Helping children grow up healthy

Helping children grow up healthy – includes related information

Parents contribute to their children biologically, socially and psychologically — in the way they react to and bring them up. The genes inherited from parents determine physical characteristics — whether a child is male or female, short or tall, blue or brown-eyed — and also influence intelligence, personality and susceptibility to disorders such as diabetes, schizophrenia and depression.

Among the early influences on child health, nutrition is one of the most critical. Other key needs are to immunize children on schedule against infectious diseases, to avoid smoking at home (which increases risks of childhood respiratory disorders), to protect children from needless injury, to recognize signs of illness in children and to foster self-esteem and competence all the way. Having already covered many of these topics in Health News – for example newborn bonding (December 1986), breastfeeding (April 1989), immunization (October 1989), injury-prevention (February 1993) and teen suicides (June 1993), we will concentrate on other aspects of child health in this issue.

Building in childhood self-esteem

The critical role of self-worth in child development is becoming ever more clear. From day one after birth, by everything they say and do and by verbal and nonverbal actions, parents, teachers and siblings communicate approval or disapproval, likes or dislikes, which profoundly influence children’s view of themselves. For example, a disgusted grimace while changing diapers can make a baby feel “dirty” or “ashamed” of his or her body and genitals.

To bolster childhood self-esteem, parents and caregivers should steadily express respect, warmth and love to children. Children need to feel valued even when their behaviour is not acceptable. While disapproving of bad or unacceptable behaviour, parents should not reject the child as a whole. Make children feel accepted for what they are, emphasize the positive rather than the negative sides of their character and abilities. Children need to feel loved for their particular qualities: “I like your sturdy legs;” “your poems are great.” In depressed or low times, children will remember such comments and feel better about themselves.

Children who don’t feel loved may think they’re worthless and therefore unable to control or change their behaviour, instead of believing they are “okay” and can change their ways. Child guidance should be positive, with a sympathetic but firm approach. Parents should consider the child’s viewpoint before handing out punishment and clearly explain what they disapprove of and why. It is damaging to be frequently cold or withdrawn. It’s better for children to know why someone is displeased than to guess they’ve done something far worse; better to be told that the parent is annoyed about “the lie told” or “skipping class” than to feel utterly worthless.

Relatives visiting young nieces, nephews or grandchildren can help by making each child feel valued and “special.” Instead of giving a blanket greeting — “Hi kids!” — they can single out each child for separate attention. “Hello Joan, how is your new school?” or “Tell me, John, are you still doing those marvelous drawings?” For frazzled parents, the extra attention given to children by others can be a great help, while the children gain self-esteem by relating separately to other relatives, friends and teachers.

Ways to help children gain self-esteem:

* value and listen attentively to the child’s feelings, thoughts and viewpoint;

* accept the child’s ideas and contributions;

* be honest with the child;

* tell children, including infants, what to expect so that any reprimand or disapproval is understood and not taken as total rejection;

* listen attentively and pick up cues from children’s unique communication modes – for example, the particular way an infant coos, smiles, cries or moves; its preferred toys; how a toddler gestures or tries out words; the way an older child communicates;

* demand realistic not perfect behaviour and set realistic limits;

* offer choices to foster independence: “Would you like your medicine now or in 10 minutes?” “It’s bedtime — would you like your teddy or doggie to cuddle?”

* communicate with “I” messages or make personal statements about the effects of undesirable behaviour. “I” messages help children see the immediate effects of their behaviour; for example, “When you throw blocks, I worry that you may hurt someone or break a window even if it’s an accident.” This beats saying, “Naughty boy, that’s a bad thing to do!” Scolding without specifics gives negative, character-deprecating information, without providing positive direction or means of improvement. Allow children to make mistakes and then remain neutral so that they learn by their errors. Children need time to find their own solutions. They also learn by having to repair the damage — for example, wiping up spilled juice.

Parenting styles likely to foster childhood competence

Parenting attitudes can help to instill in children confidence, competence, independence, stress-coping skills, responsibility and an exploratory attitude.

“Children who lack competence,” says one University of Toronto expert “have no confidence, responsibility or social skills. They expect others to do things for them, are overly dependent and can’t look after themselves.” Parental approaches that help to foster competence include what some call “responsiveness” and “demandingness.” That means being warm, empathetic, involved and attuned to the child’s needs, while also making demands, having expectations and exerting firm but noncoercive (non-bullying) or overly restrictive controls. Caring, empathetic parents who are neither over-protective nor intrusive, and who set firm limits, are most likely to foster competence in their children. Parents can be optimally loving to their children but still, at times, get angry and confront them. Confrontation does not mean the withdrawal of love.

“Responsiveness” in parenting includes:

* Affective (emotional) warmth — openly expressing love to children – but not unconditional acceptance.

“Unconditional acceptance and over-protection,” says one University of Toronto expert, “are toxic to children especially older children and teens.” Unconditional acceptance increases dependency, decreases competence and undermines social interaction, relaying the false message that “no matter how badly behaved, selfish, abusive and demanding a child’s behaviour, people will still like him or her.” Unconditional acceptance sets children up for social failure, forcing them to turn back to the family for acceptance. While children need warmth and attention, they also require firm controls and direct confrontation about unacceptable behaviour.

* Cognitive responsiveness — touching and responding to infant gurgles, telling children stories, singing to them, playing games, stimulating their curiosity and, with older children, listening to their viewpoints, wishes and feelings. Responsiveness makes children more intellectually competent and socially responsible — “especially important in boys,” notes one expert, “making them less likely to act out aggression.”

* Sensitive attunement and involvement — recognizing and responding to the child’s thoughts and feelings builds reciprocity. In reciprocal parenting with a “you scratch my back, I’ll scratch yours” approach, children learn that their needs will be met and are more likely to respect parental demands. Lack of involvement — disinterest or detachment — are more damaging than disapproval or punishment, symbolizing a non-caring attitude.

* Attachment and bonding result from high levels of caring, warmth, involvement and empathy.

“Demandingness” in parenting means:

* Making demands that are realistic and firm, but noncoercive — ideally non-punitive, not dictatorial, not intrusive, non-bullying, not shaming and above all, age-appropriate. Excessively restrictive controls — for instance treating a 12-year-old like a seven-year old — are not helpful. Children need firm limits while at the same time being given the freedom to experiment and learn by their mistakes. Effective discipline means laying down tasks and expectations, with consequences if not completed.

* Discipline should not be excessively authoritarian and should include reasonably high expectations, monitoring and direct, noncoercive confrontation, when necessary.

* Direct confrontation, once considered detrimental to child development, is now regarded as a positive influence, provided it’s done within an empathetic, caring framework. Confrontation shows that parents care and, as one expert explains, “is far better than withdrawal, silent disapproval, indifference, neglect or detachment which are more harmful than non-bullying control.” In fact, successful confrontation increases childhood competence, self-assertiveness, independence, self-control, communication, negotiation and problem-solving, so long as it is done in a non-bullying, non-shaming manner. Rather than decreasing child-parent friendliness, it rewards good social behaviour and helps children gain independence. However, bullying, violent or coercive confrontation — while perhaps momentarily successful — produces hostility, resentment, emotional dependence and reliance on control by others, rather than on inner self-control; children may respond to the immediate bullying, but not internalize the message or acquire self-discipline.

While such parenting styles may help children become competent, they are not guaranteed rules engraved in stone. The dynamics of child-parent relationships vary immensely and children are also influenced by other key adults in their lives who may make up for less-than-ideal or non-caring parents.

Instilling healthy childhood eating habits

Breastfeeding is the best infant food for the first six months of life. When starting solids, it’s wise to introduce a wide variety of different foods one by one, keeping a lookout for allergic reactions. Parents should respect likes and dislikes, follow the child’s preferences but encourage the sampling of many different foods to model well-varied diets. Although endless snacking is today’s trend, sugary and high-fat items should be discouraged and children should be taught to eat when hungry and stop when full. Caregivers are advised not to over-emphasize food and to relax when feeding young children. Day-to-day appetite swings are normal and it’s best not to coax, force-feed or insist on “cleaning the plate.” If children consistently refuse to eat at mealtimes, offer water rather than juice between meals and try to keep them from filling up on unhealthy snack-foods. If children keep up a “hunger strike” for days on end, remember that they rarely starve themselves.

It’s best not to use food as a reward or bribe, which gives the impression that food equals love or approval. Using food for bribes can make children (and adults) turn to favourite goodies for solace. Obsessive focus on food and reacting to all childhood distress as though it was a hunger signal — offering tasty morsels — may make a child regard food as the answer not only to hunger but to all of life’s discomforts.

Toilet training

Learning to go to the toilet is a natural part of human development and should start when the child is ready — usually between ages two and three. But each child’s progress differs: one child may be ready earlier than a sibling, other people’s offspring or daycare friends. Let the child set the pace. A child may seem but not yet be really ready — for example, when in the “no’s” stage, having temper tantrums or going through a stressful period (perhaps because of a move to a new home or a separation). “Accidents” will happen. From time to time even toilet-trained children may revert to diapers because of stress — perhaps a new baby in the family, a parent’s absence or some illness. This is common and usually does not last long.

COPYRIGHT 1994 Strategic Inc. Communications Ltd.

COPYRIGHT 2004 Gale Group