Category Archives: Experts

Q&A: white noise and language delay

Christianna (with the beautiful name) writes:

"My six-month-old son, Ben, sleeps with a
white noise machine on in his room.  We use it at naptimes and during
the night to mask household noises.  His room shares a wall with the
kitchen and our house is quite small.  I recently read an article about
a study suggesting that exposing infants to continuous white noise may
delay hearing and possibly language development.  Here’s a link to the
WebMD article
. Now I’m concerned that the white noise, something I assumed to be
harmless and quite helpful in bringing on sleep, is actually harming my
son and delaying language development!  Have you heard of this study?
What’s your take on it? I’d appreciate any insight you may have."

I love it when readers send links as part of the actual question! It does my lazy heart good.

Anyway, I think this is a case of the write-up of the study findings not saying the important parts. If you read the article (and go ahead–it’s short), all it’s saying is that rats who were exposed to constant white noise didn’t have language centers in their brains that were as developed as rats who weren’t exposed to the constant white noise did. What it didn’t mention is that that was probably not because of the white noise per se, but because the rats weren’t hearing other sounds that would develop those centers.

In a way, it would be as if researchers reported with alarm that kids who are only exposed to English at home all day don’t have brain centers that are primed to make the sounds used in Russian. Is this a problem? Only if you want your kids to magically learn to speak Russian while you expose them only to English.

Am I being snarky? Sorry. I haven’t had enough caffeine yet this morning. My point is that there’s no reason to think, at least from what this experiment is showing, that using white noise to help a baby sleep is a problem, as long as that baby also gets exposed to plenty of other sounds, including speech, during the rest of the day and while awake. It’s kind of proof writ large that what you give kids (well, rats, actually) is what you get from them. Give them speech and you get speech. Give them music and you get music. Give them white noise (and nothing else) and you get a brain that only produces white noise.

For me, the most interesting part of this study is the last line (isn’t it always?):

"We are already using this [white noise] research to better intervene
in children who are struggling because their auditory systems process
information in a fuzzy way," she says.

If they can mess around with this thing with the rats and figure out a way to help kids with processing problems, that will be a stellar use of time and money (and rodents, for those who aren’t opposed to animal testing).

Q&A: parents disagreeing on disciplinary techniques

Valerie writes:

"My husband and I have 2 kids, ages 4 years and 6 months.  The 4 year old has followed fairly well along with your suggested timeline for adjusting to his sister, and I am currently seeing his behavior as much better at home and feeling much more connected to him than I did just after the birth.  His behavior at school, though, is up and down.  I work part time and he is at preschool about 8 hours a day.

My husband is a firm believer in spanking and I am not.  We have talked about this quite a lot, and are not having luck coming to a compromise. My husband was spanked, but not much because he witnessed his older brother getting spanked often, and that worked as a deterrent for my husband.  I’m not a believer in spanking and neither was my mother, I was raised (33 years ago) with playful respectful parenting and positive discipline.  My mother never read a book about parenting, she just followed her heart and that’s what happened.  My mother is my parenting model.  I’m an only child, and one of my husband’s arguments is that he thinks I just don’t know anything about parenting boys.  I personally think that gender is irrelevant, we need to find approaches that work for our son, but not based on his being a boy, based on his being an individual.

My husband’s approach to parenting is very authoritative, he thinks we (as parents) should be in charge, and our kids should ‘do as they’re told’ promptly when commanded.  He has a lot of rules, and generally forbids much more behavior than I do.

So, my son’s behavior needs to improve, he’s very high energy and rough, and we have a hard time getting him to calm down and respect the personal space of others, especially me.  He is very rough with his toys.  He also has this problem at school as well as choosing not to follow directions and generally disrupting the classroom.  I think his behavior is fairly age appropriate, but it needs to be toned down.  My husband thinks he needs more spankings.

I suspect the differences in my husbands and my parenting approaches are doing my son no favors, but I don’t know what to change to get us closer to agreement on how to handle my son’s actions.

My son has been at his school for over a year.  He has been in full time daycare for 3 years.  This type of behavior started around the time he turned 3 (a year ago) and has been worse the past 8 months.  Other than the arrival of his sister, 6 months ago, nothing major about his life has changed recently."

This is a tough question for me to answer, because I honestly don’t really know how a couple can bridge two huge differences of conviction (because it does sound like both of you are truly convinced of the correctness of your approaches). And it’s very hard for me to see your husband’s side in all of this, because I’m an anti-spanker (although I have gotten out of control and smacked and felt like the lowliest worm in the world, and hey, it didn’t even work, surprise of surprises) and think that it can be especially damaging for boys to be disciplined with violence. (Not that it’s not damaging to girls, but I think it’s damaging in a different way. That would make an interesting discussion for another day.)

So I really don’t have any advice on how to make a compromise. In your situation I would try to convince my husband that spanking is counter-productive. The article "Ten Reasons Not to Hit Your Kids" is excellent, and there are great links at the bottom of that article.

I’d also talk to the teachers at his school to see if you can enlist them to talk to the two of you together about better strategies for disciplining your son. (If the teachers at school don’t spank the kids there, then that means that they have effective alternative strategies to teach you. I feel like most of us vastly underuse the excellent brains and extensive experience of our kids’ preschool teachers.) To me, your son’s behavior sounds absolutely normal, especially considering that it all escalated right before having your daughter. ("High energy and rough": check.) Older siblings act up for a long, long time when a baby sibling comes into the house, and it’s just not reasonable to expect that they’ll be "used to the baby" in a couple of months and will stop acting out. IME, it really took a full year before my older son got his feet back under him again after our younger one was born. In addition, 3 is a tough age, and kids are just starting to approach the border of being able to control their own actions. It can be extremely hard for them to navigate boundaries and control and language and physicality.

One of the strategies you may end up using is physical guidance. Not violence or pain (hitting, smacking, etc.), but guidance. My older son needed/needs this. He has never been able to stop himself from doing something when he hears a verbal command. If I needed him to put down a toy, I had to walk over to him and put my hand over his and help him release the toy. Back when he was a toddler pulling our cat’s fur, I’d have to walk over and help him release the cat’s fur from his hands. If it was time to leave the playground, I’d have to put my hands on him and help him wave to say goodbye to the park, then help him walk out of the playground. He was also one who needed to be hugged during a tantrum. It’s like he needs the physical help to make the neurokinetic connections. I think there are some kids who are more physical who just don’t respond to other forms of guidance, but parents often don’t think of guiding them physically because they didn’t have that example. (FWIW, at the age of 4.9, my son is doing really well at controlling his own actions, but he still seems to engage in selective listening more than I’d like!)

My suspicion is that I’ve answered your question the way you wanted me to, by giving you resources to help convince your husband that your approach is going to work better in the long run. But it’s possible that you actually do want to be able to reach a compromise, in which case I’m going to have to go to the readers. Have any of you bridged a huge gap in approaches to parenting? How did you do it?

Thanksgiving

Today is Thanksgiving in the United States, so by the time you’ve read this I will be on my way to having cooked a big dinner with my mother, watched the Macy’s Thanksgiving Day Parade and National Dog Show on TV, eaten a delicious dinner (maybe delicious, since we’re experimenting with gluten-free turkey stuffing this year because of my wheat problem) with extended family, and begun the stain-removal process on my kids’ clothes.

I’m so thankful for all of you, who read and comment and email me with questions and rebuttals and funny stories and challenges.

I’m also thankful for Lawrence J. Cohen, author of Playful Parenting (one of my favorite books ever), who is a calming voice of reason in the parenting literature genre. I just discovered that he’s been answering reader questions over at PBSKids.org (we spend some time there playing the Curious George games like Banana 411). His two most recent books (Best Friends, Worst Enemies:  Understanding the Social Lives of Children and Mom, They’re Teasing Me: Helping Your Child Solve Social Problems) are on helping kids navigate social relationships, and that appears to be the focus of the questions he’s tackling in his column at PBSKids.org. Definitely worth a read.

Back to Q&A tomorrow.

Guest expert Q&A: cat pooping on bed

Special thanks to guest expert Christine (formerly of The Rabbit Lived) for being guest veterinarian for this post. Unlike me, Christine actually is an expert.

Kamilah writes:

"Do you have any ideas how to deal with
a cat who’s lost its mind?  Our cat adjusted very well to the baby
when she arrived, but began acting up when she started walking 3 months
ago.  He now routinely craps outside of the litter box, and today did
it ON MY BED…
 
WHILE I WAS PETTING HIM!
 
We’ve
taken him to the vet, and there doesn’t appear to be a medical reason
for this behaviour, so I’m hoping feverishly that you and/or your
readers can offer some advice that works."

       

Christine answers:

First, sympathies on the situation.  Any behavior problem is a pain,
but housebreaking issues are horrible, because you really need it to
stop! now!

Always, always, get the pet checked out (as you have)
first and as soon as possible.  Something that starts out as a medical
problem can end up becoming a bad habit if you wait too long.  Since
you have ruled out a medical cause, I have a few more thoughts.

How
old is the cat, and is he having difficulty either getting to or into
his box?  Does he have to jump a baby gate?  When he goes, is he
positioning properly?  Sometimes cats will avoid the box because
arthirits or a metabolic disease makes it uncomfortable for them to get
into the box.

Also, think really long and hard about what may
have changed in the cat’s environment when this started.  Did you
change the box?  Move the box?  Start using a different litter?  Did he
get frightened while in his box (say, by a friendly toddler)?  Get a
dog?  Get another cat?   How often are you cleaning the box?  Has that
changed?

Where is the cat doing the deed?  Is it always in the
same place (I once had a patient that would poop only on the husband’s
clothes…the cat and the husband despised each other) or is it
dependent upon where the cat is when the need arises?

Treating
the problem is going to depend a lot of whether or not you can track
down an inciting cause.  If the cat has some arthritis, try a lower box
or make the route to the box uninhibited (some people will use a
tension gate that they can attach several inches above the floor – baby
can’t get through but cat can squeeze under).  Let me be really clear
that you should never, never medicate your cat without talking to your
vet…even if you think the underlying problem is pain, cats don’t
tolerate a lot of OTC drugs well, and I’ve had several patients land in
the hospital or worse because of ibuprofen or tylenol that the owner
gave.  If you had tried a new kind of litter, change back.  If you
can’t get to cleaning the box as fastidiously as Cat would like, try a
self-cleaning box.  If the box is covered, try it uncovered for a while.

I
always recommend Feliway, which is a diffuser of cat pheromones.  It
doesn’t always work, but if the cat is feeling some stress it can help
make him a little more zen.  You can get it online or from your vet.
You can also try dropping some Rescue Remedy in Cat’s water bowl or
mixing it with water and spritzing it about the house.  Make sure to
use a good odor neutralizer when cleaning the accidents, because you
don’t want him being drawn back to the location by the odor.

If
you can’t find a cause, or nothing you’ve tried seems to be working,
I’m a big proponent of drugs.  For the cat, I mean.  I spent years
fighting the use of behavior modifying drugs in animals, until I
adopted a dog that developed severe separation anxiety.  Sometimes the
animals need a little help with their brain chemistry so that they can
respond to behavior modification better.  If your vet dislikes behavior
problems (and most do) ask for a referral.  You may have a behaviorist
in the area or you can do a phone consult.  A behaviorist is a fully
qualified vet with extra training and board certification in behavior
problems.  This is not a trainer.  This is someone who can get you the
drugs.  Or get the cat the drugs.

I know the inclination is to
always blame the stress of the baby for this, but my first thought
reading this (understanding that I don’t have a lot of details) is that
Cat is uncomfortable in the box or is having a hard time getting to it.
Elimination problems in cats can be tremendously frustrating and are
one of the most frequent reasons why a cat will be relinquished or
euthanized.  It’s unlikely you’re going to change one thing and the
problem will be magically gone, but with patience and some creativity,
I’ve had a lot of success working with owners on this.  Keep the faith.

And send me an email if you have more questions.

Q&A: teaching self-confidence

Karla writes:

"i recently ran into an old highschool alumni at the mall.  I couldn’t remember her name.  I called a good friend of mine (from highschool), and we started flipping through our old year books to see if we could remember this girl’s name.  We began talking about who we would be friends with now, had we not felt the need to be friends with the not-so-nice, rebellious, back-stabbing, cool kids.  We didn’t even have that much fun in highschool, because we spent so much of our time competing with and comparing ourselves with everyone else.  Oh, the stress!  I know that these feelings are usually
outgrown, but still….I would LOVE for my kids to not go through that pressure-ever.  I hope that they are more self-confident (and therefore simply have fun and not care about being "cool".)  I know most of our kids are younger, but I think that teaching self-confidence STARTS young.  What books can you suggest and what advice do you offer for teaching kids to love themselves starting right now?"

My older son is only 4 1/2, so I don’t have any kind of proven track record. For that I think we’d have to look to parents of older kids, and I’m hoping that some of them (Lisa V? Carosgram? NumNum? Kathy?) will add in their opinions. But it’s my suspicion that what gives people self-confidence and the courage to avoid being swayed by popular opinion is feeling understood and valued for who we are.

If we can listen, really listen, to our kids, and avoid putting our own expectations on them as much as possible (aside from normal expectations of civilized conduct) and value them for who they are, then they’ll feel that they’re fundamentally OK just as they are. That turns into self-confidence as they grow older.

I guess I kind of knew that, but my latest rereading of Haim Ginott’s Between Parent and Child (seriously, why isn’t every new parent given a copy of this book before leaving the hospital?) just really hit me with the idea that all any of us ever wants is to be valued for who we are. Not told we’re a "good girl" or "smart kid," but really understood and seen as unique. The book has influenced a lot of the way I (try to) interact with my boys, and even my husband. Instead of generic praise that puts my expectations on the boys ("You’re such a great kid") I try to praise their specific behavior and qualities ("I felt so happy when you drew that picture for me" or "You really know what will make your brother laugh."). I’m certainly not perfect, or even all that good, at it. But that’s why I try to reread the book at least once a year, to try to get the more useful patterns to become my first instincts.

Another book I’ve found immensely useful is Lawrence Cohen’s Playful Parenting. It helps me focus on keeping interactions strife-free so they can be learning experiences and opportunities for my kids to learn self-control without feeling like I’m backing them into a corner. Instead of arguing with my son about putting on his pajamas, I can turn it into a silly pajama race. It’ll take the same amount of time for the task to be completed, but arguing puts both of us in a bad mood, while the race makes both of us feel silly and relaxed, and sets up the next night for stress-free pajama racing.

I’m hoping that by knowing that I appreciate them for who they are individually and what they do, and by feeling that most of our interactions are positive and that they don’t have to be afraid of me, they’ll feel confident in their own worth and ability to solve problems and make decisions. (And maybe they’ll even be able to write sentences that don’t run on.)

What do you all think? What are the central principles you’re trying to get across in your communications with your kids? How are you teaching them to be true to themselves?

Q&A with guest expert: replace a car seat?

Dana writes:

"I was rear-ended the other
day.  It was hard enough to give me whiplash but was still slow-speed
enough to be considered low impact.  I was alone in the car (thank the
gods!) but my year-old son’s carseat was in its usual position in the
backseat. 

The carseat’s literature was
very clear on the subject of car seats and accidents when baby is in the car seat:
replace it immediately.  But it is completely silent on the subject of
empty car seats and accidents. 

The seat was properly fastened
in the middle of the rear bench seat with the lap belt, and was tethered in
place with the tether strap as per Canadian law.  The provincial
government’s website is silent on the subject of unoccupied car seats in the
event of an accident.  Our insurance provider couldn’t give me a definitive
answer, and neither could the local police department.  (The rent-a-cop at
the police station’s front desk actually made fun of me for asking the
question!)

So what do I do?  The
insurance provider thought that given it was low-impact and the seat was not
damaged that it should be OK.  But I can’t help thinking this is sort of
like if your hard hat gets hit in a workplace accident: even if
there’s no visible damage, you replace it because it’s a safety device that’s
been in an accident."

My only advice is to go back and kick the rent-a-cop in the shins for making fun of you for being concerned about your son’s safety. Jerk.

But I went right to The Car Seat Lady, Alisa Baer, to answer your actual question. Here’s what she said:

Dana,

The
National Highway Traffic Safety Administration (for the U.S.) recently
changed its recommendations regarding replacing a car seat after it has
been in a crash.  The data behind these recommendations came in large
part from a Canadian study.  Please visit
NHTSA’s website
for more information.  Given the fact that you were injured in the
crash you should replace your son’s car seat (according to the NHTSA
criteria) — regardless of the fact that it was unoccupied at the time
of the crash.  Even unoccupied seats are stressed in a crash —
obviously less than an occupied seat, though.

One
other thing I would recommend — if your son’s car seat can go
rear-facing (and your son is within the weight and height parameters
for rear-facing) it would be wise to keep him rear-facing until he
reaches the weight or height limit for his seat.  Rear-facing is about
4 times safer than forward-facing – see
www.thecarseatlady.com for more info on rear-facing vs. forward-facing.

Alisa Baer, MD

Pediatric Resident

Nationally Certified Child Passenger Safety Expert

So there it is, right from the actual expert’s fingers. I hope your insurance company will be easily persuaded to replace your son’s seat by the information in the link Alisa gave to the new NHTSA position. I hope your neck is feeling better.

Q&A: book for raising babies

Claire writes:

"My question is one for your personal opinion – I’d like to know if you’ve read the Babywise series of books (and any of their friends) & if you have your critical opinion or alternative recommendations? I’m currently 5 months pregnant & want to make sure I’m prepared as much as possible for the challenges new babies are, but I don’t want to fill my head with useless twaddle.

I guess the reason I’m torn is that so many of my friends swear their sanity was saved by that book & indeed their children are really comparitively angelic (though still well within the bounds of
normal) compared to the few people I know who run a laissez faire attitude to babies doing whatever they do. Those friends don’t seem to be getting any sleep or routine & they are having a freak out & not so much fun.

I’m not a 100% do it by the book sort of gal, but I would like to know if there’s a book that you can recommend that’s perhaps a bit more scientific than some Ezzo dude’s opinions & aprocrypha, but will still enable me to try to have a balanced happy moderately routine friendly baby?

I’d love to hear what you have to say about this & any books you can recommend for preparing for parenting – birth is the least of my worries :o)"

I despise Babywise, and there are huge numbers of people who have been hurt (and their relationships with their children hurt) by Ezzo. For the full critique on what’s wrong with the Babywise approach, you can check out http://ezzo.info

Basically, any book that tells you to fight biology by never allowing a child to go to sleep by feeding (among other things) is completely full of it and is making tons of extra work for the parents (and let’s be
real, it’s the mothers who usually have this extra work, rarely the fathers). Nature already built in this wonderful way to get your baby to sleep, and if you mess with it by imposing some ridiculous schedule about the baby always having to "play" after feeding or only eating at specified times then you are messing around with the way babies are hardwired. Of course people who "do Babywise" have these calm, placid babies, because the babies’ spirits have been broken. They’ve been taught to ignore their own hunger cues and other needs, and just to wait passively until the parents decide it’s time for the next thing to happen.

I think there are some religious communities that value "breaking" children. If you don’t belong to one of these communities, then Babywise is something you want to stay far away from.

There is no other book I recommend as a parenting "method." Your method should be 1) trust your own instincts and 2) give your baby what s/he needs by paying attention to your baby and responding. Yeah, it’s confusing at the beginning, but the good news is that babies don’t remember much of the first few weeks. All they remember is that someone was there holding them and snuggling
them and feeding them when they’re hungry. All the other stuff is just a blur. So you don’t have to be good at reading your kid until a few months into the whole deal.

Babies and kids like predictable routine, but most babies, if paid attention to and responded to, will fall into a routine that works for their bodies within the first few months. Of course it evolves over time as they get older, but if you stick with the routine as it evolves, you’ll have a predictable, somewhat structured day and your baby will trust you and the world. There are days you can’t seem to get
it together to go through the regular routine, but letting everything slide into a big mush of a day ends up letting everyone descend into chaos. (I’m not talking about the first 8 weeks or so, when everything’s pretty much chaos anyway–cut yourself a break and just focus on getting enough water and sleep and the routine will kick itself in soon.)

One really important thing that I think most BDTD parents will recommend (even if they never consciously thought about it at the time) was going outside the house every single day, no matter what the weather (hurricanes and blizzards excluded, of course). If you go out every day at approximately the same time, even if it’s to go to a cafe to get an iced coffee for yourself or to the grocery store to wander
the aisles looking at all the new breakfast cereals, you will add more structure and more emotional space to your day, even if your baby is teething and nothing else is going right.

IME the secret to having a structured, balanced routine is simple–watch your kid and follow his/her routine. If something seems to be off, troubleshoot instead of blaming yourself. Is it a developmental spurt going on? A physical spurt? Teething? Something the child ate? A change in sleep needs? Stress from the environment around the child? Do what you can to change the problem or wait it out, and you’ll be back on track.

Raising children is hard. Really freaking hard. A predictable routine makes it a lot easier, but imposing a routine set by someone else who’s never even met your child makes no sense and can be counterproductive. People often joke that kids should come with an instruction manual, but they do–it’s their cries and their smiles and their facial expressions. Trust yourself, trust your child, and eat lots of
chocolate, and you’ll both come out of it with no major trauma.

Now, I read a lot of books, so of course I’ll recommend some books to you. (And yes, I’m working on a full booklist to put up later.) Here’s my caveat: Don’t become a fanatic about something anyone else says. Almost any routine is going to work better than no routine for a baby. So of course the people who follow Babywise will have better-adjusted kids than people who are tossing their kids Ritz crackers from the couch and watching endless reruns of "The Real World." But a routine based on your actual kid is always going to be better than any routine in a book, so don’t look to books to tell you what to do. You’re your child’s parent, and you and your child together have everything you need already.

Books I don’t recommend:

  • Babywise and all of it’s siblings. Ezzo has no child development experience, early editions of the book cause Failure to Thrive in many babies, and the alleged Biblical basis of the ideas in the book are misinterpretations at best and deliberate blasphemy at worst. http://ezzo.info
  • Anything by the Pearls. No. Just no. Although I doubt anyone inclined to follow the Pearls is reading me anyway.
  • The Baby Whisperer. Hogg’s not a malevolent nutjob like Ezzo, and she does have some good tips on certain topics, but the idea that all kids have to follow the same sequence of events every day? Not sound. Also, if your child doesn’t go down to sleep from being awake by 4 months, nothing bad will happen to anyone. This book will make you feel inadequate and make a ton of extra work for you. If you’re going to read it, borrow it from the library or a friend instead of spending good money, and keep your common sense with you as you read.

 

Books I do recommend:

  • The Wonder Weeks. Of course. The best part of this book is that it tells you what’s going on and why your child is cranky or not sleeping, but it doesn’t tell you what to do. Information but no dogma is my favorite combo.
  • Between Parent and Child. It’s about talking to your kids, so it’s way too early for dealing day-to-day with babies, but reading it now will help you understand kids better in general and help put you in the right frame of mind for dealing with tantrums and all the stuff that starts to happen at the end of the first year.
  • Happiest Baby on the Block. It’s a truth universally acknowledged that the 5 S’s are going to be helpful to settle most kids because of the way babies are hardwired biologically. Maybe not a whole book’s full of content, but definitely worth borrowing and reading before you give birth, or at least watching the DVD.
  • The Mother of All Baby Books. Common sense in a fun-to-read format.
  • Your Baby and Child. Just a straightforward resource, in a brisk, keep-a-stiff-upper-lip style.

 

Books I recommend with hesitation:

  • The Baby Book. I love the medical and developmental parts of this book. But those first few chapters can be so guilt-inducing, even to those of us who tend toward the attachment style already. Read the first few chapters with a critical mind, trust your own instincts, and remember that all this "the mother has to bond instantly with the baby" stuff is written by someone who’s never been a mother. But the medical and developmental stuff is great, non-alarmist, and balanced info.
  • What to Expect the First Year. I just really don’t like the "what to expect" books in general because they’re beyond pedantic and alarmist, but if someone gives it to you you can look stuff up in it if you’re in a good mood. If you’re worried about something in particular, though, keep it on the shelf so you don’t scare yourself unnecessarily.

Q&A: night terrors

Bernalgirl writes:

"Last night our 16-mos old daughter woke up screaming just 1.5 hours
after she went to sleep. She was inconsolable for 20 minutes. No
thrashing, and it wasn’t entirely clear she was awake, but she’s pretty
verbal, and was able to tell us that nothing hurt. As she calmed down
she just said "Hug, hug, hug" over and over again. She didn’t want to
go back to her crib (where she normally prefers to sleep) so for the
first time in a while we had a family bed. It was scary, and then
heartbreaking.

She had a HUGE day yesterday, I had her in one more activity than
was prudent (and realized it part-way through the day) and last night
she walked on her own more than she ever has in her life (possibly
cumulatively).

Does this sound like night terrors? And what should I do about it? Sears says nothing at all on this in his Baby Book; What to Expect said to leave them alone to self-soothe (no way, not when she’s muttering
Hug, Hug, Hug); and Brazelton described the lead-up perfectly,
although by his account she’s a little young yet. Then he scared me to
death by stating that night terrors show up as small seizures when
measured on an electroencephalogram.

Other than simplifying her schedule and holding her as long as she
needs to, I’m at a bit of a loss on diagnosis and response. Is this a
totally normal developmental phase or can I do something more to
prevent this from recurring?"

I don’t know if it’s "night terrors" specifically, but it’s definitely terror in the night. Poor thing. She reminds me of the monkey in the Jez Alborough book Hug.

I don’t have much experience with this, myself. There have been a couple of nights when my older son woke up screaming in the middle of the night. We did what you did–went and comforted him, tried to figure out if there was anything physically wrong with him, and then brought him in with us to sleep the rest of the night. For us it seemed like isolated incidents that were, just like they were for you, a result of overstimulation the day before.

I hate to have to say "I’ve got nothing" to people who write in to me, so I went looking to the "experts" for the thoroughly-researched theory behind and treatment for night terrors. I didn’t find anything helpful. Basically, the party line (that crosses sleep-theory party lines) is "Sometimes kids have night terrors. It’ll pass." Gee, thanks. All of you people and your collective pontification couldn’t come up with anything better than that?

So all of what I’m going to say is just a shot in the dark, but at least you didn’t spend $14.95 for it on Amazon.

It seems to me that night terrors (aka "waking up in the middle of the night screaming") could be caused by any or all of the following things (or, of course, something we don’t know about or understand):

* Too much activity or intensity the day before, or a few days before. Kids can seem fine with all the stuff that’s happening around and to them, but then it’ll come out in their subconsciouses while they’re sleeping.

* Movement, or new skills in general. The brain gets ahead of the body or the body gets ahead of the brain, and something’s got to give, so it vents off in the middle of the night.

* Food they’ve eaten that gives them bad dreams. I always thought the food-dreams connection was kind of bogus, but my husband swears that when he eats certain foods too close to bedtime he’ll have nightmares. If it happens to adults, why couldn’t it happen to kids?

* Scary sounds or images. Little kids are sponges for things they hear and see, even when they don’t understand them. If they overhear scary (or even just intense) things on TV or movies or catch glimpses of images they don’t understand, those things can ricochet around in their little brains and turn into something really frightening in the middle of the night. At our house it’s a constant battle to mute the TV or change the channel when a scary trailer or commercial comes on because the baby sleeps on the other side of the wall the TV’s against.

* Things that go bump in the night. There could be noises she’s hearing as she sleeps that wake her up, but she’s incorporating them into dreams that scare her. You know what I’m talking about–your alarm’s going off but your mind makes it the sound of a fire alarm ringing in the dream you’re in the middle of. If there are noises in your child’s room at night, they could be morphing into whatever dreams she’s having and making the dreams more intense.

* Fake panic attacks. She could be having blips in her nervous system. (Stay with me here.) During both of my pregnancies, I’ve gone through phases in which my hormones were raging so much that they stimulated my nervous system to produce all the symptoms of panic attacks. (Despite what I say about him otherwise, I will always be thankful to Dr. Sears for mentioning this as a possibility in The Pregnancy Book. I haven’t read about it anywhere else, and I thought I was actually having real panic attacks for awhile.) It really feels exactly like a panic attack–racing pulse, confusion, sweating, closed-in feeling, desire to scream, fear–except that the only thing causing it is hormones, not feelings. It makes complete sense to me that a growing child (hormones!) could experience the same thing in the middle of the night. How could you not wake up screaming from that feeling?

I guess the upshot is that if you try to calm down her activity level, bland down her before-bedtime foods, and keep the noise pollution out of her hearing, there’s not much else you can do to prevent night terrors. And they obviously do pass eventually. You’re absolutely handling them the right way by comforting her. If she’s fine going back to sleep where she usually sleeps, that’s great, but if she needs to come in with you, a few nights in with you for the rest of the night isn’t going to have much long-term effect on your sleeping arrangements. But knowing that her parents will come help her when she needs it will stay with her forever.

The "good news" is that once they’re older and potty-trained, overstimulation results in wetting the bed instead of night terrors. That may not be good news for everyone, but I’d much rather have sheets to wash than have my sweetheart screaming in fear in the middle of the night.

High Stakes

At brunch the other day one of my friends was holding my 1-year-old. He was chomping on a sour pickle (and flicking the juice all over my friend, who thought it was funny), and reached for the piece of cake on my friend’s plate. "Can he have that?" my friend asked. "Sure. He’s the second child. He can have pretty much anything," I replied.

I’ve been thinking about that conversation, and why it is that the experience of parenting the second child (or subsequent children) is so different from being a first-time parent. The recent exchange I had with Jody and Elizabeth on the posts about the woman who didn’t want to spend a weekend with her friends got me thinking about even more, specifically about how sometimes as mothers we can’t let anyone else take too much care of our children. But then I read Kateri’s latest post, and thought, "Aha!"

"Aha," because Kateri wrote in the most direct way possible about why being a first-time parent feels so high stakes and raising subsequent children does not. Go read her post. It’s short (something that can’t be said about any of my posts) and pithy and hit me right between the eyes because it’s the essence of why parenting’s so hard emotionally. I’ll wait. No, seriously–click and read it, leave a friendly comment, then come back here.

Now that you’re back, can we talk about two things? The first is how it feels to let go and let other people take some of the emotional burden of parenting, and the second is how to give yourself a break and avoid putting yourself in a perfectionistic parenting box.

Letting other people take over some of the care and emotional energy of thinking about your child is rough. That’s been one of the hardest things for me as a mother–the letting go of needing to be the one in charge all the time, or the repository of knowledge (and let’s face it, I’m Cliff Clavin), or the one the baby really wants. And I think that I had an easier time than lots of mothers do, all things considered. I had to make a serious effort to force myself to allow my husband to do things the way he wanted to with our son when he was tiny. It was hard to listen to my son crying, knowing that I knew how he wanted to be held and that my husband wasn’t doing it "the right way." I started leaving the apartment so I wouldn’t have to swallow my words of "advice" to my husband.

But it got easier and my husband started to know what our son needed more and more. The feedback loop worked like a charm. And then, when my husband was laid off and home all the time, he and my son really learned each other. He had 15 months of being at least as hands-on as I was, and I think that’s still a major influence on our relationship and my identity as a mother. At one point I started being afraid that my husband might be a better parent than I am. When I realized how scared I was of that, I forced myself to really consider that it might be the case. And you know what happened? Nothing. If my husband was a better parent than I was, it was still OK. I was still a great mother, my son still loved me, and the world kept turning.

So, Question #1 for you: Do you feel like you’ve come to terms with other people being good at caring for your child? If yes, how did you do it, and if no, what work do you think you could do to get there?

On to the second thing, which is giving yourself a break and making parenting decisions less high-stakes. I’m not sure there’s really any good way to do it. First-time parents are, by nature, concerned about everything they do in taking care of their children, and that’s the way it’s supposed to be. I just wish we could put less pressure on ourselves to do things perfectly all the time. That pressure leads to stress, depression, and the one-upsmanship that makes interactions with other parents so much less helpful than they could be.

I don’t tend to feel guilt very often or to let others’ opinions of me guide my thoughts or actions. (I think that’s a result of the way I approach decisionmaking about parenting and in general, but that’s a whole different post.) But even if I did, I think I’ve devised a pretty decent strategy for putting parenting decisions into perspective. When I was pregnant with my first son, I made a parenting mission statement for myself. I figured out what were my main goals as a parent, and then some smaller goals, too. When I started to get stressed out about what I should do, I referred back to my mission statement. If it didn’t have anything to do with one of those goals, I just took the path of least resistance or more fun. It’s been remarkably freeing.

So, Question #2: How do you keep yourself from sweating every small decision you have to make as a parent? Is it getting easier as your child(ren) grows older?

I’m hoping we can start to find some way out of the mental and emotional mazes we keep ourselves running around in. So please share your experience, whether you’ve gotten to where you want to be or not. As usual, you can post anonymously if you want to by putting "www.google.com" or "www.fake.com" into the "URL" box and only I’ll be able to see whatever real or fake email address you put in the "Email Address" box.

Q&A: finding a pediatrician

Mary writes:

"Everyone tells us we need to go out and start interviewing
pediatricians (I’m 30 weeks pregnant).  Ok, fine, but what do we ask
them?  And how do we find ones to interview?  A coworker recommended
one that she used to work with but other than that, we’re kind of
clueless, as we are with most of this baby stuff."

Choosing a pediatrician is a lot like planning a wedding. There are a hundred things to think about, and things you have strong opinions about will be completely unimportant for other people, and vice versa. The trick is to figure out what you care about. Then you can ask those questions and just not worry about the other things.

To find doctors to interview in the first place, ask everyone you know who they use(d). Also go to your insurance company’s website and get a list of names. Once you’ve figured out what you’re looking for (which I’ll cover below), call up and ask your first level of weed-out questions over the phone. You may not have to interview more than one or two people in person.

The first thing I’d think about is your parenting style. Are you going to be laid-back or highly managerial? When my son was maybe 10 weeks old he had some rash that I asked my doctor about. He told me, "Squirt some breastmilk on it. At this point breastmilk, either in him or on him, is pretty much the cure for every problem he could have." I was happy with that answer (and the breastmilk did clear up the rash), but a more highly managerial parent would have been upset that there wasn’t a definite diagnosis with a clear treatment path including a plan for contingencies. If you call and ask a question, do you want to know exactly why things are happening, or just that they’re normal? A mismatch between your style and the pediatrician’s style will leave you feeling inadequate and judged or frustrated and angry.

Don’t confuse this with the parenting philosophy you follow, which is another thing you should ask potential doctors about. If you have definite opinions about things like scheduling, feeding, sleeping, pacifiers, vaccinations, circumcision, etc. you want someone who’s going to support you, not someone who makes you feel like a bad parent for choosing those things. Your pediatrician doesn’t necessarily have to agree with you about everything, but s/he does have to support you without being judgmental. If you say, "We intend to cosleep. How do you feel about that?" the correct answer should be something like "There are a number of families in my practice who cosleep" at a minimum (because it doesn’t necessarily imply endorsement, just familiarity and acceptance) or "I think cosleeping is wonderful for babies and parents" as an ideal. If you hear "I don’t recommend it. You’ll end up with a 5-year-old in your bed," move on to the next doctor on your list. (Obviously the same thing goes if you want to have your child sleeping in a crib and you get a less-than-enthusiastic response from an interviewee ped. Next.)

There are, of course, going to be some things you don’t care about. Just don’t ask about those. If you have someone who matches your views on the things you are most concerned with it doesn’t really matter if you match on the other things. Make sure you take into consideration the style issue, though.

Breastfeeding is another thing to ask about. Every pediatrician (unless s/he’s stupid) will claim to be supportive of breastfeeding. But claiming to be supportive and actually being supportive and having the knowledge to help with common nursing problems are two vastly different things. How many mothers in the practice nursed for 6 weeks? 6 months? 1 year? The answers to those questions are going to tell you how much emotional support the doctor gives to breastfeeding and how much practical help the doctor gives (that includes being able to recommend and partner with a good lactation consultant). Medical school still does not teach much about human lactation, so what pediatricians know about breastfeeding is what they’ve chosen to learn. A good ped either has made the effort to become educated about breastfeeding (beyond the info pamphlets the formula companies send–at a minimum the doctor should have taken the same 3-hour class you took) or recognizes that an IBCLC lactation consultant is an expert on breastfeeding and treats her as a colleague and not an underling.

Antibiotics are another hot issue. Some doctors prescribe them at the drop of a hat, some are more circumspect, and others only prescribe them under duress. Here’s a pretty concise overview of why overuse of antibiotics isn’t a good idea. You want someone who will reserve use of antibiotics for when there’s an actual bacterial infection present.

I’m sure you’ve heard the old chestnut "What do you call the person who graduates at the bottom of his or her med school class?" "Doctor." You should also use interviews to try to weed out doctors who are ignorant or just plain stupid. A friend of mine (who is 5 feet tall with a husband who’s 5’6") was told by her pediatrician that her daughter was "too short" and that he was concerned because "We want every child in our practice to be in the 50th percentile." Where do you even start with a doctor who doesn’t understand the basic concept of a bell curve? Or that a child with short parents will probably be on the short side of the curve? He then continued by telling her that he thought her "extended" breastfeeding (their baby was 9 months old at the time) was stunting the baby’s growth, and he wanted her to cut down on nursing and feed the baby more apples and green beans to make her grow taller. Um, yeah.

You don’t want to end up with a doctor who’s so ignorant on so many levels, or one who’s overly concerned about things that are normal. If your baby is likely to be particularly short or tall or skinny or fat or pale or of Asian descent (and thus prone to those birthmarks that can look like bruises) or bald or hairy or a carrier of a genetic disease or whatever, bring that up at the interview and ask the doctor what s/he thinks. Any answer like "Someone’s got to be in the 95th percentile, so someone else’s got to be in the 5th percentile" or "It would be ridiculous to expect that a child with parents as tall as you are won’t be off the charts" or something else that recognizes that kids are all different and should be taken on a case-by-case basis is what you’re looking for.

Any answer that starts with "We want all the kids in our practice to" is bad news. My friend’s pediatrician got all worried because her son wasn’t walking at 18 months (the range of normal is around 9-16 months for walking, so he was late). The ped gave my friend the "We want all the kids in our practice to be walking by 18 months" line (to which I said, because I’m a smartass like that, "I’m not really sure that it matters what she wants, now, does it, if he’s not walking?") and sent him to be evaluated for cognitive developmental delays. In the meantime, the child was drooling constantly and his speech was extremely hard to understand, but his responsive language was way ahead of his chronological age and he was ahead of the curve with imaginitive play and stuff like that. It turned out that he had low muscle tone in the jaw and chest (which explained why he wasn’t walking yet, was drooling, and couldn’t enunciate) which was treated easily with regular physical therapy. The pediatrician absolutely missed the boat and focused on the wrong thing because she was so concerned with what she "wanted" all the kids in the practice to be doing.

Another thing to consider is whether you want to go with a pediatrician or a family doctor. There are advantages to both. A pediatrician is going to be more focused on specific childhood illnesses and conditions. A family practice doctor is going to have more of a long-range view and might not be as concerned about things that are only issues for a short time. A pediatrician is going to be dealing with huge numbers of kids so s/he’ll have a real picture of where your kid is compared to other kids. A family practice doctor will be able to treat your entire family. Think about which model you prefer.

There’s an excellent list of questions to ask your child’s doctor here. It covers things like whether the doctor will come check out your newborn in the hospital or wait until the baby comes home (a hospital pediatrician or intern will check out your baby in the hospital if your own ped doesn’t–it’s routine and no big deal). It also covers procedures for scheduling appointments, after-hours problems, and getting sick kids in for emergency visits.

Often times these things are a balancing act. I love my doctor (a family practice doctor who treats me, too) because he’s very laid-back and treats me like a true partner in care (not someone who needs to be told what to do). He asks things like "Are you happy with the kids’ sleeping arrangements? If you’re not, I can help you troubleshoot" and he gets my jokes. But the downside is that he’s only in the office a couple of days a week and he’s always overscheduled. For me it’s worth it to be so happy with what he does for us when we need him that I just accept the burden of scheduling way in advance. We’ve also been lucky in that our only emergencies have been off-hours so he was pageable. Other parents are going to want easier, more immediate access and will put up with more editorializing from their doctors. As long as you know what you want and choose a doctor based on that, you’ll be happy.

Another thing to think about is where the emergency room your doctor admits to is. All other things being equal, you should go with the doctor who admits to the closer ER. (Within reason. If there’s only a few minutes difference in travel time, go with the better ER.) When your baby can’t breathe from croup in the middle of the night, you don’t want to have to drive 30 minutes to the ER.

The bottom line, though, is that you have to feel good on an interpersonal level with your doctor. A doctor can be brilliant and knowledgeable, but that doesn’t mean s/he’s kind or humane. If there’s something you don’t like about the doctor don’t go with him or her, even if everyone you know raves about the doctor. You don’t want to feel any hesitation (ever) about calling to ask a question or bringing your child in to the office. So it’s important that you feel good about the person professionally and personally.

Again, read the list of questions from The December List here. Other than that stuff, is there anything we forgot?