Diary of A Child Therapist

Emotional Training Wheels for Your Young Child

2011-08-07T23:48:00.000-07:00

One of the most common questions I get from parents who come into my office is how to calm their young child down when he is in the midst of a “meltdown,” a “tantrum” or a “fit.”

Ideally, by a certain age and level of development, a child should be able to mostly maintain calm and not get – or stay - too upset in the first place, but often that just isn’t possible given the situation, a parent’s ability to help soothe a child, and the child’s own capacity for regulating his emotions. (Of course, this ideal also becomes entirely beside the point when a parent is feeling overwhelmed, is in public and feeling the pressure of onlookers, or isn’t at all sure what to do to get his or her child to calm down.)

It is so vital to remember that as parents, we are our children’s first and most important teachers. This is especially true when it comes to learning the crucial skill of managing emotions. While this ability is something we adults often take for granted, for children handling emotions well is a skill that has to be learned and supported to the point of mastery just as we help our children learn how to walk, read, or ride a bike. In other words, managing emotions just isn’t something a child can learn without an adult by his side.

I often use the words “regulation” and “dysregulation” to talk about this. We initially teach infants about regulation by picking them up when they are fussing or crying, using motion such as gentle rocking or words like, “There there, it’s okay,” to help them feel better. When we take such actions, we essentially serve as “training wheels” to help baby learn how to feel soothed, to even know that he can be soothed and calmed.

As babies get older and grow into toddlerhood, we move beyond these very basics toward teaching them about the sophistications of emotional regulation.

I have many parents who come in and tell me that when their children are upset and falling apart, they try to help by encouraging them to “use their words” or “tell me what’s wrong.” I hear the best of intentions in their explanations. Here’s what I tell them, and what I want to remind you of now:

When a young child is having a “meltdown,” he usually isn’t thinking about how much better things would be if only he could use his words. He isn’t thinking in terms of words. All he knows is that he feels just awful inside, that there is a yucky mess inside the middle of his body and he doesn’t know what to do with that feeling. Hence, he screams. Or hits. Or may shout out horribly mean words at his mom and dad.
So what is a parent to do in such a situation?

Maintain Calm
First things first: maintain calm as much as you can. Like finely calibrated seismic instruments, children pick up on every nuance of our inner quakes and are affected by them. If you are agitated and angry and inadvertently convey this to your child by your actions or words, your child will likely respond in kind.

Mirror: Tell Them What You See
Secondly, since your child can’t sort out his feelings or needs in the midst of falling apart and verbalize them to you, tell him what you see. This can be conveyed (calmly) in words such as, “I see you’re upset…I see you are very angry right now…I see you are frustrated and sad.” Or, “I know you’re mad. I can see that,” and then you may add, if needed, “But hitting and kicking isn’t okay. We don’t hit and kick even when we feel mad.”

By holding up a mirror (so to speak) in the moment when your child is clearly overwhelmed and confused, you are helping him learn how to put names to his feelings. He may even gratefully think, “Oh! That’s what this yucky stuff inside me is called!”

Be Consistent
Thirdly, as always with helping a child to learn any new or emerging skill, consistency is key. If you are able to consistently help your child name and validate his feelings, he will eventually be able to do this more and more on his own. Before you know it, the training wheels will come off and he’ll be flying down the lane to naming all those difficult feelings and using his words rather than acting them out.

The bottom line is that the more you can put into words what your child is feeling or needing for him, the better he will feel – and act. Not only will he learn how to identify emotions, he will also feel that mommy or daddy understands him enough to notice and say what they see is going on. This is a great comfort to any child.

Speaking of Calories, Sugar, and Weight Gain...

2011-07-17T13:13:00.000-07:00

Just saw this article. I'm wondering what parents think of this:

Should Raising an Obese Child Be Considered Neglect?

Rethink Your Child’s Drinks

2011-07-17T12:07:00.000-07:00

Ah, summer! Ice cold lemonade, refreshing juice, and other icy sweet drinks come to mind. While these tasty beverages can really hit the spot on warm days, they’re also filled with lots of sugar and yes, empty calories.

Shannon Whaley, Director of Research and Evaluation at the Public Health Foundation Women Infants and Children program, recently reported that "Twenty-nine percent of children 0-2 are drinking soda on a typical day. So that's really where we need to start."

There’s a much better way for our little ones to get their thirsts quenched, and that’s by choosing water first. This is especially important for young children who are still developing dietary tastes and habits. It's a simple choice that can profoundly impact their overall health. After all, drink choices can significantly affect dental/oral development and appropriate weight gain.

So help your young child choose – and enjoy – water first instead of sugary drinks. And at mealtimes, include milk for added calcium. These simple actions are some of the most important steps you and family can take toward good health both now and in the future.

And, just in case you were wondering about how many calories or how much sugar is in that drink…

Rebirth of the Blog

2011-07-16T12:07:00.000-07:00

It’s been a busy time since my family and I relocated to the beautiful Pacific Northwest last May. Which means, as some of you may have noticed, that I’ve taken a break from the blog.

Well, the good news is that after setting up a new home, new private practice, and with a baby on the way, things are actually slowing down enough so that I can now get back to doing things like posting on the blog. Yes, the blog is back!

Speaking of all the busy-ness that’s been going on, and our family’s preparations for further monumental changes in the near future, I’ve been thinking a lot about how parents are able to juggle the day-to-day demands of family life. So many families I know struggle with maintaining order in the home, getting kids to activities all over town, and staying connected and close.

Some important things to remember:
•Be willing to slow down – Now that it’s summer, not rushing off to the next activity. Signing your child up for one less thing.
•Ask for help – If you are overwhelmed or stressed by everything you have to do, is there a family member or friend who can come over and help with the kids or with that gardening or organizational project you’ve been wanting to get done?
•Enjoy low-key (non-stressful) family activities in the local area, such as going to the park; making good food and enjoying regular mealtimes together; and so forth.

This time of year is an ideal time to slow down and do less, so I encourage all you busy parents and families to remember to do just that!

Young Children and Transitions

2010-05-03T19:48:00.000-07:00

Here's a link to a very useful little article on helping your young child with transitions. Click here!

Speaking of transitions, I've moved my practice up to Bellingham, Washington. For those parents in California and elsewhere, please continue to email me with questions! I am also happy to continue to provide parents in Southern California with referrals for their young children.

Leaving People and Things Behind

2010-03-19T10:48:00.000-07:00

[With last week's time change and the lengthening of daylight hours, Spring is the perfect time to think about transitions. This is the first in a series of posts about transitions.]

As I return to writing regular blog posts again after a long period away, I've been thinking a lot about the transitions we make throughout our daily lives, and how we can help our kids with both the small and large ones.

In my own life, transition has definitely been the major word. At the end of April, I'll be leaving Southern California, moving up to northern Washington State with my own little family, and joining a group practice in Bellingham.

There has been a lot to think about and do, including figuring out how on earth to pack up a whole house! As a family, we will have to adjust to many changes including leaving behind people we love, sunny weather, and all that is familiar.

For parents with young children, there are certain things you can do to make a big transition such as a major relocation easier. Parents naturally often worry about how their child will adjust and how they can help them do so with as little pain as possible.

Some ways to do this include:

*Maintain the Same. Keep to routines as much as possible. While certain toys may have to be given away or a best friend left behind, we can help kids maintain the familiar by keeping to the same evening routines and bedtimes, mealtimes, and other such predictable, daily activities.

*Talk About It. Describe what your child can expect and have him participate in contributing ideas, such as how he might want his new room decorated. Talk about what is good about moving, what might be sad or scary, what will be different, including some of the concrete things to which he can look forward. In the frenzy of a move, talking to your child about his feelings about it might easily be one of the most crucial things you forget to do. So don't let that happen!

*Keep It Together. Make a book together that includes photos of people and places being left behind. This can be a project where you and your child can go visit with and say goodbye to important people and take their pictures (or get handprints, etc.)which can be included in the book. When you are in your new home, this will be a valuable keepsake that you and your child and look at again and again, especially when he or she is especially missing someone.

*Start Fresh. Create new routines and family rituals. Any new city or town you are going to will have different things to offer, which can be incorporated into the family as a regular activity. For instance, if there is a farmer's market in your new town that has a kids musician performing every Saturday morning and your child loves music, going there to enjoy that could become something you could go do together each week.

*Keep Things of Their Own. Separate out some of your child's things - things that he or she wants - into a box, basket, or backpack to keep close by during the actual journey for easy access.

Gather Together. Don't forget to have a goodbye party or even several get togethers so your child has adequate time to say farewell to people he or she cares about - teachers, caregivers, aunts, uncles, grandparents, friends.

By helping your child in these ways, you and your family can enjoy a smoother transition to a new location and home. Even more importantly, you will be helping your child to learn that they can survive and thrive even when their environment and the people in it, are completely different.

From ASQ to ABCs

2009-10-04T14:37:00.000-07:00

Recently, I met up with the good docs at Descanso Pediatrics in La Canada, CA.

In addition to sharing about what I do in my work with young children and families, which focuses primarily on social and emotional development, I asked them about ways they help to make sure the infants and toddlers who come to them are on a healthy developmental path.

One of their answers? Three little letters: ASQ.

ASQ, or the Ages and Stages Questionnaire, is something I use regularly as well. It is an excellent developmental screening tool broken down by age, from 1 to 66-months.

By asking parents a number of questions (which only takes 10-15 minutes to answer), the ASQ allows us to see how a child is doing within a number of areas: communication, gross motor, fine motor, problem solving, and personal-social.

Why is it so crucial to do regular developmental screenings for your child?

High-quality tools such as the ASQ enable us to catch and address problems or delays early. The sooner your child gets further evaluation and any needed extra support and services, the sooner he or she can get back to where he should be.

Remember, every child is different and normal development happens within a range.

To ensure that your young child reaches his or her potential now and moving forward toward learning his ABCs, developmental screenings are essential.

A Success Story (So Far)

2009-10-03T11:19:00.000-07:00

School is well underway now (though it feels like my last post was just written a few days ago). Whether it's preschool or first grade, many kids out there are enjoying success in the classroom, thanks to awesome teachers, teacher's aides, caregivers and most of all -- parents.

Pasadena parents Jackson and Elizabeth are a great example. They prepared their seven year-old son (who tends to be very anxious and dislike change) to enter a Mandarin-immersion class at a brand new school last month. They did this by spending time during the summer talking to him often about it. They were also able to take him by the school beforehand to meet the teacher. In talking to other parents in the neighborhood, they discovered that another child down the street from them would be in the same class too.

Sammy arrived on his first day filled with encouraging words from his parents and knowing what to expect, including who his teacher was. Plus, he had a buddy from the neighborhood! The latest word is that so far, he is learning up a storm and really enjoying the new class and school.

It's wonderful to hear good things like this from parents. It goes to show that when parents prepare their kids for major changes, the pay-off is big. Kids feel more confident and move that much closer to achieving their highest potential.

p.s. I actually wrote about Sammy getting ready to go to school not too long ago at theK5.com, so check it out!

Get Ready for School Success!

2009-08-07T15:14:00.000-07:00

It feels like summer has just gotten going.

But, the calendar says differently. Unbelievably, it’s August already, which means the new school year is nearly upon us. For parents of school-age kids, this is the perfect time not only to get new backpacks, pencils, and notebooks. It’s also a good time to reconsider any concerns you might have about your child’s ability to learn and do well in school.

Evaluation for issues that may be keeping your child from reaching his or her full academic potential is called psychoeducational testing. Our friends at The K5 give a good explanation of what this is. To avoid re-inventing the wheel, we'll let their school psychologist, J. David Carr, tell you more:

In many school districts, psychoeducational testing is done to determine whether a child needs to have an Individualized Education Plan, or IEP. In my local area, parents also have the right to seek out a second opinion – at the school district’s cost. This means that if you are dissatisfied with the school’s testing or IEP results, you may seek out additional psychoeducational testing from a psychologist on your own. To find out more about this, you may contact your local school district.

A great resource for parents in Southern California who want additional (or first time) psychological/educational testing for their child, is Dr. Paula Bruce, who has a great deal of experience, expertise, and is just terrific to work with.

Remember: Identifying and understanding how your child best learns and where he or she needs additional support is one of the best ways to get ready for school success!

So, What's the Plan?

2009-06-21T12:06:00.000-07:00

The first time I met three-year-old James, he tumbled into the playroom, a ball of energy and a huge smile on his face. Without seeming to look where he was going (even though his eyes and head were facing forward), he hurried toward something enticing and promptly fell flat on his face.

Just as promptly, he bounded up, like a real-boy version of Tigger.

James is a boy who (as you already know) doesn't really look where he's going, whether he's walking ahead of you or running across the yard. He's easily distracted. While holding one toy, he will see another and hurl himself toward it so that he can grab it as fast as he can. He loves to jump on furniture, swing, and slap down hard that piece of multi-colored Play Doh.

It's never a dull moment with James around, which can be frustrating for his parents. And, unless we help him now, he will have a difficult time in pre-K and Kindergarten. He may become labeled as that boy who never follows directions or that kid who causes disruptions. Saddest of all, he will likely have a hard time learning.

One of the best ways to help a child like James think a moment ahead (like where he is walking) or to stay on task, is to make a plan.

"So what's the plan?" is a great question to ask. A plan needs to have steps, three maybe even four, and should be clarified at the beginning of an activity.

For example, today we're going to make pizza. 1. First we roll out the dough. 2. Second, we put the sauce. 3. Third, we put on the cheese. 4. Then we put it in the oven and wait!

If your little one forgets a step or jumps ahead, remind him again of what the steps were. "Hey! You jumped ahead. That's not step 2! What is step 2?"

If he has a hard time waiting, remind him that you're right there with him. It doesn't hurt to empathize, either: "I know, I know! It's so hard to wait, isn't it? So let's wait together."

Making and following a plan can be fun when you do it together. And, it sure makes staying on track a lot easier.

The Hard Stuff

2009-06-13T13:21:00.000-07:00

One of the most common questions I get from parents is how to talk to their children about difficult things. These are things that make mommy and daddy so uneasy that they often want to do it in the therapy setting with the support of a professional like me.

I call it talking about "the hard stuff." This may include parents having to tell their child about mommy and daddy's separation, divorce, or the loss of a loved one.

Although you might find it hard, you don't necessarily need a therapist to help you talk about the hard stuff with your child. With the right tools, it's possible to navigate the waters just fine.

Tools you will need: Some quiet time without distractions, the willingness to be honest with your child, wording that fits the child's age, and a loving and supportive attitude.

I've found that kids have an uncanny ability to know that something is going on before they receive an actual explanation from an adult. They are constantly reading our expressions and picking up on other cues that we don't realize we are putting out to the world.

This means that talking to your child directly about daddy moving out or the reason why grandma stopped visiting may come as a big relief rather than as something frightening or scary.

Using words that are age-appropriate is important too. A four or five year old who may not yet understand the concept of time will not grasp a wordy, abstract explanation of death. He will, instead, understand something more concrete, such as, "She died because her body was broken...And we will miss her so much."

Once the truth is out, you can also begin preparing your child for the next step, whether it's moving to a new house, getting used to seeing a parent only on the weekends, or saying goodbye to someone they loved very, very much.

How to Deal with Aggressiveness In Young Children

2009-06-12T11:36:00.000-07:00

A parent came to me this week concerned about her fifteen-month-old child being aggressive in daycare. Anxious and upset, this mom shared that she was worried that her daughter would be expelled.

Biting, kicking, pushing, hitting...These are behaviors that most parents don't want to see their kids engaging in.

It feels even worse when other parents, teachers, or caregivers give you a disapproving look, then tell you about something "bad" that they saw your child do today.

When it comes to aggressive behaviors in young children, here are some important factors to consider:

1. How old is your child? In other words, is your child exhibiting behaviors that are developmentally appropriate for his or her age?

For wobblers, and toddlers up to about age four who are not yet able to express overpowering emotions such as frustration or anger, and who may not yet have full command over how to touch softly versus roughly, behaviors such as hitting and pushing are not only not pathological, they are within the range of what is expected and normal.

2. What triggered your child to hit, push, grab, or bite? It's important to notice this so that you can be on the look out. Next time you observe the trigger, you can intervene to prevent or change unwanted behaviors.

For instance, did your son hit another child who grabbed his toy? Next time you see this about to happen, you can remind them both that they are friends and need to share. If hitting has already happened, tell them that hitting is not okay and point out who had the toy first. You can show them how to be "nice" and touch "soft" or "gentle."

3. What does your child's overall behavior look like? If your child is usually well-behaved, is responsive to you and other adult caregivers, and generally isn't aggressive -- except for this one time -- then he still remains an overall well-behaved child.

4. If your child is in daycare, preschool, or other structured settings during the day, be willing to work with staff to help identify triggers and address problem issues. The more consistently problems are addressed in different environments (home and school versus home only), the greater the likelihood you'll see improvements in your child's behaviors.

5. If hitting, biting, kicking, or pushing continue or worsen so that your child's overall behavior becomes unmanageable, consider seeking the support of a child therapist.

Getting Creative - This Summer and Beyond

2009-05-29T11:04:00.000-07:00

Two more weeks 'til school's out!

Are you ready?

It's the time of year when kids are looking forward to year-end field trips, parents are thinking about daycare and activities to keep little hands (and minds) occupied, and teachers are propelling themselves toward the finish line and...summer break!

Summer is a great time for parents to encourage kids to be creative -- to let go of the constraints of assignments, expectations, and the limitations of each school day.

While summer is an ideal time for this, actively using each day throughout the year to foster creativity is even better.

When we encourage our young children to follow their interests, to be silly and playful, to take chances and not worry about making mistakes, we inevitably help them learn how to be creative.

Leading creativity expert, Sir Ken Robinson, defines creativity as "the process of developing new ideas that have value." If we think about it further, creativity is what leads to improved problem solving skills, gray area thinking, and the ability to be visionary adults.

Who doesn't want that for their children?

For kids, creativity gives birth to a world that is filled with possibilities, options for making choices both now and when they grow older. It brings into being a sense of flexibility and hope, which our children will need to surmount life's smaller challenges as well as its major obstacles.

There are many good reasons beyond this, and ways, to foster creativity at an early age. Dr. Stanley Greenspan writes about this in his book, Great Kids: Helping Your Baby and Child Develop the 10 Essential Qualities for a Happy, Healthy Life.

Yes, creativity matters no matter what path your child takes someday. In his funny and passionate talk at this year's TED conference, Sir Ken Robinson discusses this as he makes a moving case for reforming our educational system, placing creativity at the top of the priority list for our children. Watch him here:

Daring to Share

2009-03-09T22:04:00.000-07:00

Lately, every time I turn on the television, the radio, or pull up my favorite online news site, what I am seeing and hearing is grim. Hundreds of thousands of people losing their jobs. Millions, their homes.

It certainly is sad, anxiety-provoking, and for some families and individuals, absolutely tragic.

But in the midst of all this, there is one positive thing we can do: Share.

As parents and caregivers, teachers and therapists, we are constantly asking, telling, or teaching our kids to share. Share your toys, share your favorite bouncy ball, share that video game controller, share your room, and ad infinitum.

If we look to our kids during this difficult time, there is quite a bit that they can teach us -- especially about sharing.

Think about when your child runs up to you and gives you his perfect, crooked smile that fills you with that sunshiny feeling: it's better than a million bucks! Or, about those times when your toddler says something so cute and funny that you feel richer than the richest man or woman on earth and can't wait to share it with the next person you see.

We can follow our children's examples. We can call up the old friend we miss to say, "I just wanted to let you know I was thinking of you." We can smile at our neighbor, who unbeknownst to us, was until a minute ago, having a really hard day.

If you're willing to try it, I promise you will get something back. A good feeling, a greater sense of connectedness. And, the more you share, the better you'll feel.

Bottom line: Sharing creates abundance. Maybe that's what we've been trying to teach our kids all along.

DIR/Floortime: Support for Parents with Developmentally Challenged Children

2009-03-05T11:02:00.000-08:00

For local parents who have children with developmental delays, there is a very helpful workshop coming up in Pasadena, California on April 4th.

An "Introduction to Floortime" will be presented by Diane Cullinane, M.D. of Pasadena Child Development Associates, Inc.

Dr. Cullinane is a Developmental Pediatrician, a Certified DIR Clinician, and an ICDL (Interdisciplinary Council on Developmental & Learning Disorders) Faculty Member. She is one of the few experts with advanced DIR/Floortime training in the area. I've attended this workshop of hers before. It is highly informative and will give parents more knowledge and tools for helping their developmentally challenged children.

For those of you unfamiliar with it, The Developmental, Individual Differences, Relationship-based/Floortime model was developed by Dr. Stanley Greenspan and his colleagues for working with kids on the autism spectrum. It takes into account the individual differences of each child, including temperament and sensory issues. DIR/Floortime focuses on helping children to improve their overall development (including communicating and relating, problem-solving, and logical thinking) rather than only on skills and isolated behaviors.

While DIR is the part that helps the clinician to assess the child's overall functioning, Floortime provides a framework for how to "be" with the child in school, daycare, home, and other settings. It includes how to interact, energize up to engage with the child, and play in such a way to both support and challenge him or her. It's a great tool that parents with developmentally delayed children can use!

I am a huge fan of DIR/Floortime and have found as a child therapist that it can also be successfully used with kids with emotional problems who are not necessarily delayed.

"Introduction to Floortime" (For Parents and Professionals)
Date: April 4, 2009
Location: Huntington Hospital/Braun Auditorium, 100 W. California Blvd., Pasadena, CA

Dr. Cullinane will present an overview of Floortime, including:
* What is Floortime and the DIR approach (as described by Dr. Greenspan and Serena Wieder, Ph.D.)
* The six Functional Emotional Developmental Milestones
* Basic steps and strategies of Floortime.
* Video examples of Floortime intervention.
* Time for questions and discussion.

To register over the phone, please contact Amber at 626-793-7350 x229 or Barb at 626-793-7350 x219.

To learn more about DIR/Floortime itself, visit the ICDL website, which includes a free video showing Dr. Greenspan and Dr. Weider explaining what DIR/Floortime is. There are also useful links and resources for parents on the site.

In the Know

2009-02-20T10:15:00.000-08:00

The other day, I was working with a teenage mom and her 10-month-old baby who was fussy and irritable. The mom tried rocking the baby, soothing her with her voice, patting her gently, and distracting her with a toy. But, baby kept fussing. Mom kept trying. And, tears where starting to roll down both their faces.

The mom's frustration was palpable. She turned to me and said, "I don't know what to do!"

The same day, while I was talking to another mom with three children, she began telling me that sometimes she just doesn't know what to do when her kids get upset and tantrum.

"They don't explain how to do it all in books I've read!" She said.

Later, I thought about these two very different moms, one a first-time parent and the other with three kids' worth of experience. I was struck by how no matter what your level of experience, it is impossible to know exactly what to do every time, especially when your child is irritable, fussy, or throwing a headache-inducing tantrum which seems to have no end in sight.

Here are some thoughts:
1. It's okay to not always know how to make everything better instantly. If you could do this, then you would be Super Parent. And, you would have to run around the world wearing tights and a cape. Do you really want to do that?
2. It's important to stay calm. Even if you are completely frustrated and ready to scream, remember that your child will pick up on your emotional state and this may make him more upset that he already is. Remember that no matter how bad the situation, there will be an end to it. It will not last forever.
3. Offering empathy always helps. Acknowledging the way a child feels helps him or her to feel understood, validated, and calmer.
4. Dare to try different things. Don't always rely on only one thing (such as a time out for older children, or a bottle for infants) to deal with challenging behavior. Be flexible and willing to try a range of ways to soothe your child.

And again, remember that as a parent it's okay and quite normal to not always be in the know.

Eensies: A Giant Help for Parents

2009-02-09T23:03:00.000-08:00

In these tough economic times, many parents I know have been feeling not only worried and concerned, but understandably stressed and overwhelmed.

It's a good time to remember certain important things, including that children can easily pick up on a parent's state of mind. Younger children who tend to be more egocentric may feel that "Mommy isn't happy," or "Something is wrong with Daddy," and blame themselves. If you see your child responding in such a way, this is a great time to remind him that you love him.

If you are feeling stressed or overwhelmed, you are not alone. Now is the perfect time to reach out to friends, family members, or professionals such as teachers and counselors for support. Remember that no matter where you live, there are free local resources available.

One of the best online resources for parents (and one of my new favorites) is eensies. Started by two teachers (and parents), eensies is chock full of tips, activities, and advice. And, every Thursday is dedicated to answering parents' questions about everything from homework and reading to how to help your child make clean up time fun. Not only is eensies enjoyable to read and a giant help for parents -- it's also absolutely free.

Speaking of free, don't forget that love and hugs don't cost a cent. So give your favorite child a hug today and remember to check out eensies.

Eight Is Too Much

2009-02-06T08:55:00.000-08:00

Like many of us, I've been following the story about the Bellflower, California octuplets with interest and curiosity. This morning, the mother, Nadya Suleman, was on the Today Show, insisting that she will provide her babies with unconditional love and attention.

It's a basic and obvious fact that babies need unconditional love and attention. However, actually providing this can be extremely difficult with just one baby. For parents with multiple babies who may have developmental problems, it's a massive struggle without additional support from family, friends, medical doctors, developmental specialists, and other outside help.

I've written often on this blog about how crucial the relationship is between a parent and child, right from the start. It is the very foundation of a child's healthy social and emotional development. Through this critical first relationship with mother, babies become kids who can communicate appropriately, manage their feelings, play well with other children, and empathize with others.

It is hard enough to develop and nurture but one relationship with a single newborn infant, not to mention an additional seven who may also experience developmental delays due to their prematurity. For even the most amazing mom, eight is just too much.

From Babies to Big Kids

2009-01-29T10:09:00.000-08:00

As a child therapist, I get lots of questions from parents that start with, "Is it normal if my child is...?" There are so many developmental milestones to pay attention to and young children are changing so rapidly, it can be confusing to know where your child should be!

These days, there are lots of ways for parents to get information about their young child's development.

Parents don't have to necessarily wait until their child's next appointment with the pediatrician or see a child therapist to have their questions about development answered. There are books galore and internet resources available.

One of the newest and best of these comes from Zero to Three in Washington, D.C. They have created From Babies to Big Kids, an email newsletter parents can subscribe to which outlines where their child should be developmentally.

It's so easy! Just enter your name, email address, and the age of your child (you can enter up to three) and you will get a monthly From Babies to Big Kids newsletter tailored to your child.

This and other tools on Zero to Three's website can provide a lot of very helpful information for parents which can be further fleshed out by a pediatrician, child therapist, teacher, or other early childhood professional.

The K5: Great for Kids and Parents

2009-01-24T14:17:00.000-08:00

One of the best things about what I do is getting to know all kinds of people -- from parents and teachers to school administrators and occupational therapists. They are constantly giving me good information and support.

One of the latest helpful resources I’ve learned about from a second grade teacher is The K5 (http://www.thek5.com). If you guessed that it’s for parents with kids Kinder through 5th grade who are looking for some tips and guidance, you are absolutely right!

Here, you’ll find advice on everything from how to help your child get ready for school on time to tips about finishing homework.

You can even ask their school psychologist, J. David Carr, questions! Here’s a taste of the clear and solid guidance you get from him and folks at The K5:

A Willingness to Nurture

2009-01-23T09:56:00.000-08:00

"For as much as government can do and must do, it is ultimately the faith and determination of the American people upon which this nation relies. It is the kindness to take in a stranger when the levees break..but also a parent's willingness to nurture a child, that finally decides our fate." --44th President Barack Obama, January 20, 2009

What an amazing and exciting week this was!

I hope that many parents, grandparents, teachers, and others who care for our youngest children were able to witness the inauguration and the ushering in of an era of hope and change.

When I attended the Zero to Three conference here in Los Angeles in December, there was a lot of conjecture about President-Elect Obama's true commitment to young children and families. And, there was a lot of discussion about our feelings of hope that his administration could help to increase awareness and resources spent on this critical period of a child's life.

After all, the first three years are when the bulk of brain development happens; it is the time when children make the fastest and most dramatic gains.

As I listened to President Obama's speech on Wednesday morning, I of course honed in on the small part of it directed at parents.

Parents, teachers, daycare providers, you are key to implementing the positive changes that we seek as a nation. You are the ones who instill in our littlest ones the belief that they are loved and valued. That they can become an Ironman, Superman, or the President of the United States.

This is a task that each one of us can help with, even if we don't have our own kids. As we move through the world, we can be the adults who model good behavior, who do what is right even if it is hard. We can be grownups who are willing to listen to others' opinions and show kindness to people who are different from ourselves.

Let us move forward with hope in our hearts and as our new President puts it, the willingness to nurture our children.

A Belated New Year's Message

2009-01-09T10:26:00.001-08:00

Happy New Year!

After a period of life transitions, the blog is back!

Now that the holidays are behind us, it's a good time to make a list of what we would like to achieve in the year ahead. For parents, some of these things may be general, like "Be a better mom or dad." Or, more specific, such as "Read one story to my child every night before bed."

As for me, I want to continue to help moms, dads, and anyone else taking care of our youngest children to be the best caregivers they can be.

For this blog, this means that I will be including more information on child development and parenting issues, guidance, links to resources, and answering any questions that you may have.

So please stay tuned!

Happy New Year!

A Lot On One Plate

2008-10-24T23:42:00.001-07:00

It's been a weeks since the last post, but there is a lot on my plate at the moment - will return soon!

Sudden Endings

2008-10-01T11:17:00.000-07:00

It can be extremely painful when we lose someone close to us.

It's hard enough for adults not be able to say goodbye to a dear friend or family member whether due to a tragic accident or sudden illness. When a child does not get to say goodbye to a person who has been important, the impact can not only feel devastating; it can be very confusing, sad, and anxiety provoking.

The child's reaction may be impacted by a number of different factors: the age and developmental level; the relationship the child had to the person; how the adults around the child are now behaving; and if the circumstances were particularly difficult, the way in which the loss is explained.

One question I often hear from parents is, "How do we explain death to a child and must we do it?"

Children need to know the truth, especially when it comes to losing someone that they love. They should be told in a gentle, supportive, and age-appropriate way. It's also important to keep in mind that children under the age of five do not yet understand the concept of time and death, although they may know from the way adults around them are behaving that something is wrong.

It is okay to explain that they will not be seeing their auntie, grandma, or whomever the important person is, again. This will likely bring up more questions, including, "Why?" You don't need to provide details to a young child, but can let him know, "Well, grandma was sick." You can simply remind him of how much grandma loved him. Remind the child that this love, and the special things and times they shared together will remain. Share with him how much you love and will miss grandma too.

In therapy, to work through the feelings related to a loss, I will often have the child make a picture, a book, or if they are old enough, write a letter together with me for the person they have lost. For older and more verbal children, sharing and exploring thoughts and feelings about the loss is also crucial.

There is no sudden or "magical" cure to helping a child work through losing someone they love. There is, however, a parent or caregiver's support, reassurances, and love. This, along with time and (for some children) therapeutic support, will help a child overcome his or her sadness, grief, and anxiety.

Does My Child Need Therapy?

2008-09-23T12:11:00.000-07:00

I was recently asked by a parent, "How do I know if my kid needs therapy?"

Your daughter may need support if she is struggling with relating and engaging with you.

Your son may need help if he is unable to play well with other children, including siblings.

Your toddler may need assistance if he is exhibiting behaviors such as a high level of aggressiveness, explosive rage, or if he does not listen to you and repeatedly tests the limits you set for him (and you feel that it is beyond what might be age-appropriate).

If your child is unable to soothe himself; is frequently sad, angry, or anxious; or is going through a transition that is difficult for him (such as going to daycare or school for the first time), he or she may benefit from therapy.

Or, you may feel concerned that after a long period of growth, your child has regressed in her behaviors.

Therapy can help address these types of concerns.

Parents can often also benefit from consultation or "coaching." Coaching sessions focus on helping parents to improve their care giving skills and ability to interact positively with their child.

Some of my goals in coaching parents are to help them feel more confident, more in control, and to ultimately enjoy their child in a full and rich way.

Coaching may include helping parents with issues such as implementing discipline, teaching ways to help co-regulate and calm the child, learning about the developmental milestones for their child's age, recognizing their child's strengths, and improving the parents’ overall relationships with their child.

How to Spend Quality Time with Your Child

2008-09-22T11:02:00.000-07:00

1. Turn off the TV, put down that magazine article you were reading, get off the internet. Finish the laundry a little later.

2. Set aside twenty minutes a day to play whatever your child wants, not what you want. And remember, no video or computer games, please!

3. Let your child take the lead. If your son wants to run around the yard wearing his favorite tablecloth "cape" playing superhero, join him! Offer to be his side kick. Ask him what role you are supposed to play. Ask him to show you what his superpowers are.

4. Remember that it is through play that children are able to express and work out diverse emotions, from being scared and helpless to powerful and omnipotent. By trying out different types of feelings and roles, children develop a better sense of self and how they fit into the world.

5. Play also teaches your child specific skills such as creative problem solving and logical thinking. Help him to build bridges within the play. A simple way to do that is by asking, "And then what?" or "Now what's gonna happen?" or "What do we do now?" But, let him be the one to determine what, exactly, that should be: "Show me!"

6. Be willing to enter your child's world according to the rules governing the play he has initiated. By doing so, you demonstrate that you know how to honor him and his internal world, including the full range of his emotions and creativity.

Bottom line: By spending time in child-centered activity each day with your son or daughter, you will build a better, more loving and respectful relationship with your child.

And who doesn't want that?

Isn't That Fitting?

2008-09-21T11:56:00.000-07:00

One of the most gratifying things for me is when I see parents enjoying interactions with their children.

This is especially true when a mom or dad has been struggling to have good interactions with their child, whether this is due to the child's behavioral problems or a difficult child-parent "fit."

In our society, we expect that when babies are born, mothers should automatically bond with them. But, this just isn't always so. Just as in any relationship, there has to be a compatibility or "fit."

An example of a poor "fit" is when a parent is extroverted and enjoys a lot of different interactions but has a baby who is highly sensitive to stimuli.

The baby may turn away from sound or visual cues, including the smiling, loving face of mommy. This can be disheartening -- and even devastating -- for the mom, who may keep trying to connect by making her voice louder, putting her face closer, kissing or stroking the baby, or rocking baby harder, which only overstimulates the child even more.

Mommy may feel that due to her baby not responding to her, crying, or actually recoiling from her, she is not a good mother. She may even feel that she is a terrible mother.

She isn't; they just aren't a "fit."

The good news is that this is an issue we can work on. Infant-mother therapy sessions can help mom to be better able to read her baby's cues. Sessions can teach mom to understand what her child is sensitive to as well as what gives the baby pleasure.

Through helping mom and baby to achieve a better "fit," they can experience truly joyful and loving interactions together.

Let the Band Play On!

2008-09-20T11:10:00.000-07:00

Charlie is four years old and I have been working with him for 15 months now. He is one of the children I see who was prenatally exposed to methamphetamine (and possibly alcohol).

This means that like many other children with prenatal exposure, he has some major challenges, including poor impulse control, aggressiveness, resistance to limits, problems understanding social cues, and difficulty tolerating frustration.

What this often looks like is Charlie pushing his younger brother over, kicking his sister, yelling at everyone around him (myself included), and throwing things at us before attempting to run out of the room and down the stairs.

Children use their senses to form emotional bonds with others. Together with his father, we've incorporated a number of ways to help Charlie "regulate," or soothe himself so that he can return to a calmer, more organized state and ultimately be able to relate appropriately to another person.

In addition to weekly occupational therapy sessions, where Charlie can roll, tumble, swing, jump, and so forth, we have incorporated music into our play, which also helps him to feel better.

This week, Charlie and his sister collected toy instruments including a drum, a horn, and an accordian from the cabinet in our play room and decided that they would form a band. Each family member was assigned an instrument, including dad on the tambourine.

Charlie led the band in playing various songs such as "Twinkle Twinkle Little Star," and directed everyone to join in and sing. The play at that moment was remarkably joyful and robust. Everyone seemed to be having a good time, a smiling Charlie included. And, he was able to stay focused, calm, and organized for a much longer period of time than is usual for him.

As he continued in this activity with his family during this particular session, it was plain that what Charlie was experiencing with them was a sense of competency, togetherness, and simple fun.

So let the band play on!

A Note: I play a lot of different CD's during sessions with Charlie. A new one that we are enjoying a lot is Dan Zanes and Friends' Spanish language "Nueva York!" For lots of singing and fun, please check it out -- my personal favorite on the CD is "Pollito," which is a great way for kids and grownups alike to learn some new Spanish words.

The Miracle of Occupational Therapy

2008-09-13T09:00:00.000-07:00

A year ago, we were very fortunate to have wonderful USC-trained pediatric occupational therapist (OT) come to our clinic to start an OT program.

This is unusual in a traditional mental health setting such as ours, as OT is typically used for children with issues such as autism and feeding and eating problems.

Occupational therapy is essentially focused on helping a person to engage in meaningful and purposeful activities throughout his or her daily life. For a child, this would cover areas such as playing, learning, and engaging in relationships. A child can have difficulties with any of these areas for emotional or biological reasons, such as the trauma of loss or problems with brain development.

Since the arrival of OT at our clinic and its use with a number of the children I see with mental health and behavioral issues, the way I think about how to treat the young children who come into our clinic has changed dramatically.

Now, in addition to looking at what's happening in the family, the school, the child's relationships, the child's developmental history, and losses and separations, I also think about what is going on with the child's ability to self-soothe and manage incoming stimuli. This stimuli may include sound, touch, taste, movement, and pressure. I consider how we can use this additional sensory-related information to help the child to feel better emotionally.

For example, if a child is calmed by a rocking movement and the deep pressure of massage on the arms and back, then I encourage parents to use this at home, especially if the child becomes upset or tantrums. We might also use this in session.

I believe strongly that OT has the potential to help children with emotional problems to learn how to manage their feelings better. Through helping them manage their sensory experiences, we provide them with the miraculous beginnings of being able to handle difficult feeling states.

Sensory Awareness: Looking At the Whole Picture

2008-09-10T18:25:00.000-07:00

As human beings, we are hopefully constantly learning and experiencing new things, which we can then incorporate into our senses of who we are and how we move through the world.

The same can be said for child therapists. Every day we have contact with children and parents in the clinical setting means the chance for a moment of learning. It can mean another opportunity for a eye-opening and unexpected experience, which can then enrich the work we do moving forward.

The way that I work as a child therapist has changed and evolved tremendously in the past year. I attribute this in large part to the learning that I’ve been doing about the brain, the central nervous system, and sensory issues.

This past year, we were fortunate to have an occupational therapist come to our clinic, set up an OT program, and help us to incorporate an understanding of these areas -- including how a child regulates, or manages, his or her sensory input (sound, touch, gravity, taste, balance). Our occupational therapist taught me to understand the deep influence this has on a child’s emotions and behaviors.

Take 4-year-old Dylan. He is constantly moving, running, bumping into furniture, climbing up on the table, and jumping off things like the arms of the sofa. If he lands on his head, he just gets up again without seeming hurt at all. He has a very hard time following directions. He also gets frustrated very easily and quickly, to the point of catastrophe – and then, inevitably, there’s a meltdown. We (the caring grownups) then have to help scoop it all up and put back together into the shape of a little boy.

Using a traditional mental health model, Dylan’s symptoms could very easily be chalked up to ADHD. That’s Attention-Deficit Hyperactivity Disorder. For Dylan, the subtype that would apply to him would be “Predominantly Hyperactive-Impulsive Type.” The parent might be coached to provide increased structure and routine at home, use repetition, or use behavioral charts (which might include one sticker for every episode of “good” behavior, as outlined on the chart) and rewards.

I’m not saying any of that is bad or wrong. It’s just not looking at the whole picture. I’m not saying it’s not doing enough. I’m saying we could be doing more.

The whole picture, if you look at Dylan from a sensory perspective, would include consideration of the fact that Dylan is sensory seeking and sensory craving. He wants movement. He wants pressure against his body, the bottom of his feet. He wants to touch a lot of different textures.

Dylan wants the inner-ear stimulation of swinging which allows him to feel calmer. He wants the deep pressure of a hug from grandma that makes him feel more organized and allows him to actually pay attention when she asks him to put his shoes on. And, Dylan wants all of this now.

So, I’ve learned, why not give him what he needs if it helps him to actually feel better and prevent a tantrum or another “catastrophe?”

I’ve incorporated this way of thinking into my work and collaborated with Dylan’s grandmother to give him the stimulation that he needs. If she sees that Dylan is becoming frustrated and upset (or “dysregulated”), she can now recognize it and give him some calming pressure, like squeezing his arms, or giving him a big bear hug while also reassuring him.

And, it works!

I’m just touching on the tip of the iceberg here about looking at the whole picture. I'll be talking more about sensory integration, regulation issues, inner motivation, and ways to help a child improve the way he deals with people and the world outside of himself.

Yes We Can: Collaborating with Parents

2008-09-08T23:44:00.001-07:00

By the time parents walk into our clinic, they are often feeling confused and uncertain, helpless and exhausted, and sometimes, quite desperate.

It's my job not only to help their child but to help them too. I do this by listening to them. I acknowledge that though they may not have all (or even some) of the answers, they know their child better than I ever probably could or will.

After all, they have been there from the beginning. Each day, they are the ones who spend time with their child, dropping her off at school, making her dinner, tucking her into bed and reading to her at night.

I inform parents that I need their help to get to know their child's history and issues and to understand their family's problems. I also explain that while I may not always have the answers, I will do my very best to support them and be present to what they are going through.

Along the way, through the treatment process, I constantly seek out their input and feedback. How did the past week go? Tell me about the ups and downs and how that made you feel. What happened to make your daughter cry almost every day? What did you do to help her feel better?

Really, this is the best way to do it. By working together hand-in-hand, through collaboration, we slowly begin to see improvements in a child -- and in the family.

Yes, together, we can make change happen.

Change We Can Believe In

2008-09-07T00:21:00.001-07:00

When it comes to aggressiveness or other behavioral problems, I want to remind you that sometimes change takes time.

Four-year-old Alex was brought into our clinic by his young parents, who were at their wits' end. Alex had just started pre-school after spending most of his years thus far at home with his grandma and mom.

Recently, Alex had begun kicking, scratching, and pinching other children, including his older brother, in a very aggressive way. The parents had been spoken to by the teacher and informed that Alex might have to leave the preschool if his behaviors didn't improve.

Alex was very angry and letting everyone know. He didn't like being sent to school one bit.

In working with Alex and his parents over a period of nearly a year, there were times when mom and dad came in believing that nothing in their son's behaviors and their relationships with him had changed at all. They also would dip into believing that his behaviors would never get better.

"So he got in a fight with his brother this week?" I asked one day after several months of seeing Alex.

"Yes," Mom replied.

"And he pinched one girl this week?" I asked to confirm.

"Yes, I don't know what to do...he's not getting better!" Mom said, becoming tearful.

"Well, let's think about this," I offered. "Remember when you first came in here. How often was he fighting with his brother?"

"Every day...and lots of times every day."

"So this week he started a fight with him one time?"

"Yes."

"And how many times did he used to hit or pinch the other kids in class?"

"Almost every day?" Her expression told me she knew now where I was going with this.

I then emphasized that Alex was actually doing a lot better than before, and that although it seemed, at times, like he wasn't making any progress at all, it was important to look back at the whole picture and remember where he was starting from. I also stressed that although we all want instant improvement and success, sometimes change just takes time.

This is especially true when it comes to behaviors in young children which are tied to very strong emotions and issues such as separation, loss, moving, or starting at a new school.

After the conversation with this particular mom, in which I also reinforced that she and her husband were obviously working hard and doing something right since their son was improving, a look of relief came over her face.

Improvements that take time...now that's change we can believe in.

Eavesdropping On A Phone Conversation

2008-09-06T00:23:00.000-07:00

Me: I've spent the past two years specializing in working with children zero to five.

Marilyn K. (68 years young): "Aren't we all really just zero to five?"

What's Respect Got to Do With It?

2008-09-05T12:49:00.000-07:00

[Today's post is a response to comments on my September 3rd post about the "Time In" versus the "Time Out." The comments: When does "Time In" cross over into "giving in" and "spoiling" the child? Will it set a precedent that the child will recognize tantrumming as a way to get what he or she wants?]

Part One:
"Time Outs" should not be used with young children under six. And, a "Time In" should not be viewed as "giving in."

When parents respond to a crying, upset, or tantrumming child by soothing him and helping him to calm down (what I call a "Time In") instead of by punishing him, parents are helping the child to manage his emotional state. This process is called "co-regulation."

Co-regulation is a key skill that will allow a child to be successful in different settings including, eventually, the classroom. This is certainly not giving in.

Co-regulation can happen in a number of ways, including by reflecting back what the child feels, empathizing with him, simply holding him, or giving him a hug. The result is that the child feels safe, calm, and contained, which makes it easier for him to then respond to mommy or daddy's directions.

All young children need parents to help them return to a calm, regulated state. Children learn to eventually soothe themselves and manage anger, frustration, and disappointment on their own. But even the most exceptional children can't do this until they get older. And even then, it can sometimes be difficult.

Part Two:
Many of you are familiar with TV shows such as "Nanny 911" and "SuperNanny." I myself watch them on occasion as they do offer insight into the types of struggles that many parents face in raising their children.

The single reason why parents seek out the Nannys' help is simple: their children aren't behaving. Not only are these children not responding to their parents appropriately; they are running the show. These parents are worn down and feeling helpless and desperate.

While "behavioral interventionists" like "SuperNanny," Jo Frost, utilize time outs (or "Naughty Step," as she calls it) and teach parents how to implement them, they actually do something that is even more crucial. In nearly every episode of "SuperNanny" I've watched, Jo points out to the parents that at the heart of things, their children don't respect them and that is why they are acting out.

Jo makes a good point. We have to gain our children's respect in order for them to respond to us and behave as we'd like. And, this needs to happen from day one.

So how do you do this?

Show your child that you love and honor all aspects of who he is, including the little guy who feels that the world is ending because you have to step away to prepare dinner. Don't just praise the part of him that listens to you when he is supposed to listen. Showing him that you can tolerate all parts of him: the good, the silly, and even the "bad," creates a sense of security that fosters love, respect, and the powerful feeling that "mommy and daddy love me -- no matter what."

So what's respect (and co-regulation) got to do with "Time Ins" and "Time Outs?"

Everything.

Hey, keep those comments and questions coming!

Baby's Play

2008-09-04T12:37:00.000-07:00

Recently, I went to visit my friend, Amy, and her new son, Sven, who was just seven weeks old. Amy was adjusting well, had her Excel sheets to track Sven's sleeping and eating cycles, and was thinking about the days when she would be able to get back to her Ironman training again.

Most of all, she was trying to get used to being a mom for the first time.

Amy held Sven confidently and chatted with me about the little things she was noticing about him -- how he had long arms and legs like her but his dad's nose and eyes, that he seemed to usually hold one arm up whenever he was feeding, and that he tended to prefer leaning against her on his left side.

She also told me that she heard that you were supposed to play with your baby but that because he was still so "little," she wasn't sure how to go about doing it.

Playing with a baby even seven weeks old is wonderful fun and not that difficult. It's about cooing back when baby coos, smiling at him, laughing, and making silly faces. It's about making sounds that he responds to with a gurgle, another coo, or a slight wiggle. Then you gurgle, coo, and wiggle your fingers back, both of you filled with mutual delight.

These kinds of interactions are so important for a child to have from his earliest weeks on.

A child develops a sense of self and of the world through his relationships. The back-and-forth between baby and mom or baby and whomever else is of importance to him helps baby learn to recognize different types of facial expressions, stimulates his brain growth, allows him to develop the ability to engage with another person, and lets him try out all the fancy new tricks that his little body can now perform -- like smile, hold up his hand in a fist, and let out a startlingly loud fart.

As Amy and I watched, played with Sven, and realized that day, it's also just pure fun.

Take Time In

2008-09-03T09:23:00.000-07:00

I'll just come out and say it: I don't believe in time outs.

Yet, when I ask parents how they manage their child's behavior, the number one response is, "I give him time outs."

They commonly go on to explain scenarios such as "He was crying and wouldn't listen, so I put him in his room and told him to stay there."

I ask, "Did it work?"

They answer, "No, not really."

Time outs can work for some parents when used judiciously and when the reasons for the time outs are explained and tied to the behaviors. They tend to be less effective when used with younger children, however.

Let's take Steven for example. He is three years old and constantly moving, including jumping out of the car once he's unbuckled from the car seat, jumping off the arms of the sofa, and so forth. It's hard for him to pay attention to his dad (his primary caregiver) or any adult for that matter. It takes a tremendous amount of repetition, including "I need you to walk, use your walking feet!...Walking feet, Steven! Walking feet!" to get him to respond.

One day, a few weeks ago, Steven did not want to leave our therapy play room after his session ended. He began crying and did not respond to soothing as we left the room. In the hallway, he planted himself on the floor and began tantrumming. He was inconsolable.

Some parents might have given him a time out at such a moment. His dad and I did not.

Instead, we took the time to take him into the education center, a room where we keep books, computers, and an art table, and sat together with him on the bean bag chairs.

"I know, I know you don't want to leave," we each told him. As we acknowledged his feelings and let him know we were fully there with him, he began to calm down. Steven stopped crying and asked to pick a book. Then, he asked for the small picture book to be read to him. So, we did just that.

After the book was read, Steven was calm and we were able to let him know that it was time to go home. He got up from the beanbag with dad and hand-in-hand, they began walking.

Bottom line: Try using a "Time In" instead of a "Time Out."

Take time to acknowledge your child's upset feelings and reflect this back to show that you are there with him, you feel what he feels. Staying with him until he can calm down shows him that you love all sides of who he is. Ultimately, this will help you to build a more positive relationship with your child. And, that means a child who is more likely to respond to you when you ask him to please behave.

Children Know Best

2008-09-02T09:17:00.000-07:00

Two days ago, I was at Annie's sixth birthday party next door. The theme was "Perry," meaning my dog. Pictures that her dad had taken of her and Perry were posted up on the gazebo as decorations. A "doggy obstacle course" was set up. Snacks included dog-bone shaped quesadillas. Yes, Annie officially loves Perry.

In the midst of the festivities (lots of excitement), Annie was swinging hard and fast on the swingset, then running and jumping up and down. She had to be persuaded over and over again to join in the structured activities. At times she became irritated (because she wanted to do her own thing and swing!).

At one point when she was swinging, she shouted over at me to "help me push." I went to push her from the back, but she corrected me and shouted, "No, push my feet! Push my feet!"

For a child like Annie, all that movement, especially the swinging and the pressure on her feet, is not only fun; it's calming and organizing both physically and emotionally.

When it comes to movement, children always know best about what they need. So, follow their leads.

If you have a child who is "on the go," loves to spin, swing, and jump, give her activities and opportunities to experience that kind of movement. Try setting up a "crash pad" (a pile of pillows and stuffed animals) she can jump on. Add a big exercise ball she can lie stomach down on and help her roll -- then jump. Swinging and jumping especially stimulate the part of the inner ear that affects balance and can be very calming for certain children.

I'll be writing a lot more about movement, self-regulation, and emotions in the posts to come, so stay tuned! Happy Birthday, Annie!

Meditating on Self Care

2008-09-01T11:30:00.000-07:00

When parents are stressed out about their child's behaviors and issues, one of the most important things I emphasize is self care.

This means making the time to take a walk and exercise, making sure to have some alone (and/or couples time), eating right, getting enough sleep, or calling a friend for support. They're commonsense things that often get thrown out when a family is in crisis or feeling stressed.

Self care is also crucial for all therapists, especially those working with young children. This work can be highly challenging and triggering, such as when a child is screaming, tantrumming, throwing things, and kicking or hitting you. It can bring up a wave of feelings about your own early childhood challenges.

One of the best ways I've found to take care of myself is to meditate every morning. This means sitting quietly, focusing on my breath, and letting thoughts come and go without focusing on them. It's like building a protective cushion around myself for the rest of the day.

There are a lot of different styles of meditation out there, but simply sitting quietly with your eyes closed can often be helpful enough. Research shows that meditation aids in the formation of nitric oxide, which helps blood vessels to open up and lowers your blood pressure.

To Lower Blood Pressure, Open Up and Say 'Om': http://www.npr.org/templates/story/story.php?storyId=93796200

How Does Your Child Grow?

2008-08-31T10:19:00.001-07:00

For many, the term "failure to thrive" brings to mind images of neglected children in Eastern European orphanages and other institutional settings.

In simple, straightforward terms, "failure to thrive" is an impairment in growth.

Every young child's height and weight should be monitored and plotted at regular intervals by their treating physician. It is the clearest way to see if a child's growth has plateaued or regressed. It is the easiest way to assess for the possibility of impaired growth, which can then be addressed through medical intervention. If a child's growth is dropping off the growth curve, questions such as whether the cause is biological or environmental can be looked at and appropriate referrals made.

A great resource in the Los Angeles County area is the Failure to Thrive Clinic headed by pediatrician, Carole Berkowitz, M.D. at Harbor-UCLA hospital. The clinic has been around for over 25 years and they have a great deal of expertise in helping children who are experiencing problems related to growth.

Harbor-UCLA Medical Center
1000 W. Carson Street, Box 437
Torrance, CA 90509
(310)222-3091

An Ounce of Prevention

2008-08-31T09:49:00.000-07:00

Something that continues to surprise me, perhaps because it is not talked about enough, is that so many women I know or am acquainted with, continue to believe that it is okay to drink during pregnancy.

Let me be clear and say this: It is absolutely NOT.

I could link you to a number of articles stating the reasons why, but I'll simply describe some of the children I work with. These include a pair of siblings ages three and four whose mother drank throughout her pregnancy. These boys cannot self-soothe and are hypersensitive to stimulation such as touch and sound (even the sound of grandma singing a lullaby is intolerable). Unable to manage moving through the world, they scream, tantrum, throw toys, and bite. One of them is microcephalic, a red flag for possible brain damage.

Another child whose mother drank intermittently and moderately during pregnancy, is almost three years old now. He struggles to communicate and engage with his mother. He goes from toy to toy and wants to run out of the room. When provided a lot of support and positive feedback, he is able to respond well, but it takes a lot of energy and his mom becomes quickly exhausted from her interactions with him.

We are fortunate to have a Fetal Alcohol Spectrums Disorder (FASD) center linked to our clinic. Many of the children they screen come to us for treatment of severe behavioral and regulatory problems. I particularly feel for these children because I know that many of their challenges could have been prevented. I look at them and see the healthy children they could have been.

The consequences of consuming alcohol during pregnancy can be serious and detectable in newborns and infants. However, in other cases the symptoms are not easily noticed at first. Rather, they manifest themselves in learning and behavioral problems as the child gets older. Is it really worth the risk?

American Academy of Pediatrics: "Because there is no known safe amount of alcohol consumption during pregnancy, the Academy recommends abstinence from alcohol for women who are pregnant or who are planning a pregnancy."

Saying Goodbye

2008-08-20T08:59:00.001-07:00

Hello, and welcome to my blog.

I am a child therapist working in Los Angeles and I want to share through this blog what it is like to provide psychotherapeutic services to children. In an effort to protect confidentiality to the utmost, names in this blog will be changed, no direct quotations will be used, and information may be slightly altered. I will also focus on my own experience of providing clinical services so you can get a feel of my own process as well as the overall therapeutic process when working with children. If this sounds good to you so far, then read on!

I am starting this blog by writing about saying goodbye. That is, in therapy, when we go through a process called “termination” with our patients.

Why is it that no matter how well things are ending, it is always difficult to say goodbye? This morning while I was meditating, I began thinking about a 10-year-old boy I had a final termination session with yesterday. I call him “The Big-Headed Boy” because he when I first met him, he was so thin and small, his head appeared almost too large for his body (I’m glad to report that he has grown into his head over the time that I have seen him. But that’s another story!).

We had been working together approximately 14 months. Like many of the children I see, he was initially brought in because he was physically abused by his father. The boy and I had been able to work through much of the trauma in that time. We had developed a good relationship. Through therapy, he had learned ways to feel less anxious and generally safer in the world. He had learned to be more assertive and to stand up for himself, including most recently by speaking up and telling his mom that it was embarrassing for him when she said certain things about him in front of other people. He was still a shy and anxious, sensitive boy but he’d also grown tremendously. It was wonderful to see this transformation and it was time to say goodbye.

We sat and made goodbye cards for one another with colored construction paper, markers, pencils, and sea life and puppy stickers. He worked slowly, thoughtfully, and as I could see on his face, sadly. When it was time to exchange the cards, he said he did not want to read what I had written for him. He was saving it for reading at home. There really was no reason to explore this with him. No “What makes you want to take it home to read on your own?” business. I knew. It’s just too sad. So, I also agreed that I would read his message privately after he left. Then, I verbally shared with him what I had written in the card I’d made for him (without telling him that I had written such things in the card).

Having to end therapy with my patients has taught me a lot about goodbyes. I’ve learned that I really hate goodbyes (as I have hated them since I was a child – goodbyes were loaded for me, but again, that’s another story we’ll possibly get to later), and will probably continue to always find them to be difficult. No matter what. However, as we all know, goodbyes are also necessary and provide the child with the healing experience of a positive ending where they can say what they feel and have the other person know and honor those feelings.

For me, it’s important to tell the kids I work with that they have given me a gift. I tell them how lucky I have been to know them, to have watched them change, grow, get better, have more courage, become less scared. Then, when they leave the therapy room and move into the next phase of their lives, even if they are only 10 years old, it is my hope that they can do so with greater sureness and a well-filled heart.