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

In these challenging times, we risk losing our sense of balance. Technology and global competition have changed how we work. Multitasking has been glorified while new stresses on working parents sap more energy. Yet the most important jobs – like child raising – can’t be done without our full attention.

Working parents are less productive when they worry about their child care arrangements or about their co-workers’ resentment of parental time off when a child is ill.

Families suffer when parents – tethered to smart phones and laptops – bring work home. They may be home, but their jobs are their focus. They may be less engaged with their families, less available to them emotionally.

Yet that availability is critical for child development and strong family relationships.

Children and parents need protected time together to focus on each other, to watch, listen and respond with a minimum of intrusions.

From the start, babies and parents are learning to understand each other and themselves.

Since newborns have been listening to their parents’ voices for several months before birth, I like to help parents discover how much they and their babies already matter to each other.

I hold a newborn with his head in one hand and his bottom in the other. I ask the mother to stand on one side and to talk to her baby in one ear while I talk in the other.

Of course, most every newborn turns his head to his mother. And every mother grabs her baby, kisses him and says, “You know me already!” Then I do the same thing for the fathers. Eight in 10 babies turn their heads to their father’s voice instead of mine. With the other two, I tip their heads toward their fathers – to establish the “conversation.” The fathers react just like the mothers.

In our research, we found that 2-month-olds are already “conversing” with their parents. Sometimes a baby leads; sometimes he follows. He is learning that he can act on his world, and that he will be heard.

Babies and parents are working hard to get to know each other. They are already sharing emotions.

In another experiment, researcher Ed Tronick and I ask mothers to interact normally with their 2-month-olds – and then to turn away. When the mother turns back, we ask her to be unresponsive, expressionless: the “still face.”

Within 11 seconds the baby realizes that something is not right. Then he’ll try 15 different behaviors – smiling, crinkling his eyelids and cooing – to try to win back his mother’s attention.

The baby’s response changes if the mother is depressed. In the “still face” experiment, the baby gives up after only three tries.

Since we can detect maternal depression early and know how to treat it, we have an opportunity to protect children and families.

We used this research on Capitol Hill to advocate for the Family and Medical Leave Act (passed in 1993), which mandates job-protected leave for up to 12 weeks a year, although it is unpaid.

Parents need time with their new babies before returning to work. But these crucial interactions do not end after the first three months.

Workplaces can encourage strong families (and boost productivity, too) when job and family life are in balance.

Families also depend on strong communities where parents can find and share emotional support, practical advice and resources.

For many families, the workplace is their community. Workplaces must learn from strong communities about how to support healthy families. We must all put families first to keep our nation strong.

For more information on family and workplace:

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

Reprinted with permission from the authors.


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

Q. How do I help an almost-6-year-old learn to handle disappointment and frustration? This is a child with big emotions, both positive and negative. Nearly every time he doesn’t get his way, he instantly gives in to his impulse to stomp, throw something, cry, scream, and sometimes hit and push.

He is always apologetic and remorseful, and even berates himself, which I find disturbing (he says he is “stupid,” a word we don’t allow in our home).

A. At nearly 6, your son can learn to manage his strong feelings. The work may be hard now, but it will be much harder later.

It is good that his behavior bothers him, which may motivate him to change. But if he is feeling hopeless, he will need your reassurance that he will someday learn to control himself. He will need to know that physical aggression is unacceptable, and that you will do everything you can to keep him under control until he can manage on his own.

He sounds like he is scared of himself, and he needs to know that he can count on you until he can count on himself. Help from you will be far more effective if he can keep reminding himself that he, most of all, is the one who wants to learn.

In calm times, help him make a list of the triggers for his tantrums. Some triggers will be avoidable, others not. You can strategize together about how to handle both.

For example, when he can’t have what he wants right away, he could focus on when he can have it and what he can do while he is waiting. Instead of pushing someone when he is mad, he can stop and think about what he is feeling, and why. Rather than getting physical, he can say, “I’m mad because I wanted to go first. If you won’t let me go first, then I’m not going to play with you.”

Of course he won’t be able to substitute these reasonable responses for the pushing and hitting right away. Tell him he’ll need to be patient with himself.

Look at the list and help him to identify any triggers that have warning signs. You can agree on a special code that you’ll both use, such as, “Looks like it’s time to cool down.” But then he’ll need to know how. Ask him to think about what helps him relax when he’s feeling upset. Share with him what you’ve noticed, and give him some ideas to try.

For example, leaving the scene to go to his room, not as a punishment but just to cool down, can make a big difference. Does he have a teddy bear to squeeze really hard? Would it help him to wrap himself in his bed covers? Listen to music? Take a shower? Have a cold drink? Or scribble furiously (on paper) until eventually he feels like making drawings or writing about what bothers him?

If these strategies don’t work, you may need more help. Has your child always had “big emotions,” or is this a recent development? Have there been major changes in his life or in your family’s situation that may have gotten under his skin? Have other family members had problems with “big emotions”?

If so, we suggest you consult your pediatrician, who can refer you to a mental health professional skilled in working with young children.

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

Reprinted with permission from the authors.

Supporting the Development of Self-Regulation in Children

Maine Association for Infant Mental Health

Supporting the Development of Self-Regulation in Children
By C. Michael Sandberg, MA

Recently the world of early childhood education has once again been echoing with terms like self-regulation, executive functioning, and social skills. This is a welcome moment! Not that STEM (Science, Technology, Engineering, and Mathematics) and literacy are not important, but, rather, that it is once again being realized that success academically, socially, and personally is more dependent on these “soft skills” than it is on the content of the knowledge being taught and learned!

Flavell in 1977 called these skills “one of the really central and significant cognitive-developmental hallmarks of the early childhood period.” Their importance has been well demonstrated by several recent studies that followed children over time. In one, done in New Zealand, 1037 kids were followed birth to 32 years. They were looking specifically at what they call self control, certainly one of what might today be called the executive functions. They defined self control as being willing to delay gratification, able to control your impulses, and able to modulate your emotional expression. Even though some of the study’s participants improved their ability to control themselves over the period of the study, they did find that self control at older ages could be largely predicted by self control at 5. Children were first measured at 3-5 with a 90-minute scored observation. They were scored again in their preteen years. In adulthood they were evaluated for several social, health, and financial outcomes. Their heath score was a composite of their cardiovascular health, respiratory system health, dental health, sexual health, and their inflammation status. They found that self control at 5 was highly predictive of improved finances, better physical health, lessened levels of substance dependency and fewer interactions with the justice system. They also found it to be predictive of better decision making in the teen years. Higher self control children were less likely to become pregnant as teenagers or to leave school early. They also had significantly fewer interactions with the authorities. They were also able to do an analysis comparing the differences using social situation as a child and IQ with those found using self control and they found that self control was a much better predictor.1

These kinds of results have been found by several other long-term studies.2 Interestingly these findings echo the findings of studies of the impact of quality early childhood programming such as that done of the High Scope programming evaluated by the Perry Preschool Project. There, even though the initial finding of improved IQ washed out over time, the children still had improved outcomes in terms of social, academic, and financial success. It could easily be argued that what they had gained was improved executive function. 3 For me, these are important findings because the children failing and being expelled by our schools and preschools are mostly being excluded because of poor self-regulation skills. 4 At the same time most researchers and educators agree that most executive function skills can be taught.

While most evaluators use teacher reporting to assess self-regulation skills, (the most responsible researchers recognize that there may be bias included in these ratings and evaluate the ratings across different ethnicities and SES (Socioeconomic Status) to guard against as much as they can), there is interestingly one evaluation method in relatively common use. It evaluates cognitive flexibility in 3-5 year olds by using cards featuring different attributes. There are different shapes, such as bunnies and turtles, and among each shape there are also two different colors. Children are asked to sort the cards by shape and then to switch and redo the sort by color. What is being evaluated is their ability to let go of the old references and switch to the new one. Most 3 year olds struggle with this change, while most 5-6 year olds can easily shift. This method, known as the dimensional change card sort, can separate the age at which children are able to succeed and show that cognitive flexibility is used as an indicator of emerging self-regulatory skills. 5 For me, this is reminiscent of Piaget’s work with classification and it may demonstrate a link between cognitive and social skills!

For a while, people also thought the marshmallow experiment conducted at Stanford could become an assessment tool. The method tried to evaluate the ability to delay gratification by tempting children with a marshmallow, while promising them a second one if they could wait about 15 minutes before eating it. While the researchers reported good predictive power of later success, when people tried to replicate the experiment controlling for SES, they found SES had a higher impact than any maturity measure. The kids, who could wait, were those who had not experienced scarcity!

In order to decide what we need to be teaching and come up with teaching methods, we need a more specific definition of these executive or self-regulation skills. They include the ability to monitor and manage emotions, thoughts and behavior via impulse control, maintaining attention and focus, filtering distractions, emotional regulation, problem solving, and prosocial behavior. When we know what we are trying to promote we can both appreciate and protect it when it is happening and know more about how to create situations that will enhance the learning of those skills.

Interestingly, even fetuses have some self regulation skills. We know that because their activity level often varies dependent on the mother’s activity and mood. After birth, many newborns also illustrate their ability by turning away to take a break after an intense social interaction. They know how to shut down in the face of too much stimulation! So we are not starting with a blank slate. Reading last month’s piece on perinatal psychology might give you some ideas on how to support higher skill levels even before a baby is born!

Once they are born, what can we be doing! We can help children learn that their emotions can be regulated. We do that by allowing them to become upset, and then intervening when they are no longer able to regulate and coregulating them through our calmness and nurturance. We do it by honoring when a child needs a break and waiting for them to come back online before proceeding. We do it by recognizing when they are losing focus or becoming too frustrated to continue and then supporting their efforts and directing their attention back to what they were working with. We do it by scaffolding their explorations (Tools of the Mind, a Vygotsky based curriculum has been shown to be very effective at building self-regulation skills for those children who are starting further behind. It was less effective for those who already had higher skill levels6).

The first key to all of this is that if we expect children to learn self regulation skills, we as the adults must model those skills and remain centered and calm. It is only when we are calm that we can use our support to calm children. How can we give teachers and caregivers the supports that allow them to be present and listening most of the time? When teachers become stressed by their jobs, they may react with frustration and anger to misbehavior in the room, leaving the children who are acting out feeling alone, without an ally. As allies we are engaged in trying to assist children in meeting their goals for themselves, while doing so in socially acceptable ways. When you see yourself getting that kind of support it is easier to let go of the emotionality of the moment and to begin to use and improve the functioning of your thinking brain. Mark Rains, a board member of the Maine Association for Infant Mental Health and a psychologist, suggests that when children lose it (Flip their lids to use Dan Siegel’s expression), they need us to help them feel safe, connected to others, help them learn language to talk about feelings, gradually support their ability to see the patterns in behavior, before we can expect them to be ready to plan better actions.7

In general, we have to ask, how can I support the child’s autonomy and self-regulation rather than working to control them. As one example, if we have a child who is struggling with entering groups and tends to charge in and destroy things, what method can we come up with that might help them learn the skills needed. Could we ask them to try something new and then sit down with them to play alongside the group they want to join, without ever asking to join (the child who has poor executive functioning will often be told no if she or he asks to join a group)? Soon the child will be playing with the other children, and depending on their play skills you may have to remain and continue to support their involvement, or you may be able to leave. Later we could talk about what had worked and give them another tool (By the way, this may have to be repeated multiple times before it begins to take).

How can I help them learn to evaluate risk and make decisions? Instead of saying, “No that isn’t safe!” could we ask about where they would be landing the jump and do they want to land on that? That can be followed with, “well how could we make it safer.”

Executive functioning can be built better, and if it is, children are likely to be better citizens and parents when their time comes. Join me in trying to learn more about how to do this every day.


  1. Moffitt, T. E., Arseneault, L., Belsky, D., Dickson, N., Hancox, R. J., Harrington, H., Houts, R., Poulton, R., Roberts, B. W., Ross, S., Sears, M. R., Thomson, W. M., & Caspi, A. (2011). A gradient of childhood self-control predicts health, wealth, and public safety. Proceedings of the National Academy of Sciences of the United States of America, 108(7), 2693–2698.
  2. Jones, D. E., Greenberg, M., & Crowley, M. (2015). Early Social-Emotional Functioning and Public Health: The Relationship Between Kindergarten Social Competence and Future Wellness. American journal of public health, 105(11), 2283–2290.
  3. Heckman, J., Pinto, R., & Savelyev, P. (2013). Understanding the Mechanisms Through Which an Influential Early Childhood Program Boosted Adult Outcomes. The American economic review, 103(6), 2052–2086.
  4. Gilliam, W. S. & Shahar, G. (2006). Preschool and child care expulsion and suspension; Rates and predictors in one state. Infants and Young Children, vol. 19, No. 3 p. 228.
  5. Zelazo P. D. (2006). The Dimensional Change Card Sort (DCCS): a method of assessing executive function in children. Nature protocols, 1(1), 297–301.
  6. Blair C. (2016). Executive function and early childhood education. Current opinion in behavioral sciences, 10, 102–107.
  7. Rains, Mark. “‘Getting It Together’ Healthy Start Community Forum.” YouTube, YouTube, 21 Oct. 2009,




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

Reprinted with permission from the authors.