Wise Parent, Healthy Child: A Practical Guide to the Gentle Art of Childrearing

By Maria R. Burgio, PhD

Today’s headlines about the actions of twenty-first-century children tell us that they are in distress. Unusual behaviors surface as disobedience, failure to learn, anxiety about socializing, excessive excitability, and inability to follow directions. What can parents do?

In this guide, Dr. Maria R. Burgio reminds parents that while many behavior problems are part of growing up, they must distinguish between normal behaviors and those that require help. She explains how children normally develop from infancy through adolescence and provides worksheets for tracking behaviors and identifying problems outside the normal range.

Dr. Burgio also identifies the special challenges of parenting twenty-first-century children, discussing topics such as sexual activity and substance abuse in children and adolescents, as well as how social media can effect social development.

As a twenty-first-century parent, you must get the information you need, for a wise parent is the key to a healthy child.

• Language: English
• Publisher: Lulu Publishing Services
• Release date: Feb 4, 2014
• ISBN: 9781483400792

Book preview

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Wise Parent,

Healthy Child

A Practical Guide to the Gentle

Art of Childrearing

Maria R. Burgio, PhD

Clinical Psychologist

Copyright © 2008, 2013 Maria R. Burgio.

Cover Art work by Justin D. Wolkoff at age 7, brownstown in Carroll Gardens Brooklyn Photo by Emily G. Wolkoff

All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means—whether auditory, graphic, mechanical, or electronic—without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

ISBN: 978-1-5698-0343-1 (sc)

ISBN: 978-1-4834-0079-2 (e)

ISBN: 978-1-4834-0790-6 (hc)

Library of Congress Control Number: 2014901285

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Thinkstock.

Lulu Publishing Services rev. date: 01/29/2014

I dedicate this book to my children, Justin and Emily,

whose diverse lives molded my parenting and shaped

my character in ways I never thought possible.

Contents

Foreword: Allen S. Chroman, MD

Preface: Why I Wrote This Book

Acknowledgments

Part I: Parenting

Introduction: What Is this Parenting Journey?

Chapter 1   What Parents Worry About

Chapter 2   First Lessons of Good Parenting

Chapter 3   Parenting Styles

Chapter 4   Discipline

Chapter 5   Seven Everyday Problems and How to Solve Them

Part II: Your Healthy Child

Introduction: What Is a Well-Adjusted Child?

Chapter 6   Your Normal Infant

Chapter 7   Your Normal Toddler

Chapter 8   Your Normal Preschool Child

Chapter 9   Your Normal School-Age Child

Chapter 10   Your Normal Teenager

Part III: What to Do about Problem Behaviors

Introduction: When Everyday Problems are Not Normal

Chapter 11   Behavior of Troubled Children

Chapter 12   Getting Help when Your Child Has a Serious Mental Disorder

Chapter 13   The Ten Most Common Childhood Disorders and How to Treat Them

Chapter 14   Less Well Known Child Disorders and their Treatments

Chapter 15   Substance Abuse in Children and Adolescents

Part IV: Understanding Well-Adjusted Children

Introduction: How to Rear Well-Adjusted Children

Chapter 16   How Our Present-Day View of Development Explains Adjustment and Maladjustment in children

Chapter 17   Genes, Biology, and Psychological Causes of Child Behavior

Chapter 18   Having a Healthy Family and Good Friends

Chapter 19   Healthy Communities and Healthy Children

Chapter 20   Psychological Functioning

Part V: Finding Help for Your Child

Introduction: What You Should Know About Psychotherapy

Chapter 21   Treatment of Children’s Emotional and Behavioral Problems

Chapter 22   Should Children Take Medication?

Chapter 23   The Future of Diagnosis and Treatment

Chapter Notes

Appendix A: DSM-IV-TR

Appendix B: Child Developmental Psychopathology Model

Appendix C: Finding Help for Your Child

Appendix D: Finding Support Groups and Other Educational Material

Appendix E: Clinical Forms Used in Behavior Therapy for Children

Appendix F: Sample Behavior Management Plan

Appendix G: Professional Organizations

Appendix H: References

About the Author

Foreword

Allen S. Chroman, MD

I find myself writing this introduction to Dr. Maria Burgio’s excellent new book, Wise Parent Healthy Child shortly after receiving my copy of the new DSM V, a manual which represents the collective reasoning of the leaders of psychiatry and psychology in the Western World. The current manual’s framework is a snapshot of the ongoing process of evolution in the development of our science. It mirrors, remarkably, a Talmudic description of the ongoing process of creation,

In The Beginning God created letters. God sends these letters down to Man. The Work of Man was then to construct these Letters into Words and Prayers which are then sent back to the Heavens. The Words and Prayers are then deconstructed into Letters which are again sent back down to Man.

Thus we are an essential and irreplaceable part of the ongoing process of Creation. Early on in human development, there was behavior, most of which was purposeful in the service of survival and procreation. Soon more complex behaviors began to form including behaviors of social affiliation, leadership, and deference. These behaviors continued to evolve in ever increasing complexity from family units, to city states, and on to great nations spanning the globe; from neural nets to social networks. Within this process there is also the ever important need for deconstruction to find and understand, again, our own individual identity and humanity. In the midst of the early evolutionary process, humans developed the remarkable capacity for consciousness, namely, the ability to be aware of one’s Self and to be aware of the differences of others. We learned to observe behavior and develop insight. As a consequence of this process, there arose the awareness of the concept that some things just aren’t NORMAL, adaptive, functional, or whatever term you chose to use. The Work thus became that of organizing the component ‘letters’ of behavior into words, identifiable and diagnosable syndromes for the purpose of understanding, codification and research, but not necessarily to define or limit specific treatments or interventions. The Work of clinicians and therapists is to deconstruct the syndromes into more human and humane terms for the purpose and treatment of healing.

In Wise Parent Healthy Child Dr. Maria Burgio takes us on a parallel journey of understanding. Individual behaviors are recognized and organized as the process of child development, an understanding of the progressive works of a child’s journey in life toward independence and adulthood. She then deconstructs this process into identifiable ‘Letters’ as units of behavior, some of which are normal and some of which are not. The simple and sometimes subtle differences, for example, between a hug and a headlock, both physical and psychological, are examined toward the goal of reconstruction back into a more normal functional and adaptive development. Dr. Burgio also gives a glimpse into the future in her discussion of Genomics. The Human Genome Project succeeded in mapping our DNA, a series of independent ‘letters’ or nucleotide pairs constructed into the double helix of our genetic code. But what does this really mean? Will we ever be able to diagnose behavior from nucleotide pairings? The answer for now, and for the foreseeable future is no. Genes do not code for diagnosis and behaviors. Genes code for the elaboration of proteins. The presence or absence of specific genes codes for the presence or absence of specific proteins. The issue of Genomics is whether these proteins, by virtue of their presence or absence, affect neural network functions which might coalesce into behavioral changes. The behaviors can then be identified and diagnosed as syndromes which are then deconstructed into more target directed treatment. An example of this is that a variation in activation levels in brain circuits controlling what is attended to as important and what is ignored as insignificant is seen as a core function in syndromes as divergent and similar, as Obsessive Compulsive Disorder and certain chronic pain syndromes. The dysfunctional networks can be visualized utilizing recent advances in functional Magnetic Resonance Imaging (f-MRI). The goal of f-MRI research is to better understand the organization of altered neural functioning, in order to identify syndromes and diagnosis which can then be deconstructed into more accessible targets, whether behavioral, psychological, pharmacological, neurodynamic or in combination.

Wise Parent Healthy Child is a guide book for parents seeking an understanding of the ongoing process of creation within our children and in our families. ‘Letters’ of child behavior are coalesced into an understanding of child development, some normal and some not, and back into more discrete behaviors for intervention and redirection back to health. Dr. Burgio presents this with the fine perspective of an accomplished clinician, and a loving parent.

Thus the great Work continues.

Preface

Why I Wrote this Book

When I brought home my infant boy from the hospital, I was stunned to have gotten my wish, a perfect son. He had blond hair and a beautiful face. The picture the nurses took at the hospital showed my tiny treasure in a sterile cotton tunic, which the nurse later told me had been pulled over his tiny hands because he was scratching himself. I often look at that picture now, and I can see his anguish. The fingers of his hands are pressed against the sides of his head so hard that they bend backward. It’s as if he’s holding his head to ward off the world. He looks miserable and preoccupied, the two emotions that haunted his short life.

He died the night after he’d been released from yet another hospitalization for depression. Although the doctors said he died of respiratory failure linked to a viral infection, I am convinced that my son had lost his will to live. He succumbed to a strange spiritual illness that overtook him within twelve hours of his discharge from the hospital. He was twenty-four years old.

I have not stopped seeking greater understanding of what happened to my son’s life. When I look at pictures of him as an infant and toddler, I see recordings of his sadness and anger. Of course, I see those pictures now from the eyes of a psychologist, not just the ever-wishful eyes of a mother.

It wasn’t until Justin was a teenager—after I had received training in psychology and child psychopathology—that I realized that my son suffered from one of the most debilitating forms of depression, atypical depression. It took years to learn this diagnosis, years of constant worry, of scouring a three-state area for doctors and treatment centers, of listening to the various diagnoses and recommendations for treatment, and of praying to God to spare my son his suffering.

What were the markers of his depression? I had become a child specialist, and the study of child development told me what to look for. There were signs of illness throughout the stages of his growth that I now recognize because of my training.

When Justin was eighteen months old, he skinned his knee and began crying hysterically, but he did not seek me out for comfort, even though I was standing in front of him, calling his name. I remember calling his name and watching as he ran in a circle, as though no one in the whole world could console him.

When he was five, the kindergarten teacher said he spent more time under his desk than sitting in his chair. She recommended testing. His father and I were shocked to learn that he had an IQ of 149. But his intelligence could not explain his withdrawn behavior.

In first grade and second grade, Justin did not spend much time playing with other children. Even though he was in the public school’s program for gifted students, he hated going to school. Getting him there was a daily struggle.

Justin needed lots of stimulation, but he had a hard time complying with rules. He seemed bored at school, yet he was a voracious reader at home. He developed an obstinacy that I thought was willfulness and stubbornness, qualities that we joked about as Sicilian, our shared ethnic origin. I later discovered from my studies that this irritability accompanies states of depression.

When he was eleven, I found him sleeping in the trunk I’d bought him for summer camp. He’d had difficulty falling asleep for the past year, so I passed it off as tension and being overtired. The summer he turned thirteen, he began to have serious symptoms of hypersomnia, or sleeping too much. On a two-week trip to California with friends, he slept all night and most of the days. They left him in the car when they needed to run errands; waking him made him angry, so they just let him sleep.

Like most parents with difficult children, I did everything in my power to help my son: special summer camps, family camping in state parks, trips to his aunts’ houses, after-school play groups, and private school for third and fourth grades. I moved from the rush of New York City to a quiet upstate New York community.

Like many parents, I was also in denial about my son’s difficulties. When his therapist recommended a school for the emotionally disturbed, I dropped the man, refusing to believe that my intelligent son might not go to Harvard. I finally realized that, with my high expectations, I was creating additional pressures for my son.

I began to feel like a failure as a parent. I found myself questioning my actions and whether I was sufficiently prepared to rear a child. What was I doing wrong? What was I not doing right? I often wished that I had finished my training as a psychologist when Justin was a baby—maybe I could have helped him sooner.

We turned to medication when Justin was in eighth grade. He started the school year with high hopes, determined to get up each day for his classes, complete all his homework, and have a great year. But by winter, with its long, gray days, his sleep began to interfere with getting up on time or catching the school bus. After Christmas and New Year’s, he began to stay up all night, practicing his guitar. One week, he missed four days of school. In March, I took him to the hospital, just in time for his fourteenth birthday. The struggle to find the right combination of drugs began, and by the time he died, it seemed he had tried every drug imaginable.

Each doctor saw and treated different symptoms. When Justin was first hospitalized, sleep was the primary problem, so they put him on tricyclics, such as doxepin and trazodone, to cause drowsiness. Of course, medicine that makes a child sleep does nothing for the depression he fights throughout the day.

The available medications for depression back in 1989, when Justin was first hospitalized, did not include today’s selective serotonin reuptake inhibitors (SSRIs). So doctors relied on drugs that had a lot of side effects, such as hand tremors and constipation. Because of these side effects, Justin hated to take them—even though they helped with sleep and a good night’s sleep made him less irritable. But he was still depressed and had no motivation. The doctors then put him on stimulants to increase motivation, but stimulants made him restless. Then the doctors prescribed lithium to stabilize his mood swings. Justin would go from being irritable and belligerent to being lethargic and unresponsive.

Finally, the serotonin drugs became available; but Justin’s symptoms were so complex that one drug never did the job. He needed medication for sleep and medication for energy. He needed behavior therapy to help him control his oppositional behavior and cognitive therapy to help him take responsibility for his illness by complying with his treatment. The medication and therapy nightmare never seemed to end. And the endless assortment of doctors with their own brand of medicine and recommendations for treatment frustrated both Justin and me.

The worst year was 1997, when he was hospitalized three times. (Research shows that with every hospitalization, the chance for future hospitalization increases.) On February 22, 1997, my mother died. He never recovered from losing his beloved grandmother. He was unable to move through the stages of grief and acceptance. So he slept, starting with the day of his grandmother’s funeral and ending with his final illness and death two years later. His grandmother had died of cancer: I believed that Justin had died from life.

It should be clear by now why I have chosen to write this book. I hope to help other parents and their children avoid the suffering that Justin and our family experienced. Fortunately, I am blessed with a healthy, normal daughter from whom I have gained other insights. I hope my experience as a mother, my academic and clinical training, and my twenty years of working with children’s emotional and behavioral disorders will serve my readers well. It is my sincerest hope to guide and educate parents so they can respond more quickly and in a more informed way than I could with Justin.

My training and professional experience have taught me that early diagnosis and treatment can prevent the devastating effects of the illness. But even with that diagnosis, parents will have to face other challenges, like a confusing array of treatment options.

This book is for helping parents and other caretakers to recognize the symptoms of childhood emotional and behavioral problems and make more confident decisions about their child’s treatment. With this knowledge, I hope your children will get the treatment they need and go on to live full and productive lives.

And in the end, the love you take

is equal to the love you make.

—The Beatles

Acknowledgments

Although my thinking about children’s normality was first inspired by my professors at New York University—where I studied with noteworthy developmental specialists, Drs. Louise Kaplan and Cynthia Deutsch (who ultimately served as my dissertation committee chair), and other brilliant psychologists—I began to organize my thoughts about Wise Parent Healthy Child during 2002. At that time, I had moved my practice to Los Angeles, continued my pharmaceuticals training, and discussed my ideas about children’s behavior with many colleagues, including the faculty at the UCLA School of Medicine, where I held the position of assistant clinical professor in psychiatry and taught doctoring to second- and third-year medical students from 2002 to 2007. These conversations helped to crystallize my thinking about the treatment of problem child behavior and family mental health.

The UCLA doctoring faculty meetings, led by Drs. Arthur Gomez, Paul Henderson, and Joshua Chodash were always supportive of faculty inputs, allowing me to proffer the developmental perspective to medical students learning about their future patients. Although there are too many to list, the physicians and mental-health professionals dedicated to medical education are exemplary and caring people, with a need to affect the future of the practice of medicine. I was fortunate in being able to work with these fine people.

I would like to acknowledge Dr. Allen Chroman for his generosity in writing the Foreward. He and I opened a psychiatric office in Los Angeles, and it was he that sparked my creative drive by believing in me. His insights about psychiatric illness are so important to many topics in Wise Parent, Health Child. He remains a great listener and supporter.

Many thanks to Noel Riley Fitch, my professor of nonfiction at the University of Southern California, whose timely and helpful editing of the original text and emotional support of my early writing days at USC will always be remembered.

The behind-the-scenes technical work certainly deserves mention. For their editorial assistance of earlier versions of this parenting book, I wish to thank Marla Miller and Robyn Levine.

There were several personal friends without whom some of the material would not have come to light. I want to thank my close friend and cofounder of G6G Consulting Group, Allan Shapiro, whose background in information technology and native love of neuropsychology were instrumental in inspiring thoughts about genomics. Brilliant and curious, he scoured the web for scientific information; he then developed a self-taught literacy about the biochemistry and structure of the brain which helped shape the last few chapters in this book. Our lively conversations during long walks on the Santa Monica bluffs will be always cherished.

Finally, I want to thank my closest friend, Dr. Gunilla Karlsson, whose support during my years of self-exile to Los Angeles always kept me on task in all my professional endeavors. In addition to being a loving friend who listened to my personal woes, she fed my belief that I would become a writer of books by her praise of my medical reports for her practice.

Part I

Parenting

Introduction

What Is this Parenting Journey?

My friend Amy, a poet who lives in New Hampshire, recently e-mailed me asking for a summary of my views on parenting. Amy said she’d write a one-line poem for my book. I e-mailed her the following main points of this book:

Pay attention by active listening.

Take the child’s perspective.

Guide with love.

Be aware of their evolving needs.

Allow them to become the best persons they can be (not the persons we want them to be).

Children are God’s gift, on loan to a parent.

You grow them like a garden, and you send them off with pride.

And it’s the hardest job in the world!

This message so plainly grasps the heart of wise parenting and child development that I decided to use it as an introduction.

Pay attention by active listening.

Loving them right means we need to pay attention by active listening. Active listening is different than just listening. It means we hear what the words mean, not just what the words say. For instance, on the playground your toddler’s No! Stop! may mean he is afraid or angry, depending on his personality and the situation. Your ten-year-old’s yelling, I won’t wear that. I hate it, may mean she’s been criticized for her fashion sense at school, or she’s comparing herself with the popular girls. Active listening will help you figure it out by asking questions like, What are the other girls wearing? or What do the popular girls look like? The way you react and answer will communicate to your child that you’ve understood. If children believe you are listening, they will talk about themselves and their feelings.

Take the child’s perspective.

It’s challenging and important to see the world through your children’s eyes. Showing them that we care and understand something their way affects children in a few ways. First, we are teaching them empathy. It means they realize that everybody can have a different opinion. They also learn to trust that we believe their feelings are important. We prove the importance of their feelings.

Swiss developmental psychologist Jean Piaget’s studies of the world as seen through the eyes of actual children tell us how children’s thinking changes as they mature (note 1). Be ready to see the world their way as it changes over time. For example, infants’ minds operate according to the old proverb, out of sight, out of mind. Because their underdeveloped brains cannot store memories, they forget that a toy or their hat exists because they don’t see it. Likewise, a four-year-old may be afraid of a monster under his bed because he cannot separate what exists in his imagination from reality.

Seeing the world through five-year-old eyes can add humor to our lives. My five-year-old cried hysterically because he thought his teddy bear would suffocate if I put it in a knapsack for his trip to Grandma’s house. In this situation, I had to believe him—in his world he was right. Telling him I understood, I made sure to give the teddy room for breathing as I tucked it inside the front of his jacket.

Older children’s predicaments may be harder to understand through their eyes. For example, what if your nine-year-old comes home from school saying she hates the popular girl who’s rejecting her? You might be tempted to say, Oh don’t be silly; she doesn’t hate you, or So hate her back. The healthier solution is to say, Honey, it’s normal to feel hurt when someone is rejecting you. Then, help her to understand how some people need to feel important and that this can make them cruel. Ask her opinion: Can this popular girl be the good friend you want? If she is cruel, do you really need her as a friend?

Explain how important it is that humans care for one another and accept each other for who they are. Tell her that all persons are worthy of being loved for who they are—in spite of their color, race and religion, how they dress, or how attractive they are. Most nine-year-olds can understand discrimination, and it is a good time to teach them the value of human life.

Most importantly, be proactive. Peer groups start being very important in elementary school, so start watching who their friends are in first grade. See your child’s world through her stories. What is she feeling when she tries to make friends? (For more on this, read chapter 9: Your Normal School-Age Child.)

Guide with love.

Loving guidance is the most humanitarian act we carry out as adults, both in parenting our children and in caring for our friends or partners. It means we love our children by guiding each one to a solution that works for him or her. Each child deals differently with situations that make him or her angry, disappointed, and frustrated. Psychologists call this coping. Children who can cope have a life skill that keeps them emotionally and mentally healthy.

When their feelings are hurt, we need to remind our children that it’s natural to feel anger. They should not feel guilty about being mad, but they have to settle their anger in healthy ways. Say: Sure it doesn’t feel good to be belittled. Let’s think of a good way to fix it. Depending on how hurtful the cruelty is (e.g., name calling versus physical threats) have your child talk about possible solutions that feel right, like ignoring, calmly telling the cruel kid to stop, or trying kindness. Then, be available when your child comes home after the encounter. Ask him how it worked. And actively listen.

A child who wants to get even with a cruel kid on the block needs careful loving insight. Someone is belittling your child, and he wants to hurt back. Loving guidance helps your child walk in the other child’s shoes. Help him understand that the cruel kid may be undergoing mistreatment by someone else and is passing it on. Do you want to become like this cruel kid, or do you want to do the right thing? Guide him to solutions that rid him of anger. Help him treat others with compassion.

The benefits of parenting with sound, loving guidance are seen in how your children react to toxic emotions and work through them. We help children give up bad feelings and still keep their self-respect. They also need to be guided without blame or guilt. Children need to make a choice because it’s right, not out of guilt.

Be aware of their growing individual needs.

Child-centered parenting is at the heart of parenting effectively. Remember to use child development as a guide. Each of our children is born to evolve and grow into an individual. Parenting must change to allow for each child’s growing needs over time. What works for one child will not work for another, and what works during one period of a child’s life does not work at another. Information in part 2: Your Healthy Child explains what happens to children during each age span. As their bodies, emotions, social skills, and thinking change over time, they become more and more complex.

As we become aware of their growing needs, we become more child centered. This means that children’s needs are at the center of parents’ lives, and parents regularly check to see if they’re meeting these needs. For example, knowing how important peer groups are for children’s development, we don’t move to another school district during the school year. If our jobs demand it, we relocate at the end of the school year. Better yet, if at all possible, we take a stable job so we don’t move during the children’s school years. Disruption is very painful for them; becoming emotionally and socially stable is easier if they remain at the same schools and live in the same neighborhoods.

Knowing about normal changes at each stage of our children’s growth makes us more effective parents. A good example is how their need for sleep changes. Most newborns reverse their nights and days, sleeping more during the day and being up at night. In the early months, babies sleep from feeding to feeding. Eventually, they stay awake during the day but take several naps. By the end of the first year, some infants may sleep as many as fourteen to fifteen hours a day, while others may sleep ten to eleven hours. A two-year-old may sleep ten to twelve hours with one or two long naps. By the time they go to first grade, most children go to bed around seven thirty and get up at six thirty in the morning for school. These general times work for most children, but not for all of them. Needs for sleep are different for each child. Pay attention to the changes in your children’s needs as they grow!

Allow them to become who they are:

discover your child’s nature.

We come to parenting with our own beliefs and expectations. It’s easy to mistake our wishes and hopes for those of our children. Many times, it’s hard to tell the difference between our needs and theirs. We may believe five- year-olds must have piano and dance lessons to become cultured—but must all five-year-olds have these lessons? Can’t we give our more introverted children culture some other way? Of course we can.

We could push our personal aspirations on them without knowing it, because we may not consciously know our hopes and dreams for them. This can destroy their journey of self-discovery. How many times have we heard about a doctor who studied medicine to make his parents happy? We may want our son to go to Harvard, while in reality he wants to be a musician. We may want our daughter to be a scholar, but she wants to be an urban engineer of civil rights. We must help them find what’s in their hearts and minds, so they can take their own roads to personal success.

We have to accept that each of our children will be different, with a different IQ, different attractiveness, different emotional makeup, and different academic strengths. Each has his or her path. It is for us to aid the unfolding of our children’s strengths and weaknesses, not for us to decide what they are or will be.

Children are on loan from God.

This is one of life’s hardest lessons! Because we invest so much of our lives in our children, we take it for granted that they belong to us. We are hurt when they leave, and we are hurt when they fail. If we accept that children are gifts from God and ours for just a short period of time, our entire mindset about parenting changes. The time spent with them, and on them, becomes priceless. For those parents who lose their children, as I lost my son, this lesson is particularly heartrending.

Grow them like a garden and send them off with pride.

Have you ever tried to grow basil without lots of sun, or evergreen trees without acidic soil? Plants shrivel up and die without the right environment. At best, they remain stunted and never reach their potential. Conversely, providing the right soil, water, sun, and nutrition will usually give you a great garden.

Remember to find a good balance between what you need and what your children need. Be aware of separating the two. For example, you may need a break at the end of the day when you’re tired, but your children may need to emotionally connect when they’re tired. Find a happy medium: take care of yourself, and take care of them. To continue with the idea of growing a garden, child rearing can be thought of as bringing children through the stages of childhood, or growing them—but to grow can also mean to build and to tend.

As well, we must give children what they need to grow. Growing children is not that much different than cultivating a thriving garden. Children need

•   a safe home and neighborhood;

•   stable parents and a home free of violence;

•   faith in themselves and others; and

•   lots of acceptance and firmness.

The idea of child rearing as tending or building is a useful way to describe good parenting. If we tend and build our children, we will be proud of them, while they’re with us and later when they leave home for college, a job, or marriage. No matter what their ages, children never outgrow their need for love and acceptance from parents. Remember how you wanted your own parents to be proud of you? Well, it’s no different with your children. This is a great wisdom that comes from growing children.

It is the hardest job in the world.

As a parent and clinician, I have often said, Children bring out the best and worst in us. We can become better people as we tend them, because our children need so much from us. Providing love, patience, respect, consideration, and selflessness helps us stretch and grow. It is true that some children need much more than we can muster. Some (like my son) come into the world intense and tortured. It is also true that some children seem to rear themselves. They come into the world peacefully. Parenting pride comes from tending children as they need to be tended. Watching them grow supplies parents with a deep sense of fulfillment.

Many times we may think that they grow in spite of us. When we look back on the passing years, we see that their lives were the highlight of ours. My Sicilian-born mother would say in her broken English, Life is nothing but children. Of course, she meant that personal achievements could never give the same satisfaction as seeing children grow into happy, fulfilled human beings. I also recall the words of my long-deceased sister-in-law, who proudly said that her contribution to the world was having put five good people in it. Although she was a private-duty nurse and helped many people, her greatest fulfillment was being a good mother. I never understood this when I was young and seeking the excitement of New York City life, but at twenty-seven years of age, when I saw my newborn son’s tiny face, I realized that my life had changed forever. My life became all about him.

Let me share with you the one-line poems that Amy sent as recommendations for describing this parenting book:

Children sing the song their parents bring.

With sunlight, water, air, and tender, loving care, nature’s magic alchemy transforms a seed into a tree.

And my favorite:

Love? It’s a parent.

The Beatles express my sentiments well: And in the end, the love you take is equal to the love you make. Simply said, the more we put into our children, the more enriched we will be in our own lives. Loving them right is the hard part.

Chapter 1

What Parents Worry About

Is My Child’s Problem Normal?

In my twenty years of clinical experience working with children and their parents, I found that parents worry a lot about their children!

Most parents want to know if their child is acting the right way. They wonder if their children’s problems with adjusting are like other children’s. Adjusting to sleeping, new foods, walking, exploring, or learning bladder and bowel control are normal. Some children do not adjust as easily as others. Difficult children do not look and act like other children their age, but they still go through the normal adjustments. These children seem to suffer more as they try to cope with the ordinary ups and downs of their lives. For some of them, what starts out as a normal problem of adjustment becomes a serious problem. For example, potty training can turn into a power struggle. Either way, easy and difficult children both stress parents and try their patience. Most children, even the tough ones, eventually adjust and move on. Those children who don’t easily adjust require their parents to stretch and grow in ways they didn’t think possible.

What Is Normal?

Parents who ask this question usually don’t know what to expect at a given stage of their child’s growth. Even though parents are equipped with intense love and an emotional connection, love alone does not supply answers about parenting. Below are some examples of this.

Sarah won’t play outside. Sarah’s mother, a happily married, thirty-seven-year-old postal worker, was very concerned that her four-year-old was not normal. Sarah was normal in every way, but she feared playing outside. She had been a happy baby who had adjusted well to sleeping through the night. Later, as a toddler, she had potty trained without difficulty. She played with her classmates in her pre-K program but preferred to stay indoors when she came home. Sarah could not be part of any community activities like swimming, dancing, or soccer because she did not want to go outside.

Sarah’s mother recalled that the girl’s fear of animals grew shortly after she’d been pushed by a large dog while playing with her tricycle. Both parents had forgotten the incident because Sarah had had nothing more serious than a small bruise. They remembered that she had cried, but all had seemed normal the night of the incident. Later that week the parents had noticed that Sarah would not go outside, other than for school and then only if her mother walked her to the school bus each morning. Sarah’s parents did not want to force her, but they felt that something was very wrong.

My recommendations: After interviewing the parents and observing Sarah with both of them, it became apparent that Sarah had developed a simple phobia. I informed the parents that normal four-year-olds develop fears, because their imaginations are so lively. At four years of age, reality and fantasy are confused, so it’s natural for children to become fearful. However, Sarah had developed a fear of animals from her unfortunate meeting with the large Labrador retriever that poked had his nose at her and tipped her tricycle over. She had become afraid of large dogs and then transferred this fear to small dogs and then to going outside. It was good that the parents sought help for Sarah early, rather than waiting for the phobia to become crippling, because simple fears can grow into more serious anxiety.

Play therapy using a behavior technique called systematic desensitization helped Sarah, by making her progressively more comfortable looking at pictures of dogs and then being near a real dog. In the sessions with the parents, I shared information about the nature and treatment of phobias in children. The behavior plan developed for home use gave the parents a way to react to Sarah’s fear in the neighborhood. This normal fear could have turned into a serious emotional problem.

Is Ann’s disobedience normal? Gina is a twenty-one-year-old, stay-at-home, first-time mother. She and her husband, also twenty-one, lived in a rural area of central New York. The father worked twelve-hour shifts as a gas station attendant, leaving Gina to do most of the parenting. Their daughter, Ann, had been six weeks premature but quickly gained weight and was discharged from the hospital within three weeks. Even as an infant, Ann had been hard to soothe. By three years of age, Ann was still hard to soothe, but now her agitation appeared every night at bedtime. Gina did not believe that Ann was normal, even though her pediatrician said she was.

After their five thirty dinner, Gina would bathe her daughter and put her to bed by seven o’clock. Gina had put Ann on this schedule since her infancy, when she’d fallen asleep immediately. However, now Ann would beg Gina to read to her and begin to yell as soon as the light was turned off. Gina would tell Ann to be quiet and sometimes spank her to show her that she meant business. She could not understand why Ann was so disobedient every night at bedtime. Gina’s friends told her Ann did not get enough discipline. When I first saw her, Gina was at her wit’s end; nothing was working.

My recommendations: After observing Ann playing a game with her mother, I realized that Ann’s problem was a simple power struggle with her young mother. At three years of age, Ann needed less sleep than she’d needed as an infant. I told Gina that Ann was frustrated, and her rebellion was a way to express it. I recommended changing bedtime to around eight o’clock. I also recommended that Gina make bedtime a happy time rather than a punishment.

Gina moved bedtime to a later hour and gave Ann an after-dinner chore, which earned her a reading from her favorite book, Alice in Wonderland. Because Gina gave Ann this reward, bedtime became a special time at the end of her day. Ann looked forward to going to bed. Bedtime became a special time spent with Mom, earned by helping to clear the dinner table and putting away her toys. In no time, Ann became a happy little girl who obeyed her mother at bedtime.

Parenting consultations also helped Gina understand that spanking was not useful. She learned about other kinds of discipline for young children, like taking time out. Gina and her husband learned that children of all ages normally test parents’ limits, and they needed to learn ways of dealing with their child’s moods without losing control.

Is being a loner normal? Susan, a divorced woman who had grown up as one of twelve children in a chaotic, non-child-centered family, was concerned about her five-year-old son. Tom played alone most of the time, was obsessed with the organization of his toys, and did not want anyone to change anything in his room.

Tom was an only child. When he started kindergarten, he cried every day for the first two months. He did not want to play with the other children, preferring to play by himself just as he did at home. However, Tom was very attentive when the teacher read the class a story, and he liked to read books on his own. He also liked arithmetic, because the teacher used counting games to make learning fun. At the end of each day Tom was happy, and he told his mother that he liked school. But each morning, he had difficulty getting up, getting dressed, and separating from his mother.

Susan brought Tom to my office, suspecting that he might be autistic, because he didn’t like people. She reported that Tom had been born via a normal delivery, had slept the whole night by three months, and showed normal bonding with her.

While discussing Tom’s behavior, I saw that Susan was overanxious. She did not understand that while Tom had a temperament different from many, he was normal. Tom simply had difficulty with change. He was able to sleep normally, obey the teacher, attach himself to his mother, and be affectionate, but he was stubborn when it came