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.

Exits

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I looked at the mother who was sitting in front of me. She was crying softly. I slid my stool over towards her and told her I would help her find a way. She opened her eyes and dabbed them with the matted Kleenex she held in her hand. “I have tried everything,” she said to me. “Nothing seems to work. Every day on my way home from work I pick him up from daycare, and he never listens. He hits, he kicks, and I don’t know what to do.” I leaned towards her and put my arm on her shoulder. “We have to find a way to take care of you. Once we do that I can help you with your son.” “Can you,” she asked me. “I can’t but you can,” I answered.

Parenting is a demanding job. It ensnares you into thinking it is endless. At times you feel as if you are locked in a cell without an exit. Children depend upon us for survival.  From infancy through the teen years parents must be vigilant to identify and provide for the needs of children while keeping them safe. Learned parenting behavior and the biological drive to protect offspring, encourage and influence the way parents recognize, understand and respond to a child’s needs. These responses are limited by time, resources, finances and the emotional competency of prior learned behavior.

Studies have shown that over 50% of parents feel they have no sources of emotional and physical support. Financial stress adds another hardship. These stressors make it difficult for parents to meet the needs of their children.  Stress encourages parents to neglect their own needs and self-care soon disappears.

Parents who neglect their own self-care are at risk for losing patience and compassion. Their lives are bordered by fear, procrastination and self-doubt. Dreams, passions and aspirations are forgotten and behaviors are modeled that do not teach self-awareness and self-care. This loss of self is accompanied by fear, anger, shame and guilt. These become learned behaviors that are then passed on to a new generation prone to social isolation and fueled by anger due to the loss of self.

Self-care must be simplified and programmed into your daily life. You must acknowledge, speak up and walk away when self-care is threatened. You must seek out people, places and things that provide comfort, connection and safety in an ever accelerating world.  When self-care is embedded within your life it provides for both you and your child. You receive the personal, social, emotional, intellectual and spiritual benefits and model behavior that changes the biological and emotional decision for your child.

Take a walk and look at the magnificence of nature.  Eat dessert, read a romantic novel, watch a movie, go to a comedy show, walk on the beach, exercise or just brew yourself a cup of tea or hot chocolate. Call a friend or take a nap. Take up dancing or start a scrapbook. Learn how to say “no.” Go to the library, learn a new language or start playing that instrument you have not played since you were a child. Meditate, attend a religious service or volunteer for a favorite unspoken cause.

Each of us built the rooms in which we live. Each house is our challenge and responsibility.  Every room must contain exits for daily and emergency use. Exits provide the safety and security to live a life filled with passion and inspiration. If circumstances arise and you find yourself in darkness look for a light. If there is none, listen and reach out to someone near. They will lead you to safety. Begin your journey today.

Being Bullied

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Do you know what it feels like to be bullied? I Do. Being repeatedly bullied changes you. It can either leave a mark or induce change.

As a new freshman in high school I turned the corner and quickly scanned the hallway. Experience had taught me what to look for and how to look for it. Repeated bullying teaches you how to scan a sidewalk, a playground, a gymnasium, a room or a hallway. Never make direct eye contact and never, ever stop listening. While most children look for their friends, those who are bullied see sudden movement and hear the shuffle of feet and always know where the closest exit is. As I walked down the long hallway I approached a group of boys. They leaned on open lockers and their laughter echoed off the tile floor. Laughter was always more worrisome than loud talking.  I drifted over to the other side of the hall and softened my shoulders as I shifted my books to my other arm. You always kept one arm free when passing a bully. The laughter did not change and I sighed silently as I turned the corner and began scanning the next hallway.

For the observer bullying is often difficult to recognize. It can happen everywhere and anytime. For the one who is being bullied, bullying is always recognizable. It includes both spoken and unspoken actions, words and behaviors. A tilt of a head, a look in the eye, a sudden turn, a push, a trip, a sound or a series of words all indicate unwanted and unsought after aggression that has been directed at you. When you are young it starts with simple name calling, teasing or taunting. When these behaviors are repeated and are associated with one child trying to control or scare another child it becomes bullying. Threats of physical harm, rumors, embarrassing false stories and inappropriate sexual comments soon follow and you change. Not everyone becomes a victim but everyone changes. You notice social behaviors including how others avoid you or leave you out of games. You learn how to recognize the bully as well as those who assist and reinforce those who bully. Knocking, tripping, punching and hitting become a sport and if you are smart enough you learn how to scan and disappear.

There is no single reason why a child becomes a bully. Fear, anger, inadequate attachment, lack of control and low self-esteem are common themes. A lack of compassion and respect for others and the pursuit of social power and attention are also commonly seen in those who bully. Bullies may be well connected to peers or they may be loners who are isolated and easily pressured by others. Bullies tend to be aggressive and have difficulty following rules. They resort to dominating behaviors when they become frustrated and often think badly of others. They view aggressive behavior in a positive way and tend to have friends who bully others. In adulthood bullies often continue to have problems both at work and at home.

Children who are bullied tend to be different from others. They may be smart, sensitive, short, tall, overweight or just “different”. The way they dress, the words they choose or the way they act turn them into magnets. Bullies are drawn to these children and search for targets who are weak, depressed, anxious or unable to defend themselves. Bullying soon follows.

The best way to eliminate bullying is to talk about it and model appropriate interpersonal behavior. Bullying must be recognizable and understood if we are to prevent it. Bullying can be prevented by keeping all lines of communication open, urging all children to seek help if bullied and for those who are not bullied to be encouraged to step in and stop bullying before it happens. In this way all children will benefit. We must be clear, consistent and concise about how aggressive behavior harms both the giver and the receiver. We must never tolerate bullying and must model in our daily lives the use of effective non-physical positive discipline techniques that encourage appropriate behavior and discourage inappropriate behavior.

Being bullied changed me. I became a protector of others and along the way learned how to protect myself. Listen to your child and search for those children walking down the hall who know how to disappear. Your support, your teaching and your words of encouragement can allow an invisible child to hear the laughter and not the shuffle of feet.

Breastfeeding Success in the Hospital

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Mothers who receive emotional encouragement and informational support about the positive benefits to their health and the health of their child throughout their pregnancy are more likely to breastfeed after delivery and continue to breastfeed for at least 1 year following delivery. Support and advice are available during prenatal visits and from family and friends but involvement in breastfeeding classes or breastfeeding support group meetings can be very beneficial. Mothers often decide whether to breastfeed very early in their pregnancy. This is not a decision that is made at the end of the pregnancy. Healthcare providers play an essential role in this process. Information and support must be provided as soon as the mother to be is aware she is pregnant. Spousal support and workplace support are also essential.

From the moment of delivery contact between mother and the new infant must be supported if breastfeeding success is to be enhanced. This includes skin-to-skin contact between mother and infant immediately after birth and frequently thereafter. This contact has many physical and emotional benefits for both mother and child. Breastfeeding should be initiated within the first hour after delivery and Vitamin K injection and the application of topical eye ointment should be delayed until after the first breastfeeding.

During the first 48 hours following delivery rooming in should be encouraged and supported. This allows maternal-infant contact. Skin-to-skin contact should also continue to be encouraged and supported. There should not be time restrictions to breastfeeding. Breastfeeding should be frequent. Mother and staff must wake the infant if needed to allow breastfeeding 6 to 8 times on the first day and 8 or more times on the second day. Breastfeeding technique should be observed and close attention given to latch problems.  Formula, water, glucose water, bottles and pacifiers should be discouraged. During the first two days of life the infant’s weight and elimination patterns should be closely monitored.

Breastfeeding success is often linked to an infant’s readiness to nurse, breastfeeding positioning and the infant’s ability to obtain an effective latch. Parents must be aware of cues from their new infant that indicate a readiness to breastfeed. These include sucking on the hand, rooting and smacking of the lips. Mothers must be comfortable with and in their surroundings. Due to body exposure during breastfeeding mothers often feel uncomfortable, anxious or hesitant. Privacy and a well supported chest to chest position between mother and infant are essential. During breastfeeding the goal is for the infant to achieve a wide open mouth position with the tongue down and the entire nipple and some of the areola in the infant’s mouth. While the infant is nursing the mother should look for rhythmic sucking movements and listen for audible throat clicks which indicate her infant is swallowing. As milk production increases this audible swallowing will increase. Initial breastfeeding during the first few days may cause some discomfort. Care must be taken to prevent pain from breast engorgement, an improper latch or skin irritation. Overall, breastfeeding should be pain free.