing his role in what went wrong. This doesn’t mean everything is always his fault. But he might be helped to see that he did have trouble controlling his strong feelings, and then did something he knows he shouldn’t have. Or that he did something he didn’t know there is a rule about – but now he does.

Now he’ll be ready to apologize, and then be forgiven, a critical step to protect self-esteem that is important to include. Forgiving does not mean that his misbehavior is acceptable, but that parents recognize his potential to learn and grow.

There seem to be a number of questions within your question.

First, about the different ways your son-in-law and daughter discipline your grandson: Time-outs don’t work when they are too long because they can’t be enforced. How can any adult get a 5-year-old to sit quietly in one place for an hour or more? (How many adults can do that themselves?)

Discipline strategies that don’t work are bound to lead to conflict between parents, which in turn undermine whatever other discipline they may try. Parents’ agreement on when to discipline and how to discipline is at least as important, if not more so, than on the specifics of what they decide. Children need parents to discipline together, although it often seems that they actively make this even more difficult than it is to do so.

Second, what, if anything, can you do, as the grandmother? Taking sides certainly won’t help. Understanding that parents usually have strong feelings about discipline, and that it is expectable for them to discipline differently – even though this causes problems – may be the key.

Then your role is not to give specific advice but simply to encourage that they share their ideas and listen to each other so that they can arrive at a shared understanding. But your children aren’t likely to listen to your advice as a grandparent. So mostly what you can do is to love and cuddle your grandchild – while trying as hard as you can to avoid turning him against either parent.

Finally, what effects is this having on the child’s image of himself, and what can be done about it? It does sound like he may be struggling with the feeling that he is a bad boy. When children feel this way, they often misbehave more and more, as if they’ve come to believe the worst about themselves.

Discipline that focuses on teaching, not punishment, and that gives a child a chance to apologize, make reparations and be forgiven, can help. Spanking won’t, since it can feel to a child like it is an attack on his “badness.” Instead, effective discipline makes the child feel that he has the potential to learn and grow and improve his behavior.

See our book “Discipline: The Brazelton Way.” Da Capo Press 2003.

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.

A BACK-AND-FORTH ON BITING (follow up)

by

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.