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What about "MONO"?

by Doctor Laurence H. Miller on 01/29/13

The dreaded nightmare of the teen years: draining fatigue with a terrible sore throat, huge "kissing" tonsils coated in pus, so bad that the youngster can't swallow his/her own saliva(!), severe nausea/abdominal pain, with insomnia mixed in for good measure...

This may be the harbinger of Infectious Mononucleosis.  The infection is caused by the Epstein-Barr virus, a member of the Herpes Family.  It belongs in the Herpes group because, like Chickenpox (Varicella to doctors) and Herpes Simplex viruses, you only get severely ill from them when you are first infected by the germ.  As a rule the patient completely recovers, but never clears the virus from his body.  It becomes dormant, hiding out in body tissue (usually nerve cells).  It can make a reappearance even years later (as shingles can after chickenpox), but almost always in a limited form.  I mention this early in my essay to clear away the MYTH of chronic mono.  Because of the theoretical possibility that the "E-B" virus could reactivate, some people who suffer with relentless fatigue of unknown cause are labeled sufferers of chronic Epstein Barr viral infection.  I've discussed this condition with many Infectious Disease specialists, and not a single one believes the theory is valid.  Close to 100% of these patients are proven to NOT have active E-B viral infection.
But what of acute mono?  The syndrome I described in the first paragraph usually strikes only a teenaged patient.  If a young child is infected by the virus, she may only suffer symptoms of a standard cold/sore throat.  In communities in the world where crowded living conditions are the rule, kids are frequently infected when they are young, even four years old.  But, unlike the bacteria that causes strep throat,  E-B virus requires very close, intimate contact to spread.  Hence, its nickname, "The Kissing Disease".  But it can also be spread during intense athletic sports where young people share each others' water bottles, or share food from the same plate.
The illness begins with signs of a cold and sore throat, but it becomes MORE severe with terrible tonsil pain as a week passes.  Marked swelling of the lymph nodes in the back of the neck occur along with fever.  Rarely, it can present with terrible fatigue alone.  Often, infection with Group A streptococcus is considered as the possible culprit causing the illness.  It is important to know that both infections can occur simultaneously.  In fact, an estimated 30%of patients with "mono" have Group A strep infection at the same time!
But this illness is not just a "tired sore throat":
Hepatitis occurs in the majority of patients.  The liver is injured by the infection so that some patients can become jaundiced with yellow/orange eyes and skin.  Blood tests will prove this damage with changes in blood chemicals.  Fortunately, the injury is almost always mild and brief.  The liver heals quickly when the body/immune system overcomes the infection.
Classic "Mono" also involves the spleen.  It becomes painful to pressure and large enough for a doctor to feel in one quarter of cases when the abdomen is examined.  The engorged spleen is in danger of hemorrhage if injured.  Contact sports, including bicycle riding, aren't permitted during the illness.
Riding in an automobile is discouraged since a seat belt could injure the spleen in an accident.  And, rarely, a spleen could begin bleeding even without a noted injury.  Patients are warned to beware of severe abdomen pain and to notify their doctor should it develop.
There is no medicine to treat "Mono".  In fact, taking the antibiotics amoxicillin, ampicillin and Augmentin are almost GUARANTEED to cause a severe body rash, confusing patients to believe they are allergic to the treatment.
Occasionally, however, a patient's throat and tonsils are so swollen that he can't swallow at all.  In that case, offering the child prednisone or decadron steroid medication for a few days can avoid the need for hospitalization.  The swelling shrinks in a remarkably short time, and the patient feels much better. (Because of the possible side effects, this treatment shouldn't be used routinely.)
Rarely, an alarming neurologic syndrome occurs with the patient "not feeling like themself".  They may also be confused with the size of objects, with things appearing much smaller or larger than reality, as in "Alice in Wonderland".
These complaints are thankfully only temporary, as a rule.
The blood tests that help us make the diagnosis include
The CBC.  This reveals "atypical lymphocytes" found almost exclusively in "Mono".  The platelet count is typically mildly lower than normal.
The "liver enzyme" test is ALMOST ALWAYS abnormal with elevated levels (usually only mildly so) even to the point that jaundice (yellowed eyes and skin) can occur.
The rapid "Mono spot" test gives a result in under ten minutes.  But the test is unreliable if the patient is a young child, or if the illness has been ongoing for less than a week.  More definitive is the viral capsid antibody (VCA) test for IgG and IgM.  If the IgM value is elevated, the patient almost CERTAINLY has EBV infection.  If only the IgG level is high, it means the patient is ALREADY immune to Mono and NOT currently ill with that infection.
It is important for the patient to eat lightly, drink plenty of fluids, and try to keep out of bed during the day.  MOST patients recover in two to three weeks.
Return to school and activities is best done gradually, so the patient regains endurance and doesn't become exhausted after weeks of inactivity.

The Young Infant and Food

by Doctor Laurence H. Miller on 11/06/12

Milk, human milk, is the perfect food for the newborn.  Milk is an excellent food for young infants. Milk is a good food for older infants.  But milk is only a fair food for toddlers and older children.  (And this isn't even considering the potential problems associated with COW'S MILK.)

Why is that?  Because, once a child is old enough to eat other foods, over feeding milk will interfere with the hunger that is necessary for the child to want to eat other foods, and thus get the benefit of their nutrients, nutrients which are NOT present in milk.
Since a one year old only needs about 500 mg of Calcium daily, they NEED less than a pint (16 oz.) of milk daily.
Pediatric nutritionists advise not starting foods other than milk until five or six months. But how should we introduce them?  Generally we begin with cereals, and then certain fruits and vegetables.  After that, we offer meats and then yogurt.
We finish the first year with fish and orange juice.
Guidlines are simple.  New foods should be introduced every few days.  So that if baby has a severe allergy or reaction to a few, it will be easier to identify which one is responsible.  I advise starting a new food early in the day, before noon. ( So the family doesn't have to deal with an allergic reaction when baby is already in bed.)
It makes sense to only give one or two tablespoons of a food on the first day you offer it.  Then after a day or so, you can give as much as a small babyfood jar.
Foods should be offered once or twice a day, depending how well baby accepts it.
The schedule I advise is as follows:
At about the fifth month, begin cereals and basic fruits
OATMEAL                                APPLESAUCE
BARLEY                                    Mashed ripe BANANA
RICE
If there is any question of baby having INFREQUENT bowel movements, I avoid rice for at least a few months.
After several days on a food, another new food can be mixed in with it.  So, you can introduce applesauce by adding it to the oatmeal baby has been enjoying this week.
Each month following, we offer a new class of foods.  I'll group them together here:
Additional Fruits:  Peaches, Plums, Apricots, Pears, and PRUNES.
(I placed prunes in capitals to emphasize that they are a FOOD, not a MEDICINE, and an excellent way to keep baby's stools soft and flowing!)
Many parents today prepare fresh pureed fruits and vegetables for their child. I wholeheartedly encourage this.  Pureed Pears with the skin left on is also great for keeping stools soft and easily passed.
Yellow vegetables:  Carrots, Sweet potatoes, Butternut Squash ("Bird's Eye" makes a wonderful frozen product, "Cooked Winter Squash" that's already pureed and heated in the microwave.  Be careful it's not too hot!) and Beets.
Beautiful, purple-red beets are easily prepared: Clear away skin with carrot-peeler.  Then slice and boil/steam for about ten minutes.  Puree and eat.  They are SOO good AND good for you!
Green vegetables:  Green peas, Green beans and Spinach.
Meats:  Chicken, Beef, Turkey, Lamb.
Dairy:  Yogurt can be adult brands.  You'll want to serve baby plain or vanilla and mix in baby's favorite fruits OR vegetables.
Fish (at about ten months old).  Mashed salmon and sardines are the best.  We have to be careful with tuna because of documented toxic MERCURY contamination.  Reportedly, "chunk lite" variety is the SAFEEST and higher concentrations of mercury in Solid white/Albacore, and Ahi tuna.
It's advised to withhold egg until after the birthday. The majority of babies eating it earlier will be fine.  But it is a highly allergic food and I personally have seen a ten month old infant severely ill with hives on her second exposure to eating eggs.  She required emergency room care.
Honey should never be given to a baby under one year old.  If botulism spores are present, they could be toxic to an infant while not being harmful to an older toddler.
Juices should not be given to babies.  They are a poor source of nutrition, providing carbohydrates/sugar and nothing else.  Parents are conned into offering them because they "have vitamins".  But they  corrupt a baby's taste buds so that they reject real fruits and vegetables since those foods begin to "taste wrong".  IF you think a baby is thirsty, water is fine.
(Please make sure to look over my piece on CHOKING FOODS in an earlier blog)

Catch them being good!

by Doctor Laurence H. Miller on 09/18/12

So many parents wonder why little kids "are always misbehaving".  The answer is quite simple:  people (ALL people, including little kids) will continue to perform behavior that gets REWARDED.  Most adults tend to ignore children who are playing quietly, without fighting or being disruptive.  But children, like most people, HATE to be ignored.  So, since they know "deep down" that MISBEHAVIN' will get them ATTENTION, that's what they HAVE TO DO!  It doesn't matter that the attention they'll be getting will be SCOLDING, and anger, it's STILL a POWERFUL REWARD, or what they call "Positive reinforcement" in the psychology business.

 A parenting magazine recently offered the following tip to keep young children from interrupting your telephone conversations:   Wait until you see your little one playing quietly; approach casually and make a "phoney phone call".  Pretend to be speaking with someone.  The script should be short: "Hi Mom, everyone's fine. I just wanted to say hello.  We'll see you next week."  Then hang up. Then you look down at your child with amazement:  I CAN'T BELIEVE you waited SO PATIENTLY while I was speaking on the phone!!  No other boy/girl on Long Island could be so POLITE and PATIENT!!

All you have to do is repeat this little play-acting two more times, and the child will be UNABLE TO RESIST being "THE BOY/GIRL WHO WAITS"!!!!  You could talk on the phone for half an hour, and the longer you speak, the MORE DETERMINED THE LITTLE ONE WILL BE to NOT DISTURB YOU!
Every time the kid looks in the mirror, THAT is who they will see.  They are quite suggestible at that age, and gather their SELF-IMAGE from what they hear about themselves FROM THEIR PARENT!  So when the young child sees the enormous pride and love in his parent's eyes, he is self driven to maintain the behavior that got him that look.
(More to follow on this psychology/discipline issue)

Homo Sapiens: We are Worriers (and Warriors), addendum to original post

by Doctor Laurence H. Miller on 06/12/12

When Captain Chesley Sullenberger landed his crippled plane safely on the Hudson River, in Jan of 2009, the whole world cheered.  He, his crew, and his passengers had all been in grave danger; a catastrophic "bird strike" had destroyed both engines of  their jet.  Without any power, they could not possibly reach an airport.  But now, thanks to the pilot's amazing dexterity and judgment,  their troubles were over.  You'd think "Sully's" (the captain's nickname) worries were over. But you'd be wrong.  For several days after his heroic performance the pilot was unable to sleep.  It was not from lingering fears of the averted horrific crash that he tossed and turned:  He was playing the flight over and over in his mind because he was troubled by the thought that "he might have done something better" than perform a perfect river landing.  

What is THIS about?!  He wants something "better" than 100% survival of his crew and passengers?  There must be something wrong with him?!  Or perhaps there is something right with him! Perhaps the reason this pilot was able to make a miracle landing on water was because he was always worrying about doing his job perfectly!
When you are a passenger on a plane going down on the Hudson River with no engine power, you definitely want your pilot to be a guy who worries MORE than he needs to.  Someone who feels compelled to work endlessly perfecting his craft, whatever it may be.  Whether it's a surgeon replacing one of your heart valves, or an engineer building a suspension bridge over the Hudson River, or a concert violinist preparing a Beethoven sonata...
As the punchline goes to the old joke  about someone asking  how to get to Carnegie Hall:  Practice, practice, practice!
In this regard, the author Malcolm Gladwell has written a revealing book entitled, Outliers.  In it, he explores the characteristics of successful people, such as Bill Gates and the Beatles.   One chapter, called Ten Thousand Hours, convincingly shows that it takes that long working at something to become a True Master.

Jumpin' Jack Flash!!

by Doctor Laurence H. Miller on 05/23/12

This past weekend on NBC's Saturday Night Live, a man who will turn seventy years old in 2013 gave a musical performance that would have been insanely amazing for a twenty year old. 

 Mick Jagger, of The Rolling Stones band, was known in the sixties as one of "the bad boys of Rock and Roll". Unlike the early Beatles, who wore long hair for that time but otherwise dressed like male Barbi dolls, Jagger was clearly more openly "rebellious" regarding society's conservative standards.  In fact, his group drew from Blues and Jazz as well as Rock and Roll.  They were scruffy, frequently rude, openly using illegal drugs,  and if anyone didn't like it, "Too bad"!
Please watch his performance on "YOUTUBE". Try to imagine yourself enduring such a work-out.  Try to imagine your teen-age kids enduring such a work-out.  
Clearly this oldster is doing something right!  Clearly he has not indulged in unhealthy behaviors for a long time.  Clearly he has indulged in HEALTHY BEHAVIORS for a long time!
And what behaviors are they?  Firstly, and MOST importantly, he has been moving his body, A LOT,  for over fifty years.  Stop whining!  Stop complaining that you don't have the time! Start slowly, but START!  And, like the Nike commercial advises, "Just do it!" And please, PLEASE, make sure you get your kids to do it TOO!
Secondly, and JUST as importantly, he is doing something he LOVES to do! Clearly, this man LIVES for his music.  He is a master.  So help your kids find something (legal)  that they can be passionate about.  Something that causes them to literally lose track of time.  Psychologists have found that THAT is where TRUE HAPPINESS lies.  When a person loses himself/herself in something OUTSIDE of the self, that is the answer.  And then, whatever it is, do it, and keep doing it for as long as you can for the joy you find there.


Homo Sapiens: We are Worriers (and Warriors)

by Doctor Laurence H. Miller on 05/20/12

Frequently over the years, a young person between the ages of 6 and 26 has come to my office with the complaint of being overly anxious.  They feel that something must be wrong; that they are the only young person out there with this distress.  I believe it's a terrible loss for our young to experience "anxiety" as a sickness.  We don't think someone is sick if they cry out in pain after placing their hand on a hot stove.  Everyone knows we have five senses and "pain" is part of the "touch" sense.  The ability to feel pain is crucial for us to properly care for our bodies.  Otherwise, people would frequently be severely injured painlessly and not know about it until it was too late!

Likewise, to experience "anxiety" is to be aware that something very important, sometimes dangerous, is about to occur. Our body/mind is giving us a warning, before it is too late.  Feeling anxious may be uncomfortable, but it gets us prepared and alert.  Either we must face what's coming, or escape from it if we need to.  If we "face it", we want to be at our best to succeed as we face whatever the challenge is.  If "escape" is the right choice, we want to "clear out" fast and get to safety.
Let's look at a few examples of common "anxiety-provoking" situations:
A boy or girl would like to ask someone out on a date (Do kids still do that?).  I would say it's perfectly normal and healthy for the asker to have sweaty palms, pounding heart, and possibly chills as they prepare to pose the invitation.
It's common to "feel butterflies" and be "charged up" before taking a final exam, or sitting for the SAT's.
Anyone who's ever spoken before a large audience or performed in dance, music or theater, has had a touch of "stage fright".  That is, if they properly cared about how well the venture would turn out!
One is likely to be anxious  before an  interview for admission to a college.  And, despite the joy of being accepted to that college,  being dropped off at  school by Mom and Dad to begin four years of study away from home will give most teens a major case of "butterflies".
One is likely to be more anxious if preparing to go into combat with the military.  Most people would agree that there's something wrong with a person who feels no anxiety in that situation.
There is a classic fable of "the grasshopper and the ant".  It's an August afternoon when the busy ant bumps into the relaxing grasshopper.  Grasshopper asks Ant, "What's the big rush?"  Ant explains that winter is coming very soon and he must prepare for the cold days when food will be impossible to find.  But Grasshopper is not convinced:  "But it's August! We've got plenty of time!  There's plenty of food! Don't you feel that lovely warm summer sun? How can you even think of winter!  You are such a 'downer'!"  Needless to say, "in no time at all", months quickly fly by and Grasshopper comes starving to Ant asking for a handout. 
Our ancient ancestors lived in VERY dangerous times.  If we weren't "Ants", there was a good chance we wouldn't survive a cold, hungry winter.
We as individuals, are the descendants of SURVIVORS of those VERY TOUGH TIMES, which  lasted for MILLIONS of YEARS.  Those people had to be successful in THEIR environment.  Successful at being born. Successful at living thru the first, VERY dangerous year of life (when about one half of babies would die). Successful at growing up to find the right mate (who likewise had to BE a survivor from a SURVIVOR family!) so ANOTHER generation could be born.  And each of these "links" of generations MUST be unbroken for MILLIONS OF YEARS into the DANGEROUS PAST.  
So, if we have to decide to err one way or the other (worry too much or too little), I think it's clear most of our ancestors were the WORRIERS.  Or they listened to the advice of worriers and followed their lead. The overly relaxed "grasshoppers" and their families would be doomed.  They were bound to die out from some deadly encounter for which they were unprepared. So they FAILED to leave "relaxed" descendants who would be alive today. In any case, as the great Darwin explained it, the worriers were "the fittest" for the wild world of our past, and so they did survive, and so WE came to be alive because of their "gift" of worrying, AND we inherited their DNA, including the genes for worrying about all kinds of stuff!
But anxiety does MORE than protect us from danger. Anyone who has participated in "performance" of any kind knows how good it feels to "just DO IT".  The "kick" of competing in sport, performing music/dance or acting or public speaking becomes a "high" of sorts; exciting after the initial nerves pass and you realize you are "OUT THERE" and shining, sharing, sparkling, and doing something quite special!  Without those "pre-game butterflies", it just wouldn't be as good!

"Chariots of Water" (not quite a Movie)

by Doctor Laurence H. Miller on 05/07/12

About 15 years ago I spent two weeks in the Vermont woods as a camp doctor.  My nursing staff consisted of four delightful young women from England.  When they heard that I'd never experienced the adventure that is waterskiing, they enthusiastically encouraged me to get down to the lake and try it at my first opportunity.

Three days later I was down at the waterfront and the instructors fitted me with skis and took me out in their motorboat.  They coached me on how I should position my arms and legs and what to expect when the tow rope would start pulling me.  I got in the water and waited with excitement and some trepidation as the boat pulled away.  I nervously anticipated the sudden "yanking" of the rope I was firmly gripping.  This would test my athleticism and balance:  lean back too far and I'd fall; lean too far forward and I'd fall.  In less than ten seconds,  I had tumbled over and was being dragged across the lake surface until I wisely let the rope go.  I coughed water and tried not to thrash or make a fuss as I swam in place, waiting for the boat to circle.  They came around and picked me up.  The counselors reassured me.  Told me to try again.  And I did.  Again. And again. And again.  For about forty minutes and five exhausting, frustrating attempts of my flopping around and feeling a foolish oaf.  Suddenly I realized that my limbs were lead, drained of strength, that my chance of successfully getting up on the skis was nonexistent.  I told the ski instructors that I was through for the day and the boat took me sadly back to shore.  I knew that I would never be able to do this sport...

Dispirited, I trudged back up to the woodsy medical clinic, only to be greeted by the four up-beat English nurses who laughed at my down-hearted attitude. "Don't you worry!," they chirped in chorus. "The same thing happened when we took our first spin at summer's start!  That session beat us up;  near to lyin' down on the shoreline like dead mackerels!  We were certain we'd never learn. But we went back to the boat a week later, and first try out, up we went, skimin' along the surface like we was ice-skatin'  at Christmas time! You go back next Tuesday! You'll see!"

A week passed and I was back at the lake.  This made no sense to me.  I was forty. I knew how to do what I knew how to do (biking, swimming, awkward snow skiing) but my body and mind were done with "learning to do new stuff".  There was no way that I was going to succeed "right off" today, when a week ago,  I was a pathetic half-drowned wreck!  But those pesky English "birds" were so certain.  They left me with a glimmer (but only a glimmer) of hope to give it one more ride:

I imagined that the boat counselors were not pleased to see me.  But they politely set me up again in the water, calmly motored away from me AND THE NEXT SECOND I WAS UP!  SAILING ALONG, SKIMMING THE LAKE!  Elegantly, I trailed behind as I held onto the tow line:  not too tight, not too hunched, not too stiff, knees bent just so.  I almost felt like I was dreaming!  How did it happen this time?  My legs, arms, back and head had all known what to do as the moment to ski arrived.  The boat crew cheered.  I felt like an Olympian.  We made several circles around the lake and they even let me thrill to crossing the boat's wake.  I was victorious!  They signaled me that they had to give a turn to someone else - and it was done, over.

Over the passing years I still MARVEL at what had transpired that summer:              I took a chance and attempted to learn something brand new for this forty-something year old city dweller.  I tried to master the new skill but seemed to have had NO SUCCESS on the single day I'd devoted to it.  But after a week's passing and no conscious thought or effort devoted to the activity, I had  MASTERED the skill!  I had become a proficient waterskier by NOT ENGAGING in the activity!    The only conclusion one can make is that, despite my consciously neglecting the skill (possibly BECAUSE  I "let go" in an Asian way and stopped pressuring myself), my body and mind had solved the puzzle, and, during that week of inactivity, had learned what they needed to do to be successful.  

 If it had only happened to me, I might wonder if it had been some kind of religious, miraculous experience!  But those English nurses had guaranteed that it was going to go down that way!  The same thing had happened to them.  So the real lesson is that our mind/body can still surprise us with what it can do, what WE can do, when we put our mind to it.  But it's essential that we know when to "cut ourselves some slack", because DOING JUST THAT may be exactly what's needed for the recipe of success!   And it's true for children of all ages, even forty-something ones.  

(Keep an eye out for "The Bike Riding Lesson" - A Blog coming soon to Your Neighborhood!)

The PURPLE baby and the 5 S's

by Doctor Laurence H. Miller on 03/27/12

What is colic?  The term has been used for about 100 years, but it is still shrouded in mystery.  All babies cry.  Some babies cry more than others.  In 1954, Dr. Morris Wessel described "infantile colic" in the Journal Pediatrics, as "paroxysmal fussing in infancy", in a baby "under 3 months old crying more than 3 hours a day, for 3 or more days a week". To meet the definition, it is critical that the baby have no existing discoverable medical illness.  It is necessary for a doctor to evaluate a baby who is so distressed for a prolonged time to "rule-out" such conditions as: scratched cornea of the eye, ear infection, a "hair tourniquet" (in which a long hair, usually Mother's, is wrapped tightly around a finger, toe, or penis, so that it cuts deeply, painfully into the flesh), intestinal obstruction, serious infection, or severe cow's milk intolerance. (In babies with severe cow's milk intolerance, catastrophic gastro-intestinal symptoms can appear with relentless vomiting, bloody diarrhea, and even cardiovascular shock. Soy intolerance is also present to the same degree in up to 30 % of these infants. So switching such a baby to soy formula is a terrible idea; you are making a bad gamble with the infant's safety!)   Once that examination has been performed, parents will need to accept that it is NORMAL for THEIR baby to cry A LOT for that part of his/her life.  Easier said than done!  It is painful for parents to have to listen to and watch their much-loved infant in obvious pain.  In this situation, I try to comfort parents by advising them, that if they are distressed by the sound of their crying baby, that is a good thing!  Through eons of evolution during which survival for human babies was very tough, the baby that cried with the right pitch/quality, in such a way as to get adults to care for them, would be a baby much more likely to survive!  (If one likes the sound of his baby crying, there is something terribly wrong, and perhaps that baby should be promptly brought to the authorities for safe keeping.)

To educate parents to this situation, Dr. Ronald Barr, of Vancouver, Canada, developed a program called "PURPLE crying".  "PURPLE" is an acronym describing the six characteristics of this crying baby:
1. P(eak) age the crying behavior is present; from approximately the 6th through the     9th week.
2. U(nexpected) appearance of distress in the baby, without warning.
3. R(esistant) to soothing; unlike earlier crying behavior, these "attacks" aren't                    calmed easily.
4. P(ainful) appearance on the baby's face and in his manner.
5. L(onglasting) attack of intense crying that can persist for as long as five hours.
6. E(vening) is the time of day it usually comes on.

Getting relief for these children (and parents) is problematic.  Some babies, sometimes, just won't quit howling!  It isn't advisable to give Gripe water as a treatment.  Just because it's "over the counter" and "has herbs" in it, that doesn't guarantee it is safe.  Over the years, American capitalists have come up with many ideas to cash in on families' suffering from colic:
taking the baby for a ride in the car, placing a vibrating device under the crib mattress so that the baby feels like she is riding in a car at 50 miles per hour, a papoose for carrying the baby on your chest.  An explanation why these efforts may help is that the baby feels the way he did back in the womb, and that is very calming.
There are a few free recommended maneuvers a parent can try that can really help ("not guaranteed- but you get your money back if baby's still crying!"). 
Conveniently, they all begin with the letter "S".
1.S(waddle):  wrap the baby snugly in her light blanket, into a little bundle.  When baby's flail their arms and legs while crying, it sets off startling reflexes that can upset them even more.  So immobilizing them can stop the vicious circle.
2.S(waying): gently, softly, slowly hold the baby in your arms and slow dance, rhythmically.
3.S(sssshing): making this soft sound can be soothing (to the parent as well as baby)
4. S(tomach) positioning often calms the baby who molds against the mattress, perhaps feeling more secure.
5.S(ucking) a pacifier could be compared to meditation, reducing stress.

The "take-home" message is that it IS normal for babies to cry.  There is a "range" of normal that increases in the number of hours per day as the baby ages into the second month of life.  I was fascinated to notice that each of my daughters, born eight years apart, were "angels" their first month, but began to suffer almost daily attacks at six weeks old with what seemed to be cramping abdominal pain.
The baby seemed to be trying to push out a bowel movement, so it occurred to me that gently inserting a well lubricated  thermometer about 3/4 of an inch into the rectum could give relief.  The majority of the time, it was a great success.  Baby would push against the inserted thermometer and, usually, gas or stool would shoot out as I'd withdraw it.  Some medical authorities disapprove of this technique.  They worry that it could be "habit forming"; that baby (or mommy) will become overly dependent on anal stimulation to have a bowel movement.  One doesn't have to worry about this if we limit the maneuver to once in 24 hours.  Also, consider that the Miller babies showed this urgent, crampy behavior for a period of about 7 to 10 days in the middle of their second month, and never again!
But let's explore a bit more this apparent behavior of seeming to strain at pushing out stool.  Why is baby struggling?  Perhaps it's partly because baby's instinct when they get this feeling of pressure is to clamp down all the muscles they can.  So they tighten the muscles in their face, neck, arms, abdomen, limbs, and rectum!  Now we may have hit on something!  It makes sense to constrict/tighten all those other muscle groups; but it's counterproductive to constrict the anal sphincter if one is trying to pass a bowel movement.  It will happen eventually. But only with a great deal of force.  My suspicion is that babies calm by their third month because they are finally "getting it" and have learned to squeeze all muscles except the anal sphincter in order to pass stool.
More on the possible "cause" of this challenging time in my next post...
  

"Mom always liked you best!"--Tommy Smothers, 1965

by Doctor Laurence H. Miller on 03/12/12

- Why is this quotation, a "running gag" from a 1960's musical/comedy variety show, funny?  Is it funny?   Sigmund Freud wrote an entire volume on humor.  When we joke about something, the reason might be that we feel a troubling emotional connection to the subject and  gain relief and comfort by giggling about it.. A recent survey of United States adults revealed that about 25% are estranged from their siblings.  So this business about Sibling Rivalry, and its long term consequences, is powerful.

But is this a new phenomenon?  Another "plague" of modern society?  Apparently it's been around for quite awhile.  There are multiple examples in THE BIBLE  in which our ancient ancestors had serious problems with their brothers.  The story of Cain and Able is that of a tragic fratricide, resulting from Cain's resentment of Able's sacrifice to the Lord being acceptable, while his was found wanting, not worthy.  Then there's Isaac and Ishmael, with Abraham favoring Isaac so that he sends Ishmael and his mother away.  Isaac had twin sons, Esau and Jacob.  But their mother, Rachel, loved Jacob  more!  So she connived to get Jacob his father's inheritance, CHEATING HER OLDER CHILD Esau, HER OWN SON.
And we mustn't forget Joseph, the interpreter of dreams (an early Freud?), who is SOLD INTO SLAVERY IN EGYPT BY HIS BROTHERS because their father Jacob  favored Joseph.  Subtly, this story shows the progress of their "civilization", since this group of brothers rejected the plan of killing Joseph, because they would have "felt guilty" if they took his life outright!  The consequence of their "mercy" leads to their own survival much later, when their land is suffering famine, and Joseph, now Prime Minister of all Egypt, welcomes their families into his kingdom.  This is a great example of that old saw:  What goes around comes around!   Do good deeds out of SELF interest, because your goodness could very well come back to benefit you in a real way.
Bruno Bettleheim, in his classic "A Good Enough Parent", explains that sibling rivalry exists because succeeding at being "the favorite" would have given survival advantage to those babies over the eons of human evolution.  Let me give an example. Suppose Mr. and Mrs. Jones have a three year old daughter, Alexa.  If there were a fire in their home in the middle of the night, they'd know exactly what they had to do:  get Alexa out of the house.
But suppose we change the story now and give Alexa a baby brother Danny and send Daddy out of town on a business trip.  Now a night-time emergency poses a terrible quandry for Mother.  Whom does she rescue first?  She loves both children to pieces.  But she can only rescue one child at a time!  Her pressured decision could be a matter of life or death!  
THIS is the crux of the problem.  And young children (and older children subconsiously) really "get" this.  You can reassure them endlessly, but they'll still be anxious.  "Am I getting my fair share?" "Does he play the instrument better than I do? I have to be better!" ( Hilary and Jackie is the heartbreakingly brilliant film of the life of gifted cellist Jacqueline Du Pre.  Her obsession as a young child to practice her music came from the need to keep up with her talented older sister.  It is obvious that she never would have attained the heights of her art without the drive that came from her need to compete with her sister.)
 The arrival of a new baby can be unnerving for a toddler sib.  In "Rugrats", Angelica explains to Tommy Pickles that since a new baby has been brought home, Tommy will be moved out of the house to stay with their dog, Spike, in the backyard doghouse.  Tommy believes her.  For all he knows, there was another kid in the house staying there until Tommy came along, and then that first kid got bumped out!  So now it will be Tommy's turn to "move on".  With that in mind, it's reasonable for Tommy to "act out", with problem behaviors appearing.
Consequently, the toddler is very likely to have early resentment/hostility towards the newly arrived newborn.  As explained above, it is normal.  It may be normal, but it has to be dealt with.  The older sib can not be permitted to act on his aggressive feelings towards the newborn.  That would be emotionally damaging to the older child as well as the poor baby getting hurt.  But it's a good idea to allow him to express his hostility in an indirect manner.  Freud called this healthy release of pent up emotion displacement.  We can call it "blowing off steam" because it really does feel better to release the built up pressure. In The Magic Years, psychologist Selma Fraiberg describes her advice to a friend to buy "Puncho", the blow-up clown figure, a toy designed to be pummeled by little kids. Fraiberg advised the purchase because her friend's toddler, Lawrie, felt compelled to hit his new baby sister, Karen. The problem is that the little fellow can't "use his words" to express his occasional feelings of hostility towards the baby.  At 28 months old, he can't speak his emotions. So he hits and pinches.  Fraiberg's friend is instructed to offer the toy as a stand-in so Lawrie can inflict harm on it instead of the baby. But the next day, the friend complained to Fraiberg that the plan was a failure.  Little Lawrie still wanted to hit baby Karen, but he wouldn't hit Puncho because he LIKED Puncho! The clown was his friend!  "Some psychologist YOU turned out to be!", was the essence of the friend's critique of Fraiberg.  But the psychologist "has an ace" up her sleeve:  "Let's give it a week or so.", she advises.  Loyalties are fickle at two years old and perhaps Puncho will still make the grade as Lawrie's target for his anger.  Sure enough, a few days later, the friend joyfully shares with Fraiberg that she'll soon need to buy another "Puncho";  little Lawrie is now beating the heck out of the toy.  But when he is done with that "work", he's generally calmer, and gentle with his baby sister.  Success!
 Please don't get me wrong.  This sibling relationship is not all "dark".  A big dose of love and true admiration is mixed in.  Nobody makes a baby laugh and delight the way an older sibling can.  The spontaneity and playfulness of a child "turns on" the baby brother or sister like nothing else.  And if the older sib "likes it", whatever it is, it must be good. Whether it's a food being eaten, an activity engaged in, or an item of clothing that's being worn, the baby is likely to go for it, if it's "good enough" for big brother or sister!  Big brother or sister will get a big kick out of being baby's hero, and take great pride in that status.  When handled properly, they will become baby's great protector.   
In regards to "handling", one mistake many parents often make is to insist that young kids learn to share.  If they have a ball that belongs to them and a little relative (or friend) wants to play with it "now", the grown-up will turn to the owner of the treasure and pressure them to "share".  The main problem here is that as young as they may be, the young child has a legalistic view of social engagements: they take things literally.  So if you tell her to "share" with another child, that means giving up sole ownership of her property! 
Now the ball belongs to the other kid as well!  And that would mean a real loss to the original owner. So a two or three year old is likely to revolt in anger at this proposal.   This crisis, then, results from a communication break-down.  What does the grown-up mean to request of the ball owner?  We are only asking that the owner of the toy lend it the other child.  In that case, title to the property, ownership, remains in the hands of the original ball-holder.  The other child is only borrowing it briefly and must return it when done.  Does this sound "over the top", silly?  It is not.  Because the proper use of language we use with young children can matter enormously.  Although there is no guarantee, a revolution in the nursery could be prevented if a child can be convinced peacefully to compromise.  (Try it.  Next time you're in this situation, ask if "Johnny" can borrow the LightSabre toy.  And don't say "share".)
So what kind of sibling rivalry do my kids demonstrate?  Eight years apart, they are very close and loving sisters.  They are real friends.  But there's still some "rivalry" action going on.  Our older daughter was so crazy/excited when the new baby came, having longed for her arrival for so long, she didn't show any real hostility.  What she did express now and then, was concern that we were spoiling her sister, being too accommodating to a youngster's childish demands.  She would sometimes act on her feelings about this to "toughen up" her sister.  
But it was our little one who knocked me over one bedtime when she was four years old.  We'd just finished our sleep routine reading when she asked innocently/wide-eyed, "Daddy, who do you love more?  Me or Darya?"   I was stunned.  Out of the blue.  My mind raced.  I was unprepared for this.  Of course I knew the wrong answer.  One can not tell the asking child that they are the favorite for several reasons. (The only reason an exhausted, foolish parent would do this would be to quickly satisfy the little one and get her off to bed!)  Hopefully, the first is that it is not true.  Hopefully, there is no favorite child in the home.  If a parent foolishly were to tell a child he/she was the favorite, it would likely cause anxiety and guilt in that child.
This would be a conspiracy, a betrayal of the sibling "not favored".  And the child told she was the favorite would carry this "offering" as a burden, like the "mark of Cain".  Not for a second did I consider telling Juliette she was the favorite.  Then, in a flash, I saw my way out of the dilemma:  tell the girl the truth.  I replied, "I'm sorry, darling, there is no answer to that question."  She was taken aback, really surprised, and a little bit peeved.  She was used to my having all the answers she needed. (Well, most of the time.) She said, "What do you mean?  It's either her or me!"  To which I replied, "No, honey, you know there are some questions without answers, like: How high is the sky?  Well, this is one of those questions. All I can say is that I love you both very very much.  I guess I do love you both differently, since you're different people, but not one more than the other."  But she had to try one last time, "Come on!  You can tell me!", she exhorted. "If it's me, fine; if it's her, I can take it!"
The moment was surreal. .  I felt like I'd stepped into a Soap Opera with a twenty-four year old!  But I held my ground, and she went off to sleep, grumbling.
Five years later, when she was nine years old, I recounted the story to her, and she laughed with pleasure at the precocious, persistent baby she had been. "Did I really say that?"  Then, as we were ending our chat, she asked, "So, who do you love better? Me or Darya?"  Two seconds passed, and we both broke into laughter.  (Freud again? With our use of humor to break the tension of sibling competition that still had a germ of existence.)
Frequently, when I pose this question to parents, they fall for the trap I avoided.  You don't want to answer that you love both of them "the same". Even a young child will smell hypocrisy in that answer immediately.  It's impossible to love two children "the same" because they are different people.  So the child will know the parent is uncomfortable with the question, and is trying to hide behind a dishonest answer!

The MILLER "LIGHT" Plan (It Ain't Rocket Science, but it works if you do!)

by Doctor Laurence H. Miller on 02/03/12

When you're struggling with an overweight condition, you're dealing with a BioPsychoSocial Disorder...

"What does THAT mean?"  It's a health problem stemming from multiple sources. 
"Bio" is for "biological".  It's been shown in studies of identical twins separated at birth and raised by different adoptive families, that the body type of one twin will be SIMILAR to his brother (or sister) regardless of the weight situation of the family they were raised in.  If ONE twin is heavy, the OTHER one is very likely to also be overweight, even if the adopting parents were very thin.  Fraternal twins separated at birth DO NOT resemble each other nearly as much.
The "Social" means this problem goes WAY beyond the family's good or bad habits.
In 1960, when I was a kid, only 5% of American children were overweight.  Now about 30% of kids are overweight. That can't come from BIOLOGICAL changes, because it would take about 200,000 years to see that much change in our genetic inheritance.  What's new in the last 50 years? 
 --WORKING MOMS, which leads to MANY more meals eaten out of the home (or "ordered in" from a restaurant). 
 --SUPERMARKETS, with aisles dedicated to DESSERTS, COOKIES, SODAS, CANDY Breakfast cereals, and TAKE HOME PREPARED MEALS.    
 --Overcrowded cities and suburbs with too much auto traffic to allow kids to play outside safely unsupervised (or at least that PERCEPTION).
 --VIDEO GAMES and COMPUTERS tempting kids to stay inside the house instead of RUNNING around outside PLAYING EVERY DAY after school. (But kids CAN PLAY ACTION VIDEO games to help them stay fit if parents are encouraging!).
 --School cafeterias that offer fried foods galore and Soda and Sugary Juices in vending machines (I actually heard an interviewed school nutritionist JUSTIFY serving all the fried stuff by explaining that "the kids demanded it and would stay away and REFUSE to purchase food that was healthful"!).

 Changing the BIO really is impossible for now, until research scientists find a REAL treatment to reduce the REAL metabolic predisposition of SOME people to be overweight. Changing the "SOCIAL" is NEXT to impossible, because it means going up against trends/pressures of your whole community.  (Ninety per cent of Moms aren't likely to start STAYING AT HOME the way they did in the 1950's; schools have come to depend on the income they receive from beverage sales.)

So that leaves us with changing the Psycho part of the equation to reduce our weight in a healthy manner..  Literally, that means "changing your mind".  This is NOT a trivial task, but it IS doable!  The INDIVIDUAL has more CONTROL over his/her OWN experience, attitude, and behavior than over society or biology.  The person making a change in eating behaviors will need to PLAN AHEAD,  ANALYZE what he can do to IMPROVE his nutrition, and initially expect to be UNCOMFORTABLE as he makes changes.  But ALL change is uncomfortable. The first day of school, putting on a new pair of shoes, being the newest member of a sports team, are ALL uncomfortable AT FIRST.  But all experience gets EASIER if you persist.  The chance of success is far greater if the CHILD DETERMINES, makes the CHOICE of what she will give up and what she'll eat more of TO IMPROVE HEALTH!  So it's NOT about LOSING weight, being skinny.  It's about DOING the RIGHT THING.
  And that links us to physical activity.  Kids should move their bodies every day because that's what we've done for A MILLION YEARS.  That's how "we got here", through centuries of evolution. It's good for us, and when we "get into it", it FEELS REALLY GOOD!  Doing cardio work outs, with our hearts beating fast and our needing to breath deep and fast, has been shown to truly make us HAPPIER, CALMER and SMARTER at problem solving/thinking.   So we parents need to see that our children engage in it!
The Nutritional plan itself is as follows:

Daily:
1. Eight (8) glasses of COLD water, throughout the day, but especially before and during meals.

2.Vegetable servings: At least four (4) throughout the day.  Important to begin your meals, especially dinner, with at least one veggie serving.  It could be salad, or any vegetable THAT YOU LIKE!

3. Fruits:  At least four (4) daily.
                Plan to snack on these throughout the day for energy and to refresh yourself.

4. Salmon/tuna/sardines.  At least twice weekly.  Fish has now officially been raised ABOVE the other meat/protein foods for its healthfulness.  But note:  Wild salmon is strongly preferred because the farmed fish has the chemical PCB's in it that are toxic.  (Canned salmon is ALL wild; that's GOOD!)
All TUNA has mercury in it.  The fancier the tuna, the HIGHER the mercury content. Ahi sushi tuna is worst.  Solid white albacore is also high in the toxin.  Chunk light is the safest to eat, especially for little babies and pregnant women.  Check the NRDC website( http://www.nrdc.org/health/effects/mercury/guide.asp)to see how often you should be eating it.

5.Eat LESS starch (potato, rice, pasta, bread, cookies/cakes).

6 Fast food restaurants less than once a month.

7. Eat only 1/2 to 3/4 of the portion served to you in ANY restaurant.

8. Soda and sweet drinks (like Gatorade) only once weekly.

9.EXERCISE at least 4 times per week for 1/2 hour up to ONE HOUR.

10. STOP EATING when you're NO LONGER HUNGRY!  If you eat UNTIL YOU'RE FULL, that means eating TOO MUCH, eating until YOU CAN"T EAT any more or you'll BE SICK!

Daddy's Shining Moment in the Sun

by Doctor Laurence H. Miller on 02/02/12

"Pick your fights".    That's frequently the advice parents get from the experts who "know best" about child rearing.  But what does that mean "in the trenches"?  In the give and take of "everyday"?  Here is a tale of how this Daddy handled one "crisis":

It was a lovely, frigid Sunday in early February which we spent in the luxurious Trump Tower Cafe on Fifth Avenue within the windy skyscraper canyons of Manhattan.  My two year old daughter was quite precocious and she felt very grown up in her "elegant" party dress at brunch.  When it was time to leave, we strolled out of the restaurant and into the pink marble lobby. But when I offered to help her into her winter coat in preparation to our braving the cold outside, I was reminded of why I called her age/stage "The Tyranical Two's"!  "No! No! No!" she pulled away from me.  "I don't want it!"  "But darling," I reasoned, "It's FREEZING out there.  You have to put on your coat.  We all have our coats on."  She was unconvinced, increasingly indignant, and more adamant by the minute!  She would not put on the coat!  It quickly became clear that in order to put on her coat, I would have to wrestle her to the pink marble tiled floor!  We would struggle together there in tears and sweat, while the fancy people of midtown gawked at us in disdain as they passed  us by.  My poor baby-girl would be debilitated, humiliated, enraged at our having "disrespected" her, and feel sick with the dreaded "post tantrum" headache!  But suddenly, just like in a cartoon, "a little light bulb" went on over my head, and I knew what I had to do to save the day.                                                                         I looked her in the eyes, calmly, but in deadly earnest, "Are you sure you don't want your coat, because THIS is the last time I'm asking and WE are going into the cold outside RIGHT NOW?"  As she balked a last time, I turned on my heel and announced  like a General that we were "moving out".   My wife is usually the family quarterback, calling  the big plays with confidence, but she stared at me in awe, "Larry, are you sure?"    After all, it WAS about 15 degrees out there. "Absolutely! Let's go!", and we were suddenly straining against the vicious ice storm of Fifth Avenue.  I marched about three steps in front of my little girl, watching the horrified faces of people heading the other way as the sight of what looked like a "half naked" doll came toward them.  With my ears straining for her voice, I'd only walked about five feet when I heard her desperate baby-cry: "DADDYYYY!!!"                             I "stopped on a dime" and turned to find her shamefacedly looking down at the sidewalk with her arm extended upward toward me, silently begging me to wrap her in her coat.  ( It was clear from her body language that it was hurting her pride to have to ask to be covered up, after all!) "OH!!", I shouted in mock surprise, " We forgot to put on your coat!!", and I scooped her up, engulfing her in the thick warm wool.

 

What did my two year old learn from the day's events?                                                                                                                                                                                                                                     Her Mommy and Daddy wanted her to do something, but when she firmly refused, they DID NOT USE THEIR SUPERIOR STRENGTH AND SIZE TO FORCE HER TO COMPLY. So they RESPECTED her NEED for INTEGRITY, to decide FOR HERSELF,  WHATEVER HER REASONS.  

   And they acknowledged her RIGHT to be wrong.    It's when we make mistakes, errors in judgement, that we learn the most. Every great, successful person, without exception, had the opportunity to make great, big mistakes on the way to his or her amazing achievement!     

And when the little one realized her "terrible" mistake as the "needles" of painful ice air hit her in the face and body, she only needed to call "DADDY!" and I was at her side catching her in my warmth and safety. So she had reason to feel confident and secure as she moved on, choosing HER OWN WAY in NEW ADVENTURES!        

And what is MISSING from the little tale?   NO ONE FELT  THE NEED TO POINT OUT HER ERROR IN JUDGEMENT.  To "rub her face in it" and remind her that she had been "difficult" and "foolish" in refusing the coat. What "GOOD" would come of a playback of that videotape in the Trump lobby?  Only humiliation, shame and sadness.  But we want this little one to feel EMPOWERED by her choices every day.  OF COURSE she is going to make mistakes, but that is not only UNAVOIDABLE, it's actually GOOD FOR HER CHARACTER DEVELOPMENT!  "It's not that you got knocked down that matters, BUT HOW YOU GOT BACK UP!"  Thomas Edison made a point of saying that he had not FAILED 9,999 times when he endlessly chose the wrong metallic alloy while trying to make a light bulb filament, but that he had LEARNED 9,999 ways NOT TO MAKE A LIGHT BULB!!        (His 10,000th try was the charm when he finally discovered that Tungsten was just right for the job!)                                                                         

   Later that day, I considered the reason she had declined the winter coat in the first place.  My best guess is that my darling was feeling so beautiful in her party dress, so special, that it was painful for her to "cover it up" with the coat.  And just as important was the meaning of "putting on the coat":  WE WERE LEAVING. IT WAS ENDING.  And that was too sad for her.  She had wanted it to last and last.

Reviewing the scenario in full, I was too proud for words.  It was the battle and the tantrum that never happened because, on that given Sunday, I had played a great "round of chess".  And you can be sure I've been "check-mated" by my kids PLENTY of times!

"S-H-Y" is Just a "four letter word"...(After Bob Dylan and Joan Baez)

by Doctor Laurence H. Miller on 01/22/12

If a young child in my examining room seems uncomfortable as I attempt to engage them, I always hang back, try to move and speak softly and allow them their distance.

Occasionally, a parent will cajole the child with: "Are you being shy?"
My back always goes up if that happens.  I feel protective of the child and resentful of the affront of being called a bad name by their Mom or Dad.  
Let's take a look at the behavior in that room.  If I were two or three years old, in a cold and strange/new place, and a strange big guy in a white coat was threatening to loom over me, I'd be pretty intimidated!  The parent most likely knows "the drill", knows what's going to happen in that room - the kid probably has almost no idea of what the immediate future is going to bring - except it very well could be "a shot"!
It seems natural to me that the little guy or gal will be very "cautious" and "act reserved" for a while.  So I can't keep myself from championing  the little one. I begin, "Oh, I hate to hear a kid called 'S-H-Y'.  It's pejorative (very negative name-calling) because, if you think about it, it really translates into the phrase 'excessively reserved', only worse.  One little syllable, and three letters, is more cutting/damaging than the six syllables of 'excessively reserved'?  That's language for you!  You don't want to label your child a word that evokes shame and pity.  I believe that's what 'shy' does for most people.  It means weakness, fearfulness, and unfriendliness.  And we know from  psychology research, that when a child hears himself called something, by someone he respects/trusts, he's likely to internalize (make part of himself) the trait that's being pasted on him."
So unless the parent has a "need" to have their child take on that role, they don't want to describe him or her in that way!  Because if the child hears Daddy say that's what he is, it will likely stick and that's how the child may feel he's really supposed to act, all the time, because it's how he's made.  The little boy or girl will be even more likely to act that way in the future when confronted with new situations. In fact, Daddy may be making his child "SHY"!
To redirect the parent's feeling about the child's behavior, I suggest "cautious" or "reserved" as a replacement adjective for how she's acting. Most of the time, I see the parent's eyes light up with understanding then.  "Cautious" and "reserved" are really neutral words.  If anything, they make you think of someone with social maturity. It takes good sense to be careful!  And these words aren't sticky!  Because someone can be cautious, a little "slow to warm up", and then transition gradually into having a rowdy wild good time!

You Can Drive Your Child Sane

by Doctor Laurence H. Miller on 01/17/12

I remember seeing a famous psychologist, Haim Ginott, on the old "Tonight Show" with Johnny Carson when I was a teenager.  In an amusing way, he encouraged parents to "drive their child sane".   He described the following scenario:

A man takes his son to the ice cream shop.  He orders an ice cream cone for the boy.  The store owner prepares the cone and is about to hand it to the little fellow (who is about 5 years old), but before he can give it to him, the Dad starts to tell his son to be very careful...If he's not careful he'll drop the cone and make a mess...This kind of thing has happened before....He's always doing things in a rush!...If it falls there'll be a big mess!!!....                                                                                         The little boy hears that his father EXPECTS him to drop the cone; he hears the NERVOUSNESS in his father's voice; he believes his father KNOWS EVERYTHING and so HE BECOMES VERY NERVOUS with SHAKING HANDS, (to NOT DROP the cone would make his Dad a LIAR) and of course he finally DROPS the cone on the floor.  The father YELLS and SHAMES the boy for his CLUMSINESS ONCE AGAIN!!  Reinforcing the boy's INSECURITY.

But the father COULD have AVOIDED HURTING the little boy he LOVES.  What if he SAID NOTHING as the shop keeper handed the cone to his son?  Maybe, because the little guy wan't crazed with anxiety from his father's warnings/threats of shame, he would have smoothly held the cone.   Or, perhaps he would have dropped the cone because he really was a clumsy kid.  Would that have been truly a TERRIBLE event?  Would anyone have ended up in the hospital because of this "accident"?  Not at all.  So, the helpful, calm, supportive parent would then get the attention of the counterman, "Excuse me.  We've had a little mishap here and dropped our ice cream.  Could we have some paper towels to help clean up the mess?  And another ice cream cone, please..."  What a different day that is compared to the first story!  The second little boy learns to keep things in perspective; he learns from his Dad that little mishaps aren't a big deal; even though he isn't perfect, things can be fixed.  THE NEXT TIME HE'S HANDED A CONE, HE'S LESS LIKELY TO HAVE A PANIC ATTACK.

Those of you who've met me know that I occasionaly have moments of being "highly strung"!  So when I took my own two daughters to the ice cream shoppe (they were two years old and 10 years old), I couldn't help but anxiously consider the possible ice cream accidents that might be in store for us!  But then, I remembered the vignette described above as we were in the process of being served.  I felt my inner self grow still and calm... What would be would be....That's when my ten year old, handed the cone to her two year old sister in her stroller. As the cone was changing hands, the thought occurred to me:  "That cone is not long for the world..."  But I kept silent.  Sure enough, it quickly slipped from my baby's hands and "plopped" on the floor!  Shocked, the girls both looked at me with expectation of doom.  But they were even more surprised when I CALMLY reassured them that it was "no big deal".  I admit I felt a bit self-conscious, like I had walked into a TV show sitcom and was now on board as an actor.  I strolled back into the ice cream shoppe and suavely explained that we'd had a little accident with the cone outside, and that I needed a replacement cone.  My daughters were beaming when I emerged from the store with a new cone.  And I sensed that their happiness had as much to do with the way their Dad had behaved that day, as it did with the cool sweet treat they were about to enjoy.

To Sleep or Not to Sleep: The Tyrannical Toddler

by Doctor Laurence H. Miller on 12/12/11

Some families get themselves into really bad bedtime habits with toddlers.  The parents are exhausted from the every night battle of putting the child to sleep. So the baby ends up sleeping in the same place that "the 500 pound gorilla" does:  any where he wants!

One of the best shows I've ever seen on TV was a "20/20" episode with Dr. Richard Ferber (of  "Ferber Method to put your child to sleep" fame).  Two-year-old Billie had "trained" his father to put him to sleep by dancing him around the living room to the mellow songs of Lionel Ritchie.  He'd fall asleep in dad's arms and then be put in his crib.  Unfortunately, Billie would awaken in the middle of the night, EVERY night (as EVERY person of every age does every night, usually without remembering it), and NOT go back to sleep until Daddy put on the Lionel Ritchie songs AGAIN and DANCED HIM TO SLEEP!  So Daddy was exhausted (and resentful toward Billie), and Billie was irritable, and there was no end in sight!
Dr. Ferber is called on to help.  He makes a house call.  Using "Psych 101" strategy, he saves the day with a guaranteed success protocol.  He sets up a video cam showing Billie's crib.  Prior to being left in the crib, Billie enjoys the kind of soothing routine recommended in my last blog.  Then "the SHOW" begins:  Once Mom or Dad leaves Billie's room, they can NOT return for 3 minutes; no matter HOW HARD he cries.  When they DO return, they are to comfort him for NO MORE THAN 30 seconds, WITHOUT TOUCHING him.  They leave quickly and can not return for a full 5 minutes, NO MATTER WHAT.  (The live video feed was important for the family to ease THEIR distress as they listened to the boy's hysterical screams.) They should then reenter the room for 30 seconds of verbal soothing ("It's okay Billie....Nighty night...mommy and daddy are right next door...we love you.....sleepy time now.....see you in the morning...").  They must now wait for 10 minutes before the 30 second verbal comforting.  Then 15 minutes.  Then 20 minutes.  Then 25 minutes.  Then 30 minutes.  Then 45 minutes.  Then 50 minutes. Then ONE HOUR.    The parents are warned that it could easily take three or four HOURS the FIRST night of training. If Billie vomits, they MUST NOT DO A FULL LINEN CHANGE OF THE CRIB!  They can do an "express" wipe down of the crib and Billie's pajamas, but NO CLOTHING CHANGE. (If Billie's vomiting gets him taken out of the crib, he is sure to make himself vomit again because HE WAS REWARDED FOR DOING IT!)  They are advised that the time to treatment SUCCESS can take as long as a WEEK. "SUCCESS" is defined as a sleeping baby in LESS THAN a half hour of settling. In reality, it's rare for it to take more than THREE DAYS to CURE and PEACE!
The TV audience watches with the family for several cycles as Billie tantrums in the crib.  Suddenly, Dr. Ferber starts abruptly alert. "Watch!!", he commands, "Look what he's doing!"  Billie is still clearly distressed.  But he's taking action! He picks up his Teddy Bear and throws it to the head of the crib; he picks up his blanket and throws it to the head of the crib; and he does the same with his pillow.  Then he throws himself onto them and into them!  "He's made a nest!" blurts out 
Dr. Ferber, "And now he's burrowed into it  so that he can  comfort himself and get himself to sleep!"
       And THAT's the key to the whole process.  It's wonderful how Billie loves cuddling with his Dad.  But even a toddler MUST begin to have some INDEPENDENCE.  When the boy goes to sleep without PHYSICAL CONTACT with a parent, he has achieved an IMPORTANT MILESTONE of MASTERY.  In order to accomplish this step of "growing up", his parents need to make it possible for him by allowing him to work it through; they must have faith in his ability to tolerate the frustration of not getting it HIS own way.  When he DOES tolerate the frustration and SUCCEEDS in getting to sleep BY HIMSELF, he has GROWN and is STRONGER.  Parents who "feel guilty" letting their child cry at all and so give in to his UNREASONABLE demands, will keep their child WEAK and DEPENDENT.  In fact, children who experience healthy "limit setting" by their parents, feel MORE secure and are HAPPIER, better adjusted  people.
I advise parents to apply the "Ferber" technique as a team.  If they alternate with each other as they go into baby's room for the "30 second reassurance", it shows the baby that BOTH PARENTS insist that he stay in his crib.  So he knows they have both "teamed up" against him. He is more likely to "give up his fight" sooner.  Also, alternating makes the training LESS STRESSFUL for the parents, because they are SHARING the job and have to pay baby his "visits" less often through the evening.
Investing in this effort over a few evenings will pay off for EVERYONE in the family!

To Sleep or Not to Sleep: The Young Infant

by Doctor Laurence H. Miller on 11/10/11

"My baby still wakes up at night. Is that normal?"  "Why does my baby wake up in the middle of the night?"

Such a common question.  Let us consider why the baby will call for you at night.  But let's be honest.  The baby being awake isn't the real problem:  It's the PARENT being awakened that's causing distress. 

1. The baby is hungry.

2. The baby is not tired.

3. The baby is lonely.

4. The baby is frightened.

5. The baby is in pain.

6. The baby HAS WAKENED AND CAN NOT GET BACK TO SLEEP.

     If an infant is under four months old or fourteen pounds, she is entitled to demand a night feeding.  If the baby is waking after those limits, it is not for reason of hunger.  One of the commonest mistakes new parents make is to rock their baby to sleep or regularly allow them to fall asleep while sucking on breast or bottle.  If the baby becomes accustomed to that routine, they will become unable to fall asleep without rocking or sucking.  So when the baby wakes in the middle of the night, (AND PEOPLE OF ALL AGES WAKE SEVERAL TIIMES EVERY NIGHT) she will call out; not because she needs to feed, but because she needs to get back to sleep.  And the half asleep parents will be bamboozled into feeding the baby because THEY want to get back to sleep.  If this pattern goes on for even a few days, the baby who has woken and is still half asleep will awaken completely because she has NOW been trained to EXPECT a middle of the night feeding!

How do we fix this mess (or prevent it in the first place)?   A BEDTIME ROUTINE is the key.  You may want to start with a soothing warm bath.  The baby should usually be PUT TO BED in HIS OWN bed.  This becomes MORE important as the child gets older.  If a baby falls asleep in the living room with the TV on, or in Mommy's bed, and is then carried to his crib, it can be frightening for the baby to rouse and find himself somewhere else, BEHIND THE BARS of a crib! A baby has NO CONCEPT OF WHAT SLEEP IS.  He didn't know he was ASLEEP. He only knows he was resting comfortably, securely in the bosom of his family, closed his eyes "for a second" and now has magically been moved and IS ALONE!!  

Once the baby is lying in her crib, a lullaby or two is helpful; a musical mobile near the crib is calming.  Reading the child a short story is pleasant, and frequently the baby will look forward to the SAME story night after night.  A gentle massage can also be very relaxing and get the baby ready for sleep.  Sometimes, baby will still be upset as you are leaving.  I devised a "last goodbye" routine that helped my daughter:  I'd lay down on the carpet beside her crib and offer my hand through the bars.  I'd coax her to lie down and take hold of my finger for comfort while she was settling.  POP QUIZ: Could anything possibly go wrong with this plan?...........ANSWER: If you get TOO COMFORTABLE lying there and STAY TOO LONG so that baby ALWAYS FALLS ASLEEP holding your finger, this could become A CRUTCH.  When baby wakes lightly in the middle of the night, she will be UNABLE TO GET HERSELF BACK DOWN and REQUIRE you to hold her hand.  Not good.  To prevent this TRAP I would slowly count to "60" as I'd lie beside the crib with her holding my finger.  At "60" I'd gently withdraw my hand from hers, remain still for another ten seconds, and quietly creep out of the room.  She WAS STILL AWAKE, but SO RELAXED that she was okay with my leaving!  Within the next minute or so, she'd be asleep.

Of course you need to consider the baby could be teething in infancy and crying from throbbing they feel at bedtime (PLEASE see my notes on TEETHING on this site).

This is also where the PACIFIER shows its real value:  Rhythmic sucking is likely to calm and satisfy the baby who uses it frequently during the day.  In my own home, we encouraged our daughters to enjoy the pacifier all day long and all night long from early infancy.  This prevented thumbsucking.  But at night, if they woke, after they were 3 months old, we'd pop the pacifier back in their mouths before they really wakened completely and got upset.  Sucking on it usually got them right back to sleep.  By the time they were 6 months old, we'd keep 3 or 4 pacifiers in the crib, and if they awakened at night, they'd find one by chance and PUT THEMSELVES RIGHT BACK TO SLEEP.  That was great for everybody.  IMPORTANT:  If you don't want a four year old still stuck with a pacifier, you have to begin limiting the pacifier to SLEEP TIME ONLY beginning at about 16 months or so.  MAKE NO EXCEPTIONS TO THIS RULE.  Baby will quickly learn the new limits and really relish going to bed.  (When my daughter was 2 years old, we left her with a baby sitter and were surprised to learn she'd gone to sleep shortly after we'd left.  SHE HAD CONNED THE SITTER to put her to bed because she was lonely without us, wanted the comfort of the pacifier, but knew the only way she'd be allowed to have it was if she were in the crib!!  So she PRETENDED to be sleepy to get to her "long lost friend"!!)  I advise complete elimination of the pacifier at 3 years old.  With our daughters, we began to warn them of its impending departure a month before that birthday party.  We got the book, "Miss Piggy's Bye Bye Pacifier" and read it nightly with them.  The day after the third birthday party, we explained the pacifier was gone.  We all suffered two cranky evenings, and our kids quickly accepted the loss.  They were fine because they were ready to move on and COULD USE WORDS NOW and didn't need to suck the way toddlers do. 

In my next blog, we'll explore sleeping difficulties in babies who are beyond infancy.

The Human Spark

by Doctor Laurence H. Miller on 10/02/11

The actor Alan Alda recently hosted a PBS special exploring what makes humans different from all other mammals and primates.  

In the final episode, Alda demonstrates before our eyes a trait of very young children that is unique to humans:
 He walks into a room with his arms burdened by a huge number of bulky books.  A toddler who is about 18 months old is playing there. The child is not yet verbal.  He doesn't know Alda, but Alda enters the room slowly and quietly and smiles at the child in a friendly way.  He then looks away from the child to a cabinet with a hinged door located on the floor.  He repeatedly looks from the child, to the books that fill his arms, to the door of the cabinet.  He says nothing.  After a moment, the child OPENS THE CABINET DOOR AND THEN STEPS BACK TO ALLOW ALDA TO DEPOSIT THE BOOKS INSIDE.  No chimpanzee would help this way. Nor would "man's best friend". A dog wouldn't have a clue what the man needed from him.  But this little baby/child "got it".  He UNDERSTOOD how he COULD HELP and he WANTED TO HELP.  That is key.

Here is the second vignette:  Scientists at Yale University had six-month-old babies watch a "play" while sitting on their mother's lap.  The "action" was in three "acts" and there were three wooden block "actors":  a small circle, a triangle and a square, each with a little face drawn on it.   The "set" was a vertical flat board with a slot shaped like a big "Z".  In the first act, the circle slides along the bottom of the "Z", and then climbs up the slope of the Z to reach the top bar.  The second act begins like the first, but when the circle is half way up the Z slope, the triangle comes sliding down from the top of the Z and bumps repeatedly into the circle until it is knocked all the way down.  In the last act, the circle begins to climb the Z slope, but when it is part of the way up, the square comes from below it and repeatedly gently bumps it from behind until the circle reaches the top of the Z.  "Curtain"!!!  End of show!!
Now for the chilling part:  An experimenter then comes around from the stage and presents each baby with a tray holding a square and a triangle.  The baby is able to reach the shapes easily and pick them up.  VIRTUALLY EVERY BABY PICKS UP THE SQUARE SHAPE !!   What is the explanation?  Human infants do not want to associate with obstructors of achievement!  "No Debbie Downers for us!" It is clear to the babies that the triangle is keeping the circle from reaching its goal.  So it is "BAD" or even morally "EVIL".  The square is a friend to the circle by helping it climb; it is "the wind beneath my wings", as Bette Midler sings in her song.   In real life, little babies who have no spoken language are watching the world carefully and already prefer and chose to be with HELPERS.  And THAT is why our species is  running the planet (for now).  We don't have the sharpest teeth, aren't the strongest or the fastest runners.  But we COLLABORATE.  And when we WORK TOGETHER and WATCH EACH OTHER'S BACK,  we can do amazing things.  And this desire to help and be with helpers is AN INSTINCT that's part of our genetic makeup and shows itself in babies WITHOUT BEING TAUGHT!!

The Danger of Praise

by Doctor Laurence H. Miller on 09/22/11

It probably would never occur to a normal parent that complementing his child could have negative consequences.  But groundbreaking research done at Columbia University's Teacher's College a few years ago (and reported in NEW YORK MAGAZINE) is very disturbing.  Four hundred fifth graders were given a very simple exam (meant for 3rd grade kids).  Every child taking the test did very well and found it easy.  The youngsters were then divided into two groups.  All the kids in the first group were told that they did very well and that THEY MUST BE VERY SMART.  When the kids in the second group were told their results, they were told that THEY MUST BE VERY HARD WORKERS.  

All the kids were then given a difficult test, meant for 7th graders.  While ALL the kids had trouble with the test, it was clear that those in the FIRST group of "smart" kids were emotionally distressed, breaking into a sweat or becoming agitated.  But the "hard workers" in the SECOND group didn't seem to mind the difficult material and seemed interested, engaged in the challenge.

Then a very easy test was given again to end the experiment:  The kids from the "smart" group DID NOT DO AS WELL AS THE FIRST TIME AROUND. The kids from group 2, "the hard workers", did just as well as the first time.  The only difference between the two groups was WHAT WAS SAID TO THEM WHEN THEY FINISHED THE FIRST EASY TEST.  So it is apparent, that BEING TOLD THEY WERE SMART DAMAGED THE SUBSEQUENT PERFORMANCE OF CHILDREN. 

Just as important, when children were praised for being HARD WORKERS, they took pleasure in facing a difficult challenge.  In fact, many of this group said the impossible 7th grade test WAS THE FAVORITE PART OF THEIR DAY!

But why was there a dramatic difference in outcome?  It is probably the result of errors in logic that occur in the immature reasoning of young minds.  The child who was told she was smart had just taken a test she found EASY.  The conclusion she came to is that, WHEN A PERSON IS SMART, A LESSON OR A TEST IS EXPERIENCED AS EASY.  But if a person finds a test or lesson DIFFICULT,  she must not be SMART.  So, when the child found the second exam hard,  her distress came from feeling she must NO LONGER BE SMART.  The disasterous outcome is that the child doesn't realize that with CONTINUED EFFORT, difficult material CAN BE MASTERED.

On the other hand, the group praised for HARD WORK, has a sense of reality that links success to EFFORT.  So these kids ARE NOT HOPELESS when they face a challenge.  If the material is more difficult, they continue to believe they CAN SUCCEED if they MAKE A GREATER EFFORT.  The feeling of having CONTROL over their destiny is EMPOWERING.  They are less likely to GIVE UP because their SELF IMAGE  is that of the persistent WORKER.  And they equate the PRIDE and PLEASURE of their success WITH the EFFORT they offer to the task.

One doesn't have to stretch the imagination too far to see the consequences of this ATITUDE toward learning in high school and college.  So TAKE CARE when you praise your little loved ones; when you praise them, let it be for their EFFORT, their ORIGINALITY, their IMAGINATION, their PERSISTENCE, rather than for an intelligence they did nothing to earn.

Choking Foods

by Doctor Laurence H. Miller on 09/12/11

There are few things more fun than watching your baby explore and delight in eating real food.  But like all things in life that are worthwhile, some risk is involved.  Managing that risk is key.  So there are some simple safety rules for babies and food.  Kids should be sitting down when they eat; not running or jumping.  It's more enjoyable when the atmosphere is calm during a meal.

Some foods are inappropriate, not safe for babies.  The official word is that kids under four should avoid the following 10 foods because they are a choking hazard:

1.Raw Carrots

2.Raw Celery

3.Peanuts

4.Popcorn

5.Hard Candy

6.Raisins

7.Grapes

8.Frankfurters

9.Apples

10.Peanut Butter

Numbers 1 thru 5 are absolutely forbidden under every circumstance.  If a very young child/baby laughs or coughs with one of these in her mouth, it can lead to tragedy.  A peanut or piece of popcorn could easily be inhaled through the larynx (voicebox) and plug the trachea (windpipe) so the child chokes.

Raisins, though, can be soaked in water until they are quite soft and then cut in half.  Grapes can also be cut in quarters and peeled so they pose little threat. Frankfurters, true JUNK food, (very high in fat and processed chemicals) can be cut paper thin like bologna and only present a nutritional danger (shouldn't be eaten more than once a month). Apples can also be cut paper thin.  Peanut butter should be spread extremely thin in small amounts. 

Following this guide is really easy and your peace of mind will be worth the effort.

 

 

Toilet Training

by Doctor Laurence H. Miller on 09/03/11

The successful accomplishment of toilet training is one of the most important and gratifying milestones of childhood.  Most parents worry and ask about "the correct method" to train their child.  I answer by pointing to the head and the heart.  "The child has to be ready UP HERE and IN HERE".  They have to KNOW, to UNDERSTAND what is required of them, and they have to be READY, to WANT to COMMIT to this civilized behavior.

I didn't invent this approach to the training, but I subscribe to it because it works, and it takes a burden off the parents AND the child.  Some authorities in child development advise an ACTIVE TRAINING process:  INTRODUCE the child to the potty.  PLACE the child at the right time on the potty.  ASK repeatedly about the child's urge to urinate or have a bowel movement (BM).  My reason for a more passive role for the parent is that it avoids another situation of child rearing CONFLICT.  Parent is not really being passive. Mom and Dad make sure child has regular opportunity to SEE how the BIG people use the toilet every day.  These young kids are VERY OBSERVANT and the repeated exposures will make a tremendous impression on them.  The grown-ups or older brothers and sisters needn't even SPEAK about what they're doing.  Little kids love to imitate what their family does.  (Just watch how DESPERATELY a toddler tries to stand up and walk like Mommy and Daddy.  No one has to badger her to try!)  
But KNOWING what to do is only HALF of the project.  When the little one feels really BIG, grown up, they will feel  a strong need to join in and also use the toilet the way the other BIG people do.  So the parent's task is a natural and pleasant one, really WITHOUT PRESSURE:  treat the child respectfully, and give them the opportunity to join in on gradually more mature, grown up activities.  Every child will arrive at success at HIS OR HER OWN TIME.  I warn parents not to let a nursery school or relative state an age limit by which the finish line must be crossed!  Our children are not "cookie cutter gingerbread men and women" that come out the same at the same time!
My younger daughter was always stubborn about doing things the way she wanted to and also very determined to accomplish something when she set out to do it.  It was just before her second birthday when she came toddling into the bathroom where I was shaving.  She was naked from the waist down, and purposefully climbed up onto the toilet seat, next to my sink, turned around and squatted, balancing on the balls of her feet on the toilet seat, and proceeded to have a bowel movement into the toilet.  I experienced a surreal moment of disbelief.  She had never before shown any interest.  We had pointedly encouraged her to sit on the portable potty chair that we'd placed in her playroom; but she refused steadfastly for months.  (Our older daughter had been delighted to play with and sit on the same potty chair when she was training, and was successful in using it.)  We knew even then why she shunned the little commode:  she never saw her older sister, or her mother, or me use this potty.  If she was going to do something, it would be done properly!  The same way the rest of the family performed!  And she would NEVER use a little booster seat that folks put over a regular toilet seat so a toddler can practice on it.  For the same reason:  WE DIDN"T SIT on the booster!   Of course, SHE couldn't sit properly on a standard toilet seat, as her little butt would fall right through!!  So she squatted!  Our whole family made a big fuss over her feat and she continued this way for a few weeks.  Then, to my dismay, she approached me one day and demanded:   Doo doo in the diaper.  I tried to reason with her; that she was already adept at balancing nicely on the toilet seat and how nice it was to be clean without messing in the diaper.  She was adamant!!!  Doo doo in the diaper!!   Then I had a moment of clarity:  If I persisted to badger her and pressure her, she would not be persuaded but would defy me by withholding her BM!     This could lead to a CHRONIC CONSTIPATION PROBLEM  and likely a need for a psychologist at a later date.
With this foreboding of doom if I didn't relent, I accommodated her and she went back to using her diaper for stooling, although she was content to use the toilet to urinate. We were sure she'd come around soon.  And so 3 months passed, 6 months, a year, a year and a half!!  We would playfully tease her, cajole her, but she persisted in her diapers for BM's.  
When she was 3 1/2 years old, we took her skiing for a weekend in Massachusetts.  We had to bring a box of diapers with us!  I spent an afternoon riding up the chairlift with her and skiing down the "bunny slope".  I was really impressed at how well she did!  I thought we might have a toilet breakthrough, but she persisted in demanding the diaper for BM's.
Spring came.  She was 3  3/4 years old.  We went back to ski in Massachusetts for a weekend.  As she'd done so well the last visit, we put her in ski class with a bunch of other 3 and 4 year olds.  She joined in happily and went up and down the bunny slope with a teenage girl teacher.  Lunchtime, she waved to us from across the cafeteria where she ate with her fellow skiers:  "Hi Mommy! Hi Daddy!" (Proud and feeling her oats!)  To celebrate her successful class experience, I offered to take her to the top of the mountain and ski all the way down!!  She was game and we took two chair lifts to the top.  Then we skiied down together.  I was behind her leaning way forward with my arms hooked under her armpits.  Mostly she was fine but whenever her skis got tangled and she began to trip up, I'd lift her up quickly so she could straighten her skis, and then I'd lower her back down.  All this while "racing" downhill.  My back was KILLING ME!   We laughed all the way, and after several "near misses," finally fell, sprawling across the path and shrieking with the fun and adventure of it.  We got ourselves back together and finished the ride down.  Tired but happy and proud of how far we'd come!  We returned the rented skis and drove back to our hotel.
As we entered our room, the little one announced matter of factly, "I have to make doody," as she headed alone into the bathroom..  My wife, older daughter and I were stunned! Was this really happening!!  We SILENTLY jumped for joy.  Shortly, we heard the flush, and  our big girl emerged from the bathroom.  In a casual voice I beamed at her, "Congratulations, darling, we're so happy for you!"  
Why did we downplay our excitement of the moment?  The answer is in the way we expressed our happiness:  The event was about HER. ("...happy for YOU!")   It was HER achievement and it wasn't supposed to be that important to US.  (Even though we were VERY happy for her and us.)  If we'd made a big fuss in that hotel room, our little girl might have been tempted to use toilet behavior in the future as "political capital".  If we didn't buy her a doll or a toy she wanted, she might decide to "get even'  by returning to diaper days.  But since we'd made it clear on that big day that we were pleased but that "it wasn't THAT big a deal",  it wouldn't occur to her to use it for blackmail if she got angry about an unrelated issue.
And what was it about THAT DAY that caused our girl to finally choose to use the toilet for BM's? She'd had a great time AWAY from Mom and Dad, DOING WELL at a NEW activity, DINING with new friends like a grown up, and then ATTACKING the mountain with her Dad, like a real BIG kid.  And THAT was it!  She'd finally got it.  She was a BIG kid because she was doing all the stuff that BIG kids and people did.  And BIG people used the toilet for their BM!  A person who skis down from the top of a mountain (TWO CHAIRLIFTS!) doesn't POOP in a diaper!  It just ISN"T DONE!!   So she truly felt COMPELLED by HERSELF to use the toilet.  Her insight into the true maturity she'd attained put an end to the story.  She was a secure and happy girl. 
So, all that parents of young children need do is "find the right ski slope" for their kid!  Or help them enjoy any kind of "grown-up" activity and let nature take its course.

Breast Feeding

by Doctor Laurence H. Miller on 07/22/11

They say that when it comes to feeding a new baby, " Breast is best."  How did this saying come about?  First of all, if we look at it from evolution, the system is well tested and has been the main way of feeding for a million or so years.  In fact, bottle feeding has only been around for about 100 years.  Breast milk is always served at the right temperature for the baby and is fresh, never sour.  It is possible that what mother ate in the prior hours to feeding may change the flavor of milk a bit, but that variety might actually increase a baby's enjoyment of different solid foods and their tastes when they are eventually offered.   Breastfeeding clearly protects the infant by boosting the immune system with the antibodies and immune cells from the mother. It was hoped that children genetically prone to allergy would be protected from this problem if breastfed, but this has not been shown.  What is clear, is that severe gastrointestinal infections ALMOST NEVER strike breastfed babies.  This could mean a matter of life and death in Third World countries.  It is well documented that breastfed babies tend to be heavier than "bottle" babies at their first birthday.  They then tend to be lighter than bottle fed babies by the second birthday, and for the rest of childhood.  It's advantageous to gain more weight early on as this protects the infant in case of illness during the first year.  And it's better to be less predisposed to obesity in childhood.  This is achieved by breastfeeding.

Formula companies are endlessly tryi;ng to imitate breast milk. The latest venture involves DHA which is an unsaturated fatty acid found naturally in breast milk.  It appears to improve vision and possibly general brain function.  If a mother breast feeds her baby, she can be assured this nutrient will be supplied in exactly the right concentration for her child.

The biggest problem today surrounding breast feeding is starting it from birth successfully.  Many mothers want to breast feed  but are prevented from doing so by fear of failure.  The sabotaging of their efforts may come from well meaning relatives who express concern that the baby might not "get enough milk".  If the mother feeds her baby often, right from birth, the odds of success go up.  By "often,"  I mean even every one to two or three hours between feedings, as long as the mother has the energy and is ready to do it.  A wise lactation consultant answers the question how one knows it is time to feed an infant under two weeks old:  When the baby is awake!  If you wait until they are crying, you waited too long!  An upset baby isn't likely to take a good feeding, or LEARN how to suck properly on the breast.  We call it "latching on". 

The consultant strongly advised against offering supplemental bottles for the first several weeks.  That's  because "nipple confusion" is extremely common when a baby gets formula in a  bottle alternating with the breast feedings.   The baby loses patience with the mother.  Her milk doesn't come into his mouth as fast as with the bottle of milk.  Soon, the infant may refuse to suck on the mother's breast at all.  Most mothers will simply give up at this point, feeling the baby has rejected the breast, and prefers the bottle. But a few years ago, one of the mothers in my practice who has diabetes was incorrectly told by the hospital nurses that she could not breast feed and they started the baby on formula.  When the baby was almost one month old, I advised her it was fine to breastfeed and SHE SUCCESSFULLY SWITCHED OVER to breastfeeding by persisting to offer the breast frequently.  IN a MONTH OLD INFANT!  In fact, if the mother completely stops the bottle at this point and offers her breasts every one to two hours, ninety per cent of babies will be successfully breastfeeding again with one or two days.  All mother needs to do to be sure baby is getting enough is to watch for wet diapers.  About three urinations in a day assure adequate milk

Many mothers suffer from sore nipples the first week of breast feeding.  This is made worse if mother feeds more than 15 minutes per side at a feeding.  (The baby gets 90% of the milk in a breast within 10 minutes of feeding.  Any longer than that is for comfort AND to PRIME the breast to INCREASE its milk production to keep up with the baby's increasing needs as the days pass.)   Several baby supply companies make a NIPPLE SHIELD that is a thin soft membrane to slip over the nipple.  It has perforations in it and when the baby sucks on it, the breast milk comes through the holes for the baby to swallow.  The little cushioning provided by the shield can turn intolerable pain into bearable discomfort.  In a few days, the breast is conditioned, the pain gone and the shield no longer needed.

Till what age should a baby be breastfed?  As long as the mother feels it is right for her and her baby.  Some mothers stop when a baby is one or two months old, and some kids are breastfed until one or two years old or older.  It truly is nobody's business but mother and baby.  Sometimes a mother is unsure what to do when a baby gets teeth and painfully bites down on the breast.  If the mother quickly pulls the breast away each time with a disapproving look and firmly says, "No, don't bite",  most babies quickly learn to refrain from clamping with teeth.

A Division of ProHEALTH Care Associates, LLP