Are Your Child's Behaviors or Emotional Reactions of Concern?

Are your child's behaviors or emotional reactions a serious problem?  Truly this is a question that comes up many times a day in my office.  Mostly I find that I can offer reassurance and guidance on what to do and what to expect next.  Many concerns simply represent normal and predictable parts of a child or adolescent's development.  Sometimes I must dig a little deeper.

Keep in mind that I am a general pediatrician and a mother, not a psychiatrist or psychologist.  I received the education a board-certified pediatrician is exposed to during her training and ongoing maintenance of certification.  My experience has developed over the years, as I have interacted and provided health care for many children.  I have a few validated assessment tools I can use when I need a more objective point of view.  However, to get an idea of what is going on, mostly I talk to parents and children and observe children in my office. 

Now, having properly oriented you, I want to let you in on some of the big things I consider when trying to help parents figure out if their child has a behavioral or emotional problem beyond the range of normal variation or development. 

1.  HAPPY?
I want children generally to be happy and able to participate in school and the activities they usually want to do.   Certainly a child will have ups and downs, good days and bad, temper tantrums, mood swings, and upsetting things that happen to them.  However, overall, a child will normally stay interested and have some enthusiasm for family, activities, friends, and at least some parts of the school day.

2.  PARTICIPATING IN LIFE?
I don't want a child's behaviors or emotional reactions over time to significantly limit their participation in family life, the school setting, friendships, and individual interests.  Again, this doesn't just mean having a bad day, or week.  The overall arc of a child's day-to-day life should allow them have the experiences they need to develop meaningful relationships, independence, confidence, and self-esteem.

3.  FITTING INTO THE FAMILY?
We have to get to know our children.  Different temperaments respond better to various forms of discipline and structure.  A frown and slight shake of the head may bring one three-year-old to the point of tears, while another won't respond until they have had several time-outs and a toy taken away!  Still, unless it is necessary because of a child's young age or special needs, a family should not have to adjust everything they do around a child's behavior or emotional reactions.  If, because of their child, parents find themselves usually quite limited in the places they can go, food they can eat, and people they can visit, this might be a concern.  Or, if a time-consuming amount of planning is necessary to get out the door, get a child to school, stay on a schedule, make sure the right snack and drink is available, etc. then this could be a red flag.

Can I generalize and say that if a child is usually happy, participates willingly in life, and fits into the family then there is nothing to worry about?  Probably it's not that easy!  However, if one or more of the above three questions starts to reveal a persistent problem, then I know I will have to look into it further.

Your personal pediatrician is a resource for you in helping to figure out what is normal for your child.  Other pieces of the puzzle may be filled in by talking to your child's teacher or daycare provider, other parents, relatives, or a school administrator or counselor. 

Answering the question of what to do about a particular behavior or emotional reaction will always involve trying to determine if it is a major or minor problem, if it is a part of normal and expected development, and if it is affecting multiple areas of a child's life.  I hope, as you struggle through the ups and downs of parenting, this gives you some ideas about how to think clearly about your child.

Help Your Child Remember "You are Loved!"

It's the early weeks of the school year and the excitement and novelty is wearing off.  You might start hearing some comments like "I want to stay home with you," or "I don't want to go to school."  Little bits of the school day are revealed at odd times in the evening--sometimes sending a jolt of panic through the center of your chest.

"My teacher never calls on me when I raise my hand."  "When I got back from the bathroom everyone was doing a new assignment and I didn't know what to do."  "No one would play with me at recess."  "I didn't have time to eat my lunch."

You can't be with your child all the time any more, and that can be hard for her and for you.  Some children, and parents, have to be very brave to make it through each school day.  It's time to remind yourself that an appropriate amount of independence and successful, gradual, separation from you will help your son or daughter become more confident, with higher self-esteem.  However, as you ponder these theories, you still need a way to get both of you through the school day.

I don't have all the answers, but I do have some ideas.  Some books for children address this topic in an appealing, caring way.  I found the following books amazingly helpful:

The Invisible String, by Patrice Karst, describes in a touching simple way how we can be connected to each other by an invisible string of love, even when we are apart.  Two children are woken by a thunder storm and run to find their mother.  On each page the family explores how they are linked to different people they love.




The Kissing Hand, by Audrey Penn, stars a baby raccoon who doesn't want to go to school, but would rather stay home with his mommy and familiar toys.  His mother kisses the palm of his hand and tells him that if he puts his hand up to his cheek he will feel her love any time he wants.  The story is sweet, and concept easy to understand at almost any age.




Wemberly Worried, by Kevin Henkes, is about a little mouse who can't go anywhere without his special blanket.  His mother comes up with a creative solution so he can secretly take his blankie whereever he goes.

After the first week of school my youngest daughter and I read The Invisible String together.  We made red construction paper hearts, exchanged lipstick kisses imprinted on the hearts, and put them onto necklaces of string to wear the next day.  In this way we can carry a tangible symbol of love, that hopefully will carry us through until we can be together again.  Maybe some of you will see me with my "heart on a string" tomorrow in the office.



I would love to hear comments on book suggestions or ideas you have to help with separation anxiety, or other special traditions you have that help you feel closer when you have to be apart!  Maybe you can find some books about children and their fathers, too.  Good luck.

What does it mean to be a member of your family?

As we counted down to midnight on December 31st my girls got excited talking about New Year's resolutions. Remember those? Usually they are things like exercise, spending less money, going on a diet, saving, or not eating out as much. As the ball dropped on Times Square in New York I still couldn't think of a resolution that seemed very important to me. The result was that I have been thinking about it for the last two weeks.

I want to talk about family values, and I don't want it to be a cliche. I want to reflect on what helps our children figure out what is important, and what it means to be a member of their family. What can they fall back on when times are tough? What thought makes them stand up a little straighter as they walk through the halls at school? What is something they know is true, that can give them more insight into themselves and others?

What I mean when I say family values is probably a little different that the phrase used in the media. I am asking you to think about the principles by which you are raising your children. I want you to consider what kind of person you hope they will be as adults. What would you, or they, say if asked what it means to be a Smith, a Jones, a Roberts?

I really started thinking about this when talking to a friend who had to advocate for his daughter about a school/peer-related problem. When I asked him why he intervened, knowing that there was potential for things to backfire, his answer to me (probably paraphrased) was "What I want my daughter to know is that it means something to be a _________. We stick up for ourselves. We don't take things lying down."

That conversation has stayed with me. It made me think about what it means to be a member of my own family. What kinds of things do I say to my daughters when we are reflecting on the day, or looking forward to a new school year? What will be foremost in their minds when they are in a tricky situation, trying to make friends, watching how others interact with each other, taking a test, behaving in a classroom? If it was at all possible, what influence would I want my daughters to have on others?

One guiding principle that is important to me is that my daughters try to treat other people as they would like to be treated. Without getting all religious on you, I have to tell you that this is definitely based on the "extra" commandment given to us by Christ (Do to others as you would have them do to you, Luke 6:31, NIV) that is also known as the golden rule. My husband tries to help our girls respond to others (and each other) "in a loving way." None of us are perfect at this, but I know we all think about it and talk about it.

Instilling the sense of what it means to be a member of your family also includes the way you live your life each day. What fills your time? What takes priority? How do you spend money? Your children are living it, too. The way they grow up will become their "comfort zone."

I need to think about this part more for my own family. Are we (and I am speaking personally, of my own family, here) living daily (or at least weekly, monthly?) in a thoughtful way that is caring, will foster a healthy mind, body, and spirit, and will help our daughters become responsible, independent adults? I think I might have trouble sleeping now that I have put into words what a huge responsibility this is!

My resolution for 2011 is to think more carefully about what it means to be a member of my family. I want to better define what we stand for, what gives us reason to get up each day, and what will get us through when things don't happen as expected. I want to make sure that my daily life reflects these values, and make adjustments when I find discrepancies. I only have one chance to parent my children, and to live the way I want to be. I want to think about this.

And just to make you smile as you consider these thoughts:

http://www.youtube.com/watch?v=L64c5vT3NBw