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Archive for the ‘Ask the Expert’ Category

Five Ways to Discourage Children from Lying

Dr. Kyle Pruett, clinical professor of child psychiatry at Yale School of Medicine and member of The Goddard School Educational Advisory Board, offers five ways to discourage children from lying.

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  1. Keep your cool when your child lies. Try to say ‘Oh,’ or ‘Okay,’ to give yourself some time to think about what to say next. Something like ‘I wonder what happened to the flowers’ works better than ‘Whoever did this had better tell the truth (‘or else!’ is implied).’ This strategy makes it easier for children to be truthful and improves your chances of hearing the truth later as they will feel less intimidated.
  2. Calmly, try to help your child understand why he lied and what he can do next time to avoid lying.
  3. Explain to your child that it’s okay to make a mistake and that she doesn’t have to lie about it. Also remember to praise your child for admitting that she made a mistake. Lying lessens when it’s safe to tell the truth.
  4. When you are on the fence about whether or not to believe your preschooler, err on the side of believing that your child is telling the truth. Or his version of it. After all, imagination is a powerful and creative force that might cause a child to tell a lie that he thinks is true. For example, a child might claim that there is a monster in the closet when that obviously isn’t true.
  5. Be aware that you are under constant scrutiny and that the ‘innocent’ white lie that you can’t make a donation to a charitable organization because you don’t have any cash, for instance, will be noticed by your child. Set a good example and remember that the truth starts at home.

Six Ways to Cope with Your Child’s First Crush

Navigating the waters of our children’s emotions can be tricky. Learning expert and award-winning writer Susan Magsamen, member of The Goddard School Educational Advisory Board, offers six tips on how to cope with your child’s first crush.twenty20_9d20fa78-9565-49b8-96b5-6ae19b9d349c

  1. Remember what it feels like. Our inexperienced children might feel uncomfortable, vulnerable and self-conscious about a crush. Respect this sensitivity and help them to put words to these feelings if they’re open to talking with you about it. The older they get, the less they will want to talk. Respect this, too.
  2. Keep lines of communication open. Try not to judge your child’s crush. It is easy to start to share your opinion—“She’s cute,” “He’s trouble,” “Be careful” and so on, mirroring your wisdom and experience. Remember it’s unlikely that this is your child’s first and only crush. They are experimenting and learning what it feels like to love others. This is important for setting boundaries and building independence. Encourage them to talk with you. Be open and be a good listener. They’re not usually looking for advice, but they may want a sounding board.
  3. Don’t take it personally. The fact that our children have crushes doesn’t mean they love us less. A strong relationship with a teacher, stepparent, coach or other adult in a child’s life is healthy. There’s more than enough love to go around, and children need to know they don’t have to choose who they love for fear of losing us.
  4. Don’t obsess over their obsession. Crushes can last a short time, even a few days, or longer. Crushes are healthy. Sometimes they are a fantasy or an escape. If they are distracting to the point of interrupting daily routines or if they become emotionally stressful, you may need to intervene. “How much is too much?” is always a question that needs to be considered. Talk with other parents about how they cope with this topic. Since your children are often getting information from many sources, it can be hard to figure out what’s appropriate. If you feel uncomfortable, listen to your instincts.
  5. Offer strategies. Talk to your children about what their goals are. Are they enamored but not interested in letting the crushee know? Are they feeling uncomfortable and wanting to talk about how to feel less stressed? Help them identify their feelings and develop strategies for how to move forward.
  6. Be there for a broken heart. I will never forget the time my son came home from school and said, “How can you love someone and they not love you back?” Unrequited love is by far the most painful. Time and empathy is the only way to heal a broken heart. “Getting back on the horse,” as we all inevitably do, might help too.

How Dr. Jack Maypole Encourages Healthy Eating

It can be challenging to get children to eat vegetables. Pediatrician Dr. Jack Maypole, member of The Goddard School Educational Advisory Board, offers five tips on how to encourage healthy eating.

  1. Offer one new food with two well-established foods. For Hand with Heart Breadexample, if you know your daughter likes pasta, serve that as usual and add a portion of a new vegetable to her plate.
  2. Establish a rule that children have to at least try one bite or taste of a new vegetable. Research shows that most children will take to a food after up to about a dozen tastings (for some super picky or rigid eaters, such as those on the autism spectrum for example, it may be many more times).
  3. Set children up for success by discouraging snacking or tanking up on beverages before mealtime.
  4. Keep mealtimes positive by involving children in food prep and getting enthusiastic in the craft and presentation of food. This may cultivate interest and curiosity in the food, which can lead to the development of a more adventurous palate.
  5. Never force feed or go to war about making your child eat. Everyone loses. If you are concerned that your child may have issues with food, such as allergies or sensitivities to texture, contact your child’s primary care provider.

For more information, check out this article in which Dr. Maypole provides additional nutrition advice.

Pica: When Kids Eat (and Eat!) Non-Foods

Jack Maypole, MD
Contributing Writer and Goddard School Educational Advisory Board Member

Infants and toddlers are like wobbly ninjas, focused maniacally on tasting and mouthing items from coins to blocks to the odd flotsam and jetsam that lives on living room floors. Parents know to beware, to police an area well…as you never know what they’ll pop in their mouth next.  Infant  and toddler oral fixation is considered developmentally appropriate (if not entirely healthy) behavior.  Fortunately, most children outgrow this item-to-mouth impulse by the time they are closing in on their second birthday.

And then, there are those children with pica.

Pica, of course, refers to the old typewriting term of 12 points of line space equal to 1/6 of an inch. However, that has nothing to do with the more intriguing medical definition we’ll discuss here: Children with pica (estimated to be about 10-20% of kids at some point) demonstrate a persistent tendency to ingest or mouth non-food items for more than a month, at an age for which it is not considered developmentally appropriate.

What are we talking about here? The items children and adults with pica may consume range from the everyday (ice, fingernails, batting from stuffed animals, pebbles, and chips of wood), to the unusual (erasers, talcum powder, coins, cigarette butts) to off-putting or dangerous menu items (feces, pins, lightbulbs, batteries, and burnt matches).

In some cultures and communities, family members may promote eating non-food items for health, well-being, or enjoyment.  For example, in Turkey and Rwanda, geophagia–the practice of eating soil–occurs in huge segments of the population. Dirt can be bought in marketplaces expressly for eating. In parts of the American South, particularly in African American communities, pregnant women may eat laundry starch, or bits of clay to allay the symptoms of morning sickness.  Children or parents who consume these items report it works, and pass it on down the generations.  But is it ok? More on that in a minute.

Even  after documenting this phenomena for centuries, we don’t have a full explanation for pica, and the compulsion to consume non-food items  in otherwise healthy individuals.   The pre-eminent  theory explains pica as a compensation for nutritional deficiencies–such as iron, zinc, or other minerals– in an individual’s or community’s diet.  Ironically, the consumption of clay and starch block the body’s absorption of iron, and can create or exacerbate a  low iron problem for a woman (not a good thing in pregnancy).

Even in a child who is progressing normally developmentally, pica may be associated with other complex factors. Children with histories of stress, economic hardship, trauma, depression, parental deprivation or frank hunger may consume non food items. Distraction? Boredom? Soothing? Perhaps.  In other situations, pica strongly correlates (for reasons unclear)  with certain mental disorders, such as schizophrenia, or developmental conditions, such as mental retardation or pervasive developmental delay (PDD ).  This can be an important heads up for caretakers, and another challenge in managing these kids as they go through their day.

Pica  behaviors in children and families may go on for years, undisclosed but in plain sight or in secret. For some children and families, shame or embarrassment may hinder discussion with their health care provider. Families may not perceive pica as a health issue, or consider the matter worth mentioning.  For the primary care doc, if there is a suspicion or mention of pica, this is a matter best approached with awareness, sensitivity, and the right questions.

The medical problems from pica derive from what gets eaten. Kids with damaged  or missing teeth from chewing or mouthing unusual materials may arouse suspicion and herald an unrecognized case of pica. Consumed items may exert poisoning effects when swallowed over days or weeks. Lead toxicity is most common, and may be subtle (anemia) or devastating (encephalopathy and brain damage).   Pica behaviors around eating paint chips or contaminated soil may be the source, and observations by parents or astute history taking by health care providers may prove critical in helping manage the acute symptoms and preventing recurrences.

Other children and teens with pica may present with GI discomfort caused by items they’ve eaten. Constipation, ulcers, perforations, and bezoars (wads of undigestible items, such as hair, that are unable to pass out of the stomach) may require special imaging, ER visits, or surgical intervention.

The ingestion of soil or fecal matter in some individuals can also cause bacterial or parasitic infections.   Toxoplasmosis, toxocariasis,  and worm parasites like ascaris can occur, cause havoc, and require prompt treatment and evaluation.  And, they are unpleasant.

Treatment of children and teens with pica requires a team effort.  When the diagnosis is made, the first priority is to determine the health status of the child in question.  Clinicians will perform complete physical and neurological examinations, with  laboratory  or imaging studies, or specialist consultation done as needed.  Medical treatment for pica will be tailored to address any acute problems (infection, GI issues, or toxicity) and longer term, applying a comprehensive and collaborative approach to the family.

Primary care providers, social workers, and mental health experts need to partner with a family to understand their cultural attitudes and health beliefs around pica behaviors to develop trust, communication, and a workabole plan. Ideally, family members learn about the potential risks of pica, and to recognized potential symptoms of ingestion.  With time, families can apply  individualized strategies to redirect and distract from unhealthy mouthing or munching. In most cases, the prognosis is good: healthy children will often outgrow pica by school age, while children with mental or developmental disorders respond well to intervention, but may relapse into the behaviors into their adolescence, and beyond.

So then, while kids may gnaw on this or nibble on that, be mindful. If you are concerned, be careful. And if necessary, talk to your child’s primary doc.

 

Really? Is Infant Colic Due to Migraine?

Jack Maypole, MD
Contributing Writer and Goddard School Educational Advisory Board Member

For those of you who might be pediatric research wonks, or better yet, for those of you out there who may be parents of young fussy infants, take note: now we have a (another) new theory as to the cause of colic. Now, while you shift that crying baby to your other shoulder and rock gently, let’s dig a little deeper as to what this is all about.

Colic is the unpleasant term for the young infant who follows the Rule of Threes: he or she cries for three or more hours a day for three or more weeks, at least three days out of the week(for anyone who has survived even a flight with a howling babe, we know that is a lot). Colic is common: it happens in about 1 in 5 babies. These so-called colicky infants tend to have a sort of routine, with the onset of a frantic crying pattern— often at around the same time each day(perhaps leading to why some parents call this ‘grandma time!”).  The peak of intensity for colic hits at around 6 weeks of age and can last up to about 2 or 3 months, depending on the child.  As one might expect, colic is a common topic in the first few visits to the primary care clinic.

And, colic is a bit of a medical conundrum. There is no blood test for colic, and nor is there any physical finding that slam dunks the diagnosis.  Sorry, Dr. House. Classically, the diagnosis of colic is one of exclusion, whereby the clinician works with the family to rule out other potential causes of infant crying and fussiness. And, for the record, the comprehensive list of ‘what makes babies cry’ would—no joke—go on for dozens of lines.

For the family members and the health provider, the history is key.  An evaluation best reviews the entirety of a child’s schedule, patterns of eating and sleep and wakefulness, and makes a careful examination of how the crying and fussiness occur (are there triggers? What makes it better? When does it happen? What have you tried so far? And how has it worked?).  Fortunately, a little bit of information, time, and a reassuring exam can go a long way towards making the diagnosis.  Along the way, a discerning clinician will work to rule out the more common or concerning causes of infant distress, such as fever, acid reflux, food or milk protein allergy, a hair in the eye, or a piece of hair tourniqueting on a toe.  When necessary or if other causes are suspected, appropriate lab testing may be considered.  If all else turns up unremarkable, and there is an otherwise thriving, growing child before us  who cries with regularity…colic rises to the top of likely explanations.

So what is the most recent explanation for colic in infancy?  A study published in the Journal of the American Medical Association suggests that colic may be a form of infant migraine. You heard that right:  there may be an association between babies with colic and migraine headaches in older children.   Migraines themselves are incompletely understood and are thought to arise from the interplay of inflammation, nerves and blood vessels running to the brain. Alterations in blood circulation precipitate the infamous headthumpers with their raft of other symptoms.  And, we do know in preschool and school age children, a fair number of pediatric migraine sufferers describe abdominal discomfort as the most prominent symptom of their episodes, especially nausea and belly pain. Interesting, eh?

In the study, researchers followed 208 children, ages 6-18 year old, diagnosed with migraines in 3 European medical center emergency rooms. Parents were questioned  about their children’s headaches and personal health history. Analysis of the data showed children with migraine headaches were more likely to have had a history of colic than children without migraine headache histories—(about 73% versus 26% respectively).

Here’s the rub:  the researchers propose the colicky symptoms in infants could be due to disruptions in blood flow to the gut that mirror the supposed mechanism of migraines in older children and adults. In effect, the babies  have a headache in their stomach. Total bunk? Not necessarily.  But, as parents and clinicians, we have remember the old trap of ‘association doesn’t necessarily mean causation.”  In other words, this baby migraine theory could explain some or all of colic. Or, not.  The study goes on to propose (like all good researchy papers) with a call for more research, including trialing migraine therapies on infants with colic. Given babies are fragile research subjects, and the enthusiasm for trying pharmaceuticals on them is low, this is not likely to happen soon.

So,  babies will continue to fuss and kick and scream during their grandma’s time while we suss this out. Meantime,  I recommend that parents work with their child’s primary care provider on the tried and true approaches to reducing colic-related fussiness. White noise (such as fans, washing machines, or TV screen snow), gentle rocking, or spins around the block in the stroller or carseat work best. For other mainstream and complementary and alternative approaches, see here: (http://www.mayoclinic.org/medical-edge-newspaper-2010/oct-29a.html  )

And, stay tuned colicwatchers! We will see if this new theory on an old problem bears out.

Link to the Journal of the American Medical Association Article

http://jama.jamanetwork.com/article.aspx?articleid=1679399

Ask the Expert: Parents and Their Daughter’s Self-Esteem

“What can my husband and I do at home to build and reinforce our eight-year-old daughter’s confidence so she is self-assured when she is with her friends?

Family - Mom Daughter AYou can do a lot, but exact amount depends on your daughter’s personality. Who she is determines what you can and can’t do at home, so be honest about her temperament. A lot also depends on who her ‘friends’ may be at any given moment. As you know, eight-year-old girls often have transient friendships. These are practice friendships; your daughter’s main influences are still mainly you and your husband, and not her friends, for the time being.

Thanks to a recent, thoughtful NYU study of the development of female self-esteem, we see confidence increase during kindergarten, plateau between eight and ten and then decrease, thanks to many factors, including hormones and confusing media messages. As thoughtful parents, planning ahead is necessary, because low-esteem can make her more susceptible to smoking, bullying, eating troubles, drug use, depression, premature sexual experimentation and more.

Tip the playing field in her direction. Both of you should tell her regularly that she is your treasure and praise her for her abilities, strengths, courage, overall smarts and attractiveness. Self-doubt is already bouncing around in her head, and in the heads of her friends.

Limit her screen time and monitor her media and phone use. Forget being hip and use parental controls. Media literacy is no longer an elective.

Practice listening carefully to her during your conversations, whether they are held at dinner or in the car, and let her know you have heard her. Her own voice is just now gaining strength and needs regular training.

Mothers are their daughters’ model for how to be a woman, so mothers should watch their own self-esteem during this period. Lots of moms begin to feel that they need to let go of their dreams while their children build theirs. A daughter notices this. If you support your daughter’s friendships but do not make time for your own, she may choose to imitate what you do, not what you say. Similarly, she develops her attitudes towards clothes, nutrition, weight issues and relationships based both on what you say and on what you do. Try to live by the values you want her to cherish.

A daughter’s relationship with her father is a model for her relationships with men. How you treat her affects how she will expect men to treat her. Most men significantly underestimate their influence on their daughter’s self-confidence and self-regard, and often focus too much on playing a supporting role to their partners, over-stressing discipline or teasing. Spending time alone with your daughter while participating in activities she likes helps build a firm foundation that can easily withstand puberty.

For more support, I recommend a website called New Moon. It was designed by parents and their daughters for eight- to twelve-year-old girls and offers them safe and authentic conversations about the issues that matter to families with daughters. Our family liked it a lot.

The Goddard School’s Internet Radio Show — Balancing Act: The Art of Parenting!

Need help navigating the world of parenting a preschooler? The Goddard School’s panel of early childhood development experts discusses and answers your questions on our Toginet Radio show — Balancing Act: The Art of Parenting. From education guidance to bullying-proofing advice to nutrition and fitness tips, our experts are here to help you.

Want to know how to choose the right childcare for your family? Need tips to help your child cope with divorce? Looking for help to balance your home and work life? Join host Ashley Betzendahl as she welcomes an incredible group of educators, researchers and experts in child development, early learning, technology integration, brain development, parent engagement and health and nutrition to share their tips and advice with you.

Dr. Kyle Pruett, internationally known child psychiatrist; Sue Adair, The Goddard School’s director of education; Susan Magsamen, award-winning author; Dr. Craig Bach, educational researcher; Dr. Jack Maypole, pediatric health and nutrition expert and popular pediatric blogger; Lillian Kellogg, educational technology proponent; and Lee Scott, Chair of The Goddard School’s Education Advisory Board and early education programming expert, are a few of the special guests who will be joining us each week.

Have a question for our experts? Listen and call in (877-864-4869) on Thursdays at 2 PM Central / 3 PM Eastern.

Ask the Expert: Regression – When Development Seems to Slip

“My son recently turned three and we have noticed a change in his behavior. While he is doing great at potty training, he has been acting more aggressively by hitting and pushing at school. My son has always been a daddy’s boy and recently has been hitting me, telling me I can’t play with him and that I don’t love him. Help!  Is it a phase?”

Dr. Kyle Pruett A

This mom has a three-year-old  son who is toilet-training, learning language, playing ‘I-wanna-be-a-big boy-like-daddy-right-now,’ and giving her and a few of his friends a tough time these days. This last development feels new to her. She asks, “Is it a phase?”

I titled this answer ‘regression’ to remind us that development is not a steady progression from young to old, unknowing to all-knowing. The road of development is full of speed bumps, potholes, slips backward and endless side streets. Why is it so rough? Development is a highly dynamic interaction among children’s genes, personality, environments and experiences. Three-year-olds are especially busy because of the high volume of traffic flowing across this intersection. Their vocabularies are exploding (100 words a month), their bodies are increasingly under their conscious control (toilet training and staying asleep are VERY complicated things to pull off with their abilities and wishes and your rules) and they are whizzing past emotional landmarks at blinding speed (envy, shame and embarrassment are new arrivals in their brains and in your homes).

Preschoolers are more powerful and impulsive than ever, and are just starting to learn the differences between girls and boys, mothering and fathering. By now, children have developed different repertoires of behaviors for mom and for dad. Moms are often aware that they are getting the toxic waste from the day on a regular basis (mouthy and aggressive pushback is more common around moms), while dads seem to get away with being Mr. Nice Guy and enjoying the playful, physical rough-and-tumble stuff and little pushback. These trends are normal. The child is learning how to be away from mom without needing her so much and feeling helpless (hence the pushback).

T. Berry Brazelton, the previous generation’s go-to pediatrician, taught us that a period of regression is common just before a child makes a big developmental transition (sleeping through the night, giving up breast feeding, learning to walk or talk, going to preschool, staying overnight with relatives without you). Often, these periods of regression are more obvious in retrospect (“Oh, that’s why he was such a mess the week before he slept at grandma’s.”). I compare it to trying to jump over a puddle on the sidewalk. In order to clear the obstacle, you might have to back up so that you can gather enough momentum to carry you safely to the other side. Parents usually miss this because we are so focused (if not preoccupied) with supporting constant forward and upward progression. Unfortunately, the brain and personality don’t work that way.

To handle a child’s apparent regression, back up yourselves, don’t change much (appropriately, the mother kept using her time-outs, to some avail), put your faith in your child, calm down the other adults in the circle of upset and let your child clear the puddle. If he continues to have difficulties, you should talk with your pediatrician. In the meantime, enjoy his baby pictures to refresh your spirits.

Ask the Expert: When Should Parents Start ‘Teaching’ Discipline?

A recent ‘Ask the Expert’ question to The Goddard School Blog reads, ‘Everyone at our house knows that ‘discipline by distraction’ works well for very young children. At what point should we start  actively teaching boundaries and appropriate behavior? Is 20 months too late to start the process? At what age can that kind of gentle discipline start to become effective?’

All children–and parents–are unique, so I have no clue what age would be best for any particular child-parent pair to start a system of discipline. All I can discuss are ranges when developmental agendas are unfolding and try to give you some heads-ups.

Between 18-36 months, so much happens developmentally that it’s easy to lose sight of the objective. The long-term goal here is cultivating self-control in the child, not parental control of the child. Through your words and your own behavior during this period, you are teaching the basics of judgment and control that will work not only when you are present, but hopefully when you are not, as in those teen years.

Before shame and guilt show up, discipline by distraction is your best hope.  Shame and guilt are critical partners in disciplining children and they develop late in the second year for most kids.  Shame arises when a toddler gets an unexpected, negative reaction to something he/she has done from someone he/she loves. He/she feels instantly deflated and may or may not blush, but he/she clearly registers a negative physical reaction to this interaction. This reaction doesn’t exist earlier because the brain has only just now developed the complex connections between words, behavior and emotions.

What you do next will help the child learn over time that his negative behavior violates your important standards for his well-being, and that there are ways to avoid guilt, which is the primary consequence of shame and hurts just as much. Therefore, once that shame reaction starts, it’s worth adding a firm but simple “No, we don’t jump on the coffee table.” The toddler’s increasing memory skills are sometimes  helping him to remember that even when the coffee table leap looks like fun, the grown-ups don’t like that behavior.

Your consistent, firm,  low-key and brief repetition of the same words and actions in response to his dangerous or uncooperative behavior enable your child to begin to feel emotional distress (shame and guilt) when he breaks those rules. His desire to please you is something to rely on, but not to manipulate. After about18 months of this kind of interaction, your child will show the beginning of a sense of right and wrong. Voila! A conscience starts to emerge just in the nick of time (about pre-K).

Our kids aren’t the only ones feeling shame and guilt. How we manage those emotions in ourselves is related to our own personal character and temperament. Periodically reassess the fit between you and your child’s temperamental styles enough to stay in sync so that you don’t feel you are ‘constantly battling.’ Laid-back kids are often confused by feisty caretakers, just as shy parents are flustered by feisty kids. One solution is to do more tag-teaming with the parent or grandparent that seems to be less ‘undone’ by the challenging behavior during this stage. Now you know why there are quotes around ‘teaching’ in the title.  Remember, it DOES get better.

Additional guidance is from Chapter 8 of Dr. Pruett’s Me, Myself and I: How Children Build Their Sense of Self: 18-36 Months, Goddard Press.

Ask The Expert: Second Languages

What are your thoughts regarding the role that learning a second language has in child development and raising multilingual children?

Research on dual language acquisition (DLA) shows that given the opportunity, very young children can and will learn two or more languages at the same time.

An effective learning environment for the young dual language learner is one in which strategies are in place to intentionally and continuously support bilingualism.  Parents can do the following:

• engage young children in conversation during daily routines, for example, during mealtime or before naptime using the second language;

• read with children, using common words, poems, songs, and stories in the second language;

• label objects verbally using the second language;

• introduce the sounds of the alphabet letters to the dual language learner in both English and the second language;

• venture out and explore environments where the second language is spoken.

Young children can become increasingly fluent in a second language if they have opportunities to speak it with a variety of individuals, on a variety of topics.

For young children, the language of the home is the language they have used since birth, the language they use to make and establish meaningful communicative relationships, and the language they use to begin to construct their knowledge and test their learning. The home language is tied to children’s culture, and culture and language communicate traditions, values, and attitudes.  When introducing a second language, parents will need to have command and comfort of that language in order for children to become fluent.