Category Archives: Family

Handling the Anxious Child

“Mom, could that happen to me?” “Could I get asthma?” “Will you die next after grandpa?” “Will you be there when I  get out of school today?” How much reassuring can a mother do?  Why do some kids get more anxious and worried than others?

Anxious worried children exist. Of course, our  sensationalized news media does not help. But some kids are by  nature worriers. How can parents help?

First, it is important to recognize that some worry is  good. Everyone who succeeds in life succeeds because of their  ability to overcome worry to accomplish what they need to do.  People, who don’t worry, don’t push themselves to “fix” the  worry. Some level of “worry” is necessary in life unless you  don’t care about anything. (I have greater concern for those  who don’t care!)

Nevertheless, too much worry is not good. It causes stress  – that causes health issues. We can be so overcome with worry  that we become dysfunctional. So we do need to control our  anxieties and worries. What about your child worrier?

The first question is whether the worry is functional or  not? Is he or she succeeding in school? Is he or she passing  his worry off to you alone or do teachers and coaches see his  anxiety as well? If your child is doing well, you can probably  relax about his worries. If your child’s worries interfere with  school performance or his interaction with teachers and coaches,  seek some help. But the majority of kids don’t fall in this  category.

Most little worriers are just that. They worry. They  always have worried. And they will worry in the future. So  long as they continue to function well you won’t change that.  However, you can help decrease exposure to scary movies and  scary news. There is no reason to increase their reasons for  worry. Secondly, a lot of children just lack confidence. They  feel uncertain so they question how outside forces will affect  them. Much of their worries are questions and not real worries.

When we take on our child’s concern as part of a parent’s  package of worries, kids worry more. That’s right. By worrying  about our child’s worry we make them worry more. This is not  fair to us as well as them. “You do very well in school. I am  sure you will do your best on the math test.” “You may not be  the quarterback, but with your skill, there will be a place on  the team for you.” “Grandma was older and suffered her  illnesses for a long time. I’m afraid you’ll be stuck with me  for a while.” Off hand easy confident phrases work wonders for  kids. Some comedy helps too. But leave their worries for them.

Good News About Vaccines

For the past several years I have found myself on the defensive over a very fundamental treatment I provide as a pediatrician. I have been giving children vaccines according to the American Academy of Pediatrics guidelines for 22 years. But in recent years there has been a backlash against the very vaccines we use to prevent known serious illnesses. As a response to this backlash I built a file of articles that supported the use and defended against supposed side effects of the vaccines. In recent days there has been great news about vaccines to add to my file. The news is they are safe and do not cause autism.

In the late nineties two events stoked the fires of skepticism about vaccines. First, in 1998, a well known British medical journal, the Lancet, published a report based on work of thirteen prominent physicians stating that the MMR vaccine was associated with autism. A storm of controversy over the use of the MMR vaccine followed. The second event in the late nineties that caused a furor was the removal of thimerosal from vaccines. Thimerosal, a preservative used in vaccines, contains mercury. It has never been shown to be a health hazard. However, because of the potential for buildup of mercury in the body, it was prudent to remove thimerosal from vaccines. This was done on a voluntary basis by the manufacturers. Just that move caused speculation that vaccine manufacturers were hiding something. Further speculation followed that thimerosal was associated with autism – with no medical evidence proving it.

Through the early part of this decade, scientists and lay people have battled on both sides of the argument. Advocates for parents of autistic children questioned the MMR and thimerosal link while doctors and researchers tried to study the association. Now, within the past two months two news reports help clarify the reality.

First, in April, ten of the original thirteen investigators who published the link between the MMR vaccine and autism retracted their conclusions. It was revealed that the study, which was funded by lawyers who focus on vaccine damage cases, was markedly flawed. The original study that served as a basis for legal cases involving the MMR vaccine around the globe was biased. The lead investigators in the study are currently under legal investigation for conflict of interest.

A second story about vaccines came out in May 04. The Institute of Medicine released a report by its thirteen member panel saying that there was “little credible evidence that thimerosal was associated with autism“. Autism is a complex and difficult problem for parents and children. I know many autistic children and their families. There is still no clear explanation for autism. I wish there was. But at least we can learn some lessons from these two reports.

These two reports are of great value to physicians who promote vaccines for kids. The first report about the authors of the Lancet article takes the wind out of the sails of the MMR – autism relationship. It had been viewed with skepticism and was never supported by other research. But now to have the original authors retract their opinions makes the original article meaningless. Coupled with research disproving the MMR autism association we can now put this speculation to rest.

The thimerosal argument was piggybacked onto the MMR argument for those who wanted to link vaccines to autism. But with “no credible evidence” for such a link we can now be doubly reassured that vaccines have no connection with autism.

The general public never sees the illnesses we seek to prevent with vaccines. The illnesses are awful and often deadly. It is one of the miracles of medicine that we have vaccines for our children. Due to vaccines far fewer children need respirators, spinal taps, intravenous medicines, hospitalizations, ER visits, and intensive care unit treatments. We see far fewer cases of meningitis than we saw even 10 years ago. And in our lifetime – we will see polio eliminated worldwide because of vaccines.

So when I give immunizations to children these days, because of the recent news, I give them with renewed confidence that they are the most valuable preventative care treatments I give to children. I feel so lucky to have them. Now, I just hope more people can be reassured about their safety.

Getting Your Child to do Chores

Wouldn’t it be nice if one Saturday, you wake up and your kids say to you, “Mom, can we do chores today?” Then  as you sit happily sipping coffee and reading the newspaper your kids clean their rooms whistling while they work.  Even the bathrooms and mud hall get cleaned! This  obviously is a scene from a fantasy movie. It will never  happen in your home or mine.

It must be one of the most universally dreadful of all parenting jobs to try to get your kids to do chores. You  dread it. Kids resist and resent it. And after hours of pushing the issue, you end up doing most of it yourself.  There must be an easier way!

Well, there isn’t. (I should end the article here,  but I’ll add a few tips.) Children do need chores. They need to accept some responsibility for maintaining your home. Chores should be age appropriate for your children and should increase with age. Certainly write them down and post them on your ever expanding refrigerator billboard. But those are the basics we all know.

The biggest secret to getting chores done is that kids need us to do things for them. That gives us leverage to  have them do things for us. So, to get chores done, try these suggestions.

On chore day, stop serving your kids until the jobs are done. Respond to no requests, demands or inquiries. Stick to this. Keep on them about their chores but use  your presence rather then your voice. Accept less then perfect performance at the beginning but expect improvement over time. Teach them what you expect. Be persistent about having chores and getting them done. They will never like it. They will always grumble. Don’t grumble back.  Remember they are very uncomfortable with your silence.

If you can distance yourself from their grumbling,  persist in the chore demand, resist any of their requests  and pester them with your presence instead of your words, you might get a chore or two out of those lazy leeches you  call your children! If not, send them to my house and I’ll put them to work.

Getting Kids to Listen

“It’s time for dinner, Johnny. Come to the table. Johnny, it’s time to stop playing and come eat. Come eat  Johnny.

JOHN JOSEPH FANNING the third YOU GET TO THIS TABLE  RIGHT NOW !

Why don’t they listen the first time? Listening.  Hearing. Cooperating. How do we get kids to do these things? Why do they make us yell? Perhaps it’s because  they know they don’t have to listen until they get you to

So what are kids thinking? From their perspective, they are listening. They listen to your voice to  progressively increase in volume. They listen to your tone  get more strained. And then when you get to the most  strained voice and highest volume, they act. It appears to  me they know exactly what they are doing. As you are  trying to control them, they control you.

To get kids to listen they need to know that we mean it before we get to that loud strained voice. Perhaps we  should call once then go and touch them to be sure they heard. Then gauge whether they are willing to part with  what they are doing. Giving them some warning ahead of  time helps with this part. Then as you touch them, meet  their eyes and tell them again it is time to come. Then wait there a second. They hate parents to hover over them.

Of course not all listening problems are solved so quickly. Parents need to realize that kids don’t like  being ordered around like a disrespected employee. Nobody appreciates being treated like that. So we have to back up and think about how we talk to them. Do we yell a lot? Do  we order them around? Are we always telling them what do do and not letting them think for themselves. These actions will make children want to tune us out.

To help children listen better, keep your voice even. Use nonverbal cues like touch, meeting their eyes and  getting down to their level. Stop giving orders and commands. Give options instead. Sometimes just present the problem you are having and see if they can come up with a solution. The solution might not be what you exactly want but it might work as well.

Getting our kids “to listen” is a perennial problem  for parents. We always think of it as their problem with  hearing and cooperating. But if we turn this problem to be  ours then perhaps it is really at least in part a problem  of how we present ourselves and our daily concerns to our kids.

Getting Not Giving

I must confess. I am a pediatrician who dislikes Halloween. “How much candy did you get?” is a common refrain at the end of every Halloween evening. Kids spill out their treasure to see how much they got. They often separate their goods into piles – from favorite to least favorite candies. Of course, the least favorite are the ones that are dispensable to others. This ritual begins the “getting season”. Before the Halloween costumes are hung to dry, Christmas items are being hung on display in every store in the country. In this culture of getting, when do we squeeze in the lesson about giving?

The lesson about giving doesn’t start with  Thanksgiving that is for sure. Yes, people will give an  extra dollar at Shaw’s to buy a turkey for a needy family.  But Thanksgiving culminates at a meal where we sit and  overeat and get sleepy. I was struck recently when in a  store I saw the title page from Martha Stewart Living – A  Season of Plenty. I wasn’t sure whether we were supposed  to be thankful and appreciative or just happy we have so  much. So I return to my question. When do we squeeze in  the lesson about giving?

It is my opinion that we need to stop squeezing in  this lesson. This lesson of giving of oneself or of some  money or effort to a good cause should be a year round  lesson in all families. Let’s not spend Thanksgiving  giving ourselves self congratulating appreciation of what  we have. Starting this season, starting now get your  family participating in active projects of giving. The  biggest stumbling block is where to start. Here are a few  suggestions.

  1. Kids won’t want to instantaneously start in a project  of giving. It’s hard to force it on them. The first  thing parents need to do is get information about an  area where you may want your family to make an effort.
  2. Once you’ve chosen an area of concern (i.e. hunger)  find out about that issue in your area. Then provide  your children information about that issue.
  3. Parents should start working on the concern by  themselves. Let the children know why you are  interested in the work. Be clear about what you are  doing about it – no matter how small.
  4. Continue your commitment all year and be clear to your  kids that you have a long term commitment to help.
  5. After some time ask your kids to join you with your  commitment – even in small ways.
  6. Here are some ideas for families to contribute their  time. In the book, Parenting for Peace and Justice  by Kathleen and James McGinnis, the authors talk  about the “two feet” of Christian Service. On the  one foot there are acts for social change. These are  works of justice. Included in this are actions such  as helping to organize a good co-op, educating the  public on social needs, and even inspiring people to  get out and vote. The other foot of service is direct  service. These are works of mercy that include direct  volunteer work such as working in food and clothing  centers, visiting with the elderly, tutoring children  or contributing to known worthy causes. These are  some categories where families can contribute their  time and efforts. And there are many more. But how  can families get off the dime. Families need to start  somewhere. Locally people can help at the Open Door,  the Cape Ann Food pantry. They can contact Cape Ann  Families to look for opportunities to help. Schools  need people to help tutor and read to children, or  you can contact your town’s Senior Services to help  with the elderly. If you want a more worldly area  to contribute, sponsor a child at the orphanage in  Honduras. Check the website at www.nphhonduras.org.  If you want to contribute to the orphanage you can use  the website or contact me. Look into other world wide  organizations such as OXFAM, Doctors Without Borders,  or Habitat for Humanity. No matter where your efforts  take you, make sure your kids know what you’re doing  and where you are helping and why.

Even in small ways, families working together can help  develop a society of Givers and decrease our society of  Getters.

Fixing Bad Habits

Those thumb suckers, and nail biters and nose pickers, and knuckle crackers,  what are we to do with our kids and their bad habits. As parents we often feel  responsible for our children’s behaviors. Because of this feeling of responsibility we try  to take charge of our kids annoying habits. Unfortunately they have control of their  fingers and nails and knuckles. So the more we try to control these habits, the worse they  often become.

Parents need to recognize that we are not responsible for our children’s behaviors.

The problem with bad habits like nail biting is that these behaviors or actions are  directed towards themselves – not toward others. You cannot separate your children  from themselves or separate their nose, mouth, or fingers from them. Although  sometimes you may want to! Yet these habits are annoying to watch. Many parents can’t help but yelling “Stop biting your nails! Don’t you see what you are doing to your fingers? Your nails are dirty. Keep them out of your mouth.” Yet the temptation for  them is always there as is our temptation to correct them.

Some parents try the toxic route – Tabasco on the thumb for thumb suckers for  example. And some parents try the hiding method such as using gloves or wraps over the  hands as if by hiding the extremity the child will forget they have nails to bite or fingers  to suck. But somehow kids work around these “fixes” so they don’t work.

What parents can do is equate these habits to other body care issues that demand  privacy. Nail care, nose care and thumb sucking all can be done in privacy. In fact, we can make this a family policy. All nail biting, thumb sucking, knuckle cracking, and nose picking need to be done in privacy! Making these privacy or bathroom issues, changes the battle over whether they can do their bad habit to where they can do it. That is  something we can enforce. Over correcting and giving undue attention to these habits  often increases them. Demanding privacy for them at least diminishes what you see of  these bad habits over time. And when it comes to habits, out of sight – out of mind is a win – win policy for home peace.

Experience Is A Good Teacher

As parents, we always think that we have to do all the teaching of lessons for our kids. After all, we are the grown ups. We have the experience and wisdom. How many lectures  do we need to give our children until they take in and understand our wisdom? A long  time ago I learned that some lectures are better off not given at all. I am an avid Boston  Red Sox fan. My son has inherited my love of baseball. And his love of the game and of  one of its stars provided the opportunity for an important lesson for him and me. Here’s  my story.

Ten years ago, when he was eight, I took him to a Red Sox game. For days before the  game he asked me whether we would get autographs. We were planning to go to the  game after my workday, so I told him repeatedly that we would be getting there late and  would get nowhere near any players.

We got a late start that evening since I got home from work later than expected. We  raced out the door and headed to the train. He was jumping out of his shoes with  excitement.

I knew we were late and felt the pressure of maneuvering the two of us from  our train to the “T”. We got seats on train and started moving towards North Station.  I knew we had to change to the “T” so I was anxiously watching our movement toward  North Station. My son tapped me on the arm.

“Look Dad, I brought my favorite card.”  It was a Nomar Garciaparra rookie card (then worth five dollars according to his baseball card books and now not worth a dime). At that time, Nomar’s card was special to my son.  “Do you think we can get him to sign it?”, he asked me.

At this point, I thought to myself, first, we are late and we would never get anywhere close to Nomar. Second, the chance of him losing the card was 50/50. I initially felt like saying, “Why did you bring that? It is your special card. You’re going to lose it. And what were you thinking? We won’t get near Nomar.” But I had been reading some  parenting books, like a good pediatrician. And I had recently learned about experience  being a good teacher. So I held back.

“I don’t know if we’ll get close enough, but we can see.”

I didn’t react. I didn’t lecture. I just kept his hope alive and I hoped he wouldn’t lose the  card. I did not offer to hold it for him. It was his responsibility.

We arrived at our station and we carved our way through the crowd and out of the train  station. No sooner did we sit down on the next train than I heard a dreadful “Uh-oh,” and  my heart sank.

“What is it?” I said.

“Dad…Do you have my Nomar card?”

“No, pal. You didn’t give it to me,” I replied.

“Why? You can’t find it?”

“No,” as he looked frantically around the seats.

“Quick dad, can we go back to the last train and see if I left it on the seat?”

“No, pal. I’m sorry, that train is long gone.”

“My Nomar card…I lost it,” and with that he started to cry (and I almost did, too).

I held him and let him cry. I didn’t say I would replace it. I just let him cry. I said I was  sorry that he lost it and that I understood how it hurt. After a while he asked me whether I had ever lost anything of value. I reassured him that I had and that everyone has. But it was so hard to see him so heartbroken over his lost card.

Later after the game when we were home and I was tucking him in bed he told me “Dad, thanks for not being mad at me for losing my card. It made me feel better to know that  you lost something too.” This was a “Father Knows Best” moment for both of us, but  what he doesn’t know is the pain I went through to have it. It was hard to let him have  this lesson about caring for his things, and sorrow over losses. However I knew at heart  that these were important lessons.

I realize that many parents try to avoid having their children experience  disappointment and loss. But I wish more parents could allow their children some of  these experiences in life and not fear our role as parent to just be there to support them.  We don’t have to fix every break or replace every loss. We don’t have to lecture to teach  these lessons. In fact, lectures won’t work. You see, some of our children’s most  important lessons won’t be taught by us, it will be experienced by them. We just need to  be wise enough to support them through it.

Expecting A Playmate And Just Having A Baby

So you are expecting your second child. Of course you want to prepare your older child who is probably one or older. You show them your growing belly. You let them feel some movement.  Perhaps they even see the baby on the ultrasound “TV” screen. You hope that involving them will  prepare them. But will they be prepared? What do they really expect when you’re expecting? Do they expect a playmate or a baby?

Naturally involving your children in changing family events is important. It is just difficult to  make them fully understand the coming of a newborn into your house. No matter how involved or  prepared they are, they will have some adjusting to do once the baby comes home.

At first, when your older child sees the new baby, there is a time of awe. It is not unlike the  awe we have as parents. Could this little being really have come from mommy’s belly? This awe  period may be short. It may involve a questioning of “what next?” And with that wonder, they may  have some fear. As a result they may want to be close to one or the other parent.

After a short time, children get a sense of pride along with the rest of the family that they “have  a new baby”. With that sense of pride comes a protectiveness or a possessiveness of the new baby.  Your child may react badly to others outside the immediate family when they hold the baby. They may  need reassurance that their baby is still theirs and won’t be taken away.

Even after witnessing some protectiveness, and knowing that rarely do older children intentionally hurt their younger newborn sibling, you cannot trust your older child around the baby. They may get angry at the newborn and want the baby “put back”. They can strike out or even  “accidentally” hurt the newborn. Though you need to protect the newborn, you do not want to  ostracize your older child. He or she still needs to be involved. Give them a role. They can be  guardian of a blanket or fetcher of the new diaper.

Some older children see the new baby and realize in their self centered world that the baby is  actually no threat to them and their kingdom or queendom. These perceptive children may be more  interested in the hospital bed going up and down than in the newborn. They may remain oblivious to  the baby but as a result may want the same amount of attention from you as before the baby was born.  Of course, this can be frustrating and impossible to do. Give them what attention you or your spouse  can. You may see them act out in negative ways to get your attention. Don’t give the negative  behavior undue attention. Try to complement and praise good behavior and minimize attention to the  negative acting out behaviors.

Some children challenge their parents after a newborn comes just to see if the rules at home are  the same. A big mistake parents make is being too lenient. Older children actually feel more secure to  know that the rules of the house are the same – bedtime is bedtime, there is no hitting allowed, and you  can’t throw food on the floor. Once older siblings discover that the home with a new baby has the same  rules as when the home didn’t have a baby, they back down from challenging the rules so much.

Many times the real challenges with the new life with two children come when the new child  becomes more of an equal of sorts to their older toddler. Once the older child sees the new child  walking and talking he may then see his younger sibling as a threat. Now his toys and his space might  be invaded by the cruising little monster. The older child does need his or her space. And their toys  may truly be unsafe for the younger child. Parents need to respect this space for the older child and not  push “sharing” too soon. Remember your cruising one year old won’t understand sharing at all. One  year olds think the world is theirs. Over time the older child, who has their “space” supported and  secured with the help of the parents protection, will come to feel secure and be able to open up to the  younger sibling on their terms. And sharing can then be taught.

Parents need to play a balance between two young siblings. The tendency is to put too much  pressure on the older to be the sharer, the accepter, and the more mature playmate. It is best to respect  the older and not take sides favoring the younger sibling. Kids perceive fairness and practice that  amongst themselves over time. Recognize that young siblings will have conflict. This is a challenge.  Use separation when necessary. Limit blame. Accept the conflict as natural. Be fair, balanced and  even tempered. Over time your kids will learn to be fair and balanced to each other. Eventually your  older child will have the playmate they always wanted.

Expectations For Our Teens (Parenting Teens Part III)

Do you expect anything from your teen? Do they have chores?

Parents are used to setting limits for their teenagers.  “No you can’t go out tonight. You have too much to do at home!”

How can any parent expect their child to achieve anything  if you aren’t clear with what you expect? I have witnessed this  question in action many times. When discussing school grades I  often hear parents tell me that their son or daughter does  “fine” in school. When I inquire further I discover that barely  passing is acceptable to that parent. If I ask if their child  could do better, invariably the parent says “sure, if he only  applied himself.” It is hard to press a parent further but I  often wonder in my head “why don’t you expect him to do better  and apply himself?”

It is an unwritten law of teen parenting; children will  rise to the level of their parents’ expectations. (Of course  there are some conditions – realistic expectations, good mental  health, organizational skills, etc).

Realistic expectations are a sign of respect towards your  children. They tell your child that you think so much of them  that you think they can achieve. That is powerful to these kids  who are going through so much internal questioning. “My mom and  dad think I can make it through college.” Kids internalize  these messages and sense a positive image of their skills.

These are some prerequisites for parents to set proper  expectations. Parents need to recognize their children for who  they are. They need to fairly assess their skills. They need  to respect them for their abilities and compliment them. Then  parents can help children set some short and long term goals.  Parents and kids should reassess these goals periodically.  Monitor progress. Then back off when they are achieving well  and taking ownership for their own accomplishments. Keep  witnessing their progress and keep the complements coming.

This kind of system helps guide teens in setting and  holding expectations for themselves. They attain more skills  over time. In the area of expectations, if you do you job, they  will do theirs.

Expectations and Consequences Are Better Than Threats

You need to get something to wear for a weekend wedding. Despite your better judgment, you are with your kids while shopping. They start running around and going  in and out of clothes racks. One hides. You can’t find  him. Finally, he is found by another woman as he sits in  the middle of a circular clothes rack. You are getting  frustrated. “Can’t you be good? If you don’t stop it you  will get a time out when we get home and no snack!”  (Although you know they are hungry) Your children have  pensive looks for three or four seconds. What they are  thinking is this: We don’t know exactly what she means by  “being good”. We are being good! And as for this threat,  we bet she won’t carry it out by the time we get home. Ah  what the heck, that’s a long time from now. We might as  well be good while having fun. Having fun is good. So  after the three to four seconds of thinking, they take off  together and play in the clothes again. Now you re really  frustrated. You yell, “Now that’s it. You are definitely  getting a time out at home.” Your kids stop for a second,  the same thoughts in their heads, and go on playing.

The problem with this scene is twofold. One problem  is clarity of expectations. And the other is of  consequence. A vague instruction like “be good” allows  wide interpretation for children. They may always see  themselves as good. After all, what is wrong about  exploring an environment? Parents need to be specific  about expectations. “You can’t run in here and I need to  be able to see you”.

Secondly, there has to be clear and immediate  consequence. “If you keep running and hiding, you will  have to sit in the carriage or hold my hand.”

By clarifying the specific expectation, your children  know how to want them to “be good”. And by having an  immediate consequence that you can carry out, they know  that you mean what you say.

By giving kids meaningless threats, you put yourself  at odds with your children. By nature anyone who is put at  odds with another feels challenged. Few people don’t  accept the challenge. Therefore, by threatening your child  you are almost asking them to misbehave. You are  challenging them to “cross this line”. Threats are a  useless tool to get your children to behave. Don’t bother  with them. You are setting yourself up for failure.

Threats are also demeaning and authoritarian. They  are an attempt by you to use fear to get your way. This is  not constructive for your children in the long run. When  children are given a clear framework within which they  should operate (no running or hiding) and clear consequence  of what happens when they go outside the framework (hold  hands with you or put in a carriage), they use their  intellect to make appropriate choices. As parents, this is  what we want children to do over time – make appropriate  choices for themselves.