Toddler Behavior: Louise Bates Ames Writes About Your One-Year-Old

I'm reading every parenting book ever written on an obsessive quest to find helpful nuggets and insights to include in my first BabyShrink book. Those of you who know me know that I think much of what's available these days is garbage. Junk. Not practical. Not worth the money.

But once in awhile, I find a gem. Most of these gems are "oldies but goodies" -- dated, in some ways, but true and superb in the way that classics always are.

Louise Bates Ames, PhD, wrote a whole series of parenting books over 30 years ago, with a new book for each year of life. I've read most of them, but so far, this is my favorite. It might have to do with the fact that I have a particularly spicy 1-year-old in the house (thankfully NAPPING, at the moment -- something I don't take for granted with her).

Ames doesn't take 12-24 months for granted, like so many other parenting writers. Ames contends that, in fact, this is one of the trickiest ages to parent -- and I fully agree. In this book, she explains why -- and gives the simplest, sweetest, most effective suggestions I've ever read on how to contend with your newbie toddler.

Enjoy.

Aloha,

Dr. Heather The BabyShrink

BabyGeek: Chronic Stress In Children

I recently wrote about amazing findings showing that stress in early life actually causes DNA damage. Researchers at Duke have taken the next step, finding the exact receptor that is disabled by chronic stress, resulting in genetic damage.

This adds strength to what I believe about making sure our kids are brought up in Good Enough environments: We already know that a LITTLE bit of stress is a good thing. It toughens us up and helps us learn new lessons. But too much stress, over a long period of time, is a bad thing.  That's why children brought up in chronically abusive or deprived environments fare so poorly. And these folks at Duke have found a glimpse into exactly how that works, on a molecular level. Cool stuff.

Their research is connected to how our cells are damaged in a variety of ways -- including by the aging process -- and I know I'm not the only 40-something parent out there hoping science will help us push the envelope of healthy life way out into the future, giving us more time with our children, grandchildren, and great-grandchildren.

Do you think science will offer us a cure for stress and aging -- in our lifetimes? I hope so!

 

Aloha,

Dr. Heather The BabyShrink

BabyGeek: Early Trauma Damages Babies' DNA

It took me over a year, but I finally started to understand the fabulousness that is Twitter. And no, it's not because I want you to know what I had for lunch (although I had some amazing Indian food today). It's because I meet a lot of interesting people on Twitter, and am directed to some fascinating info. The geek in me LOVES the immediate access I get via Twitter to all sorts of interesting infant research. But I do realize that most of you don't share my fascination with primary-source research -- you just want to get through your parenting day with your wits reasonably intact. And that's why I'm here -- to help sort through all the clutter, and show you what I think is TRULY interesting, relevant, and important to parents. So I'm starting a new category on BabyShrink -- BabyGeek. It will give me the opportunity to use more than 140 characters to help interpret the most current findings from the world of infant and child development, and the mind-boggling findings from brain and neuroscience. I hope I can make it all interesting for you, too.

And now, for my first moment of BabyGeek:

Early Trauma Damages Babies' DNA

This heartbreaking study confirms what shrinks like me have long suspected: The mind and body are closely linked, even from the first months of life. This study shows how deeply linked: Traumatic emotional experiences such as institutional care actually damage the child's DNA. Scientists have been investigating how the length of the telomere (the cap that protects the ends of the DNA strand) is related to health and longevity -- and the orphans in the study had significantly shorter telomeres. Here's the study report.

In college, we used to argue about "nature vs. nurture". Now, we know it's nature AND nurture -- down to our DNA.

I'm waiting for the research that shows longer telomeres in babies from "good enough" homes.  I wonder what other aspects of parental care will show impacts -- positive or negative -- on DNA?

What are your thoughts?

Aloha,

Dr. Heather The BabyShrink

And I hope to see you on Twitter! Follow me here.

Child Development: Update On The Whole Vaccine/Autism Thing

Just a quickie to point you to an update about the "doctor" who started all the craziness about the SUPPOSED link between the MMR vaccine and autism. The most lifesaving discovery EVER -- the vaccine

(My friend Esther runs the site -- a smart cookie and a doctor to boot -- look around her site a little bit, too):

mainstreamparenting.com

Remember, there are no guarantees when it comes to weighing the healthcare options for your family. But the more informed you are, the better prepared you will be to balance the pros and cons. For my money, vaccines are an easy bet.

Aloha,

Dr. Heather The BabyShrink

New Info on the Autism/Vaccine Issue

In an interesting development in the ongoing saga of the alleged link between vaccines and autism, the medical journal The Lancet is retracting the original study that proposed the idea that the MMR vaccine could cause the disorder. If you've been a BabyShrink reader for awhile, you know my stand on vaccines: They've saved millions of lives. It's just like any medical advance: There's a cost-benefit ratio to consider. And when you're talking about saving the number of lives that vaccines have saved, SIGN ME UP.

In terms of the supposed autism/vaccine link, I've always been skeptical. I want to know more about possible environmental and genetic causes, but I believe the reams of research done that show NO CAUSATION by vaccines. And I'm still wondering about the issue of autism recognition, diagnosis, and the increase of cases: Clinically, I see a lot of pressure to diagnose autism, and much greater willingness to give the diagnosis. If you're interested in more, here are a couple of links:

Here's a link to my other posts on autism and vaccines.

Here's a link to the CNN article on the retraction of the MMR/autism article by The Lancet.

Aloha, Dr. Heather The BabyShrink

Developmental Issues: Is Your Young Baby Showing Signs of Autism?

Hi Dr. Heather, I came across your website when doing a search for signs of autism in infants. Our 3-month-old doesn't look at us very much, doesn't track objects across the midline well, and doesn't often respond to our voice. He stares at the wall or just beyond us pretty much anytime we hold him in our lap looking up at us. He is very calm and mellow, and only cries when he is tired or hungry. He would sit in his bouncer or swing all day if we let him. We also have a 3-year-old very active boy with sensory processing problems so I know our baby doesn't get as much attention as i would like to give him. We know he is way too young for any of these signs to be a definitive answer, but I am having a hard time finding information on what we can do preventatively as we observe him over time. There is a program in our city, but other than that, everything I find is geared towards 18 months to 2 years, since that is the time that it is easier to see more clear signs. Can you help?

Jennifer

Dear Jennifer,

I'm so glad you are aware of this crucial aspect of your baby's cognitive development. I think most parents would be happy to have a "mellow and easy" baby who would happily sit in his bouncer all day. But you recognize that he might not be reaching out to you for the important "give and take" and communication that he needs to trigger important aspects of his development. He needs to engage with you and play "Baby Games" in order to solidify his relationship with you, which forms the foundation of his cognitive growth. What to do?

I understand that you want to be as proactive as possible, given your experience with your older son. And while there is a possibility that your baby may suffer some similar developmental issues, it's also quite possible that everything you describe is well within the norm for typical development. First of all, try not to over-worry, but maintain the watchful engagement that led you to research your concerns. Your baby can pick up your fears and anxieties, and this can push him to be even more distant. There is some interesting psychological discussion and observation going on about this very basic "give and take" in the parent/infant interaction, and in the ability of a baby to pick up on his parents' feelings. When a very anxious parent reaches out to a baby in a way that seems desperate or demanding, the infant can sometimes seem to feel pressured, and retreat even more. So, as with many aspects of parenting, containing and managing your own feelings is Job One.

That said, there are many things that ALL parents can -- and should -- be doing to maximize this incredibly important time in a baby's development:

Carefully watch your baby's sleep/wake/activity schedule for clues as to when he is most likely to be responsive to parent interaction. Sometimes he'll be fussy, or seem overstimulated by your efforts. Other times he may be more receptive. Often, these receptive times are shortly after waking from a nap and having a feed. But you are your baby's best expert; try to figure out when he's most approachable.

Then, make a conscious effort to play "Baby Games" during these times of approachability. Try to match his energy level and catch his gaze. Follow his lead; if he coos and looks away, try to respond in kind. You want to reinforce any efforts on his part, even brief eye contact that might be just 1 or 2 seconds long. Each baby is different; perhaps your baby is more auditory and responds well to your cooing back, other babies might be better reinforced by a brief touch to the face or hand, or from a big returned smile. Experiment, and see which response generates another round of interaction from your baby.

Don't give up if your baby continues to avert his gaze. Take a deep breath if you start to worry, and try to be as available as you can for "Baby Games". Give him time and keep trying.

Jennifer, I have a 3-month old too. Although she does engage in periodic eye contact, coos and smiles, she is much more reserved than her siblings were at this stage. At first I also worried about her relative lack of eye contact and her willingness to hang out in her crib for long periods of time. I can't help but think that the noise and chaos of our busy household causes her to be a bit more protective in her interactions; there's a lot for a little baby to absorb in this household! But her Daddy and I have been engaged in the exactly these exercises with our little one, and I can see the difference in just a couple of weeks of consciously trying to engage with her.

Dr. T. Berry Brazelton has some excellent suggestions for engaging a baby who might have sensory issues or sensitivities. Use your parents' detective skills to determine WHICH senses your baby tolerates -- and DOESN'T tolerate -- very easily. Use this information to "fine tune" your interactions with him. For instance, our baby seems to respond longer to us, and with more smiles, when I'm quiet. Responding both with my facial expressions AND my voice seems to be too much for her, and she turns away. But if I keep focused on giving her a big returned smile, maintain eye contact, and maybe even stroke her hand or her cheek, she's much more likely to stay engaged in our "Baby Game" than if I coo or talk back to her. Eventually, she'll develop the ability to tolerate my voice as well. But until then, I'll hold back a bit. Experiment with using different modes of communication with your baby and maximize what works.

I also double-checked on the expected timeframe of infant response to parents' voices, and most authorities agree that this isn't regularly observed in most infants until 4 months. Our baby is 14 weeks, and only in the past few days has she started responding to our voices on a somewhat-regular basis.

Now, I'm not able to evaluate your little one, but there are many things you can do to maximize this important aspect to your son's development. Over time, you can judge his progress and if you're not satisfied, have him evaluated by the program you mentioned in your city. If they're not yet able to enroll him due to his young age, perhaps their specialists can take a quick look at your son and make some further suggestions to you. I'm a firm believer in erring on the side of having a child evaluated early, not only for reassurance of an expert opinion, but for the often very helpful recommendations that the specialists can give you, even if there's nothing really atypical with your child.

And I can't stress this enough: At 3 months of age, you should be aiming for interactions measured in SECONDS, not minutes. Feel good if you generate a few "rounds" of interaction between you and your baby at this age. Over time, you'll both want to stretch these interactions to last longer and become more complex. But at 3 months of age, your baby is still very young and new to the world of interaction. A 3-month-old is only recently "hatched" -- our psychological term for the opening of awareness that marks the end of the "squirrelly newborn" phase. So manage your expectations accordingly.

Jennifer, thanks for the opportunity to write about this extremely important topic. I hope you'll write back to update us on your progress!

Aloha,

Dr. Heather The BabyShrink Mom of Four, Parenting Expert

Sleep & Nap Issues: Understanding Your Baby's Sleep And Wake Cycle: A Recipe For Sanity

Having a new baby throws all semblance of a household schedule into chaos. Your little interloper has demands around the clock, and as YOUR ability to sleep decreases, your feelings of insanity increase! Sleep deprivation is really one of the most difficult parts of being a new parent. You can't really blame the baby; he's obeying his internal needs and commands, which don't yet follow a nice, predictable pattern. Or do they? Believe it or not, you CAN make some sense of your baby's sleep/wake/activity cycle. Most babies generally cycle through the following phases:

1) Sleep 2) Hunger/awakening 3) Feeding 4) Alertness 5) Fussiness 6) Sleep

Very young babies may be in each phase for only a few minutes each, gradually lengthening the time spent in each phase as they get older. And of course there are variations on the above cycle; for instance, some babies like to feed again, for comfort, before they go to sleep. But most babies WILL have even some very basic, cyclical pattern that they follow around the clock, even from the earliest age. And as your baby gets older, his tendency to develop a more predictable pattern will become more obvious to you (as long as you look carefully for clues to his own unique cycle). Become a parental detective, and you'll learn a lot about your new little one.

It helps to know where your baby is in the cycle at any given time, so that you can know what to expect from him now, and in the near future. For instance, if your baby is at the tail end of a nap, it might not be a good idea to plunk him in his carseat for a long ride; he'll likely awaken with a powerful hunger, and you won't be able to feed him easily. It makes more sense to let him awaken and then feed him before you leave. Understanding where he is in the cycle also helps you know when you can expect to interact with him most productively (and have the most fun with him!) I know our new baby will awaken from her longest stretch of sleep in the morning, feeling good and ready to "play". I try to schedule my day so that I can linger with her while she coos and smiles at me from her favorite perch; the changing table, in the morning. We have fun, sweet little "conversations" that are both fun AND important to the development of her little brain. But at the tail end of her period of alertness always comes the fussiness, and I know we can wind down our playtime, as I start to rotate among her favorite soothing techniques. (At 7 weeks of age, it's anyone's guess what will soothe her at any particular moment; sometimes it's her Daddy's "Heismann Hold", sometimes it's her binky and bouncy seat, her swing, or a ride in the stroller).

Getting to know your child starts at even this very earliest of ages. You'll find, over time, that the general patterns you observe about her sleep/wake cycle eventually extend into her personality tendencies and temperament. This will help you over time to meet your child's unique parenting needs. Have fun -- and try to get some sleep!

Aloha, Dr. Heather The BabyShrink

Parenting Tips: A Comprehensive List of Parenting Resources

Adrienne at NursePractitionerSchools.org contacted me to let me know about a comprehensive parenting resources list she's compiled. CHECK OUT HER "TOP 100 LIST" HERE. I like the breadth and quality of the sites she's selected and check in on many of the sites she's included on a regular basis (and aww, shucks, thanks for including BabyShrink, Adrienne!) Also, thanks to those of you who have been checking in on our progress on BABY # 4. I'm 34 weeks along, and although a distinct waddle has made it's way into my walk, so far so good -- with the baby, at least! I, on the other hand, wonder where my lungs went, as I can't seem to BREATHE in the summer heat, and the various aches and pains of pregnancy are making it near-impossible to sleep. Oh well, at least it's temporary...once the baby is born, I'll be able to get some sleep....HAH! However, I am truly grateful and amazed at the miracle of conception and development, and I cannot wait to meet this newest member of our family. There's nothing better than this!!!

Aloha,

Dr. Heather The BabyShrink

Developmental Issues: Did Swine Flu Cause Autism In My Son?

There's a lot of confusion out there about illness, the flu, vaccines, medications, and autism. This poor Mom is terrified that her son may have contracted Autism from a bout of Swine Flu. Here's her email to me: Dear Dr. Heather,

Please help. I saw your article on autism, and I am very intrigued and impressed by your knowledge and insight.

I don’t know what to do. I have two beautiful, 91/2 month old identical twin boys who were always very social, smiley, interactive, looking directly into the face, etc. The one I am most concerned about would turn his head and smile at his brother in their crib, smile at everybody, I would play the ‘up’ game with him and he would gaze into my eyes, smile, and giggle… and they both almost always responded by looking when I said their names.

Then one of them got sick with Swine Flu on August 6th. His brother got sick on August 8th. I will never forgive myself as the last time I remember him (the baby who got sick on the 8th) acting distinctly like himself was the 6th when I went to pick up his sick brother at daycare… he looked right up into my eyes, threw up his arms, smiled, and said ‘Mommmmm’…. And I barely paid attention to him, I rushed to his sick brother… I should’ve thrown my arms around him and hugged him and praised him…. I have such guilt and keep worrying/wondering what if that is the last time he ever does that?

They were both put on Tamiflu due to being high-risk (they have asthma symptoms). The baby I am most concerned about didn’t get as high a fever, but the virus infected his eye, and we think he also got a bacterial infection, so he got eye-drops and Amoxycillin as well. He was miserable and cranky for days. I know he can hear (by testing by loud noises, etc.) and he doesn’t have an ear infection, as he’s seen a doctor.

Now he is not himself. I first noticed this as he got better. He is not responding when I say his name, hardly ever. If he does he just looks for a second. He will make eye contact, but only for a second or two. He looks away when I try to play the ‘up’ game with him. He is still babbling, but not as much. He did this weird whisper-babbling this morning and smacked his lips. He is still playing with his toys, but is also playing with non-toy objects like straps and blinds.

The doctor has an ear test set up for him, but I have to wait two weeks just for a call to make the appointment.

Can a virus or antibiotics trigger autism? Does a flu ever attack the ears, eyes, or brain which might cause sudden symptoms? What are the other possibilities might be going on if he doesn’t have an ear infection? This is a very, very abrupt change.

What tests should I push for to find out what is wrong as soon as possible? What are the possibilities?

So far his brother is acting normally, but I am terrified as I'm worried about it affecting both twins eventually.

Please, I would love a response. We have (mega-large HMO) and it is hard to get tests/things done. I am eagerly awaiting your response and guidance.

Very, very sincerely, Concerned Mom

Obviously, this mom is in a state of desperation, so I responded immediately:

Dear Concerned Mom,

Of course I cannot evaluate your son myself and as such, I can only provide some educational information for you. But I did want to respond right away because you sound so very upset and worried.

First of all, please know that autism is thought most likely to be a genetically-related developmental issue, and I have seen no convincing information that it can be caused by a simple flu or other virus in a child, nor by antibiotics or antivirals. Additionally, the timeframe you mention of the abrupt changes in your son do not sound like the onset of autism. After all, it's been barely 2 weeks since the onset of his flu symptoms.

A (temporary) step backwards in response to illness However, it is VERY common to see temporary developmental regression in response to illness. This means that your child can take several steps BACKWARD developmentally -- in response to illness and/or stress -- and then "bounce back" days or weeks later. It's all part of the normal developmental process,which is full of starts, stops, and reversals -- the old "one step forward, two steps back" thing. Young children don't understand that the course of illness is temporary; that they will get better. They simply know they feel lousy. They are not up to showing off all their "best" developmental skills. They commonly regress to earlier stages of development, temporarily, until they feel better. And often times, symptoms of illness can linger for WEEKS in children -- especially for something as yucky as a flu. If he is showing regression in response to illness, the regression itself can linger for weeks as well, past the time that he gets better. This may vary from child to child and from illness to illness, so his brother may be fine (at least this time). Personalities vary in response to illness and stress I don't know about your husband, but when mine gets sick, he just wants everyone to GO AWAY. (is this a guy thing?) He's crabby and won't talk to me and is just a completely different personality than when he's feeling well. Everyone is different, and your boys also will have different responses to stress and illness. The point is that there are very reasonable possible explanations as to why your son is acting so differently than his usual self, for this relatively short timeframe.

It's important that you respond in a positive and supportive way, and not convey to him that you're so worried. He's able to pick up your anxieties, and internalize the message that "something must be wrong with him". He needs reassurance that he WILL get better, and WILL feel better, but for now he still feels lousy and needs to be babied -- and that's OK.

As I said, however, I cannot evaluate your child from afar, so it's important you get your doctors' advice, as it sounds like you are doing. But since you have to wait for appointments, I would take this time to hang out with your boys in a relaxed way, giving them the chance to fully recover.

Please let us know how you're all doing in a few weeks' time.

Aloha,

Dr. Heather The BabyShrink

Child Development: Can't Our Kids Be "Normal"?

Living in Hawaii ain't bad. But one of the things I truly miss about living in Southern California is reading the LA Times. I especially love the Health section; I find things in there that I don't even come across in my geeky science-journalism review sites. My in-laws lovingly and patiently collect them for me, since I'm over 40 and still get a thrill from smudged newsprint on my hands. Lately I've been reviewing my lovely stack of Health sections, and I wanted to share this great article with you. It echoes a BabyShrink theme: We need to have REALISTIC expectations of our kids and their development. The pressure to "perform" these days, even in preschool, is ridiculous and even damaging. Accepting our kids (and ourselves), with all of our interesting variations and wrinkles, is the only way to see them eventually have a solid sense of self-acceptance, and to ultimately excel in areas where they're truly exceptional.

Here's the article. Let me know what you think!

Aloha,

Dr. Heather The BabyShrink

Deveopmental Issues: The Amygdala, Babies, and Autism

Following up on yesterday's post is an interesting new finding from the University of North Carolina, where researchers are confirming more evidence for an actual structural brain difference in babies with Autism. Please excuse the "science geek" in me, but this stuff is really important for us to understand. It will help us to better diagnose and help even very young children with Autism-related difficulties, and it will help us to screen out those who SEEM to have Autism, but don't (see yesterday's post).

For my non-science-geek, non-shrink parent readers, this is the bottom line here: It's important to really be watching the quality of your baby's social development. Your baby's glances, smiles, gestures and babbles in his first year of life tell you a TON about whether he's developing normally. The article highlights the importance of "Joint Attention", which is what your baby does to attract and sustain your attention, in order to share something interesting with you. If he likes doggies, when he sees one, he'll try to get your attention so that YOU can see the doggie -- and get excited by it -- too. He'll want to share his interests with you, even if he doesn't yet have the words to tell you about them. By the end of his first year, you should see him doing this more and more. Children with Autism have trouble with this -- and now we have more information as to why.

If you're interested in more, check out the summary article here.

And as always, post a comment with your questions or thoughts, if you'd like.

Aloha,

Dr. Heather The BabyShrink

Attachment Parenting: Broadening the AP Debate into Vaccinations

We've had a lot of action around here regarding Attachment Parenting. The issue doesn't end at sleep training, babywearing, or extended nursing. It also is smack dab in the middle of one of the most contentious issues in parenting today...the issue of the safety of vaccinations. If you've read my posts here for long, my thoughts won't come as any surprise to you. I'm strongly pro-vaccination. And I evaluate toddlers all the time for autism. I realize that I may incur the wrath of some sadly misinformed readers out there, but I gotta tell ya: Vaccines have saved millions of lives. Case closed. (To me, at least.) If you haven't already, check out this post stating my thoughts on the issue.

Along with a mini-flood of reader questions about infant sleep, reader Julie posted this comment today, and I thought I would write about it because there's a lot of momentum going in this direction in the parenting press these days:

Hi, I also have a 7-month-old and I just did the sleep training with the Sleep Easy Solutions book. It has been a great experience! We actually bedshared for a bit, but it became very taxing in the evenings, as he could not go to sleep without me. He now sleeps longer and better and gets himself to sleep. We are now working on naps. Interestingly enough, he used to nap so much better next to a parent, but now he sleeps better if he gets himself to sleep. I think seven months was the perfect time for us to transition him to his crib and help him learn to sleep on his own.

I wrote about this on my personal blog, ilovemonsters.blogspot.com.

I heard about your blog on Mainstream Parenting Resources. I also have a new blog with some other folks called Rational Moms.

I’m very interested this whole AP thing–I have some major issues with Sears. So I was looking at your articles on this in preparation for my own post.

After reading her comment, I pulled a link to a fantastic article in the New York Times from the Mainstream Parenting site. It broadens the issue of Attachment Parenting into the issue of vaccinations. Check it out.

Can't wait for the fireworks.

Attachment Parenting: More Discussion On Its Pros And Cons

There's an interesting discussion that's taking place on several sites simultaneously, and rather than responding to comments down below one of my more recent Attachment Parenting posts, I thought I'd highlight the discussion here, since lots of us are interested. Many of us are confused when we read parenting advice by "gurus" like Dr. Sears (who coined the term "Attachment Parenting"), because it makes us wonder whether we're doing a terrible disservice to our children if we use some form of "Cry It Out", DON'T co-sleep, engage in "babywearing", or do "extended breastfeeding". Poor Susanna came over to BabyShrink, after feeling scolded by AP proponents when she tried the "Cry It Out" (CIO) approach in a desperate attempt to get her son to sleep. We've continued to discuss the issues, with Annie at PhDinParenting bravely supporting her beliefs here, and elsewhere.

Annie left a link on a fascinating, very thorough anthropological review article looking at aspects of "natural parenting" worldwide. If you've got the time to read through the 82 page document -- go for it. Seriously, it's extremely interesting. I certainly find very little to quarrel with in the report. Perhaps Annie doesn't realize it, but here at BabyShrink we agree that responsive, "tuned-in" parenting is crucial in child development, and that physical -- and emotional -- contact, and very involved care, is an essential component in the ultimate well-being of a child. And that the lessons learned from in-depth study of attachment -- via well-accepted research -- informs our approach and intentions.

But the research review that Annie showed us mainly focuses on the young infants we ALL agree need to have close, physical contact and deeply involved parenting. It doesn't extend much to a discussion of toddlers and preschoolers, which is the group most often asked about at BabyShrink. It also doesn't tell us that the "Attachment Parenting" approach is somehow BETTER than the "Good Enough" parenting we strive for.

My beef is with those who take excellent research, and make unwarranted generalizations about it. The research shows us that excessive crying and non-responsive parenting is bad for the development of babies. --Well, duh. The research does NOT say, for instance, that a certain amount of crying, in the service of getting an older baby or toddler to sleep through the night, in their crib -- is a bad thing.

The bottom line here is that I'm against any sort of "holier than thou" parenting approach that doesn't respect individual differences in babies' temperaments and family circumstances. Good Enough is GOOD ENOUGH -- and there's research to support THAT. You don't have to be a perfect parent, and in fact in trying, you can make everyone nuts. There are far too many parents out there on "information overload", worried that they are daily making bad decisions for their kids, and in the process, not learning to trust their own best instincts as parents. You know your child best. I've always said to take what I say, or what any "expert" advises, with a grain of salt. Take what makes sense, leave the rest, and improvise from there.

Do I think Attachment Parenting can be applied with excellent results? Of course. Are there AP parents who are doing a fantastic job? Absolutely. But there is a vocal AP minority who insist on spreading the "gospel" to those of us who don't appreciate the prosteletyzing -- and whose children are turning out pretty great, thank you very much.

FOR MORE OF DR. HEATHER'S THOUGHTS ON ATTACHMENT PARENTING, SEE THIS POST, AND THIS ONE TOO. IT'S BECOME A HEATED TOPIC!

Dr. Heather The BabyShrink Mom of Four, Parenting Expert

Attachment Parenting: Is It Bad for the Child?

Dear Dr. Heather, Does breastfeeding past 2 years of age encourage dependency? I know a child who is still breastfeeding and has become very whiny and attached to her mother. The mother is making no effort to wean the child. Is this type of emotional attachment healthy for the child? She still wakes up to nurse during the night and sleeps in the parent’s bed.

Thanks,

Concerned about a child

Dear "Concerned",

This is a polarizing issue that tends to bring out strong opinions. There is a community that promotes an approach called "Attachment Parenting", based on the work of well-known pediatrician and author William Sears, MD, and one of they key tenets of this approach says that "extended breastfeeding" (past the age of two years) is recommended and important to the development of a child to promote a solid sense of safety and security. However, their key tenets are only based loosely on well-known child development research, and Attachment Parenting certainly has it's critics.

One of the things I do like about Attachment Parenting (AP) is it's understanding of the cultural differences that exist in families around the world, and the promotion of various ways of raising a family that can resonate more fully with various non-Western cultures. For instance, many Asians traditionally -- and happily -- share a family bed, or a family bedroom, as is suggested by AP. I also like the fact that AP promotes the reliance on the family's own resources to know what is best for their children; we don't have to rely on outside "experts" for everything. AP is also well-known for it's insistence that the attachment between infant and mother is essential to the development of a healthy baby, both physically and emotionally. That message sometimes gets lost, or diluted, in Western cultures.

The problem I have with AP is that it's adherents often tend to be quite orthodox in their beliefs. I myself have been sternly lectured for simply using a stroller (as opposed to "baby-wearing", another AP belief), as well as for using a bottle to feed my baby in public. Of course, this is the opposite of the intolerant demagogues who criticize breastfeeding in public -- it's their shared judgmental strictness that bothers me most.

The other concern I have is that it takes a blanket, "one-size-fits-all" approach to all children. Some babies don't want to be held all the time. Some babies need time without physical contact to "decompress" from all that physical stimulation. Some babies don't do well breastfeeding either, and many babies sleep better when they're not disturbed by the direct physical contact of their parents. And your approach to raising your babies has to be dependent, at least partially, on the unique constitution of those babies. You've seen me write about sensory differences here at BabyShrink, and I know far too many babies who have these quirks and preferences to be comfortable giving a blanket statement about "baby-wearing", breastfeeding, or co-sleeping. In our family, only 1 of our 3 children enjoyed being held all the time; the other two needed "time-outs" from direct physical contact in order to look around and "process" all of that physical contact. They (and I) both felt better for a little break now and again, and I used bouncy seats, strollers and cribs regularly for these breaks. It simply isn't fair to criticize parents who accurately judge the needs of their babies to include a little "down time", or to make them afraid that they risk their child's optimal development if they use a stroller or have their crib in their own room.

If you've read other BabyShrink posts, you won't be surprised to hear me say that I strongly support the uniqueness of each individual family to best decide the individual needs of each of their unique babies. And to that end, I say that if it works for a family to have a family bed, or for mom to breastfeed for over two years, I'm not going to criticize that. However, I have met many families who suffer negative consequences of making those decisions, but stick with them in the false belief that it's what's best for their children. Often, an AP family will come to see me for a problem related to the development of their toddler. When I start to gather more information, guess what? Mom is exhausted, usually because she has been unable to sleep through the night since the day her baby was born; she's often still nursing several times a night. And her husband is grumpy because he can't get any "alone time" with his wife, and he's sick of being kicked through the night by a toddler who gets bigger by the day. So mom is beyond exhausted, dad is frustrated and distant, and the toddler becomes the focus of the problem. Everyone suffers in this scenario. In this situation, my advice often includes the suggestion to transition the toddler into his own bed, in his own room, to restore some balance in the lives of the couple. The relationship needs attention, too! If the parents don't have a strong relationship, the development of the child will surely suffer. And if the child needs to sleep in his own bed, and be weaned from breastfeeding, that is a small price to pay if it serves the purpose of bringing the parents back into a more harmonious relationship.

So, "Concerned" reader, I can't say that "extended breastfeeding" will hurt the development of the child, without knowing all the other factors in the family. It remains the responsibility of the family to determine what's best for them -- and for their child. But I certainly don't promote Attachment Parenting as the "be-all, end-all" guide to what's best for your child. Only you can decide that!

Aloha, Dr. Heather The BabyShrink Mom of Four, Parenting Expert AND MAKE SURE YOU CHECK OUT THE COMMENTS TO THIS POST FOR AN EXTENDED, INTERESTING DISCUSSION AMONG READERS!

AND DON'T MISS ANOTHER ONE OF MY ATTACHMENT PARENTING POSTS HERE PLUS THIS POST AS WELL -- IT'S BECOME A POPULAR TOPIC!!

Parenting Tips: Lessons Learned From A Baby's Surgery

Thanks to all of you who wrote your comments and emails of support over the past couple of weeks while I anxiously awaited our 2-year-old's hernia surgery. He's fine today; a little tender, walking around like an old man who put his back out. He's covered in the dirty, gummy remnants of surgical tape, and has two (yes, TWO) inch-long diagonal scars in his groin. But he is fine. So while the memories are still fresh, here are some important things I learned yesterday: Be Ready for Changes in the Surgery Schedule Not easy for a control freak like me, but important to know. The schedule can be changed for any number of reasons, so plan accordingly. For us, T was found to need more extensive surgery, requiring more time (2 hours, as opposed to the 30 minutes we had expected). That meant the doctor had to shuffle his schedule, which affected our arrangements. Stay light on your feet, and keep your options open on the day of surgery. If at all possible, arrange to have both parents present AND a support person (like a grandma -- Thanks Mom!) so you can juggle communication with the staff, care for your child, and other basics like parking, travel arrangements, and food.

Don't Be a Hero I'm a health-care professional, right? I grew up in a medical household; my Dad was a physician. The sight of blood doesn't bother me, I have more than a passing familiarity with medical practices, and I've been roaming around hospitals since I was 3.

But yesterday, I was just "Mommy". A shaky, scared Mom who was an idiot and asked to help carry her baby to the Operating Room, and assist with the baby until he was asleep. I thought that helping out as much as possible would be best for the baby. Big mistake! The sight of my baby struggling and screaming while he was being held down (by me) while the nitrous was administered -- that's an image I'll never forget. And it certainly didn't help T. Take my advice and don't be a hero. Treat yourself with some TLC as much as you can. And let the professionals do their job. I don't care if you're in the profession yourself; on Surgery Day, we're all Just Mom, or Just Dad.

Don't Be an Idiot -- EAT Something! I assumed my stomach would be too upset with worry to eat anything, so by the time 11 am rolled around, I was shaky, dehydrated, and bitchy. Not too helpful (nor very appreciated by Mr. Dr. BabyShrink). If you're used to caffeine in the morning, make sure you get some. And at least bring a banana and some trail mix to the hospital; I picked at it, and once T woke up, he devoured it (and the outpatient surgi-center usually doesn't provide food afterward to the kids; you need to bring something for them, since they may very well get hungry afterwards). And since the surgery took so long, I actually did go to the cafeteria for 20 minutes. I forced myself to read the paper, have a snack, and NOT picture my baby being strapped down to the operating table. Even though part of me didn't want to be farther away from the operating room, walking away from the surgi-center for a short break gave me some perspective and allowed me to decompress for a bit.

Thank You To The Doctors and Nurses We are all incredibly indebted to the doctors, nurses, and other health-care professionals who take care of our kids; those like Dr. Sid Johnson and post-op nurses Jessica and Mike who were among those who took care of TT yesterday at Kapiolani Women's and Children's Hospital. These people have the stamina, dedication, courage and expertise to take care of difficult, challenging, and often very sad cases every day. But mostly they love kids, and it shows in the work that they do.

A Hernia Is Just a Hernia; Nothing More. When TT was resting in the "wake-up room", Jessica shared stories with us about some of the very sick children who come in and out of Kapiolani every day. It gave me some healthy perspective: To them, TT is a healthy, strong child who just needs a little patch-up work. The child on one side of T was a 9-year-old who has had leukemia for 3 1/2 years. On the other side was an 18-month-old who has had multiple surgeries from birth defects, and had reconstructive work done on her pelvis. She was put into a full-body cast. And although our little guy will be sore for awhile, in comparison, this was small potatoes. So while the day was grueling, and we hit some tricky spots, we're home, and everyone is on the road to recovery. We're extremely grateful for the health of our family; even more so, after our experience yesterday.

BabyShrink's Baby Needs Minor Surgery, and Dr. Heather Needs a Little Reassurance

First of all, I want to thank you all for hanging in there with me while I get the feed worked out for BabyShrink. Before I started this site, I thought "feed" was simply the activity in which I engaged, oh, 17 or 18 times a day. (My boys, especially, eat....a LOT.) But thanks to the Other Heather at OhMyStinkinHeck.com, it's all good now! Heather, I really appreciate your responsiveness and expertise. Second, some of you have noticed that my posting has been a little less frequent. After our trip, I intended to jump back in with lots of new stuff. But here's what happened: A few nights ago, Baby TT was jumping around naked after his bath, as he is wont to do. He got into some kind of toddler freak-out about something, and Mr. Dr. BabyShrink noticed a strange little bulge in TT's groin area. It only popped out when TT was screaming, then went back in.TT at the zoo

We both knew it had to be a hernia. The pediatrician confirmed our suspicions, and he's scheduled for surgery August 19 at Kapiolani, which is a children's hospital in Honolulu.

Everyone is very reassuring about the procedure. "It's the bread and butter of the pediatric surgeon. They do it all day, every day.", "It's not considered deeply invasive, and he'll jump right back immediately.", "It will be over before you know it.", "You're lucky it's not something serious."

Of course all of this makes sense to my logical mind. It truly is not a big deal, and we are so grateful for the good health of our three kids.

But my Mother's Fears are going crazy. How can I surrender my BABY up to the the doctors and nurses who will strap him down, drug him, and cut him open? How can I hand him over to total strangers to fix something that doesn't even bother him? What if...What if....What if....

To complicate matters, we have a family history of malignant hyperthermia, which apparently makes the anesthesia more complicated. It should be safe, since they know in advance about what drugs to avoid giving TT. But it still makes me damn nervous.

Lately I've gotten questions from many of you who have children with chronic health conditions. I've thought a lot about the impact of health issues on our relationships with our families, and on our parenting. And of course it's easier to answer questions that OTHERS have. I'll be posting some of those letters soon.

But first, I want to hear back from YOU: those of you who have gone through procedures like this with their children.

What was it like? What can I expect? How did you cope with the anxiety and fears? Were there any lasting impacts on your parenting? How did you explain to your little one what was about to happen? What about siblings; what did you say to them?

Thanks in advance for your ideas and support. You'll be helping me -- and a lot of other families out there who are going through the same process.

Developmental Issues: How To Tell If It Is Autism

*Please note: This post was updated by Dr. Heather on 11/22/2010 .

Autism diagnoses are skyrocketing, but is the incidence of autism really increasing? Are there really more autistic kids out there than there were before?

We don’t know for sure, but one major contribution seems to be the increasing recognition of developmental problems in children by professionals like me. In other words, is it possible that the increase in autism is simply an increase in our diagnosis of the disorder?

Yes.

The single most frequent referral question I get, as a BabyShrink, is: “Is this child autistic?” Often, I see a two-year-old who is head-banging, language delayed, or performing repetitive behaviors. He may already have a speech therapist or other specialist who worries about autism. Or his parents may have seen Jenny McCarthy on Oprah, and say, “my kid does that!”

The New Autism?

When I went to grad school in the 1990s, we learned that Autism was a rare, severe, and life-long disorder of communication and social relatedness. These kids exhibited the most obvious signs of the disorder:

Near complete retreat from communication with others

Hand-flapping and other odd self-stimulatory behaviors

Severe developmental delays and behavioral outbursts

These kids really could not be taught in any regular school setting; They needed support and help in daily living for a lifetime. But as time went on, clinicians started to see less severe forms of these symptoms; we got better at recognizing them in their more subtle forms. As more behavioral health-care professionals were trained, we had more “eyes” looking for the problem. Parent advocacy and special education laws increased pressure on the school systems to widen the array of services for kids with less severe symptoms. Soon, I had parents and teachers asking me to diagnose autism or a related disorder so the child would qualify for intensive, expensive help that was only available under the autism spectrum range of diagnoses.

The pressure is tremendous; here is a child who has communication and other developmental delays. His parents have few resources. The school will only pay if there is an autism diagnosis. Many clinicians admit that they rationalize labeling the child “autistic” if it helps them get the services they need.

Digging Deeper: When Autism Diagnoses Are Misguided

So, back to the typical 2-year-old head-banger referral. A toddler I saw recently already had a new speech and language therapist, and an occupational therapist. They were concerned about his lack of progress in therapy. He had “lost speech”, meaning he no longer used the words he once did. One psychologist had already labeled him “autistic”, after spending just 60 minutes with him….in an office, not the child’s home, where he is most comfortable and most himself. I found a shy little boy who needed a lot of reassurance from his parents with me, a stranger, in his home. But he was outgoing and comfortable with his siblings and cousins on the playground. Later I found a buried note in the records about ear infections and asked about it. Fast-forward two months; after an ear/nose/throat and audiology consult, the child had ear tubes placed to drain the accumulated fluid behind his eardrums. He immediately began speaking meaningful words and his head-banging decreased by 90%; Nobody is worried anymore about him; he is progressing beautifully and is on track to start preschool at age 3.

That child had painful, unremitting ear infections that interfered with his hearing and language development, and caused him to bang his head in an effort to deal with the pain; His “lost speech” was a result of his shyness with the new speech therapist, and his hearing difficulty. He never truly “lost” any speech; he just was too shy to use his words with a new stranger, the speech therapist! And he was diagnosed with autism, and that diagnosis is “counted” in the statistics of the increasing “epidemic”.

I’m not arguing with the possibility that the actual incidence of autism is increasing. But I am not 100% convinced that that is taking place. And I’m worried about the panic and alarm caused unnecessarily to parents.

Misdiagnosed?

I am worried that there are several other distinct disorders being thrown together inappropriately with autism. Children with these disorders deserve to have them studied and understood uniquely, and not just lumped together with other disorders. In particular, there is a large group of children with sensory and motor problems; for example, a baby born with difficulty in tracking her vision. She cannot control her eyes properly so she cannot make eye contact with her parents. She does not learn to communicate well because she cannot make her eyes look where she wants them to go. Her parents think she does not “want” to look at them to communicate. These days, when clinicians hear that a baby does not make eye contact, they immediately think “autism”. But in this case, it is primarily a visual problem – one that, if corrected, will completely eliminate all her delays and symptoms.

Check out the following illustration I found online…(if anyone knows the source, please email me! I have been trying to locate the author but cannot find any information.)

Figure 2. At the age of four months this baby girl turned her head away when an adult tried to interact with her. This was interpreted as a sign of infantile autism. Since two of the older three siblings had esotropia, the infant was referred for an examination. She had normal looking eyes, a refractive error of +1.0 I both eyes and no accommodation to accommodative targets. Therefore +4.0 lenses were placed in front of her eyes to give her a clear image on the retinas. The effect was immediate, the baby looked surprised and a few seconds later showed a normal social smile for the first time.

One thing that health-care professionals seem to agree on is the fact that “Autism” is really a general term for many different disorders, each with different causes and outcomes. We need to work harder at understanding all of the unique disorders that are now being lumped together under one umbrella.

A Word About Vaccines

People are desperate to find a cause for autism. Childhood vaccines protect children from some of the most horrible, deadly, disfiguring, dangerous illnesses that routinely used to kill thousands. Are there dangers with vaccines? Of course. As for all medical treatments, you must weigh the potential risks with the potential benefits. But this problem has been studied extensively by gold-ribbon teams worldwide. Their findings? Vaccines do not cause autism. Not even the older vaccines with thimerosol, a type of mercury. Mercury poisoning by itself does not cause autism either. My kids have all their vaccinations. I have relatives who are survivors of diphtheria, polio and other horrendous illnesses. They don’t want me to lose sight of the misery (and death) that these illnesses inflict. And honestly, when other families choose not to immunize their children, they put the safety of others at risk; especially babies who are too young to have their full complement of vaccines, and other children and adults with compromised immune function. Please do not be misguided by the misinformation out there on vaccines. If you have any questions, please review them carefully with your pediatrician, who will probably agree with what I am saying.

True Autism Symptoms

Now, what does make me worry about autism in a child? Here are the main things I look for when evaluating a baby or toddler. (Remember: each child needs to be seen and thoroughly evaluated in person, preferably in your home, by an experienced professional.) These are some things that should trigger an evaluation, often to simultaneously include the evaluation of developmental psychology, vision, hearing, genetics, neurology, and occupational therapy/physical therapy specialists.

 

* No eye contact after four-to-five months of age;

* Inability to comprehend any language by 12 months (comprehension of language is far more important than spoken language or speech);

* Lack of gesturing (including pointing) by 18 months;

* Not turning to parents for emotional support/reassurance;

* Exclusively preferring objects to people at any age;

* Lack of imaginative play (make-believe/pretend games) by 18-24 months

There are many other possible, "lesser" symptoms, such as lining up objects compulsively, not responding to the child’s name being called, frequent tantrums, making “strange” sounds, and the apparent “loss” of speech. Often, these symptoms are problems, but are better explained by other diagnoses, such as the visual/motor example above, family stresses and problems, or even complex genetic disorders. And sometimes, these “problems” are simply normal expressions of toddlerhood!

So the bottom line is this: if there are any concerns, get an evaluation for your child sooner, rather than later, since time is of the essence. But make sure you get a comprehensive, thorough evaluation that takes all of the above into account. And if someone does use the word “autism”, don’t panic. These days the word means many different things to many different professionals, and often, the symptoms can be completely ameliorated by the right therapy.

Do you have stories to share about the diagnosis of your child's developmental delays? Please share!

Aloha,

Dr. Heather

The BabyShrink