Rx For Parenting Today

Setting Limits for Teenagers

I have often quoted a psychologist who wrote that "the time to disarm a teenage time bomb is when he or she is two.". I think that is very true, because if little children grow up realizing that they are in charge of a family, rather than their parents. trouble lies ahead. Yes, it is far easier just to be your children's friends, but as parents I am afraid you will pay a high price for not setting limits. I had a rebellious teenager as a patient  who had had two bad marriages by the time she was in her early twenties and now supports a deadbeat husband, a partner of her daughter's who makes a living by dealing drugs and a daughter who has had a small child by this man. No close family members are alive, so she has little support. I wonder how she celebrates Thanksgiving?

I realized early on that being a loving, but firm parent was what I needed to do. Having two hard-working doctor parents was difficult for my children, I am sure, but the time we spent with them was special. They both became hard working and caring adults and raised their children, and in my daughter's case step-children, with firm, loving hands. When limits are not set, children can become   anxious and not quite sure how to act. They respect parents who set limits and usually raise their children the same way, unless the rules were unfair or cruel. There is never any excuse for limits that are not reasonable and if there is a problem with a rule, teenagers should be able to discuss it with their parents. Single parents have a much tougher time, but the closeness that they can have   with their children can be very special if they act as parents and don't try to just be  friends to their children.

Thanksgiving and Parenting

My hope for parents this Thanksgiving is that they will be able to sit with their children at an old-fashioned Thanksgiving dinner. I realize that parents are extremely busy these days, but children will long remember holidays such as Thanksgiving, if it is special for them. They will not remember the food, I suspect, but whether it was a time to really talk with their parents and perhaps other family members and friends.  Many families no longer have relatives close by, but reaching out to others can help children realize that not everyone has a family. Single parents can have a particularly hard time on holidays,, but getting friends and other single parents together with their children can be a time of celebration for everyone. I hope that all the cell phones  will be turned off and texting not allowed at the dinner table. If it is how do children learn to talk with others? Thanksgiving is also a good time for children to practice their manners. There was a great article in today's New York Times about a teacher in South Carolina, who each year has her seniors eat a Thanksgiving meal together. She  teaches them how to set a table with her best china and silverware and what to do with their napkins. It is a lesson that I suspect will long be remembered.

A good friend who is a psychologist told her children growing up that she wanted them to  learn good manners because some day they might be having tea with the Queen of England. Her daughter told me this story and said how glad she was that her parents had stressed good manners, because she did have  tea with Prince Philip, the Queen's husband, when she was getting a Ph.D. at Cambridge in England. I love that story and shared it with my own grandchildren. Many parents may not feel that table manners are important, but I disagree. With so much anger and unpleasantness in the world, if we can help our children to have and remember some happy and special times, it will pay off royally. 

Children and Divorce

When parents divorce any children involved can suffer terribly, unless the mother and father make the kids their main priority. I have cared for children who sailed through their parents divorce without terrible scars because the parents worked together to make the children feel safe and wanted. Other children, who have been caught in the middle of bitter custody fights have suffered terribly. Judith Wallerstein has written extensively about the long-term effects of  divorce, when the parents were more interested in their own lives than their children's lives. Carole Brille, a children's attorney in San Francisco, remarked to me that " Children are supposed to be divided up pleasantly like the other parents assets: the furniture, TV, books etc."

When one parent bad-mouths the other,  expects the children to keep secrets or carry messages back and forth, trouble is ahead. Many children feel responsible for their  parents' divorce and some counseling may be needed. If one or both parents start dating immediately or if one parents re-marries right away, this is very hard on the children. Nightmares, bedwetting, or anxiety can all be reactions to these situations. There are some good support groups for parents and many sites are available by looking at the Internet. When couples divorce, one of the sad things that can happen is that friends usually take sides. Many mothers find that they have to find a whole new support system, particularly if they were the ones to file for the divorce.

Holiday Parenting

Now that the holidays are approaching, parenting can become difficult, but the holidays can be magical times for children if parents don't become too stressed. Many mothers want their homes to be beautiful, their meals to be picture perfect and delicious, and their children well behaved. This is a pretty tall order, particularly if the children are little. All children really want is to have fun with their parents and not become overwhelmed with too many activities or gifts. Children look forward to yearly traditions and establishing some for your family when the kids are little pays off royally. Because holidays can be so busy, there are some things to think about to be sure the children are kept from any harm. Lighted candles can be a problem, as can some holiday plants, such as holly and mistletoe. Toys should be checked for pieces that can be pulled off and swallowed or that contain magnets that can also be swallowed and cause great medical problems.  If there are many people at a holiday gathering, it is easy for a little child to slip out the door or get into a woman's purse and find some pills that may look like candy. Children with autism or especially good about finding ways to escape and windows and doors should be kept closed. Hiring a teenager or other babysitter if there is going to be a large crowd is wise to have an extra pair of eyes watching the children.

One of the things I did when I was divorced and my children were ten and twelve was to have one party indoors for the adults and a special party for the children in the patio. Jennifer and Geoffrey were host and hostess and helped plan what to serve and what games to play. Children can make invitations and even party favors. We have taken so much creative time away from children with the TV, DVDs, game boys and video games that going back to some of the old fashioned games can be a real treat for many kids. I still have the board games my children played and have a toy corner in my home office where visiting children love to go.

Rest and routine are important to remember for both children and their parents. Tired, overworked mothers and fathers are not fun to have around and accidents can occur when everyone is stressed.

Delayed Speech and Hearing

A woman asked me the other day if I would be concerned that a two-year-old was not talking. "Yes," I answered, "I would be greatly concerned and would want an immediate hearing test in a pediatric  hearing center, not a doctor's office." Then I asked what the child's pediatrician had done or said. The woman answered that the doctor had said " She will talk when she is ready!" I was horrified and wondered where the doctor had trained and if he was really an M.D. No child should be allowed to be without any language by age two. If a child is not making sounds by three months of age, hearing should be checked. Even though most states require hearing to be  tested before a newborn is sent home from the hospital, there can be mistakes.

I also asked the woman how the child seemed developmentally and she was said to make eye contact and was happy to play with other children. My reason for this question was that about ten percent of children with autism are also deaf. There are children who are diagnosed as developmentally delayed when they are actually deaf. One such child was an attorney's child, who was placed in a state institution because he was thought to be delayed. Fortunately, a bright social worker became concerned and pushed to have the child's hearing checked.  Can you imagine how the parents must have felt to know their child was deaf and not delayed? Now that cochlear implants are so successful, a deaf child can usually be helped to hear and speak if the deafness is identified. So if doctors are not going to push to have a child's hearing checked when speech is delayed, I hope a child's  parents will be sure testing is done in an accredited pediatric hearing center.

Rx for ADHD in U.S. and Other Countries

There was an excellent article by Katherine Ellison in the 11/10/15 New York Times about the diagnosis and treatment of ADHD in the world.  The diagnosis of ADHD or attention deficit hyperactive disorder is made many times more in the U.S. than around the world and the prescription of Ritalin for this disorder in other countries is only 17%, as compared to the United States. Of concern is that the greedy drug companies are pushing the use of medications, as this is an eleven billion dollar market for them. However, if a child or teenager needs treatment they should have it. Testing  needs to be done by a qualified psychologist to be sure the diagnosis is ADHD. One physician stated that a lack of sleep and parents who put too much stress on a child can cause a condition that looks like ADHD.

If a child or teenager does not receive medication for this disorder, it can change not only their life, but the life of the family. If a child cannot focus at school, cannot do their homework or has anxiety as do 25% of these patients, then Ritalin or a similar drug can make a great difference. I have seen children who should have medication, but instead they were referred for cognitive behavior therapy that did little good. In some children, this might be helpful, but if they need medication, then they should have it. However, it should be carefully monitored and not prescribed by a social worker or nurse practitioner, but by a physician. Children may not have many friends if they are always fidgeting or seem different from their peers. Some sad examples were given in the article of children who were kept from playing with other children because of their behavior. Some countries were reported as actually banning the use of the stimulant medications that these kids need and one family had to send their child to a private school in a country where medication was available.

Children and Divorce

When a couple decides to get a divorce and children are involved, the kids are far too frequently used as pawns in the divorce. Money most often becomes the primary focus and without a tough, aggressive  lawyer, either the man or the woman can suffer terribly. I seen this happen both ways. The children, however, are the ones who can suffer the  most. Yet, if the parents work together and keep their fighting and arguments away from their children, everyone will benefit.

One of the problems with divorce is that both the husband and the wife can become very lonely, unless the divorce was caused by either one having a prospective mate lined up before the divorce. With loneliness, the children can be subjected to a series of men and women in and out of their parents' lives and houses. This can be very unsettling  for kids and can make some very anxious. Bedwetting can be a reaction, as can clinging to a mother or father. If one  parent has left, a child cannot be sure the other parent will not leave also. Temper tantrums, behavior problems of all kinds, thumb sucking and nightmares can also result. It may be necessary to find a good child psychologist who can do play therapy with a small child or sit and talk and listen to an older child. Boys  may try to become the man of the family and girls are often given too much responsibility with younger children.

When a divorce is friendly and children can go easily from one parent to the other, the children can feel safe and blossom. If there is only angry and hostility, the parents, children and entire extended family can be badly affected.

When Little Children are Given Choices

I listened to a woman reporter on TV the other day say she always gave her two-year-old several choices. I felt sorry for the child and  suspected the parent or parents might pay a price for doing this in the future. Two-year-old children don't have the maturity to make choices and they just want their parents to provide guidelines and limits, so they feel secure and safe.  Let's say, for example, that the child is being given various choices and when he starts pre-school, as a two-year-old, as some children are doing, that he decides on different days that he does not want to go to school. This can start a pattern that can be very confusing to everyone in the family or his caretaker. Later on when he attends real school he or she may want to continue the same pattern, which can cause a lot of trouble.

I think this idea of lots of choices goes along with parents wanting to be friends and not parents. Yes, sometimes it would be fun not to have to be the one to say what the guidelines are, but if you are going to  have children, then you no longer have the luxury of being just a friend, until your child is an adult. A fifteen-year-old who takes the keys to the family car, when they should be home studying may not respond to a "No", if he or she is not accustomed to the parents being in charge. Parenting is hard work, but there are lots of great times if everyone knows the rules and the limits. Lots of hugs and letting your children know how much you love them will pay off greatly. When your children are adults and  tell you know how great you have been as parents, it is a special gift.

Physician Referral of Kids with Disabilities to State Programs.

I was talking with a friend in another state yesterday and she told me the distressing story of triplets that were a news story on her local TV station. Two of the  infants died soon after birth, she said, and the third baby was in some kind of breathing trouble. The parents had been hit with a three million dollar bill that their insurance company was refusing to pay. I was outraged, because the insurance company should not even been involved. When babies are born with problems or if problems develop later on, the attending doctor should immediately refer the parents to the state program for children with disabilities. There the case is taken over and no insurance company is involved. Unfortunately, we are not teaching our doctors about resources for children with special needs. I recently talked with a woman at a local business who had two children with special needs and she was overwhelmed with  insurance bills. I printed out the application for her to apply to the California program(CCS) and told her how to get help. I also sent an e-mail and left a message for the doctor who heads the local chapter of  pediatricians suggesting he invite someone from CCS to talk with his group of doctors, so they would know when to refer a child to CCS. The doctor didn't have the courtesy to return my call.

In my book, Raising a Handicapped Child (Oxford University Press,) I list each state's telephone number and address of the programs for children with special needs. I also have the list in my book, Raising a Child with a Neuromuscular Disorder. There is absolutely no excuse for parents to be saddled with enormous medical bills when they have enough to worry about if a child has special needs. At  least if parents are aware of the state programs, they can demand that a referral be made.

Over The Top Birthday Parties

When I was growing up in a small college town, birthday parties were pretty much family affairs. Most of the families were middle income, although there were a few wealthy families. Even they seemed to  have family parties and not the lavish events that many families now seem to be have. One grandmother told me of going to her grandson's second birthday party. There were sixty guests and some of the  parents did not even know which child was having a birthday. The birthday cake was elaborate and cost well over $100. The parents were not wealthy, but wanted to be part of the wealthy social scene, so they went all out. Another grandmother told me of going to her granddaughter's friend's birthday in a home where the parents were quite wealthy. She had her car parked by valet parkers, and costumes were provided for all the guests. There was a bar, lunch, a clown, lots of things for the children to do and all in all it was overwhelming, even for the grandmother. I wonder what the five-year-old thought?

I remember going to a party for one of my  teenage patients  in a beautiful home. All the classmates  from her private school were invited, as well as their teachers. The birthday girl was quite shy and I remember her hiding in a corner not wanting to mingle with the guests. We talked a little and I persuaded her that because the party was for her that she should at least make a brief appearance.

I think parties like this send a wrong message. Often the party is for the parents and their social standing, not for their child. A simple party that the birthday child gets to help plan and help devise the games or other activities seems to make more sense. More is not necessarily the best and the birthday child may get lost in all the noise and excitement.