Parenting Tips: Talking To Children About Tragedies

 12/14/2012 Unfortunate update: It's time to talk about this again. My heart is broken, as is yours. Feel free to connect with me here or on Twitter to ask about how you can approach this in your family. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~ The Colorado shooting has come and gone -- and now the Connecticut school shootings, and we're left trying to explain things to The Littles. One well-meaning mom criticized me on Twitter for even suggesting we talk to young children about violence. "Why even bring it up?" she wondered. Her life is much more insular than many of ours -- I have a 2 year old. But I also have a 6 year old. And a 9 year old. And an 11 year old. And those kids have completely different levels of awareness and understanding of these situations -- and they talk. In front of The Littles. So parents like us need talking points for those tricky situations. So here are my thoughts about how to navigate these unavoidable conversations. Let's be ready, because unfortunately, it won't be the last time. I was also quoted in Newsweek/The Daily Beast about the issue. I hope I made the point that parents taking their young children to movie theaters aren't the problem. Untreated mental illness and widespread availability of guns ARE. Aloha,

Dr. Heather The BabyShrink Mom of Four, Parenting Expert

Parenting Tips: How To Leave Your Baby For The First Time

I get a weird, quivery feeling in my stomach when I think back to the time, 8 years ago, when I first left our first child in the care of a sitter. That sitter, Keri, has gone on to become a part of the family -- a central figure in our lives and the reason I can function on a daily basis. But on that day, I had horrendous visions of the damage that would be done to my daughter. How could anyone care for her as well as I? I had to force myself away from them -- Keri holding my daughter's arm up to wave "bye bye" as I drove away. I cried on my way to the meeting I had to attend. It's harder on us than it is on them

Of course, all went very well that day, and for all these years since. But that day ranks up there with one of the most difficult things I've ever done. Here are some tips for those of you facing that fateful day:

Ease Into It Slowly

You and your baby will adjust more smoothly if you plan to be away for progressively longer periods of time. Start out slow: figure out the least amount of time that you'll be able to handle being away, even if it's just for a few minutes. Arrange to have the sitter come anyway, and explain to her that you'll be coming and going as you all adjust to the new arrangements. Or if you're leaving her at daycare, work out a "transition" time with the teacher so that you can come and hang out for awhile at drop-off and pick-up times, helping your baby (and you) to adjust. Eventually build up to the length of time you'll usually be away. For some, this may take days -- or weeks. That's OK.

It May Be Harder For You Than It Will Be For Your Baby

Regardless of baby's age, talk to her about your plans to leave in advance. Even if she doesn't understand your words, the tone of your message will sink in. It will also be therapeutic for you to talk about it. Up until about 5 or 6 months, your baby will be pretty cool with you being away for awhile. Older babies and toddlers will need more "practicing" in advance, but for most, their protests will only last a few minutes at most after you leave. A good sitter will have a plan to distract her quickly after you've gone. Have the sitter call you when the baby calms down -- you'll feel much better.

Know That You'll Feel Like A Part Of Your Body Is Being Removed

You're supposed to feel that way -- Mother Nature makes sure of that. Know it in advance and make plans to deal with the feelings: Call an understanding friend after you leave, and make plans for a fun thing you haven't been able to do because of the baby. But don't let the feelings keep you from getting the sitter in the first place.

Each Time It Will Get Easier

As long as your sitter is good, you'll feel better and better each time you leave. And then you'll start to feel a developing sense of relief and gratitude that you don't have to do it all yourself. You have help now! HOORAY!

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

Pregnant with Baby #4 (and I Just Turned 41)

Dear Readers, This post isn't an emailed question from one of you. It's from me, your BabyShrink.

I can finally come out with the news I've wanted to tell you for 18 weeks now: I'm pregnant!

This has come as somewhat of a surprise to us, although a very welcome one. Many of you recall we originally went through infertility treatments to get this ball rolling, but needed no help with babies #2, 3, and now 4. So here we are: a 4-for-1 deal!

My age is not the least of it. As an old lady of 41, my OB chart has "Advanced Maternal Age" stamped all over it. I've gone through several rounds of genetics screenings, and all the anxiety that goes along with it. I had killer morning sickness (uh, ALL-DAY sickness) for several weeks. But the worst part has been keeping the secret: from you, my coworkers, and even my kids. But we finally feel safe -- at least safe ENOUGH -- to break the exciting news.

So thanks to all of you for your patience; I've been remiss in posting quite as often as I'd like, and my response time to your questions has stretched out a bit. But I've been accumulating some heavy-duty experience that I hope will continue to help make BabyShrink fun, interesting and new.

Depending on your interest and questions, I'll be posting some of the things I've learned these past several weeks. I expected to have a CVS (for early chromosomal testing) -- and didn't. Then I expected an amniocentesis -- and didn't have THAT, either. But there are some wild new screening procedures that helped us though that decision-making process, and these are all pretty new. I look forward to your questions about how to decide when, if, and how to make decisions about genetic testing in pregnancy, and all the strong emotions that can go along with the process.

And in the meantime, I've discovered that my good-old standby baby bottles -- the ones that have gotten us through 3 babies -- are no longer considered safe (due to the BPA). So I've got to learn about all the newest STUFF out there as well....and I LOVE baby "stuff". So I'll need your help in deciding what to buy (and what to skip) this time around.

I'll also be asking for advice from those of you with large families. Having #4 feels exciting -- but daunting. This is uncharted territory in both my family and my husband's, so we need all the help we can get!

Thanks to all of you for your support and encouragement, and I look forward to going on the rest of this exciting journey with you.

Aloha,

Dr. Heather The BabyShrink

Parenting Tips: The Challenges of Motherhood

Moms have too much pressure. (Sorry, Dads: you have too much pressure too. But I think society puts more of the burden on moms.) It aggravates me when the media (and even our neighbors and family) depict motherhood as some kind of utopia, and when we can't live up to that ideal, something must be wrong (with us). That's why I like to recommend writers who tell it like it is. I just came across this Oprah article and wanted to share it with you. Enjoy! And stay tuned: I have my own news to share with you in the next few days...!)

Click here for the Oprah article.

Aloha,

Dr. Heather The BabyShrink

Attachment Parenting: In Praise of Attachment Parenting (Sort Of)

Every week, I buy groceries at our grungy, local health-food store. My daughter affectionately dubbed it "The Stinky Market" -- partly because of that characteristic "health-food store" smell, but also because of the bodily odors emanating from some of the motley group of customers frequenting the place -- a weird combination of surfers, hippies, homeless people, backpacking travelers, and "Euro-Trash". --- Oh, and the occasional yuppie mom like me. (Except I hope I'm not one of the stinky types. In all honestly there aren't TOO many stinky customers, but the one or two in there at any given time are certainly enough.) During each visit, I see at least 4 or 5 "Baby-Wearing" mamas in the store. These dedicated parents take their childrearing (and food shopping) very seriously, braving the narrow aisles with groceries piled precariously high atop rickety shelves, all the while with an infant (or toddler, or preschooler) attached to their bodies. These are the Attachment Parenting advocates living at a major heart of the AP movement. These are dedicated baby-wearers, extended-breastfeeders, family-bedders, and gentle-discipliners. And because I live in a nexus of strident AP, we have more than our fair share of AP fundamentalists. And in fact the Stinky Market is the very place where I've gotten an uninvited comment (and plenty "Stink-Eye") about using strollers.

But this week, I was feeling quite contrite about my last AP post -- not because I have changed my opinion (I haven't). But I realized that the AP parents are really coming from the same place that motivates me in my parenting approach -- we just get to somewhat different places with it. And I also feel really bad about offending some of you out there whom I consider to be readers, supporters, and friends....those of you who practice AP, and don't deserve the uninvited criticism from me. To any of you I offended -- you know who you are -- I offer my sincere apology.

But because it was on my mind so much, I went back to developmental theory, to remind myself exactly WHY I disagree with some of what AP espouses. This is the quick version:

Infant Development: A (Very) Quick Primer The infant starts out in life as a completely dependent being. She relies on her parents (usually the mother) for such fundamental things as nutrition and the regulation of bodily processes. In many ways, the infant is born "unfinished", being delivered at 40 weeks' gestation not because she's really ready to be born, but because the human mother is not physically capable of delivering a larger infant. She needs to be "attached" to her mother to fulfill these needs. This attachment allows successful development into later phases of growth.

Over time, the infant becomes capable of voluntary movement. She starts to control her body in ways SHE wants to; it's no longer up to her own random or reflexive movements. And with this voluntary movement comes the spark of the ability to be mobile, and to communicate.

Movement away from the parent requires a means of communicating over distance with that parent: When you crawl across the room, it's nice to be able to say "Doggie!" and to point at the doggie, to get your parents' attention. Communication becomes more necessary when the child can move away from the parent. And communication is a symbolic way of continuing attachment. We can tell older babies I love you! And their ability to understand abstract communication helps them to feel the love, without being physically held. It's not that physical comfort is no longer necessary, but rather, the baby now has a new, more advanced way to be attached; through communication. And that allows the baby to become more independent, and venture out, away from the parent.

And moving away from the parent is really the point of development, isn't it? It's called independence. This isn't dictated by some non-AP theory, it's simply accepted developmental fact. Remember reading about Margaret Mahler in your Intro Psych class? She was the acknowledged queen researcher of infant development. She observed infants all over the world moving through phases of complete dependence in early infancy, through the phases of Separation-Individuation later in toddlerhood. This phase is topped off by the challenging, difficult phase of Rapprochement, in which the infant is conflicted about independence. She varies between clingy attachment, and boldly venturing out on her own. Many of the questions I get here at BabyShrink have to do with the fundamental conflicts inherent during the Rapprochement phase.

Of course this does not mean that our 2-year-olds are completely independent; we shouldn't be expecting them to bring home a paycheck any time soon. But it does point out the slow modification that our parenting approach needs to make over time; the understanding that the increased ability of the infant to handle (and explore) independence requires us to give them room to do so. The infant starts out needing complete "attachment" to the parents, and gradually needs less and less attachment over time in order to develop independence.

How is this different from Attachment Parenting? Yeah, I know that AP understands and appreciates the nature of "attachment" -- they used it in the name of the approach, after all. And I'm totally with them on the use of AP principles, but only with very young infants, and only when that infant is constitutionally amenable to the intense physical contact of AP. As I said in my previous post, AP comments very little on those infants who simply do better with a little time and space on their own; a little less handling -- and little "breaks" from being "attached" all the time. Many of my readers have babies whose sensory systems simply could not handle all that attachment, and are so much happier with a little "breathing room". And as infants become toddlers, they crave less and less dependence -- and more and more independence. And we, as parents, need to walk that tightrope of "Rapprochement" with them.

So I guess this is my lengthy reply to all of you who commented and emailed on my last AP post -- and also my apology, to any of those I unintentionally offended. I hope this post shows that I agree wholeheartedly with the intended goals of AP -- we just vary in our approach.

IF YOU FOUND THIS POST FIRST, MAKE SURE TO CATCH ANOTHER ONE OF MY AP POSTS HERE AS WELL

Parenting Tips: "Racism", Young Children, and Obama: Lessons Learned in Hawaii

Racism, Young Children, and Obama: Lessons Learned in HawaiiThere's been a lot of focus on Hawaii lately, since Barack Obama was raised here. It's been very exciting for our little outpost way out on the end of the country to see a native son go so far in the world. My own claim to fame was that, when I lived on Oahu, I attended the same school from which he graduated. When I went to college on the mainland, it was difficult to explain my sense of race, ethnicity, and diversity. In Hawaii, everyone is a minority. We co-exist in an intermarried hodgepodge of nationalities and ethnicities. Interestingly, being Caucasian has a slightly negative connotation; we're called "haole" here, meaning "outsider"; so much so that I grew up "passing" for being part-Japanese, even though there's not a drop of Asian blood in my woodpile. I aspired to be part-Japanese. I considered the other races of my friends...Japanese, Chinese, Hawaiian, Korean, African-American...they were all "something". Part-Chinese. Part-Hawaiian. Part-something. Being a haole, in contrast, was not "something". It was.....boring. Nothing. So my view of racial and ethnic differences was formed in a place where variation and difference was exciting, challenging, and essential to the vibrant success of the community. The best of all worlds. If I may so humbly draw a parallel to the Senator's upbringing and my own, I am proud to say this is it.

Recently, a friend called to ask about his 5-year-old daughter. He was appalled that she had told her teacher that she doesn't like "brown-skinned people". This is from a family dedicated to acts of social justice, and fairness and equal opportunity for all. He was mystified (and mortified). Where did she come up with this hateful idea? And how could they turn around her thinking?

The issue of race is, of course, a hot-button topic that quickly raises all sorts of feelings, attitudes, and ideas. I'm going to make the assumption that people who read a site called BabyShrink are fairly progressively-minded, so I'm not aiming to convert anybody with racist leanings. I'm preaching to the choir on that account, folks, right? We're all hoping to raise kids with the ability to comfortably live in an ever-increasingly cosmopolitan world; kids who appreciate others (and themselves) for their unique individuality and differences, and who seek to learn from others with a different background or skin color -- not to negatively judge them. So instead of getting into a dissertation on race-relations, let's focus on the parenting issues involved.

Is it possible for a young child to be "racist"?

OK, that's my first question. For some answers, let's look at the developmental issues. We know that babies have an innate preference for faces that look like the faces they usually see. In other words, babies with fair-skinned parents and siblings prefer to look at strangers with fair skin. The same holds true no matter what the family's skin color. A reasonable explanation for this has to do with our innate drive to survive. Something in us, probably genetic, tells us "People who take care of me look like this.......Those people help me to survive, and I want to be part of that group. Therefore, I prefer people who look like those of my group." If that means a young child from a fair-skinned family prefers fair-skinned faces, is that child a racist? Of course not. That's just evolutionary protection aimed at keeping families and kin together, for the protection of the group. And it's hard-wired at a pre-verbal, pre-thinking stage.

How can I make sure my child does not develop racist ideas and attitudes?

Of course, there comes a point in the child's development where rational thinking then becomes possible. It's at that time that automatic, hard-wired assumptions can be challenged by thoughtful discussions and actions. That cognitive ability doesn't really kick in until about the age of 7. But even as early as 12-18 months, children start to imitate us, and soak in our examples by osmosis. So you can start early by modeling the behavior and attitudes you wish your child to have. As they get older, you can begin to talk about the issues more abstractly.

Live a life of diversity

So the bottom line here is that, as families, it's important to surround our kids with examples of diversity in day-to-day life, just as a matter of course. Even a very young child will take in the modeling you show when you interact in a comfortable, relaxed way with people who look different from those she's used to seeing. But don't start making abstract statements about race, color, religion or other topics of difference until a bit later. When she's in first grade or so, she'll begin to understand it when you start talking about differences. Esoteric, abstract concepts will bounce off a 5-year-old's mind. "We're all people inside, even though we look different on the outside", and "What makes you different is what makes you special" are all great things to say, but really can't be understood by a young child. So wait on the discussions until first grade or so. But make it a priority to appreciate differences of all kinds; different hair color, clothing styles, body types, differing physical abilities, all of it, and make a comfortable environment where the acceptance of differences is fostered and encouraged.

"How would you feel if someone said that about you?"

You can also start to talk about manners and feelings, and have your child look at it from an empathic point of view. "How would you feel if someone did not like you for the way you looked? How would you feel if someone said something mean about you, and they didn't even know you?" Talk about how others might feel for being negatively judged. Let them practice putting themselves in others' shoes. This will help them to consider the impact of their words on others.

So I don't think that my friend's child is becoming a little racist. Far from it; she's looking for differences where they do exist, but she doesn't yet have the analytic capacity to apply abstract concepts to those differences.

How do you handle differences, when it comes to your young children?

Halloween and Young Children: What's TOO scary?

Reader Fran in Massachusetts wrote recently, asking an interesting question about her 3-year-old son, who has an unusual request for a Halloween costume. He wants to be Cruella de Vil this year.

Fran's not worried about the gender thing; she knows that it's perfectly fine for a 3-year-old boy to dress up in a female costume. She lives in a progressive neighborhood, and so her neighbors aren't likely to make a thing out of a little boy in a Cruella outfit. And she knows that, developmentally, it's really common for 3-year-olds to have fun dressing up in opposite-sex costumes, and that it means nothing about the future development of sexual identity. (In fact, just about every 3-year-old boy I've known wants to have his nails painted, often much to the dismay of his Daddy.)

But Fran's question has to do with the downright scary nature of the Cruella character. After all, she kidnaps puppies for their fur. She offers to drown newborn animals. There are all sorts of hellish, devilish references in her story. But Fran's son insists on dressing up as Cruella. What's a Mom to do?

This isn't a simple issue. But you wouldn't know it by scanning the popular parenting media, where we're offered suggestions about trick-or-treating safety, or handy-dandy costume and recipe tips. What about the fact that Halloween is meant to scare the daylights out of our children? Aren't we supposed to be protecting them from frightening movies and TV news during the rest of the year? How come it's now OK to send them to a stranger's door to take candy from a guy wearing a Scream mask? And what about all the ghouls and goblins coming to our door? Isn't the home supposed to be a safe place?

As a reaction, some parents take the approach followed by our local Waldorf school, which does a "Night of Delights" kind of party, and doesn't allow traditionally scary costumes. Fairies and dragons are fine; Cruella is not invited. Yet many kids bristle at the restrictions placed on this kind of celebration. Kids like Fran's son WANT the scary stuff. They seem to CRAVE it. So what's the best way to handle it with YOUR kids? First, KNOW YOUR KIDS Each child is different. Fran's son loves the scary stuff; many do. There's nothing wrong with that; it's his way of learning to understand scary and mean things in life. Sometimes, acting out bad things is a way of gaining mastery over them. If I can act it out, I can control it, and then it won't hurt me. But other kids are truly frightened by scary characters and scenes. Those kids need a more gentle introduction to things that go bump in the night. Using child's language, explain how this night is different...and fun Tell your 2, 3, or 4-year-old how people have fun dressing up in costumes. And on this night...just this night...we get treats at other people's houses. And it's all for pretend, just like we do when we pretend at home. Practice with simple masks -- in front of a mirror, show him how it's still him underneath the mask. Practice what will happen when the kids ring the doorbell and yell "Trick Or Treat!". Enlist his help in handing out candy. And dress up yourself, in just a simple costume, to show that the adults are in on the fun, too...and will still protect him and make sure he's safe. Follow your child's lead Be prepared for the lead-up to Halloween to be at least as exciting -- if not more exciting -- than the actual night of the holiday. Many young children are thrilled with decorating and preparing costumes and treats in the days prior to October 31. But Halloween night can feel overwhelming; after all it IS nighttime, which in and of itself is a scary time for kids. And the disruption and weirdness of having costumed strangers come to the door and roaming around outside can be just too much. If your little Fairy wants to visit one or two houses for trick-or-treating, or even forget about it altogether, be prepared to change your plans as needed. Make alternative arrangements for older kids Your older children have more advanced coping mechanisms in place. They understand that the death themes of the holiday are pretend. They can use the frightening images to learn to master their own fears. And they can enjoy the unusual opportunity of breaking the rules, if just for one night. So arrange with friends to have the brave kids go out with one family, and the scaredy-cats stay home with another. Parents can split up for the night too; in our house, Dad takes the big kids out for trick-or-treating, while our 2-year-old and I stay home to dole out candy. Last year, he was frightened about the kids coming to the door in their costumes. I had them tell us their names and show under their masks before having TT give them their candy. Eventually, he got into the swing of it; then at 8 pm, I turned out the porch light and devoted the rest of the evening to giving him his usual bath/bedtime routine, for reassurance.

Will your young kids dress up for Halloween this year?

Television & Technology: Am I A Horrible Parent If My Baby Watches TV?

My friend Ilima is a highly educated, successful career Mom who reads just about everything, in her capacity as a newspaper reporter. So of course she has come across the American Academy of Pediatrics' warning about television: No "Screen Time" for children ages two and younger. None. Nada. Zip. And she wonders if this warning is absolute, and how worried should she be about it? One of my most popular posts dealt with this issue, and I got blasted by the Stonyfield Farms yogurt people, of all things. They obviously hadn't read my entire post, and who exactly DID write their complaint about me, anyway? But I digress.

The AAP really means business; when they say "no screen time for babies," they mean it. But how realistic is this? And how should we interpret that advice? We wonder, "Hey, what about a Baby Einstein video now and again, while I fix lunch? Is that really so bad?" Or, for families with older children as well, "How about when the Big Kids come home after school and watch a show as they wind down from their day? What am I supposed to do with the baby while they watch something? Will something terrible happen if the baby catches an episode of Hannah Montana?" And if we've been allowing the little ones to watch the tube, we worry about whether we've done irreparable damage to their developing minds. Is all of that college-savings money for naught? Little neurons blown away by Sesame Street?

Our "Good-Enough" parenting selves say, Wait a minute. Surely some well-chosen shows watched for a limited amount of time can't be so horrible.

I say: Your "Good-Enough" instincts are right.

As an Early Intervention psychologist, I pay home visits to evaluate the development of young children. Sometimes, I'm greeted by a huge, blaring television, left on 24/7, with few books or toys to be found. The parents in these homes are struggling with paying bills, keeping food on the table, and other major problems. The children often have developmental delays. Why? Because their parents are struggling to make basic ends meet. Maximizing the psychological and emotional development of their children is an unfortunate luxury they can't afford. High-quality childcare and access to parenting resources isn't available to many in this country.

I'm not saying that developmental delays are always caused by poverty and other environmental problems...but it certainly can be a contributing factor in many cases. And in those homes, a TV being left on 24/7 is part of the whole picture of lack of education and resources that contributes to developmental delay.

The AAP statistics on cognitive deficits and TV look at all kinds of households, and don't discriminate as to the type of television watched. The don't examine all the factors we're interested in here at BabyShrink. So again, we're forced to rely on our our own best instincts as "Good-Enough" parents. Our best instincts tell us that there has to be a middle ground. Based on your comments and emails to me, this is what your instincts are saying:

Don't leave the TV on as background noise. It takes a lot of mental effort to filter out the constant stimulation, and babies have less ability to do that anyway.

Don't let babies watch stuff that wasn't specially created for babies. Minimize the fast-moving shows with quick cuts and changes.

However, don't beat yourself up if the baby ends up watching some of the "older kids" programs. You can't create a PERFECT environment, just a GOOD-ENOUGH one.

And your instincts are backed up by research as well. (This is a good synopsis, which shows that the issue is far more complex than a simple "yes or no" rule.)

You as parent are by far the best teacher your baby can have. No TV show can even come close. If you've somehow ended up leaving the TV on more and more, re-think how to manage your day and the kids with less TV. Quiet has a way of stimulating creativity, for everyone.

By the same token, it's OK if your baby watches a little quality TV now and again. Not only is it enjoyable to her, it gives YOU a break for a few minutes. And I'm very interested in supporting you in your ability to get a break from time to time. Because that's good for YOU -- and what's good for YOU is ultimately good for your whole family.

And the AAP statistics didn't examine that.

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.

Parenting Tips: Do I Have Childhood "Baggage" About Moving?

Hello Dr. Heather, My husband and I have a 6-year-old son, a 4-year-old daughter, and a baby due in early August. We are moving across the country about two weeks after I have the baby. My husband will be attending graduate school in our new city. We were settled here and I'm having a really hard time with this. The kids are, too, though not as much as me. My daughter threw a penny in the fountain the other day and said "I wish we didn't have to move." My son was really looking forward to starting first grade with his kindergarten friends, and he's quite upset from time to time, although not every day. Currently, we are still searching for a place to live there, and we have just sold our home here, which we all love, and so everything feels so unsettled.  I moved in the middle of second grade and still remember how traumatized I was by it, although my dad had lost his job, so there were some other difficulties going on in my family. I don't want to project my childhood onto them, in addition to the sadness I'm feeling now.

My question is, how do I make this transition go as smoothly as it can for them, and how much does my sadness about this situation transfer to them?

Thanks,

You can call me "Emily".

Dear "Emily",

Did you see my recent post about moving?  I'm getting lots of questions like that at this time of year.

I do understand your concerns; it's a big deal for me too; we moved several times in my childhood, and I am pretty sensitive about the issue. Uprooting your life is no small thing. The familiarity of your routine, the process of making new friends, adjusting to new jobs and schools; it's harder than most people realize. But for young kids, it's a lot easier.

It sounds to me like the challenge is going to be more for you, not the kids. Wow, Mama, you have your hands full! Moving 2 weeks post-baby? With 2 other little kids? Yowza! That's a huge job, physically and emotionally. And your past negative experience with moving is likely to haunt you, to some degree.

YES, your kids totally pick up on your emotional reaction to the move. You (and their Dad) are their main emotional signposts, at least until they get to about second grade. In order to get through this with as little stress as possible, you need to lean on your husband as well as anyone else you can; family? Friends? Clergy?  Don't hold back on asking for help.

Do you have any risk factors for postpartum depression? Please keep that in mind, especially in the 2-week-plus-postpartum period, when PPD is most likely to strike. That much change and stress -- moving and a new baby, with two little ones, a whole new city, as well as your own childhood history of the difficult move...it all raises your risk for depression. Ask your husband to help monitor your mood as well. Make sure you hook up with an OB/GYN as soon as you get to your new city -- and make sure you go in for a checkup. There are lots of resources available online to help you find a counselor if you need one.

Try to look at it all as an adventure. Help the kids see how to handle change in a positive way. Look at this as an opportunity to have a "re-do" on your own negative childhood experience of moving. This is not the same thing as when you were a kid; this is not an unfortunate turn of events that you all have to live with. This is you and your hubby making a decision for the ultimate good of the family. You have a chance to do it again...but different. Better.

Good luck with everything and keep us posted!

Aloha,

Dr. Heather

The BabyShrink

Parenting Tips: Separation Anxiety and Daycare. Can't a Dad Get a Break?

First, I want to thank you, my readers, for giving me such great suggestions. Tons of you submitted questions and ideas for posts, and I'm diligently responding, writing, (and plotting and scheming on site improvements!) Many of your questions centered around babies and infant development, so I thought Backpacking Dad's question was perfect:

Hiya Babyshrink!

The last few times I've gone to the gym I've had to turn around almost immediately and head home. My once delightful, friendly, playful, and charming 13-month-old daughter turns into a wailing ball of snotty tears when I try to drop her at the gym day care center now.

It's made me wonder if they did something there that she's afraid of (although I don't rationally believe this, it's the crazy worry that I have when faced with this inexplicable reaction).

I'd hate to stop going to the gym. And the child care there is highly recommended by parents I respect, and I personally like all of the girls who work there. I also don't want to reinforce any "if I cry he'll take me home" attitude she might have begun developing.

In talking with one mom there, who is also a pre-school teacher, she said that kids go through peaks and valleys, sometimes very comfortable with everybody, and other times, suddenly and briefly, hating being separated from mom and dad. Since this is the first time in a year that my daughter has manifested any such attitude I'm not sure if it's just a phase or if there is a problem that I need to work through with her.

Thanks, Backpacking Dad.

Hi Backpacking Dad,

Between about 10- 18 months, there's a peak in Separation Anxiety, based on your baby's newfound independence from you. SHE can now walk away from YOU...get around the house by herself, even lose sight of you as she explores. As exciting as that is, it also scares the daylights out of her. If SHE can go away from YOU...then YOU can certainly go away from HER.....and so you do, at the gym. Did you study Ainsworth and Attachment Theory in undergrad, by chance? If not, here's a link to a classic psychological/developmental theorist who addresses just this issue.

Jakestanding_3 Now, you say that you trust the daycare people at the gym, so I would assume nothing bad happened there. It's worthwhile to ask them, though, if there was a bossy kid around her one day? Or perhaps she witnessed a tearful separation with another child and parent? Anything to give you a clue. Use the daycare people as a resource; ask them for suggestions and advice.

But the bottom line is this: Your daughter is facing a really difficult life lesson in separation and reunification.

It's important that you help her through it by being supportive, but not denying that separations will occur.

She's still not 100% sure that you WILL RETURN when you do go away from her. And there's no way to learn but through experience.

PHOTO: When they start walking, they make the scary realization that YOU can walk away from THEM, too.

Plus, as you say, you don't want to give her the message that her tears will be so powerful that she can control important adult activities.

Having supportive daycare people, plus an understanding Dad, will help her to learn this important life lesson and skill in a way that will help her deal with the issue productively in the future.

I also think it's important to model for her that you value some adult time, and your own health, by sticking to a workout schedule. You can be very understanding with her about it: Talk with her frequently about what you see as her fears. Be reassuring. Remind her that you will return. Tell her you know she might cry a little. But her teacher Ms. So-and-So will be there to help her feel better while you're exercising. And then when you return, you'll both be so happy!

Talk to the teacher first, to let her know you expect a reaction from your daughter.

Plan it out in advance. Don't try to sneak out.

Be upfront and matter-of-fact with your daughter about it. "I know you'll be sad, but you'll be fine. See you soon!" And then leave. If you must, listen by the door, or have someone check in on her after 5 minutes. I almost guarantee she'll be fine after a few minutes of tears. (She may protest an extra while at first, since her crying DID deter you from exercising in the past, so surely she'll try it out again. But stick with it.)

I know it's heartbreaking to see your baby in such distress. I know your instinct is to rush in and make it better for her. But she's a toddler now...the baby rules don't apply as much anymore. She's older and sturdier now, psychologically. She's ready to plow into this difficult life lesson. And she's so lucky to have a caring, thoughtful Dad like you to help her through it in a good way!

If you're worried that she might develop "abandonment fears" from being left at daycare, let me give you an example of how that MIGHT happen: If you took her to a gym that she'd never been to before, and where you had no knowledge of the quality of the teachers, and you didn't give her any time to "warm up" to the situation, and you just left her there for a couple of hours, without explaining that you were going, or that you would return, or providing any reassurance. Just dumped her there. THAT'S what you would NOT want to do. But you're so far away from that!

Know that this is good for Erin, AND good for you.

Aloha,

Dr. Heather The BabyShrink

Post Script After a nice discussion with Backpacking Dad about this, he let me know that Erin started walking the following weekend! Surely, her developmental changes were disturbing her usual acceptance of the separation at the gym. But he and his wife kept trying, and after a few minutes of tears, his daughter settled back into her nice gym-daycare routine.  Nice going, Shawn! And check out his backpacking  "dadventures"  here at his blog!

Developmental Issues: Does Your Baby Have Sensory Integration Issues? So What?

NancyToday is the final installment of my extensive interview with Nancy Peske. She and Lindsey Biel, co-authors of Raising A Sensory Smart Child: The Definitive Handbook for Helping Your Child with Sensory Integration Issues, have given us some terrific information about sensory development in both typically and atypically-developing children.

Today, she'll be helping us manage our expectations of our children. What is reasonable to expect, as a parent? If our child has sensory differences or challenges, how can we avoid disappointment, and respect and value our kids for who they really are?

BabyShrink: My readers are talking a lot about the emotional side of having babies who challenge their expectations of what it will be like to be a parent. If their baby is somehow different than they expected; needs more (or less) stimulation, comforting, sleep, etc., they are often surprised when their babies do not match the descriptions of newborn behavior in the "What To Expect" type books. They start to feel guilty that they are somehow not "making the grade" as a parent.

What can you say to these parents about the realities of parenting such a baby? How can they themselves cope with the strong feelings that may arise in such a case? How can they avoid beating themselves up, blaming themselves, and instead enjoy their own, unique child?

Nancy Peske: We're told by books and experts to not compare our children to others, but then we constantly get the subtle message that we should do exactly that! In general, most people don't look at a child's behavior or development and say, “Oh, I wonder if there's something unusual happening with that child at a biological level?”

And some people don't believe at all in biological causes of behaviors, and will quickly judge you and your little one, saying, “Send him over to my house for a few days. I'll straighten him out.”

When you hear criticism, consider the source. This is not necessarily someone who understands you, your child, or your child's special needs, and they might very well completely fall apart if they had to deal with your child 24/7 not knowing all that you've figured out! Picture them dealing with the screaming tantrum, the panic attack, or the diaper showdown, and just smile.

The more you use your sensory smarts to discover what's going on and come up with solutions to problematic behaviors and to help your child move forward developmentally, the more you'll truly understand that your child is dealing with a system that functions differently from that of other children. When you hold your toddler in your lap, gently squeeze her feet, legs, hands, and arms, and “magically” transform her from an overstimulated, fussing child into one who will walk over to the other kids and begin playing next to them, you start feeling empowered, because you know her shyness and whimpering is not due to her being a “bad” child or you being a “bad” parent. You're able to recognize what she needs and help provide it (and as she grows older, you can teach her how to get the sensory input she needs in a socially acceptable way).

One thing that can be extremely helpful is to join a support group or play group where you can talk to other parents whose kids aren't developing or behaving typically. There are many wonderful online support groups where you can hear from parents who have been there, who have advice and encouraging words that will make you feel that you're a competent, wonderful parent who is simply dealing with a bigger challenge than you anticipated. A special needs playgroup or Mom-and-Baby group can provide your child with a chance to socialize in an atmosphere where his “different” behavior will be accepted and honored, and where you can be supported by other parents as you support them. Parents of typically developing children--even when they've known you for years or are family--may never understand your child's issues, but over time, they may well come to see that you truly did have a very different challenge to face.

BS: What can you say to these parents about the realities of parenting such a baby? How can they themselves cope with the strong feelings that may arise in such a case? How can they avoid beating themselves up, blaming themselves, and instead enjoy their own, unique baby?

NP: I always think it's a good idea to keep records of your child's milestones and to celebrate them. Bake cookies the first time she takes a bath without a meltdown. Write it on the calendar and mark it in the baby book. Take a photo of her smiling in the bath. On your worst days, go back and look at your photos, or your home movies, of your child and remind yourself how far she's come.

Focus on development as a process and forget about timelines and what he "should" be doing by such and such an age. Again, this is where support groups can help. I learned I'm not the only one whose child didn't dress himself until age six, and so what? He eventually learned, and it certainly didn't prevent us from having a happy family life.

Try to let go of your ideas about what's “normal.” What's so very important about being “normal” anyway? Many of the most interesting, creative people in the world are wired differently, whether they're dyslexic, have ADHD, or whatever. If your child isn't typical, it may mean she's meant to do something very special. Then too, really make a point of noticing your child's wonderful qualities. It's so easy to see them as a bundle of problems when you first begin dealing with diagnoses such as sensory integration dysfunction. Isn't it great that your kid has such high energy that he gets plenty of exercise? Isn't it great that she has exquisitely sensitive hearing and truly appreciates various types of music? Whether your child's special qualities are being empathetic, creative and resourceful, or able to deeply focus on tasks, remind yourself of these gifts so that you don't become disheartened by all the challenges in raising a child who is different, and so you don't start thinking that “different” is bad.

Mahalo and aloha to you, Nancy and Lindsey! Don't forget to visit their website for loads of support and information.

Dr. Heather

The BabyShrink

Developmental Issues: Does My Child Have Sensory Issues? Nancy Peske Helps Us Decide

Nancy Peske, co-author of Raising a Sensory-Smart Child: A Practical Handbook for Helping Your Child with Sensory Integration Issues, has been so generous in her support of BabyShrink. Last time, Nancy told us about what it's like to have a baby with sensory issues. Today, she'll tell us about how we can begin to sort out our baby's sensory preferences.

Dr. Heather: Tell me about the "detective process" that parents must go through in order to figure out their baby's sensory issues. It starts out being a vague sense of something wrong, or just having a "difficult baby". How do parents start to narrow down the issue to find what's really going on? What do they need to observe or record? What can parents do to better understand their baby?

Nancy Peske: There are different "detective" methods. For me, it was simply a matter of tuning in to my own senses. I have mild sensory issues, as many parents of kids with sensory issues do, so when my son would fuss or show signs of anxiety, I would automatically think about the sensory environment, focusing on anything that was unusual or perhaps intense: lighting, smells, background noise, wind, temperature, and so on.

Journaling can be very helpful. Write down what your child did each day, and at what time, including what he ate, when he was cooperative and happy and when he was miserable and uncooperative. One mom told me this helped her realize that she was keeping her child too busy, not giving him enough quiet, unstructured time. Another told me she realized her daughter was always cranky if she went more than 3 hours between snacks or meals. If there's a sudden change in behavior, look at what might have changed. Always consider sleep, nutrition and eating, and external stress as well, from seasonal allergies and the sniffles to a substitute teacher at daycare that the child isn't yet comfortable with.

Focus, too, on when your child is unusually comfortable with a situation that would normally bother him and try to determine what's different. A mom told me her toddler suddenly wasn't agitated about his evening bath, and she realized the one thing she'd done differently was keeping the door closed while running the tub. Apparently, the harsh sound of water hitting porcelain was what had been agitating him, so after that, she always ran it with the door closed and he was fine with baths.

You can also run down the list of senses as you try to analyze what's working or not working in the environment for your child. Consider sight--is there a lot of visual clutter in the room overstimulating him? Is the lighting too bright or unusual in some way? Are the colors or contrasts too intense? Is it an unfamiliar sight-the yogurt container change its look and now your toddler won't eat the yogurt? (Hint: try not to serve kids foods from the container to prevent this!) Think about sound, from background noise to volume, to direction of sound (is it behind her? does she think that the rumbling truck outside might be coming toward her?) and quality of sound (stringed instrument vs. brass instrument, someone singing on a recording vs. someone singing live). Touch--this involves textures, temperature, wet vs. dry, and amount of pressure on the skin. Keep in mind that eating is very tactile, involving skin in the mouth. Your child may eat only one brand of mac and cheese and insist that the sauce not be too runny or thick. Taste and smell--children can be exquisitely sensitive to differences in taste or crave strong smells or tastes. Don't forget movement and body awareness. And finally, remember that transitions and getting used to new sensations are difficult for children. A child who just came out of a car that was driving on hilly roads may need a good, long stretch of lying on the ground or sitting quietly to regain her equilibrium after that vestibular stimulation. Leave extra time when shifting activities, and give plenty of warnings, so that your child's atypical nervous system has a chance to adjust to the change.

If you recognize that your child is processing sensory information atypically, that doesn't necessarily mean you need professional help. Simple accommodations for her differences, and gently encouraging her to try new activities that will broaden the range of sensations she'll tolerate and help her system function more typically, may be enough to make her feel more comfortable in her world. However, if sensory issues interfere with learning, socializing, and eating to a degree that's concerning and significant, more help is probably needed. A pediatric occupational therapist trained and experienced in dealing with sensory issues, who has worked with children your child's age, can be extremely helpful.

Aloha,

Dr. Heather The BabyShrink

Developmental Issues: Sensory Issues in Young Children

We’redeep into Sensory Integration week, so I thought I’d describe some of the remarkable cases I’ve had that have triggered my interest in the area.

I’m a licensed psychologist, and as such, I must fiercely protect the confidentiality of my clients. But some of my cases are so fascinating – and provide such a valuable learning opportunity – I will disguise the identifying information in order to share an important issue with you. Please know that I’d never, ever sacrifice client confidentiality for any reason other than legally or ethically mandated situations. At the same time, there are professionally accepted ways of illustrating important case material, and protecting private information.

Are All the Senses Functioning Properly? First, there was the little two-year-old boy I’ll call “Liev”. Liev lived with his father, 4 siblings, and several foreign nannies. His mother was off on another continent, using drugs. She had abandoned her family.  Father was struggling to deal with the terrible strain of the effects of her behavior on all of them, especially baby Liev. Luckily, the family was well-off, financially. Because father had money, he was used to delegating tasks to others. But he couldn’t “phone in” his parenting responsibilities; he needed to be present with his son. 

His son worried me. At first, we thought Liev was autistic. He constantly waved his hands in front of his face. He didn’t make eye contact. He had constant tantrums. He was very awkward, and seemed to move as if he didn’t see what was in front of him.

Ahhh…that was the key. Nobody thought to ask, until I found it scribbled on a page, deep in his file. Liev was nearly blind.  He had a congenital condition that made him not completely, but nearly, blind. The family had moved from place to place, and in the process, his medical situation had become muddled. The stress of the situation with Mom made things more disorganized.

Once the team recognized his visual impairment, his progress was amazing. I saw him six weeks later, and literally did not recognize him. His occupational and physical therapists helped him use his senses of touch and hearing to move around the room. They got his attention by using touch and sound as well, instead of expecting him to catch their eyes. He listened. He followed directions. All of his “autistic” behaviors vanished.

Sensory Integration “Diagnoses”, or Just Mild “Differences”? Let me also tell you about a little girl I’ll call Leilani. Leilani was referred to me, also at age two, for being “hyper”. She didn’t want to nap, didn’t want to sleep at night, and was constantly “on the go”. She didn’t seem to listen, and her speech was slow to develop. Her parents were exhausted, and they had two other young children to care for as well. There were constant power struggles, tantrums, and now a strain on the marriage. Dad thought Mom was being “too easy” on Leilani. Mom worried “something is just not right”, but had no support in her exploration of that possibility.

Their Early Intervention provider (there’s one in every community, funded by Federal dollars) sent her to an Occupational Therapist (OT). The OT found that Leilani overall had no severe sensory diagnoses, but there were some mild sensory differences that were worth noting.

Leilani was found to have a minor difficulty filtering out noise; when things were noisy in the house, she couldn’t really focus on what was being said. With that information, we helped the family speak quietly to Leilani. Instead of talking loudly over the “din” of the household, we instructed them to try talking in low, quiet tones to her.

The OT also found that Leilani responded well to “heavy play”; she suspected that Leilani needed a great deal of vestibular stimulation in order to get “centered”, regulated, and able to listen and pay attention. The OT demonstrated providing Leilani with very physical playground activities. Swinging was a huge favorite for this little girl. Like many kids with sensory issues, she could swing and spin endlessly, and never get dizzy. After the activities, Leilani was calm and willingly sat down to engage in quiet activities.

The combination of tactics; “low talking” and “heavy play”, utilized throughout the day, resulted in a little girl who shot forward in development. The family saw remarkable improvement in 2-3 weeks.  They especially noticed the improvement in her nighttime sleep if they provided her with at least 45 minutes of “heavy play” at the playground each day.

If you suspect any difficulties like this with your own kids, know that children aged 0 -- 3 (and 0 -- 5 in many communities) qualify for a free developmental evaluation with their local Early Intervention provider. Certainly, your pediatrician should be involved, as well.

I've learned so much from such cases that I analyzed the sensory tendencies of our whole family. It’s helped tremendously. One of our kids is a bit over-sensitive to sounds. So I decided to pick him up first from school, to give him a few quiet minutes in the car before we pick up his sister. He’s much happier to see her now; in the past, it was constant squabbling in the back seat. But now that he can “chill out” in the car, in peace and quiet, for just a few minutes….it makes all the difference in the world.

Stay tuned for Part 2 of my interview with Nancy Peske. She’ll be talking more about how to do the detective work in your own family….who has what sensitivities? How can you help to manage them?

The BabyShrink Interview: Nancy Peske on Raising a ‘Sensory-Smart’ Child

Untitled1_2 I am honored to present my two-part interview with Nancy Peske, co-author of Raising a Sensory-Smart Child: A Practical Handbook for Helping Your Child with Sensory Integration Issues, now in its ninth printing. Nancy and occupational therapist Lindsey Biel wrote their groundbreaking book to continued rave reviews in both the parenting and special needs communities. A National Parenting Publications Award-winner, Raising a Sensory Smart Child is easy to understand and provides real-world descriptions of sensory/developmental issues in children, and gives loads of activities and suggestions to help with our kids.

Nancy is a freelance writer and editor and has co-written, ghostwritten, and edited several bestsellers, including co-authoring the successful Cinematherapy series. She lives in Shorewood, WI with her husband and son, who was diagnosed with sensory integration dysfunction and multiple developmental delays at age two.

BabyShrink: How do sensory issues affect even very young babies? What is it like to be the parent of a new baby who has sensory differences?

Nancy Peske: Babies with sensory issues overreact to everyday sensations, or underreact, often seeking the sensory input their body needs. My son, who never stopped spinning and kicking in utero, was a very physically active baby, and he never seemed to touch things so much as whack them with all his strength – yet he never quite understood that he was hitting people instead of patting them. He also seemed to be constantly teething because the drooling just never stopped; I now know that this can be a sign of low muscle tone and poor body awareness, both of which are associated with sensory issues.

He was also a bad latch; it took three sisters-in-law and a lactation consultant to help me figure out how to get him to nurse properly so that he was getting milk and not whimpering every thirty minutes. Again, this was a problem with body awareness, and with motor planning. He was also overstimulated by wind, becoming hysterical whenever it kicked up, as well as by swinging. He would pitch a fit if we tried to take him out of the baby swing after 45 minutes. So you can have sensory seeking and overstimulation, but you can also have overstimulation and sensory avoiding. A baby might scream and carry on every time it's bathed, or its diaper is changed. Feeding might be an issue; if the food is the wrong color, temperature, or texture, she won't eat it, or will even gag on it. A baby might need to be held a certain way, such as on her stomach instead of her back, or get motion sickness extremely easily if she is sensitive to movement.

Sensory issues also affect the body’s internal regulation. Falling asleep, waking up without being groggy, and calming down after stimulation and excitement, can all be very difficult for a sensory baby. Letting the baby “cry it out” a few times does not work with these little ones!

Habituation (getting used to a new situation) is also an issue. The toddler who is chilled just can’t seem to warm up, and if she's used to wearing thin little cotton dresses and sandals, she'll insist on wearing them up until the first day of winter because heavier, warmer clothes just don't feel right. She may take a week to feel comfortable with that new, short haircut she got because her scalp feels tingly and different for a long time.

The confusion caused by sensory issues makes babies and toddlers resistant to transitions. They need a lot of preparation before changing activities, and they need a lot of external structure, such as a more rigid schedule. They also tend to be more anxious and sensitive than other children, and are often reluctant to try new activities, but then may love the activity once they’re coaxed into it. The key is to gently introduce a new sensory activity in a pleasant or playful way. Persuade the toddler to fingerpaint, to offer her a smock and a paintbrush and the chance to wash her hands every thirty seconds if that will help her to do this type of important sensory exploration.

Pushing her, or berating her, will just make her more anxious and uncomfortable. Try to make new sensory activities fun.

Also, we expect babies to be inconsistent and a bit of a mystery, so it can be difficult for a new parent of a baby with sensory issues to acknowledge her gut instinct that something is “off” with her baby. Her concerns are likely to be dismissed by others, from her husband to her pediatrician to her mother and sisters, and well-meaning friends who have more experience with babies. The parents most likely to be encouraged to listen to their instincts about their child’s sensory differences are either parents of other babies who were much easier to deal with (less fussy, less inconsistent in their sleeping and eating habits, and so on), or parents of babies who were adopted from overseas orphanages, born prematurely, or experienced birth trauma or medical interventions shortly after birth. This is because the experts expect some difficulties in these situations. Often, the NICU will send them home with instructions about what unusual behaviors to look for, or the adoption agency will educate them about sensory issues and developmental delays.

But it’s important for parents to realize that if they feel there’s something different, or just not right about their child, they shouldn’t dismiss that impression. The more you learn about sensory issues, the more you’ll start to understand why you instinctively hug and massage your child in a crowded room before letting him down to the floor to play with the other kids, or why you put a snug cap on her head when she’s getting antsy. One mom I met swore that her toddler, who it turned out had visual processing issues, behaved worse on days when he wore red or orange shirts, and better on days when he wore less intense colors.

If you have the impression that your child is experiencing the world differently, then that’s probably what’s happening.

My interview with Nancy continues tomorrow. In the meantime, check out the Sensory Smarts website for more info!

Developmental Issues: Sensory Integration Week on BabyShrink

I’m devoting a great deal of time, space and energy on BabyShrink this week to sensory issues in your child’s development. It’s a topic that effects many families around the world, and I think this week you’ll find some great tips to try out with your own kids (and maybe even yourselves). Young children are a work in progress, neurologically. New connections are made every day, connecting the body and bodily sensations with the brain. Sight, sound, smell, touch, taste, the vestibular sense (the sensation of the body’s position in space) -- all of these sensations are bombarding your child’s brain with new information. How can the brain sort it all out? How can the brain “filter in” and “filter out” certain information? For instance, in a noisy room, how can your child pick out YOUR voice, when he’s hearing several? It’s a complicated neurological process that develops slowly, throughout childhood.

Children differ in how they process sensory information. They can be over- or under-sensitive in any (or several) of the senses. This can be overwhelming for the child and result in frustration and behavioral problems.

Our Children, Ourselves I don’t know about you, but I certainly have my own sensory preferences. If there’s a lot of background noise, I find myself extra-tired at the end of the day. Conversely, my husband likes background noise and is calmed by having the TV on while we sleep. (I hate it!) These are normal variations in temperament and biological constitution. We all have our preferences. If we understand those preferences in our children, and ourselves, we can work with them better and have more comfortable lives.

Some children have sensory differences that are stronger than usual. Occupational therapists, specially trained in pediatrics and sensory issues, can be extremely helpful with detecting what those differences are and what to do about them.

Questioning the Legitimacy of Sensory Integration There is some controversy over whether sensory integration issues are “legitimate”, from a medical standpoint. Many pediatricians will dismiss the topic as unfounded or irrelevant. Studies are ongoing as to the efficacy of treatment approaches. But while these studies continue, many parents are finding these approaches extremely helpful. In my practice, I have seen exceptional progress made in cases with sensory issues, and I work closely with OTs who provide invaluable assistance to families. I do often recommend that an OT conduct an evaluation of a child with behavioral difficulties.

An Important Topic for BabyShrink Readers Many of BabyShrink’s regular readers work with OTs and find the exercises extremely helpful for their kids. I have learned a great deal about myself and my family’s sensory preferences, and I have modified things in our everyday lives to maximize what I have learned. It works for us! (But of course, your child’s pediatrician should be involved and consulted at every stage of the process.)

It should be an interesting week on BabyShrink. As always, your participation in the discussion is welcome.

Parenting Tips: How DO You "Play" With A Newborn Baby, Anyway?

Katie J. had some great questions last time: How much does she need to “play” with her new baby? Should we call out the Mommy Police if a new baby is left to coo and gurgle on her own, once in awhile?

Now that I’ve (hopefully) dispelled the guilt that Katie J. felt for not “maximizing” every possible play opportunity, I wanted to answer another related question….How DO you “play” with a tiny baby, anyway?

Easy. Hold her facing you, propped up at an angle on your legs, so her face is no more than 1-2 feet from yours. Babies’ eyes don’t focus well at longer distances. (And babies’ brains are hard-wired to look for and be interested in the human face…especially their parents').  Or let her stay in her bouncy seat, and sit on the floor in front of her. See what she seems to like best.

When you catch her gaze, smile and talk to her, in short, simple sentences. While she won’t “respond” in words, she will respond by using her body. Try to figure out what her body seems to be “saying” to you. Tell her what you think she’s “saying”, even if it’s just a guess. “Answer” her. Be silly. Sing to her. Experiment with the tone and volume of your voice, and with the way you move your body and face. See what she responds to best, and do more of that.

After awhile (for many babies, just a few minutes), she will have had “enough”. The direct interaction is intense for a baby that age. She needs it, but often can only tolerate it in short bursts. When she gets fussy, starts to look away, cough, drool and otherwise get “disorganized” with her body movements, you know you need to make a change. Perhaps she’d like to be held now? Maybe facing away from you, to cut down on the direct stimulation of your body and face? Or perhaps she prefers being “slung” over your shoulder, to get a nice, calming back rub? Or maybe she just wants some “alone time” now for a bit in her bouncy seat or swing, so she can try to make sense of the intense interaction with you she just had? Experiment with your baby. Find her rhythm. It’s there, it just takes your parent detective powers to figure out the ebb and flow of her cycle.

Your baby is most receptive to direct interaction with you when she is alert and calm. These periods come regularly throughout the day, in a cyclical pattern. Start to take notice of your baby’s unique (and often, predictable) rhythms. Very young babies like yours go through fairly rapid sleep/wake activity cycles throughout the day. These cycles consist of 3-4 hour cycles throughout the day that are usually fairly consistent, from baby to baby. For instance, here is a typical pattern for a very young baby:

  • Sleep (1-2 hours), transitioning to:
  • Happy/awake alertness --“play time” (the shortest of the phases, sometimes as short as just a few minutes), transitioning to:
  • Fussing/overstimulated/hungry, needing to be fed, held, soothed, transitioning back to:
  • Sleep, and so on, throughout the day.

Each baby is a little different; our first baby tended to go straight from sleep to fussy/hungry, then had her happy/alert “play” time after her tummy was full. But her younger brother could wait awhile after waking up and liked to “play” before he got hungry.

Start to observe your baby’s sleep/wake/alertness patterns. Jot down her activity level and the time of day. After a few days, you’ll start to see her pattern emerge. You can then target your play time for when she’s most receptive.

Have Fun!

Aloha,

Dr. Heather The BabyShrink

PS If you're interested in learning more, you must watch The Baby Human series. It's fascinating, and demonstrates exactly what I'm talking about here, and more. It also showcases current infant research in a really exciting way (I promise)!

Parenting Tips: How Much Time Should You Spend Playing With Your Baby?

Dear BabyShrink, I’m having trouble figuring out when to put my two-month-old daughter down, and when to pick her up and play with her. I've heard many ways of encouraging her development, but I feel guilty when I place her in her chair to get things done. She sleeps well at night, but I often spend a lot of time holding her and rocking her to sleep in the daytime. When I put her down in her bassinet she frequently wakes up crying, so I end up holding her while she naps. A big part of my problem is that I really don't want to be like my mom, who I feel was pretty neglectful. Sometimes when I put her down, I feel like I'm being like my mom. So, my question is, how much do I need to play and interact with my baby? How much is it okay to sit and let her play by herself?

Katie J.

Dear Katie J.,

Good questions: Is it OK to let a happy, alert baby sit alone in her baby seat while you get something done? And if so, how much, before there is “neglect” and developmental damage?

Trying to Improve our Parenting with Every Generation You say you want to change the pattern in your family of origin; and you want to pay more attention to your baby than what you experienced. Let me say this: The fact that you are conscious and aware of the issue tells me you are already most of the way there. It’s hard (but critically important) to be aware of the psychological baggage we bring to our parenting. If we’re not aware, we’re likely to do one of two things: Repeat the same negative patterns as the generations before us, OR overreact in the opposite direction in an attempt to “correct” the wrongs of our parents. So if you were neglected as a baby, you might find yourself either automatically leaving the baby alone too much…or being a “helicopter parent”; hovering every second, not allowing the baby any room to be alone. Conscious awareness of our ingrained tendencies makes it possible to move past them.

Once you’re aware of your tendencies, you can react less to your own inner demons, and respond more to the unique baby in front of you. What does she seem to need, today? What are the patterns you notice in her temperament? When is she most responsive to interaction and “play”? When is she content to be left on her own for a bit while you get something done around the house? There is no magical formula that tells us how many minutes per hour or day that will be optimal for her development. She will “tell” you, through her behavior. Babies are all different. You’re best off trying to “read” yours from moment to moment.

How Do I Know What My Baby Really Needs? When you observe your baby’s behavior over time, you will notice she has unique rhythms and patterns. Sometimes, she will have better control over her body, and be nice and alert. Other times, she will be disorganized in her movements, overwhelmed, irritable, tired or hungry. These patterns follow a fairly predictable cycle throughout the day. Your baby is most receptive to interaction and “play” when she is in the quiet, observant, alert phase of her sleep/wake/activity cycle. Other times, she will prefer to sit on her own, observing her environment, trying to make sense of it all. At two months, she is working so hard to try to focus her eyes, move her head (and feet and hands) purposefully, get used to her digestion and other internal sensations, and make sense of all that information. So giving her some time alone to “take it all in” while she’s in her bouncy seat (or crib, or bassinet) is perfectly fine. READ HER CUES. A well-developing baby will thrive on both her intimate, intense “play times” with you, and also be able to tolerate some time just watching the world go by.

A Mother’s Guilt: Never in Short Supply But it’s OK if you can’t play with her at each and every opportunity... I give you permission! Perhaps you have other things to do…Oh, I don’t know, like make dinner? Do laundry? Take care of other kids? Or, even lie down on the couch and relax for a bit (what a concept)? You need to balance her needs, and the needs of the family; that includes YOU too. You need to re-fuel yourself so that you can be your best with your baby. A tired, overwhelmed Mom doesn’t read anyone’s cues very well.

You can find practical solutions to some of the challenges in your baby’s early months, too. I hear you when you say your daughter is awake and fussy more in the daytime. You want to give her attention, but you also need to balance the needs of the rest of the household and the family. My second baby wanted to be held more than the others and didn’t nap well, but he slept well at night like your baby. So while we did play together during the day, when he was fussy and tired (but not willing to sleep) I schlepped him around in a front-carrier so that he could get the physical contact he craved, but I could still get something done around the house. Find solutions that are workable not only for your baby, but for you too.

Experiment with these ideas and let us know how it goes.

Aloha,

Dr. Heather The BabyShrink

Next time, I’ll tackle a related issue: How DO you “play” with a tiny baby, anyway?