Empathic Grandparenting

As I publish more and more about parenting, I’ve been getting a lot more questions about the role of grandparents. Parents, whether biological or foster or adoptive or step or any other kind, have certain reasonably uniform tasks they usually need to accomplish with their children. Survival basics, such as food and shelter, schooling, love and support, and promotion of the child’s general sense of growth and accomplishment as they grow and develop. If there are some hurdles on the way, people ask me about it, and I do my best to give them some ideas on how to manage.

When grandparents are the primary caregivers for the children, and there are many, many families like this, then they are really acting as parents. In this context, parenting advice applies no matter what your title is. I have known fine adults raised by relatives both close and distant, and sometimes by parents who weren’t related to them at all. In all of these situations, I recommend openness about the reasons behind the situation. This openness should be limited to what is developmentally-appropriate for the child, and which protects the child’s sense of self worth. If parents are gone, then they’re gone and there’s no point in giving the child further opportunity for emotional scars by learning that what you say can’t be trusted. It’s hard to imagine a sadder image than a child waiting at the window for the parent who won’t return. So be as honest as you can with them.

An important part of the bargain when we take on the responsibility of being parents is that there are no warranty periods or lease expirations, during which we can trade up to a new model as long as the one we’re returning has only normal wear-and-tear. More needs to be said about what is and is not appropriate, and I’ll try to do that another time.

For most grandparents, however, the primary responsibilities of care for the grandkids falls squarely on the shoulders of your children and their spouses. This is a blissful arrangement in which you get most of the benefits of child indulgence with little of the consequences. Sure, it’s not as good to buy love as it is to get it spontaneously. But--just between us--it’s still love and it feels mighty good when bartered for some new toy or ice-cream before dinner that mommy would throw a fit about but we’ll just keep it as our little secret.

For those who’ve been reading my advice about getting kids to eat right and behave nicely, it might come as a surprise to know that I don’t disapprove of any of the above. Every child deserves to have somebody in this grandparent role, where some of the rules are a little more flexible than at home. I think there’s an important place in every child’s life for a trusted non-parental adult who isn’t spending every waking hour managing the relationship. But that’s not the same as having carte blanche.

With that said, however, we all know that childhood obesity is a big problem. There are many causes, of course, and I have no special cure or treatment. But I have had one insight that I have not seen written about in all the studies I’ve read: grandparents.

There are many reasons that both parents have to work outside the home. Mine did. With most elementary schools still dismissing their students at 3:00 in the afternoon, most working parents have to find some arrangement for the 2-3 hours or more before they get home from work. In my community, this is often a job gladly taken by grandparents. They treasure the opportunity to be with their grandchildren and have such an important role in their lives. They also are happy to help their children by being there when needed.

But when I talk to children who are overweight, I ask them about their diets. It becomes clear that their parents aren’t usually taking them out for fast food, and aren’t letting them eat potato chips instead of dinner. Most parents are reasonably careful about what they feed the kids, so the extra calories aren’t coming on their watch. Again and again, the calories just don’t add up. While it’s true that school lunch is often not nutritionally optimal, it’s usually not a major problem. They usually don’t have the money or transportation to get fast food. But again and again, I hear about the time in the afternoon with grandparents. There’s a lot of school-day afternoons filled with television and very fattening snacks. It’s one thing to be the indulgent grandparent who gets the kids stuff their parents wouldn’t or couldn’t get them. It’s quite another to be contributing to serious and long-lasting health problems for the child. Though I don’t want to be confrontational, I really wonder if these grandparents, who melt at the first hint of a whine, really feel all right with the consequences of that big piece of cake as an after-school snack.

I have often wondered about the mysterious mechanism by which brain functioning seems to change as soon as one’s offspring has offspring of their own. There is a clear difference between being a grandparent and being a parent, and I’m fine with that. But why, besides failing vision, can’t grandparents see that their grandchildren don’t need that extra cookie?

We get our parenting knowledge from several sources. Our own experience as a child is a major source, whether this was good or not. Our perspective on the parenting techniques used by our parents is a very biased one. In general, we love our parents. Perhaps as a result, I have heard people describe as useful some incredibly counterproductive experiences they had as children. Did washing your mouth out with soap stop you from using bad language? Sometime, parents are aware of the mistakes made by their own families, and make a conscious decision to go in another direction. This leaves the parent trying to find a path when they have no landmarks. And, of course, there are all kinds of parenting experts willing to suggest things, perhaps in a book or blog, that the parent hadn’t thought of.

Grandparents, however, have the certainty of their own experience. This can be a pain in the neck for parents who have decided to do some things differently. Just because you raised your kids a certain way, doesn’t mean that’s the only right way to raise them. This is often a major source of friction between adult children and their parents. If you, as a grandparent, value contact with your children and grandchildren, you must respect their point of view.

I guess it should go without saying that there are always exceptions. But it’s a mistake to assume that you are one of these exceptions.

In the next post, I’ll offer some specific guidelines for grandparents.

Bad Attitude

 

I don’t remember the first time I was told I had a bad attitude. I asked around, and it turns out that everyone I asked had been told at some point in their lives that they, too, had a bad attitude. This suggests an epidemiological question. Is a bad attitude like a common childhood disease, which everybody has had at some point in their lives, or is this a case of ‘selection bias’ in which I happen to choose to be surrounded by those who either have or have had a bad attitude? I guess if there were some sort of test for it, perhaps there might be an answer to that question. I don’t think I was ever fired from a job for having a bad attitude, but certainly being told this in a declarative way, as if it were a clinical observation made with the wisdom of specialized training and experience, didn’t help me feel closer to my manager or employer. Now self-employed (I guess that answers the question if I ended up staying in that job those jobs.) 

What is a bad attitude? I suspect it is often an expression used as a surrogate for questioning the authority of somebody who thinks that they have authority over you. Does it mean that you are subversive, fomenting revolution? Does it mean that you simply don’t follow directions? I think I have an idea.

Many of the children that I see note that they have been disciplined, kicked out of school, put into detention, or brought to me with the intention of a parent that they be medicated in some way, because of their bad attitude.

I searched Yahoo for “bad attitude.” It returned 7,360,000 results. I liked that it came up with dozens and dozens of t-shirts. Some said simply, ‘bad attitude.’ Apparently, this self-identification is meant for those who would like others to use this trait as a means of identifying them. As in my epidemiological problem stated above, it’s unclear if they mean for others to simply stay away or if they would like to help like-minded folks seek them out. One said that ‘A bad attitude was a terrible thing to waste.’ This implies that it is valuable. ‘A little bad attitude makes for a lot of great hockey.’ Not much of a sports fan, I found this deeply insightful. There were also a lot of posters and coffee mugs. I can’t help but draw some inferences by the preponderance of cats pictured on so many product offerings with a ‘bad attitude’ caption. I have always associated indifference with cats, but essentially they are, after all, predators.

In April of 2009, I published an essay about a disease called pinkeye. I have a 2000-page pediatric textbook in which the index at the back is several hundred pages long. Pinkeye does not appear in the index or in the book. Though accepted as common knowledge, pinkeye is not a disease as understood by medical science. It is a symptom, literally a pink eye, which has attached to it whatever definition a school official feels certain about. It isn’t treatable by me without the crucial diagnostic information to establish a medical cause of this single symptom.

It is a deep truth that no one in the history of attitude ever believes that their own attitude is bad and somehow in need of adjustment. The person making the claim that someone has a bad attitude is assigning a label. Do you like being labeled? We all like the good ones, but the bad ones don’t come off. So permanent are these labels that people remember them their whole lives. I bet you can think of adults you know who have said that they were told they had a great talent...when they were 6.

On my very first day of residency, I was scheduled to attend a welcome meeting in the Pediatric Conference Room. No room number was given, just the time. I was nervous and arrived an hour early. I asked the person at the entrance desk to the hospital where this conference room was. I sat in the empty room and waited. No one ever showed up, so I eventually called the residency office and they told me it was in the other building, where there was a different room with the same name. I ran over there, and arrived sweating and breathless. Without missing a beat, the leader of this meeting said, “You’re expected to show up on time. Lateness is irresponsible and won’t be tolerated.” Luckily, I had the real-life experience to keep my mouth shut and just sit down. (Did he have a bad attitude? Oh my yes. There’s something about doctors with Porsches that says so much.)

What I’m getting at is the label that we can’t wash off. How many hundreds of times can I be early before he decides that I don’t have a problem with lateness? In 3 years I was late to that one meeting. Three years of being early to everything was not enough.

How many times can a bullied child do anything to remove the names that he has been called? Several times a year I have to recommend to a parent to take their child out of school and send the child elsewhere. It’s the only way to wash that child of the names that hurt them so deeply. What happens when the names are assigned by a teacher? That doesn’t go away by switching classes. Sometimes not even switching schools. I have had children go to private school, boarding school, or home school because a single teacher at a single school decided that the child had a bad attitude. They told the other teachers, they told the principal.
If you hear that your child has a bad attitude, the person saying it is a bully. If you are saying it, say it really slowly. Your child with not ever forget any syllable of that label. Go ahead, seal the deal. Call them lazy, ugly, ditzy.

How about stupid?

You didn’t see that dark turn coming? Rather than looking back in amusement, think hard about how you felt when you were told you had a bad attitude. Angry. Maybe defiant, distrustful, vengeful. Or maybe you were depressed, hopeless. Labeling somebody is mean work. When it is done to a child, it is bullying.

When a parent does it to a child, there is no more self-fulfilling an act. The child feels bad that you don’t like something about them. They don’t know what, exactly, because you haven’t told them. You don’t like something they can’t change. How would you—how did you—react? You would be angry, defiant, vengeful, depressed and hopeless. Would this statement of definition about who your parent thought you were make you somehow change for the better? Would you suddenly become optimistic, cooperative, trying twice as hard?

I do indeed see children who are oppositional, defiant, antisocial, and constant conduct problems. They don’t have bad attitudes. They do bad things.

There are 2 distinct lessons here, and these will come up again and again as I discuss discipline in detail.
First, being disciplined for being the way you are is just the same as discrimination. If your child is disorganized and forgetful, for example, no amount of any kind of discipline is going to help. I wrote a series about Claire, who was always called ‘ditzy’ or ‘spacey.’ She believed it about herself. Once her anxiety was diagnosed and treated, she wasn’t that way anymore. Only time will tell if she will overcome the label. Negative labels of any kind are mean. Don’t use them ever, or the throw-away line you said once that your child perceives as your true feelings will crush you when they move—or run—away.

Dr. Wolffe’s Rule 15: The Action Rule. Only discipline a child for actions they are able to correct. Would you discipline your child for having trouble reading or speaking? What if they couldn’t walk? You will lose them just as surely if you discipline them for not liking olives or Aunt Harriet’s meatloaf.

Second, disciplining a child for something you cannot specifically define is abuse. The child perceives it as abuse. Let me be more specific. Picture a parent, just home from an unpleasant day. Tired, angry at the boss who said they had a bad attitude, that parent says something mean to the innocent child at home, maybe to the spouse, too. (Substitute ‘does something’ for ‘says something’ if you need to.) The expression of negative feelings in ways that hurt others is simply abusive. The abused see this as arbitrary and unpredictable. As a result, there’s no good way to protect against it. That leads to very bad and long-lasting feelings.

Dr. Wolffe’s Rule 16: The Definition Rule. Never discipline a child for something you cannot define explicitly. Never for an attitude, a way of walking, a tone of voice. Never for being angry with you. If you want your kid to control her emotions, show her how you control yours.

I saw one of those nanny shows on TV in which the parents were encouraged to give a child a ‘time-out’ because of a bad attitude. I nearly threw up. How can the child fix that? How can the child know what they did wrong? The kid will remember the punishment, but how can he wash the label off?

Here’s what actually happened on video: the parent asked the child to help, the child said, ‘No!’, then the parent asked again, nicely, and the child said something along the lines of ‘I’m not going to and you can’t make me!’ The child received a warning, ‘Because you have a bad attitude.’ Then, time-out. I don’t have a problem with the consequence, and I don’t think that was an appropriate way for a kindergartener to speak to his mom. But the consequence must be attached unambiguously with a specific correctable action in order for the child to learn from it. In this case, all the child learned was that punishment comes when mom is angry. That’s pretty darn close to abuse.

Remember Dr. Wolffe’s Rule #2: Be Kind.

Hurting Mommy

I’m a worrier.  I worry about the patients I see and their families.  It comes with the job, I guess.  After all, part or much of a doctor’s job is to see people when they are sick or otherwise out of sorts, and try and make it better.  Make them better.  Maybe fix something that’s broken.  So I suppose it’s natural enough to worry about the things I can’t or don’t know how to fix.

Almost a year ago, I wrote about a toddler who couldn’t stop hitting mommy.  I could frame the situation in a logical way, since a new baby had just joined the family.  I thought that helping the mother see my interpretation of what was going on would relieve her of her feeling of failure as a parent, and it would give us a logical path for intervention.  It did on both counts.  I suggested that she spend extra time with the older sibling, on a rigidly scheduled basis so that the child could come to depend on the attention, rather than feel she had to fight for it.  It was insightful and helpful, and it worked.

I reviewed that post before starting this one.  At the bottom, in a smaller font, I provided a hedge against anybody thinking that I claimed having a magic formula to child behavior that works with everybody.  I’m glad to say that despite being one of the go-to people around here for difficult kids, I’ve only seen a very few who really seemed to like being difficult.

Albert came to the office today with his mother, to say goodbye.  He’s 30-months now, and he’s big for his age.  A year ago, when his mother first brought him, she cried easily.  She asked me how to manage him without hitting him.  I listened carefully to the situation she described.  Having recently moved here from out of state, she was isolated without friends or relatives.  She joined various parent/child groups.  Everyone was very nice, she said, but her little boy was so aggressive with the other children that the other parents didn’t want to get together with her.  She was alone with him all day, every day.  His father worked long hours at the new job, and came home late.  He had grown up in another country, in another culture, and didn’t think there was a problem.  Whenever he played with Albert, the child was always happy and active.  He told his wife explicitly that if there were a problem, it must be her, since Albert was just fine when he was with his dad.  Today, at 2 ½, I’m not really sure how much dad has been with him alone.  I have never met the man.

(OK, there’s obviously more than a child behavior issue here.  One of the many advantages of the conventional method of providing medical services (like at my own doctor:  6 minutes after 50 minutes of waiting; I get to ask maybe one question before the guy is out the door heading for the next patient; nothing is explained; often no exam of any kind takes place; I’m not sure he knows my name) is that the doctor can remain completely unconnected to the patient.  Time, or the lack of it, is a great insulator between people.  I spent hours with this mother and child over the last year.  She did better, she felt better.  I just couldn’t fix the structural issues of her life.  But I worried about her.)

My exam rooms have toys in them.  I have heard about—no, I have also seen—pediatric offices that don’t have toys in the rooms.  While it’s certainly less to keep clean, it seems to send a message.  Albert was getting bored quickly as his mom and I talked.  For just such occasions, I have a small inventory of double-secret toys, which often will engage even a finicky kid’s interest.  As any good magician will tell you, the patter is more important than it appears.  I make a show of reluctantly taking out my special and treasured toys.  Today it was a battery-driven hamster in a plastic ball.  Nicely designed, the ball’s relationship with the driving wheels of the hamster were asymmetric enough to redirect the device if it ran in to an obstacle.  In this way, it would keep going unpredictably until the batteries ran out (yes, I use rechargeables).

Another stroke of Dr. Wolffe magic!  Albert was completely enthralled for...maybe a couple of minutes.
 
When kids his age get bored, they ask for something, they whine about stuff, they interrupt.  Albert picked up the little gizmo and threw it to the floor as hard as he could.  The plastic sphere, which is designed to come apart in order to turn the hamster on and off, came apart.  I picked up the separated (not broken) sphere to put it back together for him.  Angrily, he tried to pull it out of my hands.  Hold on, I said, I’m trying to put it together.  He looked really mad and then, as hard as he could, hit his mother. 

This was new, even to me.  “Don’t hit your mother!” I said in my most serious voice.  He kept trying to strike her, but she deflected his blows.  He smoothly moved his head to her leg and started to bite her.  “NO!”  I said and physically lifted him to the other side of the small room and placed him on the floor.  He looked at me coldly, nearly expressionless.  He turned to his mother and started crying, sort of.  He needs your comfort, I told her, and she went to pick him up.  He started hitting her again.  “You can’t allow him to hit you.  Or hit anybody,” I said.  We started to talk about hitting.  He went to the little container of stuffed animals and one by one took them out and threw them at his mother’s head.

I need to stop this story, since I know his mom will read it and I don’t want to hurt her feelings.  She’s a smart, warm person who is not incompetent as a parent.  I respect her and like her.  My extensive experience with difficult children reinforces my reluctance to walk a day in her shoes.

Does it tell you something that the child hit mom when he was frustrated with me?  Most kids, even at this age, are socialized enough to keep their most egregious behavior out of the view of strangers.  I don’t believe he could think that hitting his mother was acceptable, and certainly not in front of me.  That he felt completely at ease about it is kind of chilling.  This was not about attention, not about having to share a parent with a new baby sibling.  He had certainly come to take mom for granted, since he knew she was going to be there with him no matter what he did.  But it bothers me that he kept pushing the envelope in this difficult, aggressive direction.  I worry that it’s not a typical instinct.

For his mother, I think there are guidelines that generally apply:

• Be the grown-up.
• If you let your child hurt you, you are permitting him to hurt others.
• Is this what you want your kid to be?  (The nonsense that pop psychology projected onto bullies for decades was that they suffered as much as the victims, and had low self-esteem.  That is and has always been crap.  In fact, the latest research on bullies confirms what I thought when I was in elementary school (and medical school)—they are happy, and have high self-esteem. ) 

At Albert’s age, the key to extinguishing a problem behavior is immediate disengagement and feedback.  Don’t punish him—he won’t remember the transgression and will simply interpret your punishment as arbitrary and mean on your part.  This can lead to an escalating problem.  A dramatic NO! or brief sentence will do.  No hitting! or No kicking!  Then remove the child from the activity.  If they do it again, remove again with the same brief message.  Don’t interact with the child or engage in conversation, don’t lecture the kid.  It’s not supposed to be fun.  But as soon as the tide turns, you need to be there, as ever, with open arms.  Every child can learn to get mom’s attention in a better way.

Ironically enough, I think that part of parenthood is loving our children despite the many little ways they hurt us, whether intentionally or not. 

Albert and his family are moving away, close to his mom’s family.  I really hope that she will get a lot more support and help.  But I’m a worrier, and I will worry about her.  I hope she stays in touch.

Kicking the Blocks

It's easy to find examples of bad parenting. Much as each of us might love our own parents, we all can remember incidents (maybe isolated, maybe not) from our own childhoods in which their instincts weren't, well, optimal. So when I'm a witness to particularly good parenting, it makes an impression on me, and I usually learn something.

The 3-year-old was building rockets out of the wooden blocks I have in the room. Some of them were 10 blocks tall. He was so proud of these that he went out into the hall to tell me about them. He liked that I went to see them and was appropriately amazed by how tall they were.

His brother, almost 5, was in the room assembling a puzzle, but he kept looking over at the younger one, especially when I came in to look at his rockets. Their perceptive mother was there, too. She didn't hesitate to address her older son, who seemed occupied with his puzzle. She said, "Kevin, if you knock over your brother's blocks, you won't get a lollipop." At that moment, this seemed like a comment that came out of the blue. I wondered why she didn't warn him about setting fire to the building, too, as a reason to miss a treat.

I haven't tried to disguise where this is going, so don't be disappointed that there is no surprise twist to this story. As soon as the little brother and I started talking about his rockets, his brother calmly stood up, walked over and kicked the blocks down. He had a giant smile when he did this. Afterwards, he stood and admired his work. The younger brother gave a quick cry, but I told him I'd help put them back together and sat on the floor and started to make rockets with him.

His mother said, "You won't get a lollipop today."

This brought on a vigorous near-tantrum, in which he repeatedly asked, "Why don't I get a lollipop? It's not fair." This continued for a full minute or two before he sulked off into a corner. The rule in my office is that all the toys need to be picked up before anybody gets lollipops. So he said, "What if I pick up the toys? Will I get a lollipop?" His mother thought for a moment before saying that he would if he picked up the toys and apologized to his brother. When the visit came to a close, he was still sulking as his little brother and I picked up the blocks and toys. Kevin moved the blocks around with his feet.

As they left, his brother chose a lollipop from the basket. His mother was unflinching. Kevin got none and was unhappy about it.

At the same time, this mother was rock-solid, yet forgiving. She didn't negotiate or go back on her word. The child's behavior, was age-appropriate. He is just beginning to have an inkling of consequences from actions he can control. But exercising that control is just out of his reach.

So often, from a child's perspective, the rules adults create for them seem arbitrary and unpredictable. New rules appear invented for novel events that they can't expect. At Kevin's age, with his completely immediate concrete thinking, he doesn't have the ability to generalize a basic but vague rule, like 'Don't hit your brother,' and apply the rule to new situations. So an empathic approach allows us to understand that he might reason that the rule doesn't apply to hitting his brother in the car, or while watching TV, and so on. In the incident in my office, his mother made this easier for him by being very specific about the rule. She foresaw what he wanted to do to those tempting towers of blocks. While he clearly heard her, he couldn't make sense of how his action could result in a consequence he didn't like. Now he and his mother will have an example to point to when the issue of actions and consequences comes up again. And it will.



The sweet photograph at the top is not in my collection but is used with permission by the photographer, Courtney Coolidge, who takes great photographs of kids and families.

Child Behavior: Spanking

Don't hit your kids. I was actually asked about spanking this past week, and thought it was worth committing some of these concepts to whatever this medium is. The issues with spanking, of course, overlap with most other discipline issues. The question was posed to me as a philosophical one. I was asked how I feel about it. This post is only a little bit about my feelings and a lot about statistics.

A group of researchers at Phoenix Children's Hospital compiled a Report on Physical Punishment in the United States. I learned a lot.

Spanking is not a philosophical question. True enough, I don't like the idea of anybody hurting anybody. I'm not alone—29% of Americans are against physical punishment by parents and 77% think that school personnel shouldn't either. Wait, I did the math too. I was surprised to learn that 71% think it's OK for parents to hit their kids, and 23% think it's OK for somebody at school to hit their kids. Though I was surprised to learn I was in the philosophical minority about parents hitting their kids, I didn't have more than a philosophical set of objections. I found statistics.

I wondered why a school would find it necessary to physically hurt a child. Curiously, African-American students were 2.5 times more likely to get physical punishments than white students, and boys 3.4 times more likely than girls. So even if no one was consciously selecting who to hit, there was definitely some selection going on. That didn't sound fair to me.

Parents are more likely to hit their kids if:

• They believe that it works.
• They were hit when they were kids.
• They are under stress.
• They are frequently frustrated with their kids.
• They are under 30.
• The child is a preschooler (age 2-5).
• They think their religion approves of it.

It's reasonable to think that the more aggressive and oppositional the child is, the more frustrating it would be to manage these behaviors. Sure enough, the active and aggressive kids get hit more. But what if it was the physical discipline that was contributing or even causing the aggressive behavior? A study was done in which new types of parenting interventions were taught to parents. Within a short time, the problem behaviors decreased. Studies of all kinds have showed that decreasing the amount of physical discipline caused a decrease in the child's problem behaviors. So it doesn't work to control the very behaviors it's aimed at—it makes them worse.

Increasing amounts of physical punishment are associated with increasing substance use problems and increasing mental health problems. These problems persist into adulthood. So you're hurting your kids for years to come.

It also won't help your children to feel close to you. Of those physically punished, children themselves, and adolescents looking back, say explicitly that they feel less warm and open toward their parents. That doesn't sound helpful.

Here's my take on this, from a parenting point of view.

1. Spanking often was used for aggressive behavior. But the aggressive behavior of the parent actually provides unintended positive feedback that supports the child's problem behavior. It confirms the idea that hurting someone is an effective way of getting what you want from them. It's confusing at best, and counterproductive at worst.
2. It teaches that the reason for good behavior, or not doing an unwanted behavior, is to avoid punishment. All of us are capable of being conditioned, like Pavlov's Dog. With severe enough rewards and punishments, we will find a path of least resistance. So I think it's possible that punishment will indeed get the kid to do what's desired. But they won't learn anything that could apply to a new situation. Maybe if we take away the threat, the kid won't have any reason to behave well.
3. It's a good way to get children to be afraid of their parents. How will they model loving relationships? Is love tied to violence?

Don't hit the kids. Or anybody else's kids, either. In fact, it's probably a good idea to keep your hands to yourself.



The photo above is not from my collection. It is from Vanity Fair magazine, 1903. Under the title 'Bifurcated Girls,' it was risqué not for the scene, but for the fact that the women were wearing pants.