Monthly Archives: April 2007

Children and Anxiety

Anxiety is a necessary part of the human condition. All of us have anxieties and our children are no exception. Anxiety is our natural alarm system, which alerts us to uncertain or potentially dangerous situations.

It can begin in infancy as some babies experience anxiety when left alone at night or when separated from their parents. To an infant this is perceived as a life threatening situation, as they depend on their parents for survival. Some experts feel much of the anxiety we experience throughout our lives is related to this “separation” experienced early in life.

In this article we will discuss childhood anxiety disorder and focus on the school age child, with a special word on school phobia.

Anxiety Disorder

This disorder is described as excessive worrying or having intense fears that interfere with the child’s daily existence and enjoyment of life. Dr. Sharon Ryan Montgomery, a child psychologist in Morristown, NJ , stresses that all children may experience anxiety at some time in their childhood as a response to a new situation or developmental challenge. The birth of a sibling, a move to a new home, the start of the school year, and illness or death of a close family member or pet are common examples of situations that can provoke anxiety in any child.

Some children, because of their own temperament, may be more prone to anxiety and have ore fears than other children. These are children who are shy, have always had difficulty with separation or new situations, or with change or transitions. As infants they may have had more difficulty settling down and may have reacted more suddenly to loud noises.

When a child is experiencing anxiety, a parent may observe a change in appetite, difficulty sleeping, nightmares, or physical symptoms such as head-aches, dizziness or stomach aches. Some children may suddenly not want to be left alone or go to a friend’s house to play or sleep over. For most children or adolescents, these symptoms will be short lived and the child will work through these fears and develop a feeling of mastery over the challenge. In fact, learning how to face fears and cope with new experiences are vital skills for our children to learn.

However, for some children, the anxiety begins to intensify and become more pervasive, and fear may spread beyond the original source of the anxiety. For example, an initial reaction to parents leaving a child at home with a relative while they take a trip, may extend to fear of any separation between parent and child. Difficulty sleeping or eating will worsen the child’s physical state and decrease the child’s ability to cope. These greatly magnified fears and anxieties will then begin to interfere with the child’s enjoyment of daily life.

Dr. Montgomery offers the following advice for parents who suspect their child is having anxiety or increased fearfulness.

  • Talk to your child about what he or she may be afraid of (remember children will not understand what anxiety is). Find out what is happening in the child’s world, especially school. What changes or losses have occurred for your child?
  • Make adjustments if possible to ease the situation, but don’t overprotect. Remember that it is unrealistic to think that you can remove all of the stress from a child’s life. So, try to help your child face his or her fears with gentle support. Encourage your child’s independence in age appropriate areas.
  • Maintain structure and set limits on behavior. These make a child feel safe.
  • Reduce your child’s exposure to frightening media reports. These alone have been responsible for some children’s sudden fears.
  • Anxiety is very contagious. Children can easily pick up on a parent’s anxiety. In addition, remember to examine family stresses to see if your child is picking up on someone else’s anxiety.
  • For the same reasons, be aware of your own anxieties and fears. Be careful not to discuss these with your child.

When do you need to seek professional help?

If a child’s symptoms last longer than a month, seem to be getting worse instead of easing, have spread to other areas of the child’s life, or are interfering with school functioning, or if all your attempts to help your child cope are not working, then it is time to speak to your pediatrician or seek help from a child therapist.

Our aim as parents should be to teach our children better coping for handling stressful situations, rather than trying to eliminate stress in our children’s lives. Because the reality is – whether child or adult – we live in a stressful, rapidly changing world, that requires coping skills to survive.

School Phobia
An important type of anxiety disorder is when a child suddenly develops tremendous anxiety about going to school. Physical symptoms are very common with stomachaches and headaches leading the list. Once a medical cause has been ruled out, the school avoidance has to be acted on immediately. This is the one situation that a parent should not wait several weeks before addressing. The child should be firmly, but gently, returned to school as soon as possible. The worst thing is for a child to get into a pattern of staying home. The longer this goes on, the harder it is to return the child to the classroom. To achieve this sometimes requires a collaboration and cooperation of parents, teachers, the pediatrician, and the therapist.

Caffeine and Your Kids

caffeineCaffeine consumption in kids can lead to health concerns if not monitored by parents and physicians alike. Here are answers to three basic questions on the subject.

Which soft drink has more caffeine?
Which soft drink has more caffeine? Coca Cola, Pepsi, Surge or Mountain Dew? Food companies do not have to list how much caffeine is in their drinks on the labels. So a recent article in Zillions (the kids offshoot of Consumer Reports) detailed the results of a study of these popular soft drinks and the results might surprise you. Mountain Dew had 55mg and Surge 53 mg of caffeine in a 12 0z. bottle compared to 47mg for Coke and 37mg for Pepsi. Most people associate caffeine with the cola color and assume that Mountain Dew has no caffeine like 7 UP and Sprite. The research shows that this is clearly not the case.

How can caffeine affect my child’s health?
Caffeine, even in doses of 20 to 50 mg, can have an effect on a child. As a stimulant, it revs up your nerves and can make kids feel more alert and less sleepy. Sensitive kids can feel anxious, restless, jittery and have trouble sleeping. The effects of caffeine can last up to 24 hours.

Is caffeine addictive to children?
There is also an addictive effect which can create cravings in kids who drink these drinks on a regular basis. If they don’t get the caffeine they can feel more sleepy and may experience headaches and irritability from caffeine withdrawal. So be aware of how much caffeine your children are consuming and be an educated consumer when you are in the supermarket.

Gender Identity in Children

…And That’s What Little Girls/Boys are Made Of

This is the age when children learn about the differences between boys and girls and become very aware of their own sex. As most experts have come to realize, there are true differences between boys and girls and these have nothing to do with cultural conditioning. In general boys are more physically aggressive, girls more verbal. Boys are drawn to anything with wheels, and most girls are not. Girls are drawn to dolls, most boys are not. There are many other differences that have to do with the way boys and girls learn and communicate.

However scientific they may be, these are generalizations. Some girls prefer typical “boy” activities, and some boys like to play with dolls. The tomboy seems to be more accepted by parents than a boy who likes to play with dolls or has other more “feminine” ways. Fathers, especially, may get very upset if they see their son playing in the kitchen or with a doll. If a child shows that they are happy and comfortable in their gender role, there is probably nothing wrong. Boys need to learn to nurture as well as girls. In addition, girls can benefit from play that is more aggressive.

If a child seems uncomfortable in their gender role or frequently makes statements like: “I wish I were a boy,” or “I’m not a girl, I’m a boy,” it may signal that your child is not happy with his / her gender identity. Children sometimes feel, correctly, or incorrectly, that their parents value one sex more than the other, or that their parents are unhappy because they wanted the opposite sex child. These matters can be very complex psychologically and usually need referral to a professional. If you suspect your child is having a conflict about his or her gender identity, please discuss it with your pediatrician or family practitioner.


teddy_hugThe sucking of fingers is only one of a group of behaviors we observe in small children. These are called tensional outlets. They are thumb or finger sucking, chewing on clothing or hair, nose picking, and holding the genitals. These are very common behaviors during this period of childhood. They help a child reduce the internal tension, which results from anxiety and fear. Each child has his or her own personal tensional outlet, which may have become associated with stress reduction during infancy or toddlerhood.

All of these are difficult habits to change in a small child, although parents spend a great deal of time trying. They spend even more time listening to advice from well -meaning friends, relatives and even strangers, who warn of the dangers of these habits aren’t corrected. The simply truth is these tensional outlets are not harmful and are obviously very important to these small children who are experiencing some form of stress. They usually are outgrown by school time.

Here are some common questions from parents:

Does finger sucking cause orthodontic problems?

Most dentists today feel that serious malocclusion occurs because of genetic factors. There may be a moderate effect caused by finger sucking that extends into the fifth or sixth year, but these can be reversed by orthodontics.

Should I do something to help my child stop?

If a child is motivated or asks for help, you can provide encouragement. However, you should never force a child to give up their tensional outlet.

If your child is motivated, a positive reward system may be useful. In regards to finger sucking, the motivated child over age 7 can be fitted by an orthodontist with a special mouthpiece which has a bridge that hits the child’s fingers as it goes onto the mouth. This provides a gentle reminder. It is not recommended to put bad tasting substances on the fingers, to restrain them, or to use punishment to curb these behaviors.

Are there any health risks?
Most of these habits are completely harmless, but there can be some complications. Fingers and nail beds can sometimes become infected. Although it is rare, swallowing hair that is chewed on can accumulate in a child’s stomach. And picking of noses can cause nosebleeds.

When will they grow out of it?

Thumb or finger sucking, and nail biting will last the longest. It will vary based on the child, but most children give up finger sucking by age 8 or 9. Nail biting, however, can go on for a life time, but can be helped. Ask your pediatrician for suggestions when your child is older and motivated.


sleeping_on_shoulderHopefully your child is going to bed without any problems and staying asleep all night. However, even if they are, it will not be every night.

All children this age have some sleep disturbance at some time. In addition, some children will still be having difficulty on a regular basis. Here are some common problems with preschoolers and sleep. If you are having difficulties with sleep, consult your pediatrician for further advice and guidance.

Your bed or theirs?
By age three, even if you have chosen up to now to follow the philosophy of the “family bed”, it is a good time for your child to be taught how to sleep by himself in his own bed. As hard as it can be for many parents, your child will be happier and healthier if you can do this. Even if you wish to have your child sleep in the same room for a bit more, sleeping in the parental bed after age five may not be healthy for psychosexual development.

Bedtime routines
Bedtime routines will help your preschooler to go to sleep. Make sure you have a regular and calming routine before a child’s bedtime A routine can consist of the reading of a favorite story after the bath, kissing all the stuffed animals, or singing a special song. This will become the signal for your child that bedtime has arrived and will also provide a transitional period during which he or she can prepare for the separation that sleep brings. It also gives preschoolers some control of the situation since the ritual must be completed before they will go to bed.

Can’t go to sleep without you

Your preschooler may insist that you be present while he falls asleep. While some respect for his separation anxiety is needed, you can still gently tell him that you understand how hard it is, but you will help him to do this on his own. After the bedtime routine simply say, “It’s time for sleep now” Give a big hug and kiss and then leave him in his bed. If he gets up again, simply walk him back to his bed and repeat the same phrase. You may have to do this many times, but make it boring without a lot of extra hugs and kisses. After awhile he will know you mean business. This method works well with most children. Another technique is to challenge your child to stay in bed until you check on him or her. They will feel proud of themselves if they can do it. Check on them at 5-10 minute intervals gradually increasing the time between checks.

The Magical Age

magical_ageWhen your child turns three, he or she will suddenly announce, “Look out world, I am here!”

From the age of three until your child enters formal school usually at the age of five, he or she will experience the wonder of the world in a way that they will never experience again in their lifetime. This is the age of imagination, of magic, of play. And yet at the same time preschool children often appear as little “scientists” testing the limits of physics or little “sociologists” analyzing human behavior to understand how people live together and communicate with each other.

The challenging role of the parent is clear. You must continue the job of civilizing these young members of society, while preserving their need to explore, examine, and analyze the world. In other words, allow for these important developmental steps to occur within certain social boundaries and in a safe, protective environment.

To accomplish this you must first recognize your child’s temperament and understand the basics of child development at each age. Then you must allow your child to play as much as possible. Provide imaginative play materials and toys and then let the child do the rest. Re-live your own childhoods as you get down and play with your child and enter their rich imaginary worlds. Pay close attention to how they see things and marvel at the wonder of imagination and the richness of play. Have fun with them.

At the same time you must learn to set limits and to effectively discipline your child when necessary. This is the hard part for many parents. But your child is depending on you for this vital role. This is a magical age. It won’t last forever. Enjoy your preschool child.

The Magic of Loveys

“Loveys” “Blankies” “Teddies” Those worn and tattered pieces of comfort to babies and toddlers. These are truly magical items. They immediately help a toddler calm down when upset, frightened, or feeling the pangs of separation from a parent. These are officially called transitional objects and it is quite common for infants and toddlers to develop an attachment to a special blanket, a piece of material, or a special doll or stuffed animal. The object has usually been near the child while nursing or snuggling with the primary caretaker, usually the mother, and then the object “becomes mother” to the child. This is the “transition” and the object can take the place of the mother in her absence. This can help a child sleep alone or stay with a baby-sitter.

There is nothing wrong with children having “loveys” They are not harmful and as far as I know no child has ever become ill from one. Not every child will develop an attachment to something and it is very difficult for a parent to make this happen. It has to happen on it’s own. You can try by keeping a special soft piece of soft material between you and the baby when they are about 6-9 months of age while cuddling or nursing, however, just like with finger sucking, these are things that develop in their own way despite parents’ best efforts. In other words, the magic occurs without our help.

If the object is forgotten, lost or washed, the child might experience significant distress since they are very dependent on their object. I still remember a former patient of mine, a little girl who had lost her special “bunny” in the supermarket. Her parents contacted the local media and an article in the local paper helped a search get underway. Not surprisingly, there was a great deal of sympathy generated as many people remembered their own “special items” from their childhood.

The loss of an object should be treated with respect and a parent must acknowledge to the child that this was something very special. If a blanket has become so tattered and dirty, some parents have cut off small pieces of it over time until it becomes much smaller and more manageable. The need for transitional objects is more common in younger children and most children will give up carrying them everywhere by age 4-5. They will still be emotionally significant (maybe for life) and your child may want to keep them in a safe place in his or her room.

Bedtime and Toddlers: The final frontier

sleeping_toddlerA big concern of parents of toddlers is how to get them to sleep independently once they can scale the crib walls, or have graduated to a junior bed. The solution requires patience, stamina, and a true desire to make this happen. All toddlers are capable of independent sleeping. If you have made a decision, however, about co-sleeping with your toddler and have set up a family bed, then you should know that there is no “harm” in this choice. Living with a toddler requires lots of energy and all that matters is that everyone get a good night’s sleep.

Here are some tips to help alleviate the struggles associated with bedtime:

  • Keep the bedtime routine short (no longer than half an hour) and simple. For example, after the bath – read up to three stories, sing one song, say goodnight to the favorite stuffed animals, say goodnight to your child, then it’s lights out.
  • You should make it clear to your child (who is no longer in a restrictive crib and can open doors) that you mean business. If he keeps coming out of the bedroom, he should be returned as many times as necessary.
  • Use a reward system for staying in bed. You cannot force your child to go to sleep, but you can force her into a bedtime. What she does in bed after that time is up to her. This may take a lot of work in the beginning, but it will pay off later.
  • The alternative to this method is staying with your child until he falls asleep. If your child becomes used to this, or if the child has been sleeping with you, the transition to sleeping alone may be more difficult. Most children should be able to go to sleep on their own by age three, even if they have been raised in the family bed.

Temper Tantrums

temper_tantrumTemper tantrums represent the stormy release of toddler frustrations. These are actually necessary expressions of your child’s emotions before he can verbalize anger and frustration.

They may occur frequently and more often when your child is tired, hungry or restrained for a long period of time (for example, in a car seat during a long trip.) You must teach your child that this is not an acceptable way of expressing his emotions. The earlier you address this behavior, the sooner it will begin to disappear. In this article we will take a closer look at the following common questions related to temper tantrums:

What should I do during the tantrum?
The most important thing you can do when your child is having a tantrum is to remain unemotional and un-phased by this behavior — this is not easy! One suggestion is to pretend that you are an anthropologist on the Discovery Channel, watching a species of wild animal doing a ritual dance. Remove yourself emotionally from the scene. Remember — you are the parent in control, she is the child, not in control.

Next, remove the audience. If you are alone at home, simply turn away and walk a short distance from your child. If others are around, remove your child to another room and remain close by. It is very important not to abandon your child when she is having a tantrum. It is very frightening for your child to have a tantrum and she needs to know you will not let her totally lose control. If the tantrum goes on for longer than five minutes, place your arms around your child, to help slow her down.

Give your toddler words for his feelings. Say gently, “I know you are angry.” “I know you are upset.” Over time he will begin to understand what these words mean. He will not have to act out his feelings as intensely if he knows you get the message.

When the tantrum begins to slow down, you can offer some soothing moments alone together. This lets your child know that you still love him and understand that he is upset.

What shouldn’t I do?
Remember — if a tantrum is in progress – do not show your child that you are upset. Never hit your child during a tantrum. You do not want to reward your child, either positively or negatively, during a tantrum.

What if you are in a very public place such as a supermarket?
Experts are divided about how to handle this situation. One method is to leave the cart full of food behind and remove the child from the store to the car. He can have the tantrum alone. If it ends, you can finish your shopping. If not, remind yourself that this limit setting is more important at this moment than the groceries.

Another method is to allow the child to have the tantrum in the store. This can be very draining for you, the parent, however, for you may have to explain to the other customers and shop owners why you are blocking the aisle.

Feeding Your Toddler

toddler_feedYour responsibility as a parent is to offer healthy foods in a nurturing environment. Your child’s job is to decide what and how much of what is offered he will eat.

This is a very important concept and worth repeating to yourself from time to time. In simplest terms – provide a balanced diet for your toddler, limiting sweets and salt. Limit milk to 16 – 24 oz. per day and undiluted juice to a maximum of eight oz. per day.

The nutritional needs of babies and toddlers are different from those of adults. A typical toddler portion is one quarter of an adult portion. Do not restrict fat and cholesterol, which are necessary for adequate growth. Do not give babies and toddlers high fiber, low calorie foods, which may not have enough calories. Offer a variety of foods over time to your toddler.

Let’s take a closer look at the following two issues related to feeding your toddler:

Is my toddler eating enough?
If toddlers are not given more than 16 oz. of milk and 8 oz. of juice per day, and are not given excessive sugary snacks between meals, they will eat an adequate amount of calories if offered a variety of nutritional foods. This is known as relying on “natural hunger” to achieve a balanced diet. Moreover, it may occur over several days of eating, not in one 24-hour period. Regular check ups with your pediatrician who will check your baby’s weight and height are essential for monitoring your toddler’s nutrition.

Food Fights
Feeding is an area where parents and toddlers can get into major power struggles. You are frequently worried that your child is not eating enough, or not eating the right kinds of foods. This anxiety may cause you to pressure your child, who immediately picks up the cue that this is an area for struggle. In battles over food, you, the parent almost certainly will lose. The more you force your child to eat, the more she will resist. If this leaves you feeling out of control – remember, you are in control. You control the food you offer your child. Eventually, she will get hungry and eat.