That Gut Feeling

We have all heard that phrase. But what does it mean? New medical information tells us that there is constant communication between our guts and our brains. We have all felt “butterflies” in our stomachs when we are nervous. How our gut feels often influences how we feel or perceive situations. How anxious we feel often effects how our stomach feels.

Many children, especially between the ages of 4 and 10 years, have recurrent abdominal pain. This pain rarely has a serious source or cause. But the children’s stomachs hurt and the pain makes them anxious. Also their anxiety makes their stomach hurt. As pediatricians we often do some preliminary screening tests to rule out disease but if those tests are normal and the child is growing well with normal stools then the next step is to try to decrease the anxiety in our patients. We can reassure the family and child that there is no serious illness going on. Which when you stop and think about it, is really good news. Most children will have the stomachaches off and on and the treatment will be to stay in school, use a benign medicine such as Tums and know that the pain will pass.

Making sure that your child is not constipated can help limit their pain. They should have a bowel movement at least every other day if not daily. Miralax or mineral oil and stool softeners can help achieve this stooling pattern. The family can pay attention to any foods that trigger a stomachache. Many children become lactose intolerant at these ages and will do better with cheese and yogurt, foods in which most of the lactose is broken down, than with milk. Many high fructose foods and candies can trigger stomachaches. These are chewy candies or fruit roll ups. In my house licorice was often the trigger.

While it is important to understand that we should take care of our gut it is also important not to obsess about everything we eat. There is new information that extreme diets or even restrictions of normal foods, i.e. gluten when the child does not have celiac, can harm our health.

Probiotics and meditation and other relaxation techniques can be helpful. Sometimes just practicing taking a few slow deep breaths can be soothing.

If there are many stressors in a child’s life or if the abdominal pain worsens, professional counseling can be helpful.

The main point is to listen to our guts, respect our guts, but do not worry too much about pain in an otherwise healthy person. A great 15 min TED talk about the gut can be found at the following link:

 

 

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Black and White

“No one is born hating another person because of the color of his skin or his background or his religion. People must learn to hate, and if they can learn to hate, they can be taught to love, for love comes more naturally to the human heart than its opposite.” – Nelson Mandela

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Last weekend my eight-year-old grandson stayed with me—our first weekend without mom in a long time. I sat next to him while he fell asleep. Adults know that there is really nothing more peaceful than watching a child sleeping. I think of the times I watched my son sleep like this. And I think of the different lives these two people will have. How different the world will see these two young men. My grandson is a person of “color”. But really so are all of us—my color is just fairer. And with that lighter color the world grants me more privileges. I’m not assumed to be wrong or causing trouble or dangerous. My son was given the benefit of the doubt. My grandson will not start with that assumption.

Police and security people often question famous black men. Just ask Trevor Noah or James Blake, a tennis star who was tackled and arrested in a hotel. All people aren’t given the same presumption of innocence.

One day when my grandson first started living with us he turned to his aunt and said, “I use to be black.” At that time he was still trying to figure out who was white and who was black. He didn’t see the world divided up. I wonder how I will help my grandson carefully navigate this world. At 5 he couldn’t really see the difference in our colors. Now at 8, he is sometimes painfully aware that he is black first, an adorable child second.

Back to School

As fall approaches, whether we have kids or grandkids or nieces or nephews we all think of this time as “back to school”. It is in our advertisements. It is on the news. It shapes our sports viewing. This seasonal change has become insinuated into our bones.

Parents are bustling around getting young children situated in their classroom and outfitted with the all the their supplies. There is the parenting angst of getting older children through postsecondary stages—college, first jobs, vocational schools.

At this time we are often reliving both our successes and failures in our own transitions. I think it is important to remember that this is not our chance to relive our lives. These stages do belong to our children. In his “Parenting with Dignity” Max Bledsoe states that at age 2, we are making 80% of the choices for our child (not 100% as some people feel). By age 16 that is ratio is reversed and we are making only 20% of the choices. By age 18, we are not really in charge. This independence is tough for parents and for children. They often come into my office at age 18 not knowing what medicines they take or key points of their health history. This transition happens over time but also happens abruptly. After age18, we can’t share information with parents without written consent from our patient. Colleges cannot share grades with parents without permission.

As your child goes from 2 to 18, stop and think about preparing them for their independence. Give them appropriate choices and let them live with the consequences of their actions. Congratulate their successes. Commiserate with their failures. Their success and happiness is wrapped tightly around our hearts but don’t burden them with our angst or confuse ourselves on whose life is it anyway.

The Power of Words

What we say to people stays in their heads. When I was a little girl my older brother constantly teased me and said that I was fat. I was convinced I was fat. When I looked at my childhood pictures as an adult, I was surprised to find I was always lean. When I asked my mother why she didn’t stop my brother, she was surprised to learn that I thought I was fat and was mad that she hadn’t told me that I wasn’t. To her, it was such an obvious untruth that there was no way I thought I was fat. But I believed my older brother…

Words are very powerful. The way we talk to our children or about our children influences what they think about themselves. When parents tell me their child is stubborn, I say, “Let’s call them persistent.” Let’s encourage them to use their strengths to succeed—even if they can’t change our minds this time.

Stop and think about the last time someone criticized you or hurt your feelings. Did you later learn that they were right or wrong?

The hardest job as a parent is to focus on when our children are succeeding; to use encouraging words for their struggles; and to listen to their fears or misconceptions and to help them see things more clearly.

New Dog Training:

I’ve become fascinated by how much dog training has changed in the last 40 years. That is the last time that I did serious dog training—including taking my miniature poodles up to Championship status in Obedience Competitions.

Fifteen years ago I trained my standard poodles—and after 14 years, finally got them to walk without pulling me off my feet by using a constant treat technique of giving them a treat more or less every 10 feet—I call it the Pez technique. This latter technique of almost persistent rewards and positive interaction is the new way of training dogs.

This year, I was given a crash course in positive interaction when I took my Labra doodles to class. The most notable changes in the class were not the dogs, but the approach to training. No longer was “jerk (on their collar) and release (the negative tension)” considered the best training method.

We used praise and treats to motivate our dogs to learn and man, did it motivate them.

When I started pediatrics 30 year ago the new approach to child rearing was logical and natural consequences with lots of “time-in”. Positive parenting concentrated on what your child was doing right and redirected them when they needed to substitute a bad behavior for a good one. This system was in contrast to the old approach of “spoil the rod and spare the child”. The acceptance of an approach to positive discipline for children has been much slower than that of dog trainers. We still hear the concept of what is wrong with children is that they are never told “no” or given a spanking.

We are told that we need to scare juvenile delinquents “straight”. But research has repeatedly shown the children who misbehave the most have been treated poorly—spanked or yelled out. Most juvenile delinquents have been subjected to abuse and neglect not coddling–not taught the logical consequences of their actions, nor shown a more positive approach to living.

Both children and dogs need discipline—but effective discipline is consistent and loving and involves teaching better behaviors. Limit setting such as time-outs or loss of privileges works if those disciplines make sense. When a child is being aggressive or destructive they need to sit by themselves and calm down. When a child can’t remember to wear their bike helmet, they need to loose the use of their bike for a defined period of time-a few days or so until they again get the opportunity to make a better choice.

Modeling good decisions and behaviors is the best way to teach your child or “be the person you want your child to be.”

Successful Parenting Approaches:

Parenting approaches fall into 3 main groups.

An authoritative or punitive approach is firm but not respectful of the child. It punishes without teaching better behavior. This approach is the classic “spare the rod, spoil the child”. Parents often use this approach because it is familiar and easy. Parents say do this and the child, being a dependent being, should do it. But humans are not made to do exactly what they are told. The best, most compliant child will only do what they are told to do about 75% of the time. When the child doesn’t do exactly as told, the parents have no “Plan B” except punishment that rarely results in sustained good behavior. How many times have you seen a parent repeatedly slap a child’s hands or roughly see them put a child in a chair and say, “Sit there”? Sitting quietly (without something to do) for more than a few minutes doesn’t work well with children or adults (without their smart phone). An “aggressive researcher” will rarely do what they are told to do without researching other options.

A permissive approach is respectful of the child but not firm. These parents make suggestions on behavior but have no way to enforce their requests if the child doesn’t agree. These parents tend to whine to their children when their children don’t take their suggestions.

A thoughtful approach is respectful and firm. The parent helps the child think about the consequences of the child’s behavior and then follows through with the consequences. These parents understand that their children are human beings with their own understanding of their needs and their goals. But the parents also know that some things are not negotiable and when they make a specific request they have a plan of action for the child to do that request. My grandson understands that he must wear his helmet to ride his bike. If he doesn’t wear his helmet, he will not have his bike for a specified period of time.

I’ve often said that parenting is a thinking game. When you ask your child to do something, whether they are toddlers or teenagers, you need to think about how they will process it, how their temperament predisposes them to react to the request, and what your actions will be if they don’t do it. Planning is everything.

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Temperament

Any study on childhood behavior starts with having parents fill out a checklist that reveals their child’s temperament. Basically, your child comes with a “blue print” that is hard wired at birth. This is the “nature” part of a person, which will be molded by the “nurture” part that is their life experiences. People tend to have one of 3 main personality types:

Fifty-five percent of people are compliant and easy. About 15% of these can be slow to warm up and cautious. These people are interested in pleasing others and getting along.

Strong willed or persistent people—sometimes called “aggressive researchers” are about 10 % of the population. These people are always pushing the limit before deciding what they want to do. They will repeatedly test a rule to see if it still stands.

About 35% of people are Fence sitters or observers: These people will sometimes side with the strong-willed or the compliant people. They are “skillful researchers”. They’re deciding which is the smartest path for them.

Most human beings are on a spectrum or combination of these personality types. Understanding your child’s temperament as well as your own is key to parenting your child successfully.

Think about where you and your child are on these spectrums and next we will talk about successful parenting approaches.

*For more detailed information, check out Robert MacKenzie’s “Setting Limits with Your Strong-Willed Child”.

Routines

 

Oh…routines. We drink the same cup of coffee, park in the same place at work, and sit at the same desk. Churchgoers frequently sit in the same pew each week. My dogs know which one goes first for the walk. Children use routines to navigate their world. When our routines get changed due to moves or job changes or illnesses, our children’s lives get completely out of whack. If your child is having trouble with mood or behavior, see if their routine has been disrupted. Something may have changed in their lives that you are not aware of: a substitute teacher or a friend shifting alliances or a new seat on the bus.

Vacations are one way of practicing changes and variations in routines.  They generally make us appreciate going back to the familiar.

Prepare your child for changes in routines: expect some difficulties. Remember that routines calm us. Offer your child other tools to calm down when routines change—try to find a few things that can remain the same.

Embrace the new and hug the old.

Chores

This is a topic that has more answers than successes. I often tell parents that “go clean your bedroom” is a really daunting task and to look around their bedroom and think how they would feel if someone told them to clean it.

Children (and maybe all of us) do better with specific tasks—put your dirty clothes in the hamper, make your bed, etc. Much of the time “too much” is the biggest problem. Too many toys or shoes or clothes. Just thinning stuff down will help a lot.

Try to model the behavior you want. Hang up your clothes and coat.

Have simple places to put everyday items. Walk your child through their chores rather than just keep yelling at them about their chores. Concentrate on every time they do what you want them to do.

Comment on how peaceful a clean house is and how nice it is to find stuff where you know it is suppose to be.

Most experts agree that tying allowance to chores is not helpful. We do chores because that is part of living and part of being in a family. Allowance is a chance to learn how to manage money and is most appropriate starting around 8-10 years. This age is late to start with basic self-care that is the primary reason for chores.

Not Tired Anymore

In honor of the holiday season, I’m starting a new campaign. Let’s not be tired anymore! This slogan started as a joke with a co-worker when we were discussing how to evaluate a patient who was “tired”. We thought for a minute and then realized that everyone we knew—friends, family, coworkers, patients and ourselves—were frequently complaining about being tired. Perhaps that complaint is a constant of the human condition. My mom’s doctor gave her the diagnosis of “Chronic Fatigue Syndrome”. This is usually a diagnosis given to younger people who have debilitating fatigue. My mom is 90 with heart disease and is the primary caretaker for my dad who is 94. She has reasons to be tired. I imagine all her doctor’s patients carry such a diagnosis.

Despite an occasional night of sleeplessness, I’ve decided to feel good and be full energy. Maybe we can all brainwash ourselves into feeling better or at the very least, recognize the days we feel good!