Sunday, August 10, 2008

Tough Love

I usually try to be nice when coaching parents, believing that a caring approach will get you further in terms of changing behavior. I always said when talking about my choice of going to my state medical school (rather than the high powered, well-known private one which was my other option) that when you have a choice of having someone lead and inspire you or kick you in the butt from behind, you'll get to the end either way, but one trip will be infinitely more pleasant.

Recently I saw a 3 year old who was so meek, so soft-spoken, so timid that he could barely tell me his name (and I've been his doctor since birth), so I dug a little deeper. Turns out he still sleeps in bed with his parents, and his mother still feeds him, she still dresses him. She felt like when he dressed or fed himself, it was too slow, so she just did it for him. Looking at this little boy, I couldn't be nice any longer.

I said, "You have to stop this. You are hurting him. You are hindering his development. I know you think you are being loving and caring, but by continuing to baby him, you are doing him a lot of harm. I am going to repeat myself-- you HAVE to stop babying him-- he will cry, he will get upset, he will be slower at dressing himself and feeding himself than you would be, but he HAS to do it himself, or he will never develop properly!" Mom was smiling in this sort of apologetic, "I guess you're right, but I don't know what else to do..." sort of way that I was quite familiar with. I had been seeing it for three years now. It wasn't the first time I had had the conversation with her about needing to be tougher. It started with him being brought into their bed since he didn['t want to sleep through the night in his own bed. It continued with him being a picky eater, and the parents not being firm enough with forcing him to eat. It was the first time I'd been so blunt. Encouraging good behavior apparently hasn't been enough.

When they're 6 months old and they're still bringing the baby into their bed when he or she wakes up and cries, I don't always pick that battle. I tell parents that while I think it's a bad idea, I'm not going to come to their house and pull the baby out of their bed. I understand they need to sleep.

It was a real lesson to me that I need to be firmer in my advice when I see parents not being tough. Even caring too much can be harmful. I'm going to be following this family more closely now.


class factotum said...

One of my college friends didn't come to our 15-yr reunion because it would have kept her out past 8:00, her 4-yr-old's bedtime. I couldn't understand why this was an issue.

Turns out it's an issue when your child sleeps with you and your husband and won't fall asleep unless you are all in the bed together.

When I asked if this affected her sex life, she claimed her husband didn't mind.

Somehow, I suspect this was not true. If he's not getting it at home, he'll get it somewhere and in this case, I wouldn't blame him.

I also think it's nuts to let a child run your household.

class factotum said...

This same friend was also upset that her mother wouldn't babysit the child. She didn't want to leave her son with strangers. I guess she thought that because her mother had raised her, she should also raise the son.

Anonymous said...

I don't mean any disrespect, but it's not really your place as the physician to interfere in the culture of the child's home unless it's a health or safety issue.

Honestly, I would have agreed that this is a disaster waiting to happen until I had my own children. When I discovered attachment parenting, with family bed, babywearing, and nursing on demand, it was like a switch went off in my daughter, and she became a different person, much more relaxed, calm and quiet. I was actually able to sleep more, and I got so much more enjoyment out of being a parent. When I dared be honest with my pediatricians at our well baby checkups, I got all kinds of lectures about the evils of cosleeping. I was scolded for not putting the baby on a schedule. It was bad enough when I had feelings of inadequacy from months of sleepless nights and a fussy baby without being judged by "experts" who weren't there with me when I had to deal with incessant crying at 4:00 am after only 30 minutes of uninterupted sleep. Give me a break! I was really angry. Some of what they said might have been true, but they were not in my shoes at that particular time. Pediatricians, as a group, lost a lot of credibility with me after that.

You don't live this woman's life. I don't know her situation, but, if she's frazzled and needs to get out the door in the morning, she's not going to make the child dress himself. If you keep it in perspective, she won't be dressing him when he's 18 or even 8. In my experience as a parent, children reach a certain competence and self-confidence between ages 5 and 7. I think any babying done before age 5 is perfectly acceptable. Delayed development in dressing oneself isn't going to be a big deal in a few years. Being shy at age 3 doesn't guarantee a terrible social life later. In some areas, my children were just as shy and babyish as this child you describe. But, they are very smart, outgoing, confident and wonderful children. My 8-year-old daughter is above grade level in reading, a promising dancer, has no stage-fright whatsoever, and got first place in a state competition for Bible knowledge through our denomination. My 5-year-old son, who would now be starting kindergarten if I weren't homeschooling, is doing 1st grade math, beginning to read, plays soccer and takes dance classes. He's not embarrassed or shy about being the only boy in his class.

Both children slept with me until age 5. Both were shy around strangers, including the doctor. When I had to work, you bet I dressed my kids in the morning. Could they dress themselves? Yes! Did it take forever? YES! That's why I had to do it. Did my interference affect their development? I doubt it.

MeanMommyDoc said...

Anonymous, I appreciate your comments-- it's always good to stimulate discussion with opposing views.

When a 3 year old appears as if they are about 18 months in terms of their development, I cannot in good conscience stay silent. You made your decisions with your children based on your needs, and if I were your pediatrician and had seen a normally developed child, I wouldn't have lectured you-- if it works for you and your children are healthy (physically, mentally, AND emotionally), I wouldn't have said "boo." You are correct, I don't live in their home, but you don't live in this family's home, either. I have known them for years, and this mother's decisions are made out of an inability to be strong and set boundaries. She's not making these decisions actively, she is making them because she is too passive to make the tough calls that it takes to be an effective parent.

I believe that my responsibility as a pediatrician encompasses far more than the mere physical health of my patients. If that were the case, what about children who are depressed? Facing social pressures at school that are making them miserable? What about when their parents get divorced-- am I supposed to say, "Sorry, I don't want to hear about that?" I cannot do that. There are patients who don't want that in their doctor, who don't want someone who will give their opinion. They go see someone else. That's why we live in a great country.