Welcome to our last parenting chat of 2015!
Sorry we are running a few minutes behind.
Dr. B. is having some trouble getting to our chat.
So excited to be back at our chats!
It's good to reconnect, Dr. B.
We have so much to talk about!
Given that the holidays are upon us, I was hoping you could share some of your experience in the ER in how to keep ourselves healthy and safe. Can you share the top ten reasons why children end up in the ER this time of year and how to prevent it?
#1 Fevers-- Holidays are a time for friends and families to gather, and people can be very reluctant to cancel Christmas at Grandma's or a holiday music concert that they have practiced just because one child has a cold. And so... the germs spread.
#2 Lacerations from opening boxes and packaging with knives. You know all that kid-proof packaging that is pretty much adult-proof, too? Kids and grown-ups alike often wind up in the ER with lacerations from opening packaging with kitchen knives.
#3 ATVs: ATV accidents are some of the worst ER cases. Many children are dead or near-dead when they arrive, or have severe head injuries.
#4 Head bumps from excited play: Every shift I see kids who bumped their heads badly from rough play or running around too fast inside the house. Lots of sugar and exciting parties when kids stay up late are prime time for toddlers to fall down stairs, run into corners, or jump and beds and head their head on the bedframe or night stand.
#5 Dog bites: Even the friendliest dogs can bite children, especially toddlers, when they are provoked. Holidays are a time when people with young children are guests in homes with unfamiliar dogs. Add in the sugar and excitement, and the dogs can bite. There is nothing like a toddler with a dog bite to the face to put the brakes on your holiday fun.
#6 The stomach flu: Gastroenteritis, better known as the "stomach flu" is a viral syndrome with vomiting and/or diarrhea. It is common in the winter time, and very contagious. One trip the the ER and we can give you nausea medication and IV fluids if needed to put a stop to all the vomiting.
#7 swallowed stuff: I see all kinds of interesting stuff on x-rays-- tree ornaments, LED bulbs, money. Swallowed magnets and batteries can be especially dangerous.
#8 Dangerous toy injuries: Toxic poisonings from lead, pthalates, and other chemicals found in gifts intended for children are a serious health issue during the holidays. Disclaimer-- most of these issues don't present to the ER, because they are not emergencies.
#9 Allergic reactions: Food allergies are common during the holidays when people may eat party food that has hidden ingredients. For example, a lot of holiday foods contain hidden nuts.
#10 Drunk teens: Parents like to drink during the holidays, and teens often follow our example. When teens are off school and left home alone while parents are at work, they often break into the family liquor cabinet. Snow days and school holidays are prime time for teens to get into trouble with alcohol, and with the alcohol comes all the other risky behaviors including sex, drugs, drinking and driving, etc. We see a growing number of teens who think that marijuana is not dangerous. Driving under the influence of marijuana is a real risk.
#11 Depression, anxiety, and suicide: Sadly, the holiday for many are not very merry. Teens are especially at risk for depression, anxiety, and suicide. I see many of these patients in the ER. Their stories are complex and devastating. The good news is that teens have a good likelihood of full recovery from mental illness with appropriate treatment.
This is great list, and I'll post it separately after our chat, so readers can share it easily.
Let's take a question from a long-time loyal chat participant.
I remember that time period so well, Mike. It's difficult and tests parents' patience and energy.
And I hate to say this, but your daughter may go through a similar phase during tween and early teen years.
So, rest assured that her boundary-testing behavior and your frustration with it is very common.
One thing I wish I had known when my own child was in this phase was that I should have focused a lot more of my energy in controlling my own reactions and less on worrying about hers. No parent likes to hear a child cry or whine or complain or lash out. But, child do react that way when they are learning how to regulate and control their emotions.
I would get trapped in this cycle of wanting her to change how she was responding which would just make me angrier and more frustrated, which made her more upset. Bad cycle.
Mike, she knows how to push your buttons. I agree with Aisha, you need try not to be moved by her tears.
Yell less, love more: Yelling is a late defense mechanism, a technique we use when everything else fails. But yelling can hurt kids more than we realize– it might cause an immediate behavior change, but in the long run can cause real psychological harm. Rather than yelling and harsh punishment, children need positive parenting for healthy brain development. Dr. Joan Luby is a professor of child psychiatry and director of the Early Emotional Development Program at Washington University School of Medicine in St. Louis. Her research shows that positive parenting of toddlers in stressful situations, rather than scolding or corporal punishment, is actually associated with an increase in the size of certain areas of the brain. If you find yourself yelling at your kids too much, you need other options for discipline.
I wish I had spent more time pointing out the times during the day when she was doing things well and praising the effort.
Label behavior: Instead of getting angry, label behavior. I got this from Sesame Street—there’s one scene where Cookie Monster is accused of lying about stealing cookies. Frustrated and upset, Cookie Monster says, “Me glutton, not liar.” If Sesame Street can use words like “gluttony” to label behavior, so can I. So now we use words like “gluttony,” “patience,” “kindness,” and “diligence.” It sounded weird at first, but now I love it when 6-year-old tells her teasing brother, “That’s not kindness!”
Be attuned to your children: The key to raising emotionally healthy children is attunement, or how well you recognize your child’s needs at any given moment. Attunement, in short, is putting yourself in your child’s shoes and then meeting their needs with the wisdom of a parent. Try to identify the root of your child’s misbehavior– why she won’t put her shoes on or why she’s throwing a tantrum– then tailor your consequence appropriately. Most books on discipline and parenting revolve around the same themes—be consistent, follow-through with consequences, don’t give too many warnings, don’t punish in anger, etc. Although I agree with these themes, there is a risk of becoming too formulaic. In attunement parenting, we don’t just give time-out as a rote response to misbehavior. Instead, attuned parents ask “why” a child is misbehaving. When we understand the root of a child’s misbehavior, we can better meet their needs, love them, and get long-term healthy behaviors. I’ve written more on Attunement Parenting and how it differs from Attachment Parenting here.
It increased my patience with my tween when I spent some time remembering those turbulent years. It increased my empathy and her tears or outbursts affected me less.
Anticipate repeat offenders: Children, like adults, have patterns of misbehavior. They do the same wrong things again and again. Do you fight about clothes every morning, or struggle to get your 3-year-old strapped into her carseat? Know your repeat offenses, intervene early and encourage your child to make good choices. I had a 3-year-old that liked to refuse to get strapped into her car seat because she knew she could control the whole family– the car wouldn’t move until she was strapped in. The more she refused, the angrier our other children became, and she felt powerful. So one day, on the way to the car, I said, “If everyone says, ‘We love you!’ three times, will you strap into your car seat and be happy?” She said, “Ok, but you have to say it five times.” We did, she strapped in, and everyone was laughing. By giving her control of a little issue, I gained control of the whole situation.
It's harder for us to remember what it is a like to be a toddler, but I think taking a moment to take a deep breath, give ourselves a time out, remember that we can only control our own reactions and validating a child's frustration in that moment can de-escalate a situation.
One other thing that comes to mind, to piggyback on what Dr. B. has already said: Give children a robust emotional vocabulary (especially when they are not upset) to be able to put words to emotions.
A three-year old can learn a lot of specific emotion words and talk about the shades of difference between feeling guilty or sad or angry.
Helping a child learn how to talk through bad feelings is an important life long skill and that work is best started early.
Thank you for sharing all those links. And thank you to everyone who joined us. Have a safe and wonderful holiday season, and we look forward to chatting with you again next year!