Headaches

If a child gets a headache and can get rid of it simply by lying down, resting, and watching television for 20 minutes, then the child really doesn’t need to see a pediatrician. Dr. Berman said, though, that a pediatrician should examine children whose headaches keep them from taking part in normal activities or cause them to miss school.

Most of these headaches can be treated with medication. Bruce Masek, an assistant professor of psychology at

STRESS

We must first recognize that there is no "magic" to reduce stress. Stress reduction is the responsibility of each individual to learn the best way for them to alter or modify their lifestyle to achieve a more comfortable and healthy life. Events do not cause tension. The view (belief) one takes of the events causes the tension. Learn to deal with stress in ways that are good for you. Ask yourself if things are really as bad as you think. Also, try "thought stopping" or simply turning off the negative thinking, such as unnecessary worry. Have a pre-planned, positive thought you can substitute for the worrisome, negative thoughts. It is important to develop preventive habits, such as priority setting, time management, decision making, taking action on decisions, learning to think in a rational manner, acknowledge emotions appropriately, and establish a balance in your life between work, play, and rest. Learn to relax. Use deep breathing exercises, physical activity, sit and do "nothing" without feeling guilty. What ideas can you add for your own relaxation? This is specifically individual to each of us. Ease tension by removing yourself from the anxiety-producing situation when possible. Resolve problems or conflicts as soon as possible. Learn to tell when you are becoming tense by increasing your awareness of your own physical and mental warning signals. Take steps for prevention before you become extremely tense and stressed out. Learn your "burnout" cycle. Plan a diversion from routine activity prior to the "burnout" period.

WAYS TO COMBAT STRESS

Use common sense with your time and commitments.

Balance work with play. Make time for hobbies and recreation.

Loaf a little without feeling guilty. Doing nothing is not a waste of time. (at least for a little while) Make friends with yourself while doing nothing.

Get enough sleep and rest.

Work off tensions with physical exercise to reduce muscular tension.

Talk out your troubles. Look for solutions and then put your solutions into action. Be aware of options. Make decisions. Take responsibility. Have an idea about constructive resolutions to problems and also alternate plans.

• Learn to accept what you cannot change.
• Get away from it all. Plan diversions.
• Avoid self-medication.
• Have a medical checkup.
• Use humor appropriately.
• Utilize deep breathing exercises.
• Find a hermit spot.
• Slow down time.
• Think before you act and avoid overreacting.
• Know thyself.
• Have a same sex friend to share communication and information with them.
• Earn love and be useful.
• Find purpose and meaning in your life today.
• Re-evaluate your life and your values.
• Be flexible.

EMOTIONAL DEVELOPMENT

A. INFANT

• Behavioral changes; lethargy, anorexia, disrupted sleep
• Separation anxiety at 6 months
• Can recall and anticipate pain after 6 months
• Stranger anxiety at 8 months

• Stay involved with day care (See Day Care Hand-Out Sheet)
• Lots of tender loving care
• Provide visual, auditory and motor activities
• Promote trust

Reactions:

• Regression
• Physical aggression, fighting, biting
• Negativism, temper tantrums, crying
• Withdrawal, reluctance to explore

• Be firm, consistent, positive
• Allow rituals
• Allow choices to provide child with means of control
• Provide mobility

Reactions:

• Magical thinking and fantasy explanations used to explain things
• May see separation as punishment and exhibit guilt
• Aggressive or passive and dependent

• Explain events (e.g. tell child he is going to doctor for check-up after you get off of work)
• Let them know it’s okay to cry (let child know he can display emotion, but it won’t change outcome) (e.g. mom still has to go to work)
• Encourage independence and initiative
• Play with child

Reactions:

• Most likely to blame self for causing separation
• Withdrawal, silence, lack of activity, social isolation
• Fear of loss of control from enforced dependency on secondary caregiver

• Encourage industry and feelings of control by giving them useful and productive things to do
• Encourage verbalization of feelings and needs
• Observe for nonverbal clues which might indicate fears
• Don’t expect child to ask for help and support - offer it
• Give more detailed explanations

Reactions:

• Mistrust adults
• Restrictive environment difficult
• Aggressive or passive, hostile and noncompliant

• Establish trust
• Involve in decisions
• Include peers
• Encourage information seeking
• Support and respect individuality

WORKING PARENTS

Working parents have a lot of guilt about leaving their child in the care of strangers, because of their needs for more income, or for self-fulfillment in their career. It is important if you chose to parent and work at the same time to really explore your feelings about the decision. This time with your child will never come around again. It may be important to you, when you look back, to be comfortable with your choices. You need to carefully review why you work, particularly in terms of what allows you to be the best parent and provider for your children. You need to be realistic in terms of the goals you set for yourself as a parent and in your career. It is certainly possible for both parents to work and successfully raise your children.

Don’t be fooled by false economy. When both parents work, they don’t make twice as much. Careful analysis shows that when the second parent begins work, more than 2/3rds of the second income goes to taxes and the costs of childcare. The choice to work should be a personal one. If your career fulfills your personal goals and allows you to be a better person and parent, by all means, work. Work for yourself, not the money. There is not as much money as you might think in a dual income family. Nor is money as important to your children as your presence!

Indeed, in this day and age, in more than half of all families, both parents work outside the home. Be aware, however, that you are doing two jobs at once...each of which requires 8-12 hours a day of your attention. If you get tired, don’t be surprised! Effective time management at home and an employer who understands your role as a parent are essential to your success. More than ever, it is important to have a supportive relationship with your spouse. As a single parent, the lack of emotional support from your spouse can be devastating.

DAY CARE CENTERS

Sample Letter from Parents

Dear Dr. Street, I am a mother who has to work to help support her family. I feel terrible that I can not stay home with my six week old infant, but not only do I have to work, I enjoy my career. What do you suggest I do with the child during the day? I have tried to find an individual, but these people are either too expensive or not really qualified to care for children. Do you recommend day care?

Yours Truly, A Frustrated Mom

Dear Mom,

You have also asked me to endorse something that is already fact. The great majority of my patients have working mothers! I’m glad that you said you like to work. When asked by mothers whether they should work---the answer is do what makes you feel right. Some mothers are better mothers because they work; others are miserable workers because they would rather be full-time mothers of their child. If at all possible, make your decision independent of money worries. Your child is a baby for such a brief period in your life.

Day care nurseries are usually an excellent alternative if you must work. In most cases, care is even superior to an individual, who has no particular training in child care (and sadly, sometimes no interest other than what you are paying.) It is very important that you investigate several to choose one that most fits your philosophy of child rearing, because day care puts a definite stamp on your child’s life. When you look, pay attention to such matters as staff training and interest, general cleanliness, crowding of infants, exclusion of sick children, and philosophies regarding such matters as toilet training.

On the other hand, you can expect more illness. Since children get sick from other children, we now see more illness in younger children, as they are exposed earlier to germs. In spite of scrupulous attention to excluding sick children, teaching staff to wash hands, and avoid over crowding, upper respiratory infections (colds), diarrhea, parasitic infections (such as Giardia), hepatitis, and some cases of meningitis may be more frequent in a day care setting. Ear infections have become so frequent that some doctors are describing a new disease, "DAY CARE OTITIS," ear infections that occur frequently because the child is in Day Care.

I really don’t think you can blame the DAY CARE, because your child gets sick. The bottom line is you must take the bad with the good. At the present time this may be your only alternative if a mother has to, or chooses to work.

Sincerely,

Dr. Street

Questions for Day Care Centers

PHILOSOPHY OF CHILD-REARING

• Does the center have as a goal the promotion of self-esteem in your child ?

• What methods of discipline are used?---Is a Positive approach stressed?---What type of corporal punishment or negative reinforcement used?

• Does the staff make an effort to reinforce the parents’ own values or theirs?

SAFETY

• Are the furnishings and toys carefully chosen? ---Are there sharp edges on furniture? ---Are toys easily cleaned and hard to swallow?

• Is there a safe play area? ---Is there a soft playground surface? ---Is equipment cemented to the base? ---Is the playground well supervised?

• Are the rooms clean? ---Are the cribs safe and widely spaced? -- -Is the kitchen and toilet closed off to common areas, yet easily accessible? ---Is soiling and diapering handled hygienically?

• Are fire extinguishers and other safety equipment present?

• Does the staff know CPR? --Are they certified?

MEALS

• Are meals planned? ---By whom with what qualifications?
• Are the meals low in sugar, fat, and cholesterol?
• How much fresh food, canned food, and additives are included?

HEALTH

• Is there health teaching for the staff?
• Are hands washed frequently? ---After changing diapers?
• Are there guidelines to isolate children found to be sick? --- How carefully are state guidelines followed? ---Can sick children return before they are well?
• Are there guidelines for food-handlers?
• Are children taught cleanliness?

STAFFING

• Interview the director---What qualifications, training and background are there? ---What is their philosophy? ---Do they like children or are merely in business?
• What qualifications are there for the teachers and workers? --- What is the turnover rate? ---Are the employees satisfied and happy?

CHILD ACTIVITIES

• Is the philosophy to teach children a certain material? ---To help them socialize? ---To help them learn to learn?
• Is play therapy incorporated into the program?
• Is there adequate time for free play? ---Alone? ---With the group?

CONSULTANTS

• Does the center have on its staff a consultant qualified to assist in developing polices for children----such as a pediatrician, child psychologist, pediatric nurse, or other child development expert?
• Is there an advisory board? ---Of experts? ---Of Parents?

This word comes from the same root word as disciple and means to teach. Discipline does not mean to punish. To teach, one must learn how to give effective commands to a child. This requires that you:

• Be aware of a child’s abilities at various stages of development.

• Give clear commands in the child’s own language. Always include who, what, when, and where. A child’s concept of when may include counting, i.e., “1-2-3. “

• Reinforce your requests appropriately and consistently. The worst punishment for a child is to ignore him - have him to go to his room or stand in a corner or sit in a chair for a brief interval - never more than one minute per year of age up to 5 minutes. Light spankings, which scare rather than hurt may be needed to teach the child to go to his room or sit in the chair as a punishment.

• The best reward for a child is your love and acceptance. Give it lavishly and appropriately. Catch them being good.

USE PRAISE

• Praising is a gift; when a parent empathizes with his or her child, praise always works.
• Provide clear, simple, positive messages.

• Turning toward your child.
• Establishing eye contact.
• Pleasantly delivering verbal and physical praise, (i.e. a pat on the back, a smile, a hug). Providing immediate reinforcement when possible.
• Don’t make praise a negative by saying something like "That’s good; now, why couldn’t you have done that before."

 

 WHAT TO PRAISE:

• When the child deos what the parent asks.
• When the child makes an attempt to do what the parent asks.
• Age appropriate play and task performance.
• Plays appropriately with brothers, sisters, friends,
• Positive verbal interaction
• Positive repsponses to others-made on child's own initiative
• In the absence of negative, undesirable habits and behavior

Under each category name five behaviors of your child that:

To manage these behaviors it is best to:

The most successful tool in modifying behavior is praise; give it especially when the child is doing something you like. For those minor episodes of misbehavior, ignore the behavior. You’re not withholding your love when you withhold your attention and expression of your love.

Time Out

Setting limits for intolerable behavior should usually involve a system of time out. When your child is having a screaming fit, first ignore him. When that is no longer possible, tell him in a calm, unemotional voice that she must go to Time Out. Isolate her in a corner, or preferably in a room for a length of time that fits the misbehavior. Use a timer, so the child won’t try to beg off. Make the timer the "bad guy" and reply to your child’s complaint that the timer has not rung! Better yet, leave the room and tell the child he may come out when the timer rings.

Behavior Modification with a Praise Sheet

A lot of your patience is needed to change your child’s behaviors. It is helpful to develop a Praise Sheet, so that everyone in the family, including the child, can watch his progress.

1. Place the sheet in a prominent family place, such as the refrigerator door.
2. Initially, select a behavior, which is relatively easy to teach, so the child can easily succeed and learn the system. After the child has learned the system add more difficult behaviors.
3. List the behavior on the Praise Sheet and concentrate only on this task during the week.
4. Place a "Smiley Face" or check mark on each day of the week on the Praise Sheet if the child successfully completes the task and praise the child for doing the task.
5. At the end of the week of "mostly" stars, give the child her reward. Negotiate with your child in advance about the reward. Usually the reward should be added time spent exclusively with a parent doing a fun activity.

The following example may help:

"Johnny, I want you to learn to put your balls in your toy box before bed, without a reminder. Every day you do this, I will place a gold star on your praise sheet. If you have mostly gold stars at the end of the week, your father will take you to the park on Sunday."

The Praise Sheet

List the target behaviors under the behavior column. List the rewards under the behavior column.

Concentrate on one task at a time and go from easy tasks to intolerable behaviors. Use this sheet or devise more attractive ones of your own.

Behavior	Monday	Tuesday	Wednesday	Thursday	Friday	Saturday REWARD
Balls in Toy Box at Night (Example)						Trip to Park with Dad