Sibling Rivalry for Preschoolers & Toddlers

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In this age group the arrival of a new baby is often accompanied by jealousy and competition for affection and attention. Toddlers and preschoolers often respond with behavior and mood changes to replace what they perceive as lost attention. This is why it is very important for parents to prepare children for the arrival of a new infant who will require parental attention which previously was directed elsewhere.

Most of these issues can be prevented by taking the time to provide love, attention, affection and a sense of security for the displaced child. A secure attachment engenders trust and eliminates the fear of loss which drives many of the behavior problems that accompany sibling rivalry for the younger child.

It is also important schedules, routines and rituals be continued. Mealtime and bedtime routines should not be changed. Toddler and preschool aged children depend on these routines to anchor their daily schedule. In addition, bedtime and playtime rituals such as story time, bath time, meal time, going on walks and various playtime activities must be continued.  Your child is looking to your behavior as a sign that he or she is still loved and important. By continuing prior behaviors you can prevent sibling rivalry from evolving into negative behavior.

The arrival of a new infant in the household is a perfect time to support the older child’s independence. By giving your toddler the freedom and encouragement to explore the world you will soften the anxiety and potential sense of loss that a new infant can symbolize. It is also a time when your toddler can learn how to respect others. Toddlers and preschoolers both need to learn they should not try to control the behavior of another. When a toddler does not respect a parent or a sibling, future behavior issues are certain to follow. It is also important to encourage and help direct your preschooler to name these competitive and jealous feelings and by praising and rewarding his or her strengths you will encourage the development of good feelings which can replace bad feelings.

For the preschooler a new sibling provides the added opportunity to feel deserved and approved of. By focusing on the individuality and unique strengths of the older child you will be supporting and acknowledging the importance of a positive and supportive relationship between you both. It is important you are always fair and never compare children.  Beware of words or actions that can be interpreted by the older child as showing the new arrival to the family is your favorite. Allow your love to show you have no favorites.

The Breadbox

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Why are memories so powerful?

“Joey, would you get some bread out of the breadbox?” “Sure, Mom,” I answered as I walked over to the counter and twisted the black knob. The breadbox was the size of a small microwave. I twisted the knob on the stainless steel front panel and reached in and pulled out two slices and remembered a trip to the bakery yesterday. “Mrs. Barber, what can I get you today?” The woman behind the counter asked. “A loaf of pumpernickel,” my mom answered.  The baker looked through the glass counter at me and asked, “Can I give Joey slice?”  My mom smiled and nodded her head. I reached my hand towards the top of the glass counter. “Thank-you,” I mumbled as I bit into the warm, fragrant and chewy bread. It was a taste and smell I will never forget.

In the next decade hundreds of thousands of people will die every year due to the ingestion of too much sugar, salt and fat. Yet, the real killer is not the food of today but the memories of tomorrow.

Every child has three lives: a life at home, a life at school and a life at work or play.  In the past the food we ate was dependent on cost, location and the season. Fresh, vegetable-based and regionally-available foods were at the center of our menu. Food did not come prepared, packaged or processed.  Limited choice and availability strengthened our resolve. A loaf of bread, saltines and graham crackers have now been replaced with an endless media parade of fast food restaurants, carbohydrates and snacks. There were no sugar or flavor additives and a pinch of salt was enough. We ate less, worked harder to prepare our food, and we were healthier.

My generation might be the last generation to rely on breadboxes, a well-stocked pantry, baking and family-owned corner restaurants. We remember family recipes, family meals, the smell of dinner cooking, aprons and lively discussions around a dishwasher-less  sink filled with pots and pans.

Yes, times have changed. The economy, a lack of opportunity, fatigue and our drive to possess has drained from many parents the ability to recognize the importance of healthy food. We make choices based on time and efficiency rather than good health.  We are conditioned to hear and see how food can make us feel good rather than keep us alive. Our tastes have been brainwashed. Food has become an escape and often an unhealthy reward rather than a lifestyle.

In the past we walked to the store and now we drive. Corner stores, bakeries and butcher shops have disappeared. In their place grocery chains with altars of processed, frozen and ready to eat sliced, diced and pre-packed or prepared foods have appeared.  Aisle placement is now both an art and science used to influence you on what to buy for you and your child. Plastic has replaced paper and the microwave has become the oven of today.

The bill for these choices we are influenced to make is coming due.  Corporate chefs have become taste conditioners. Healthy foods have disappeared under the guise of convenience. Our bodies and our taste buds are jaded by fat, sugar and salt at the expense of our health, our children’s health and the health of our children’s children. Labeling is an illusion and misrepresentation controls you. Food choice has been hijacked and the cost is your good health.

I remember the days before corporate America controlled the food that we eat. We learned how to cook meals and choose ingredients. We relied on heritage, seasonal availability and taste rather than what we saw or heard in the media. Stop this epidemic now. No fancy or expensive medicine is needed. Sit down with your child and talk about food. Make sure your child knows how to cook ten basic meals. Start this discussion at an early age. Teach by your words and example about the importance of a fresh, non-processed, healthy diet centered around vegetables, fruit, whole grains, vegetable protein and lean meats. Talk about the dangers of milk enriched with sugar and how cheese is a hidden source of unhealthy saturated fat. Make every meal an event your child will remember just as I remembered that trip to the bakery.

Today, parents have more challenges and temptations compared to parents of prior generations. The choice, however, is simple. Give in and allow these pirates to control how long you and your child will live or take control and choose a diet that supports a long and healthy life for you, your child and your grandchildren. The choice is yours.

Skin to Skin Contact After Delivery

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Much has been written about the importance of the first hour following delivery. Your infant encounters a new and previously unseen world. Sounds begin to take on new meanings and basic processes we take for granted such as breathing and eating begin. It is a time of heightened perception for both parent and infant. It is a time when every parent must be both a soldier and an ambassador as their child encounters and enter a potentially hostile world.  Parents provide comfort and safety to the new infant.

Following delivery your infant experiences major physiologic changes that can cause imbalances in the respiratory, circulatory and metabolic systems. Your infant can become cold and glucose levels can drop. It is also a time when your infant is at increased risk for infection.  To help deal with this turbulence hospitals and professionals have enacted and supported policies to make this transition safe and loving.

Your first act as a parent should be to provide skin to skin contact with your infant. Studies have shown such contact provides physiologic stability for your infant.  Benefits include improved blood oxygenation and glucose levels and reduced stress hormone levels in your infant. Basic body functions including temperature regulation, respiratory pattern and blood pressure also improve. Your infant will cry less and more easily enter a quiet alert state.

Additional benefits include a fostering of a secure attachment between you and your baby. Skin to skin contact increases the release of maternal hormones that induce and encourage attachment between mother and baby.  One of these hormones is oxytocin which has been shown to increase relaxation, facial recognition and maternal to child attraction. Such behaviors are essential for the care and protection of your infant.  In this critical post delivery period these behaviors have been associated with an increase in touching, holding and positive speaking behaviors between mother and child as distant as 1 year following delivery.

In addition to attachment the skin to skin contact prevents the risk of stress induced by separation. Your infant has never been separated from you. It is well known that infants are able to sense physical separation from their mother. Harm from separation has been seen in animals. We must assume newborns are at risk for similar negative physiologic and brain affects.  In addition, recent brain research supports the importance of early attachment for normal brain growth in terms of both myelination and synaptic development. Specific parts of our brain involved with our emotional responses are especially sensitive and reliant on both activation and modulation during this critical period.  These effects impact our learning, memory and our sympathetic nervous system.  Holding, carrying and caressing during the newborn period and infancy fosters and supports brain growth and the development of self regulation in your infant.

A final benefit of skin to skin contact is the fostering of breastfeeding. This type of contact initiates a cascade of events that results in successful breastfeeding. Skin to skin contact is the first step in a progression of stages that result in familiarization of the infant with the mother’s nipple which is then followed by self -attaching and eventual suckling. Sleep then follows soon thereafter.  Early stages include crying, relaxation, awakening, increased activity and resting and crawling.

Skin to skin contact on the mother’s chest allows the infant to be closely monitored by both mother and staff. The infant should be positioned so the face and nares are visible and the infant’s color, skin perfusion and respiratory patterns can be followed closely.

Nursery routines such as weighing and bathing that interrupt skin to skin contact should be avoided. All nursery and post-partum activity should be directed to the immediate needs of the mother and infant. Actions that can be delayed until after the first breastfeeding include vitamin K injection, body measurements and eye ointment prophylaxis. Usually a hat is not required when mother and child are skin to skin and a diaper is often not needed except after a cesarean section.  The cord can be initially clamped away from the infant so the clamp does not pinch the baby and mother during skin to skin contact. The cord can be re-clamped and trimmed at the first bath. The first bath should be delayed until at least 8-12 hours following delivery.

Pacifier Advice

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Pacifiers do not harm an infant but there are some risks to pacifier use. Never loop a pacifier around an infant’s neck. This can lead to strangulation. Self-made pacifiers may be dangerous due to the risk of choking if part of the pacifier breaks off. There should be small ventilation holes at the base of a pacifier and make sure the pacifier is the right size for your infant.  A BPA (Bisphenol A) free pacifier is also a good idea. The pacifier should be dishwasher safe and buy several so they can be washed in the dishwasher or washed frequently with hot soapy water and allowed to air dry.

Pacifiers can help soothe an infant. Many infants benefit from sucking and infants who use a pacifier have a decreased risk of SIDS. Pacifiers are also helpful on airplane flights where middle ear pressure can cause pain for many infants. They also help many infants fall asleep easier.

Pacifiers should not be used on a hungry infant to delay feeding and it is best to avoid having the pacifier become a “lovey” or a transitional object. By fading the use of a pacifier at about 12 months the transition off a pacifier is often easier. Delaying elimination of the pacifier beyond 18 months of age often makes the transition off a pacifier much more difficult.

Children who continue to use a pacifier beyond age two may change the alignment of their teeth. This can lead to future dental problems. The older your child is the more difficult it is to transition away from the pacifier. Many children use the pacifier as a sleep cue or as a transitional support. This dependence often causes sleep consequences such as frequent interval waking that are difficult to manage. Never pressure your child to stop using a pacifier. Pressure and punishment are not helpful. By relying on praise and distraction most parents are able to substitute an acceptable and less risky transitional support.

Deciding whether to use a pacifier is a great opportunity for you to learn how to recognize, understand and respond to your infant or child’s cues.  Infants who soothe and self settle easily without using a pacifier often do not need a pacifier. Infants who suck on their own hands and fingers are able to rely on these natural pacifiers in the same way as infants who suck on the little finger of a parent.

Infants who are breastfed should not be given a pacifier for at least several weeks after delivery. This allows maternal milk production to increase and supports the development of a strong physical attachment between mother and child.

The Hungry Child

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How can you help a hungry child?

I sat wide eyed and speechless as I watched the video while a friend and co-worker of mine narrated the video and the still pictures. The pictures and video were taken at a small orphanage in Liberia called Fatima Cottage. This orphanage houses 64 children and is run by an eighty-eight year old woman who has the heart of an earthly saint.  Children sat at several long tables in a dirt floored room. The room was filled with smiles and songs sung by wiggling children with sparkling eyes. It was then that I heard her words, “One of the six tables in the room will not receive food today because there is not enough food to feed all the children in the orphanage.”  As my heart dropped and my eyes widened I said to myself, “How can that be?”  I watched silently as the children who did not receive food continued to sing.

A tidal wave called obesity is here. Whether or not you are overweight it will shape your future.  We all have heard about the importance of a balanced diet that is low in fat and high in fruits and vegetables and energy rich whole-grain foods. Our portions are too large, our reasons to overeat are too numerous, our stress is too high and our bombardment with unhealthy food eating patterns and food choices are too many. We live in a country where the largest fast food company, McDonalds, spends nearly $1,000,000,000 dollars a year on advertising. We know it is time to change our approach to food yet education does not seem to work. New roadblocks to good health appear as soon as old roadblocks are removed.  We hear a never ending stream of information that trumpets the importance of improved access to healthy food, active lifestyles, as well as the avoidance of empty calories from junk and fast food.  We hear about the perils of snacking and sugar-added beverages and the invasiveness of modern day technology and electronic devices that eliminate our interest and the need to be physically active.  Children and parents become detached from a sense of purpose that each of us can relate to. It is this lack of purpose that haunts and defeats us in our daily pursuit of good health.

Children must be given the opportunity to choose compassion, altruism and respect over distraction and the pursuit of personal satisfaction.  Although we over-eat for many mindless or purposeful reasons including avoidance and comfort the fact is we continue to overeat. If we are to survive this tidal wave of unhealthy behavior and stress we must pivot, acknowledge our goal of a healthy life for every man, woman and child on this earth and adapt and alter our response to this problem.  We must stop killing ourselves while allowing so many in our world to go hungry or starve.

What can you do? Stop this disconnect between food and survival for your child. Teach your child what food actually means. How food allows not only each of us but everyone to survive. Lead in your actions and words.  Show your child how to become a steward for others and for themselves. With your help your child will stop seeing the world as a scary self-centered place where one’s own desires trump those of another. This awakening will show your child how the care of others leads to both healthy self-care and an inner happiness born from a certainty that is within each of us.

Reach out to your faith, family and friends and join an organization that is dealing with the hunger and starvation in our world.  Allow yourself and your child to be engaged in the fight to understand and defeat hunger. This battle will not be short or easy but it can be won. Your actions will change how you and your child eat.  Reframe your understanding of what you eat, why you eat and when you eat. Don’t walk away from that table of children singing ever louder hoping to silence their hunger.  Your efforts can change your life and the life of your child and lives of hungry children throughout the world. Start today. Bring your love and commitment to this battle to live healthy and defeat hunger.  You are your child’s greatest teacher.  Act now, before it is too late.

Obsessive Compulsive Disorder (OCD)

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Obsessive Compulsive Disorder (OCD) is highly variable in terms of symptoms. The obsession is the thought and the compulsion is the behavior.  Although some OCD patterns are common such as touching, counting and repeating, obsessive and compulsive behaviors can be very unique. When a behavior causes social, emotional, educational or occupational dysfunction then therapy and intervention are necessary.  In most cases OCD can be treated successfully.

The first step in treatment is identification and finding a professional who is willing and able to help you find a successful treatment regimen. The most common treatments include behavior therapy or medication.  Choose a physician or a mental health professional you feel comfortable with.  Your ability to engage with the therapist really does matter.  Ask for a no charge “get to know” visit where you can meet the therapist for a few minutes to talk about the type of care you are seeking. If you begin seeing a therapist and there is not a therapeutic reciprocal alliance then ask for a referral to another therapist. Engagement does matter.

Cognitive Behavior Therapy (CBT) is the most common type of behavior therapy used in OCD.  The goal of CBT is to identify and confront fears in order to reduce anxiety through exposure and response prevention exercises without progression to the compulsive behavior. Obsessions that cause the least anxiety are dealt with first and then each obsession is pursued in a serial fashion progressing up to the most anxiety associated obsession.

Medication can also be used to decrease the intensity of OCD symptoms. Medication is often used in conjunction with CBT to reduce anxiety and improve patient compliance and success.  The most common medication is an antidepressant such as Anafranil, Prozac, Paxil or Zoloft.

Support groups, exercise, calming activities such as meditation and yoga and other strategies such as guided positive imagery and progressive relaxation techniques can also be helpful.

Independence

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Have you ever wondered why some children grow up confident and independent while others do not?

“When are you going to start your college applications?” I looked across the room and saw the young man gaze at the floor.  He said nothing. “You have worked so hard for this, and you are running out of time.” He still said nothing. His eyes never lifted from the floor. His mother turned to me and asked, “What should I do? He is running out of time.”  I looked into her eyes and sought a word that could buy time for this teen. “Patience,” I answered.  “You raised your son. You love him. Show him you believe in him.”

A secure and loving attachment must be followed by freedom, encouragement and respect if a child is to become capable of making his own thoughtful decisions. Self-trust must be fostered from an early age. With support it leads to insight, independent judgment and the ability to discriminate.

Children trapped by excessive attachment are forever chained.  They are paralyzed by uncertainty and a fear of loss makes them unable to believe in themselves and make decisions on their own. They turn to others for support and praise and often chase reflections rather than their own dreams.  Parents who provide a secure attachment that evolves into freedom and encouragement are preparing their child for a life filled with a healthy self-esteem, a belief in oneself and the confidence to listen to their own inner voice. Parents must let go of their child support autonomy rather than self-doubt. Parents who are unable to let go, imprison both themselves and their child.

By believing in the pervasiveness of good, parents are able to detach and allow their children to make their own choices. Such behavior serves as a model for unconditional and non-judgmental love, respect and acceptance and allows a child to be both secure and capable. In this way children become responsible and comfortable with their own decisions.

The next time your toddler attempts to walk and falls remember it was his choice. When your preschool aged child jumps off the couch and breaks a lamp remember he is practicing choice. When your school aged child neglects to study for a test and his grade is a D remember it was his choice, and when your teen chooses something  you do not agree with do not throw your hands in their air and shout and stomp out of fear and anger. Draw each of these children close and revel in their independence.

She turned to her son. “I believe in you and always will.” He raised his head and for the first time that day they looked at one another.  I said to myself, “Now we can begin.”

How the Brain Works

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Your brain contains about 100 billion neurons. Each neuron is connected to other neurons like rose bushes planted close to one another. When the branches touch and overlap networks of neurons are formed. These connections are electrochemical synapses. Many hormones are released in the brain and support the growth and survival of these brain networks. Some of these hormones are released due to stressful or emotionally significant experiences while others are released due to new learning experiences or damaging brain events.

How you learn and remember is based on the strengthening and weakening of these neuronal circuits. This process allows the brain to respond and change and provides the basis for the word plasticity which is often used when discussing brain function. Brain neurons are able to adapt but there are limits to this adaptation beyond which cell death and brain damage do occur.

Your brain is able to self-organize and adapt to a changing environment. Stress, trauma, novelty and learning do affect brain structure and function. When stress hormones are released by your brain your ability to form new memories is affected. If a certain area of your brain is damaged by physical trauma or a lack of oxygen or blood flow your brain also has the ability for other undamaged populations of neurons to take over the job of the damaged neurons. This process involves the growth of new supportive networks that can perform the function of lost neurons and increase the performance and function of remaining working neurons.

Your brain is dynamic. The adult brain is not largely fixed and stable. Your ability to respond to brain stress through enhancement or rerouting of function is only now being understood. Old models that described the brain as being a hard wired circuit are not accurate. This capability allows you to continue an unending learning process throughout your life and provides hope for new treatments for those who are developmentally disabled, brain injured and for those who have psychological disorders.

Parenting Doctrines

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What is your parenting doctrine?

“What is the most important principle in parenting?” I looked across the room at the medical student who had just asked me the question. I began to smile. “What a question,” I said to myself. “Does he know how important that question is?” Feelings, thoughts, words, actions, lectures and books flashed through my head. “What do I believe?” I thought to myself. The room was quiet and every student looked at me. “There is no single principle due to the complexity of parenting,” I answered. “But there is a single doctrine. I believe physical and emotional experience moderate the life of every child.”

Some children settle easily while others settle slowly. Some adapt to change well while others overreact to stimulation. Some accept schedules poorly while others chase rigidity. Transition and change comfort some children while inciting anxiety in others. “Bad moods” are common for some children while rare in others. These characteristics are innate and difficult to change. They can, however, be modified.

Most parenting classes focus on the teaching of practices. A practice is the performance of a pattern of behavior repeatedly in search of a sought after behavior. This is accomplished by teaching guidelines that if followed, result in habitual behaviors. Examples include the importance of clear, consistent parental responses that are performed competently and confidently.  Such practices enhance behavioral outcomes but they are not principles or doctrines.

Parenting principles are fundamental beliefs that support the essence of parenting. Examples include the importance of love, encouragement, approval, trust, freedom, respect, unconditional love and acceptance. The demonstration of these principles allows parents to be attentive, responsive, attuned and sensitive.

For me the primary dogma or doctrine about parenting concerns the physical and emotional power of connectivity. The parental ability to connect with a child provides life and hope to every child.  It is well known how diet, prenatal care, the environment, toxin exposure, illness and stress affect every child. We know actual brain structural changes occur when a child is exposed to toxic stress. Stress in childhood leads to a decrease in brain development and loss of memory and healthy emotional response.

As I looked at the faces of the medical students sitting around the room I could feel and see their connections. The tone in their voice and the zeal in their step are the result of the power of connection. “My doctrine is simple.” I answered. “Every child yearns for the safety and security that connection brings. Connection is my fundamental doctrine of parenting. Parents who connect with their child both empower and become empowered. This I believe.”

Halloween Tricks and Treats

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Halloween can be a very special but difficult holiday. Parents have numerous opportunities before and during this holiday to support healthy behaviors and to share important health and safety information with their child. Sugar laden treats and “scary” costumes are learning opportunities for your child. During the Halloween season remember to see things through the eyes of your child. This requires an understanding of your child’s perception and development.

Infants and toddlers become fearful when appearances suddenly change. This can happen when a mask or costume is worn by someone they love or trust or when they see a garden hose coiled like a snake. For a preschool child certain categories and themes are common causes of fearful thoughts and behavior. These include darkness, thunderstorms, loud or unexpected noises, animals, robbers and hidden monsters. Children do not develop the ability to separate fantasy from reality until about five years of age. For older children fear is heightened when there is a social element such as group fear or social isolation.

Begin to prepare your child for the sights and sounds of Halloween long before the holiday. Become a follower of your child. Help your child substitute imagination and creativity for confusion and fear. Always listen to your child and take all fears seriously. For the school aged child it is important you show your concern. Never dismiss or disavow the way your child interprets symbols. Start by naming and discussing specific fears. Discuss calming strategies and techniques. Use rational and reasonable explanations to help your child re-interpret the emotions that are being experienced. Your ongoing support will decrease associated anxiety and bolster your child’s ability to self-manage future feelings and emotions. This type of empowerment allows your child to focus on the creative and imagination benefits of this holiday and not react with fear and anxiety.

When shopping with your child or discussing costumes for Halloween never choose or direct your child to choose a certain costume. Allow your child to be led by her own comfort level and interest. By recognizing and understanding your child’s needs you will be better able to interpret and respond to difficult emotional responses while avoiding feelings and emotions your child is not yet prepared to address.

Halloween also provides opportunities to discuss issues of health and safety. Choose a costume that is reflective, brightly colored and flame resistant. Avoid sharp accessories and facial masks that obscure your child’s vision or increase the risk of tripping or hurting oneself or another. Always test any make-up on a small area of your child’s skin before it is applied to the face.  Talk about food and nut allergy risks. Discuss safe and courteous behaviors including the use of a flashlight, avoiding candles and stairs, traveling in a protective group, never entering a house alone and not running between houses or across a street. Making eye contact and graciously saying thank-you are also important as are proper hand washing, general food safety techniques and proper inspection of all “treats” before they are eaten.

On this holiday take the time to discuss with your child the importance of healthy treats and how much sugar is healthy. Talk about balance and view this holiday as a tasting “buffet” opportunity for your child. Avoid becoming the “sugar policeman.” By including sugar education in your daily lives long before Halloween your child will know ahead of time the importance of limiting sugar intake. Help provide what and when guidelines for sugar intake for the younger child and for the older child avoid critique and criticism about sugar intake. Show by example how you limit your own sugar intake. You are your child’s greatest teacher. Children should eat no more than 16 grams of sugar a day and an adult no more than 32 grams. A can of juice or soda contain about 40 grams of sugar and a single starburst about 4 grams. Make food label awareness and healthy food choice a part of your everyday life.

Halloween can be filled with magic and learning for every child.