Check out today’s installment of one of my favorite comic strips, Zits. If you’re like me, you’ll print it out, put it on the fridge, and weep a little every time you look at it.

Enjoy! (sniff!)

Check out the link to the 1/31/10 Zits If the cartoon has rotated, click “previous” to go back to the Sunday, 1/31/2010 installment. You can click on the comic strip and it will open in a new window, allowing you to print it out for your fridge.

Aloha,

Dr. Heather
The BabyShrink

Young children aren’t yet capable, cognitively or psychologically, to tackle heavy-duty academic work — without paying a price. And I worry about those children, like Linda’s daughter below, who may be unfairly flagged as having “problems with focus”, or even labeled ADD/ADHD, at such a young age.

Read on for Linda’s question, and my answer below:

Hi Dr Heather,

Linda

Hi Linda,

In general, I do agree with you that our educators are expecting WAY too much of our children these days, when it comes to “performance” at an early age.

First grade is an interesting age. Teachers will tell you that they typically witness a huge change in children as the year progresses. Most kids will make the transition from what I see as more of a “preschool” sort of mentality, to more of a “grade school kid” sort of mentality. It’s a big step that’s made sometime during the year, and many issues of the kind you describe are sorted out in the process. That’s why standardized tests are viewed (at least by testing specialists) as being NOT super-valid until SECOND grade. There are too many variables up through the first grade. That’s also why we typically don’t diagnose a child with ADD/ADHD until at least age 7.

Our own daughter was “flagged” in first grade for variable performance on standardized tests that year. It made me crazy that they made the first graders sit for standardized tests at all — they’re worthless at that age! By the time they had a specialist test her (at the END of the year), all the issues they were concerned about had “vanished”. She is now doing beautifully in third grade.

Now of course I can’t directly evaluate your daughter, but I do think the questions you are asking are valid, developmentally. Asking a 6-year-old to focus for 10 hours a day, 5 days a week, is pretty unrealistic. But of course you want to make sure to take any legitimate concerns seriously.

You might consider asking the teacher to reinforce “on task” behavior, instead of simply worry about “off-task” behavior. You and she can collaboratively set up a plan whereby your daughter is rewarded (with something simple, like stickers or checkmarks, to trade in for small prizes) on a chart for demonstrating a few minutes at a time of “on-task” behavior. You want to set it up so that the goals are ACHIEVABLE — not something diffuse like “having a good day”. You will get much farther with rewarding her for focusing, than by making a federal case out of her being “off-task”. You also want to avoid giving her undue attention for NEGATIVE behavior, especially at this age. Kids have a way of absorbing the negative attention directed at them, and can internalize the idea that they “have a problem”. You’re much better off by reinforcing — and praising her — for doing what you’d like her to do more of. You can also tie her performance at school to things you want her to do at home — listen, complete chores, etc. If reinforcement and praise are coordinated between home and school, you have a better chance of improving things in both places.

See where this gets you, and let us know how it goes.

Aloha,

Dr. Heather
The BabyShrink

Dear Dr. Heather,

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

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

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

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

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

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

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

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

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

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

Very, very sincerely,
Concerned Mom

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

Dear Concerned Mom,

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

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

A (temporary) step backwards in response to illness
However, it is VERY common to see temporary developmental regression in response to illness. This means that your child can take several steps BACKWARD developmentally — in response to illness and/or stress — and then “bounce back” days or weeks later. It’s all part of the normal developmental process,which is full of starts, stops, and reversals — the old “one step forward, two steps back” thing. Young children don’t understand that the course of illness is temporary; that they will get better. They simply know they feel lousy. They are not up to showing off all their “best” developmental skills. They commonly regress to earlier stages of development, temporarily, until they feel better. And often times, symptoms of illness can linger for WEEKS in children — especially for something as yucky as a flu. If he is showing regression in response to illness, the regression itself can linger for weeks as well, past the time that he gets better. This may vary from child to child and from illness to illness, so his brother may be fine (at least this time).

Personalities vary in response to illness and stress
I don’t know about your husband, but when mine gets sick, he just wants everyone to GO AWAY. (is this a guy thing?) He’s crabby and won’t talk to me and is just a completely different personality than when he’s feeling well. Everyone is different, and your boys also will have different responses to stress and illness. The point is that there are very reasonable possible explanations as to why your son is acting so differently than his usual self, for this relatively short timeframe.

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

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

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

Aloha,

Dr. Heather
The BabyShrink

But that doesn’t mean my dedication has flagged. In fact, this week marks the ONE YEAR ANNIVERSARY of BabyShrink, and I’m taking the opportunity to review the excitement of the past year, and thank you all for the success that this site continues to be.

BabyShrink started as an outlet for me to share my passion for understanding the development of babies, young children, and parents. In my practice, I evaluate and treat (mostly) toddlers whose development has somehow gone awry. Many of these cases involve complex problems like autism, chromosomal defects, trauma, or abuse. But the majority of questions I get about these children have less to do with their complex disorders — and more to do with basic, “run-of-the-mill” child development and parenting issues. Parents in rural areas such as mine have little access to this kind support and information. So I decided to make my parenting suggestions and resources available online.

It’s been a thrill to discover that parents all over the world have found helpful information on BabyShrink. Each day, I eagerly check my “stats” to see what parts of the world my readers are from: Latvia, Australia, Singapore, Turkey, Hong Kong, Trinidad and Tobago, and Canada are on today’s list of visitors. And I’m especially thrilled to give a shout-out to all my American compatriots and readers; today I see you coming in from Yonkers, Berkeley, Des Moines, Anchorage, and a dedicated reader from Cranberry Township, PA who pored over 13 posts this morning. Aloha and mahalo to you all!

Over the next week, I’ll be revisiting some of your all-time favorite posts…you might be surprised (as I am) at my “most-Googled” articles. I’ll also give you a bit of an insider’s glimpse into what it’s been like for a shrink like me to reinvent herself as a blogger, with a shoestring budget and not a lick of technical know-how (all while juggling a marriage, three young children, and my PAYING shrink job). I hope I can inspire you to chase down your own dreams in the process…and continue to encourage you to let “good enough” be GOOD ENOUGH in our efforts to raise our kids.

For a trip down memory lane, I’ve included a link below to my very-first introductory post, published one year today. It’s fun to see that, despite some unpredicted twists and turns, we’ve been able to stick to our goals and interests here. Enjoy!

Welcome To BabyShrink: March 6, 2008

Aloha,

Dr. Heather
The BabyShrink

But it doesn’t stop there. The doctors and nutritionists who diagnose the allergies, and prescribe the necessary diets, unfortunately don’t often have the time to get into the psychological aspects of food allergies — and leave the parents wondering how to handle this very tricky aspect of the allergy.

The behavioral and emotional effects of the allergy and related diets include the resentment caused in the child by not being able to eat foods his friends CAN eat. The feelings of deprivation and being “different”. The parents’ worry that these food issues will lead to eating disorders in adolescence. All of these problems are very real challenges of raising a child with a food allergy.

I recently got a phone call from a friend who’s daughter has multiple food allergies — gluten, casein (dairy protein), tree nuts — the works. They’ve been able to reasonably control her food intake up until recently; she’s now an active, busy second-grader who is starting to get resentful that the other kids can get all kinds of foods that are forbidden to her. My friend was mortified to tell me that they discovered a stack of 30 or more string-cheese wrappers stuffed under the couch recently. And a rash that preceded the cheese-eating was diagnosed by the doctor as “psychological”. Poor little thing is itching herself raw, and hoarding and “sneaking” disallowed foods.

I’ve got some ideas about how to handle these issues, and I’ve had to do the gluten and casein-free diet in our home for awhile when we were ruling out food allergies with our daughter. But I know there are a LOT of you out there struggling directly with these challenges in your home. I’m hoping some of you will post your comments to my friend here, giving us some tips for what works — and what doesn’t — in your home. I’ll collect your responses and include them with some of my own in my next post.

Aloha,

Dr. Heather
The BabyShrink

Dear Dr. Heather,

Gabby

Hi Gabby,

I know it’s hard, but bedwetting is common and fairly normal for a lot of kids this age, especially boys. There seems to be a genetic component, as well. It’s important to not get into shaming him or trying to control the wetting….you have to leave it up to him. He should wear big-kid size pullups and be responsible (or at least help with) changing sheets when necessary, but the motivation to be dry has to come from him. Leave him in the nighttime pullups until he’s dry consistently, so there’s no pressure or worry about it.

They have those “bell and pad” things that go off when the kid pees, but it seems like they only serve to wake up the rest of the household, EXCEPT the kid himself….since bedwetters usually sleep really deeply. In fact, some doctors think that bedwetters’ brains are a little different, in terms of their ability to transition between sleep and wakefulness. Bedwetters may simply not have developed the ability to awaken yet from sleep in order to go to the bathroom. This ability usually develops over time, though.

In later childhood, by about age 7, bedwetters may start to worry about what others think of them, and feel upset that they can’t control their bodies at night. Reassure these kids that you will help them to do what it takes to eventually gain nighttime control; help them restrict fluids after 6pm, make sure they empty their bladder right before bed, and limit nighttime sweets, which can have a dehydrating effect. Getting a little extra sleep at night, even as little as 30 minutes more, can help for some. You can also keep trying to awaken him a couple of hours after going to bed to have him empty his bladder. But this should only be done with the child’s cooperation and agreement. Let them know that you have faith in their bodies, and their ability to gain nighttime dryness when they are ready. And try to eliminate sources of shaming or ridicule. He’s doing the best he can, and shame only worsens the problem.

We worry more about trauma, a medical condition or psychological stuff when there is an abrupt change…as in, they USED to be dry, and NOW…it has suddenly changed. But if he has always more or less been wet at night, and if there are no other indications in his daytime life that things are amiss…well, then, it looks like you’re just gonna hafta be patient.

Of course, for something like this, you always need his pediatrician’s blessing that nothing else is wrong, but other than that, all I can do is assure you that it WILL stop.

Let us know when that happens, we’d like to hear how it goes!

Aloha,

Dr. Heather
The BabyShrink

I would love your advice!

Mary H, Grand Rapids MI

Hi Mary,

It’s a very complex question you ask: How much do we push our children to stand up for themselves — and when is the right moment to jump in and protect them?

And you’re right — it is a different time we’re in now. Most of us (of a certain age…ahem) remember riding bikes until dark (without helmets, of course), exploring uncharted neighborhood territories with only our pals along with us, and riding without seat belts, in the front seat of the car (in my case, I remember riding in the front-seat FOOTWELL of our VW Bug!)

Our parents think we’re nuts about all this safety stuff. We all somehow lived…isn’t it good enough for OUR kids? And to a certain degree, they’re right. Our society does place an inordinate amount of scrutiny on the moment-to-moment activities of our children. They’re not able to run free and just PLAY, and have unstructured “down-time”. Free play, just for the sake of PLAY, is really important to the development of children. We schedule them like mad, and then wonder why they have ever-increasing rates of emotional and academic problems. There’s just too much pressure to perform, every minute of the day. So you’re right to wonder about letting them tackle their own problems, and having some room to grow.

But it is a different time — we’re more sophisticated today about safety issues, and we also understand that bullying can be really damaging to kids. So there is more than a kernel of truth in the approach that says we’d better watch our kids carefully, and intervene when necessary.

So how do you strike that balance?

That depends on your unique kids. Each one will have different needs for supervision, at different ages. Some may need a lot of coaching for how to negotiate complex social situations, like the one you describe. Other kids will have more of a knack for handling themselves. Similarly, their need for constant supervision will vary from kid to kid.

So this means you need to KNOW YOUR KID. What are their strengths and weaknesses, in social situations? What is their judgment like? Are they likely to cave in to peer pressure, or can they hold their ground? Are they leaders, or followers? Impulsive, or analytic? Constantly evaluating your kids in this way will help you know what they CAN handle, and what they still need your help in tackling. And don’t worry if they DO still need your oversight; social situations are one of the most complicated things our brains process, and they are mostly handled in the outer cortex of the brain; the last to develop in humans. In fact, it looks like these brain areas are still a work-in-progress until the early 20’s. So don’t hesitate to step in and help your kids think through these things.

The other issue for you, Mary, is that your kids are in a daycare. Your daycare provider is being paid to keep your kids safe — and so she’d better be watching them closely. Just for the sake of liability, she must provide them with an inordinate amount of structured, safe care. So SHE may be overreacting to her son’s acting out. But I certainly think it would be fine to approach her with your observations about your kids, and let her know that you’re fine with letting the kids hammer it out themselves in most cases.

And your idea about role-playing with your kids is terrific. I think that’s something every parent should do, starting at about the age of 4 or 5; play-act tricky social situations with your kids. Take examples from scenes you have witnessed with them. Wait until everyone is feeling good and you all have some time. Then talk to them about how they might handle a tricky situation. “Let’s play pretend. I want us all to practice what happens when a friend wants to play tag, but you’d rather go on the swings. What can you say to them?” I find kids really get into it, and even start suggesting wrinkles in the scenario. I think you’ll be pleasantly surprised to hear them echo the lessons they’ve learned with you — when they’re out on the playground.

As for so many of the issues we struggle with here at BabyShrink, this is not a “One Size Fits All” solution. But by following your own knowledge about your own kids, you’ll find that balance over time.

Aloha,

Dr. Heather
The BabyShrink

PS If you’re interested in learning more about the importance of PLAY in childhood development, read this great article in the New York Times.

But his older sister was more tentative, when she started school. She had to learn the routine from scratch, and didn’t have an older sibling on campus to help make her feel more at home. It took her quite awhile to get into the swing of things. For awhile, we fretted that perhaps we had chosen the wrong school, or she wasn’t in the right classroom, despite the fact that her teacher was a gem.

I’ve gotten several emails lately from parents in a similar situation. “My child just started kindergarten. She acted like she was excited to go, but now that school has started, it’s a real battle. Although she attended preschool with few problems, she’s now clingy, whiny and tearful every morning. Her teacher says she does well after I leave, and when I pick her up, she’s fine. But the next morning, all I get is crying, whining, and begging to stay home. What should I do?”

Of course it tugs at our heartstrings when our little “Big Kid” wants to stay home with us just a while longer. Their tears are surprising. We doubt ourselves, and argue over whether we made the right choice. “Maybe she’s just not ready yet,” we wonder.

But by and large, the protests put up for parents at the beginning of kindergarten are temporary, normal, and not cause for undue concern. We can help our kids get through the transition more easily if we remember where they are developmentally, and have reasonable expectations.

It’s important to understand the developmental issues of a kindergartener. A 5 or 6-year-old still has, in many ways, a preschool mind-set. We expect a kindergartener to be a “Big Kid” and go to the “Big Kids’ School”, yet emotionally, they’re still more similar to the squirrely preschoolers they were last year. Kindergarteners don’t care much about social norms, fitting in with other kids, or achieving well academically. But our current system of education in the US asks them to do just that: act like a “Big Kid”. Yet we can’t realistically expect them to behave that way until sometime in 1st or 2nd grade.

So, what to do? Luckily, most kindergarteners have a rough time for a few days (or few weeks) at most. Then, they’re off and running with the pack, happily ensconced in their classroom, with their teacher and new friends. Here’s what to keep in mind until then:

Talk with your little one about school. Listen to her fears, and clarify any confusion she has about the day. Understanding the flow of the school schedule will help her feel like she knows what’ll be happening after you leave.

Be positive, and don’t entertain a discussion about possibly staying at home. Say, “I know you feel scared. But your teacher will take care of you, and I will be there to pick you up right after school. I know you can do it. You might be scared sometimes, but you’ll have so much fun, too! What a big kid you’re getting to be.”

Rely on the teacher for advice and guidance. She (it’s usually a “she”) is an expert at this, and goes through this every year with several of the kids in kindergarten. She’ll have suggestions for how to best handle drop-offs. Usually, this involves a cheerful goodbye, a quick kiss — and then a purposeful exit.

Hold your own concerns in check until you’ve given your child (and the teacher) a few weeks to settle in. If your child is still upset about going to school, then it’s time to schedule a sit-down meeting with the teacher to explore what might be going on. You’ll also want to observe the classroom in process — unobserved by your child, if at all possible. Even a few minutes watching her will help you decide if her protests are just meant to test you — or if she’s really unhappy there.

Most of the time, kindergarten fears and tears evaporate within a few weeks. By then, we’re left tearfully wondering, “When did my baby get so grown up?”

What are your experiences with kids starting kindergarten? Care to share?

Aloha,

Dr. Heather
The BabyShrink

Dear BabyShrink,

I have two children; a seven-year-old boy and a five-year-old
girl.  We are lucky enough to live close to three sets of their
grandparents who all want to spend time with them.  The problem is that
the kids have picked favorites.  They only want to spend time with the
"fun" ones (the ones that let them eat whatever they want, watch
whatever they want and go to bed whenever they want).  This has resulted
in tension with the grandparents who believe in rules and boundaries.  The
kids have also told my husband and me that they don’t want to live with us
anymore.  I realize they’re just being kids, but they’re also hurting
feelings.  How do I speak to them about this in a way that they can
grasp? 

Sincerely, Vicki

Hi Vicki,

Thanks for the picture! Your kids are adorable, and you can’t really blame them for responding like they do when they’re showered with gifts and given no limits. At this age, they’re just following the cookies and the Wii. Social skills are not really their strong suit, yet.

But it is important to set a standard for them in how they treat people, and family in particular. In every family, there are
differences in the way one set of relatives relates to the kids, vs. the other
set. Differing cultural traditions and values can play a role. Sometimes, one
family has tons of grandkids (and therefore less time and money to spend) and
the other side has few, so therefore more time and money. The general level of
intensity of the relationships within the family often dictate things, too. For
instance, my husband’s family is more involved in general in the lives of their
friends and family. My family, on the other hand, is more "live and let
live".  Neither is better, just different. Kids have to get used to
the fact that everyone is different; and that’s OK.

Grandparents have the
inalienable right to spoil their grandkids; nothing I can say will change that.

But your children will learn over time, with your help, that you can’t "judge the
book by it’s cover". Treats and presents are great, but they’re not
everything.

The kids do have to learn
that some things in life cannot be controlled; Grandma X gives cookies and
candy, Grandma Y gives fruit and crackers. All you can do is talk to the kids
gently (but frequently) about manners, being polite with everyone, and the fact
that everyone is different. Perhaps the less-lenient grandparents have other
attributes: Maybe they can teach the kids to fish, or go camping, or how to
sew. The grandparents also have to come to terms with the fact that they will
each have different standards with the kids.

You can talk to all the
grandparents (probably separately) about your dilemma. Try to generate some
empathy for the kids, for the other set of grandparents, and for YOU in the
situation. Talk to the lenient grandparents about the bind they put you in.
"I don’t want to deny you your right to spoil the grandkids. I don’t want
to control your time with them. But when they come back home to rules and to be
with us, they’re impossible, since they’ve had so many goodies. They even told
us they don’t want to live with us anymore, or visit with the other
grandparents. Can we talk about toning it down just a little
bit?"

Also, talk with the other grandparents
about your plans to address it. Show them you mean business when you insist
that the kids are nice and polite. Really play up the cool things that they CAN
do with these grandparents. Show your kids that their tantrums aren’t going to
get them anywhere; they still need to have a cordial relationship with all
family members.

Good luck and keep us
posted!

Aloha,

Dr. Heather
The BabyShrink

Danny talks about his son, who is only a year younger than mine, having a propensity for tears. Our son is very similar. He is a budding perfectionist (as his mom was) and gets stormy when he can’t do things right on the first few tries. It really, really bothers his dad, who was teased unmercifully by other kids when he was young and did the same thing. Danny mentioned that he tries to work through those moments with the Champ, and I was kind of hoping you might get him to share some of those specifics or some of your own. (I believe he did blog at one point about trying to make the Champ laugh when he saw such a situation arising in baseball, but if you or he have any other hands-on solutions, I would love to hear them!)

In one sense we are lucky, because being somewhat overly concerned with success has not kept him from trying things, as it did me. But it took me 20 years to learn that I didn’t have to do everything perfectly to enjoy it, and I am hoping we can significantly shorten the learning curve for my son.

Thanks!

Donna, Rossville, KS

Hi, Donna,

I have a five-year-old who’s a real perfectionist too (he comes by it naturally, like your son). Sometimes he does give up trying when it’s difficult — that real danger your son has sidestepped, so that’s a great start already. As long as they don’t give up and keep trying, what you’re really asking about, I guess, is the stormy emotional reaction.

Does his reaction get him into trouble, say at school, or with his friends, like what happened to his dad? Or is the real problem your worry about his future possible perfectionism — and his Dad’s worry about his tears? Because there are different approaches, depending on where the problem lies.

If his emotional reactions DO get him into trouble, talk with him about what to do with his feelings, instead of breaking down. Make sure he knows that his feelings are always OK, but it’s how we handle them that matters. Make a plan ahead of time, when he’s feeling good. Practice some things that he can do instead: take three deep breaths (practice with him and you can make it a silly game). Help him find words for his frustration. "I wish I could do it right! It makes me so mad! "  Et cetera.

If he’s doing well and it’s really more of your worries, remember, he’s young. You might want to observe his classroom; I’ll bet there are a couple of other kids in his class who are similar. You might even ask his teacher about it; they have lots of experience in dealing with all sorts of kids, and often have insights that we as parents don’t.

His perfectionism can really be an asset — I’ll bet you have found a way to make it work for you. Help him channel his energies into being productive and successful at what he loves.

~~Heather