Your Child's Behavior and Development -- Steven Parker, MD --May 29, 2003

By Steven Parker
WebMD Live Events Transcript

You love them always, and most of the time you even like them -- but sometimes your children's behavior baffles you! We talked about behavior issues and child development with developmental pediatrician Steven Parker, MD.

The opinions expressed herein are the guest's alone and have not been reviewed by a WebMD physician. If you have questions about your health, you should consult your personal physician. This event is meant for informational purposes only.

Moderator: Welcome back to WebMD Live Dr. Parker.

Parker: Thank you. It's great to be here.

Member: My youngest son is 7. He is a very creative and bright child. He is also somewhat compulsive obsessive. If something happens that is outside of his plan he has a meltdown. He cries over everything. I am at a point with him, that I will not address the issue that he's upset about until he stops crying and screaming. He just doesn't seem able to control his emotions and everything is perceived at the same level of importance to him. How can I help him get more control and perspective?

Parker: This is a problem that parents bring up to me more than one might think. I would guess your son is a very sensitive boy but lacks some skills in what we call self-regulation. That is the ability to deal with strong emotions in a constructive way. In my experience, part of this is maturity. The part of the brain (frontal lobe) that helps us to deal with our emotions is sometimes slower to develop in some children and it takes them a few years longer to be able to control their emotions better, compared to other children their age.

Additionally, your son seems to have a perfectionist streak and, as you mentioned, may also be a little obsessional in his thoughts. In general, I view this as a normal temperamental variation and not as a true psychological or emotional problem, although occasionally that can be the case.

The goal, then, is to teach him the self-regulation skills to help him deal with his strong emotions, which usually emerge out of his frustration and disappointment. One book I like very much, in thinking about this, is called The Explosive Child, by Ross Greene. He does a nice job of talking about why some children do not do well with strong emotions and gives some excellent strategies to promote self-regulation. Have a look at that and see if it helps.

Unfortunately, I don't have the time here to list a lot of those strategies, but I think you'll find the book quite helpful. Feel free to let me know how things are going on our WebMD message board and we can discuss this further. Good luck.

Member: My 13-month-old son won't sit still on the changing table; he cries and gets hysterical and constantly tries to turn over. What would you advise? I don't want him to fall off; I don't want to swat him; "No" doesn't seem to be working too well.

Parker: I think this is another wonderful example of temperamental variation in infants. It sounds like your guy is a live wire. He's probably more temperamentally active and hates to be restrained. His agenda is to move and be very active and just have a great time with his body. Of course, your agenda on the changing table is the exact opposite. There's no way at this age he can understand why you are making such demands on him to slow down.

So the only answer in this case, especially when safety is such an issue, is tough love. You're stronger and you and perhaps someone else need to just hold him down and get the job done as quickly and efficiently as possible. Once he understands this is what's going to happen no matter how much he struggles and cries, he'll protest less and give in to the inevitable. This is not the situation in which either punishment or reward will be of any help. Establishing parental control, on the other hand, will teach him the lesson you want him to learn. Good luck. Have fun with your active little guy.

Member: I am wondering if teaching signing to a delayed child (2-year-old with Down syndrome, with no words yet) will further delay speech.

Parker: That's an excellent and thoughtful question! There has been some debate in this area, but it seems clear that teaching a child to use sign language -- especially a child who is having trouble with using speech -- will not delay their ability or desire to talk when they are developmentally ready. Of course, teaching a child to sign also has enormous benefits for his or her ability to communicate and sense of self-efficacy. So, personally, I am very much in favor of "total communication," meaning using verbal language and sign language, to improve the communication skills of children with developmental disabilities.

Member: What advice can you give me on approaching my 10-year-old daughter about masturbation? Her father "caught" her and is very upset.

Parker: I think I would like to re-frame your question to ask what should be your approach to her father! All children (all humans!) masturbate. It's completely normal and should be acceptable to parents, unless it is done excessively and compulsively or in public. Since none of that is happening here, I don't know why a parent would want their child to feel bad from deriving pleasure from their body, in a way that almost everyone else in the world is doing. That can lead to negative perceptions about normal feelings and desires, and could even have a negative impact on her long-term ability to maintain intimate relations. In short, I see this as her father's problem, not hers. I hope you can discuss this and come to some resolution that is acceptable to both of you. Good luck.

Member: She did it in his living room on the couch with her stepbrother on the floor in front of her.

Parker: That's helpful information! This is a good opportunity to help children understand the difference between "public" and "private" behaviors. While a child can be told that it is entirely normal and acceptable to masturbate, he or she must also learn that this is a private behavior and not something that is done in public. A discussion with her about that would certainly be in order and helpful. If, as I mentioned before, she begins to engage in this behavior compulsively, and cannot keep it private, then other concerns as to the reasons for that can be considered.

Member: I have a question concerning my son. He just can't pronounce the letter R and it is worse in Spanish since the R is stronger in Spanish than English. Can you help me? Do you think is possible that he needs special help? He is 8 years old. The word ready, he says "weady." Can you help me?

Parker: Speech therapy can often be helpful in improving articulation in a child this age, especially if they are motivated to speak more clearly. If there is only one sound that your son does not pronounce well, however, speech therapy may offer more help than he needs. If it is the case it is just this one sound, I would contact a speech therapist and ask him what speech exercise they would do for this specific problem. You could probably then do it yourself and avoid having him having to go to speech therapy regularly.

If, on the other hand, he has pronunciation problems in other areas, then it would be worthwhile to have him evaluated and perhaps full therapy started. Good luck.

Member: When do male hormones kick in and what behavior changes can we expect?

Parker: Ah, the joys of adolescence! It certainly is true that the hormonal surge that begins at adolescence -- both in males and females -- leads to development and behavior changes. Although most parents know about the increased emotional reactions during this time, what many do not know is that these hormones also promote logical reasoning and brain development. So, while it can be an intense time from an emotional standpoint, it is also a very exciting time to watch how your child's ability to reason and make sense of the world will become enhanced.

When this occurs is quite variable. It is true that children in this country are undergoing puberty at an ever-earlier age. Sometimes, all that is seen are the bodily changes without the changes in behavior and emotions. Other times they occur relatively simultaneously. You asked me when this might kick in your child, and I can only respond that it is impossible to predict, but you'll know it when you see it!

Member: I have a 16-month old son who is a very picky eater. His diet consists of Gerber #3 cereals, fruits, chicken noodle, lasagna, and spaghetti. Table foods consist of saltine crackers, honey graham crackers, Kit-Kat candy bars, and approximately six to eight eight-ounce bottles of milk per day. He is about 24 pounds, active and began walking at 14 months. I am concerned that he is not eating properly but if I try to insist he try a new food, he will gag so I stop and just let him eat what ever he is willing to eat. What can I do?

Parker: Of all the questions I get on our message board, picky eaters are incredibly high on the list. I give the same advice most of the time, and I think this applies to your son also. Picky eaters are tough and usually stubborn as can be. However, they almost never have any significant nutritional or medical problems from being so picky.

There is really no way at this age to teach him not to be picky. Again, it's a temperamental variation. He probably has a hypersensitivity to taste that he was born with, and which will mellow over time. Your goal is mainly to make sure that his nutrition is adequate as he learns to deal with this sensitivity to taste or texture in foods. Here's my advice:

  • Give him a daily vitamin so you don't have to worry about what he does or doesn't have to eat to meet that requirement.
  • Don't force him to eat. Power struggles around eating, in the long run, keep the pickiness going much longer than it would otherwise.
  • Let him eat what he wants when it is at least reasonably nutritious.
  • Most of the foods you mentioned, and certainly the milk, have a high nutritional content. Don't worry about variety. The Kit-Kats may not be the greatest idea, since their nutritional value is essentially zero. Offer him different varieties of foods, but make sure he knows it's his choice. One of these days he'll surprise you and eat and enjoy something that he never would even look at before.
  • Keep mealtimes fun! If he doesn't eat what you want him to, that's OK.

Most kids, in the long run, will eat better if they associate meals and food with family emotional closeness and fun. If you stick to these principles and everyone lightens up about his pickiness, he'll do just fine. Good luck.

Member: My 13-month-old isn't really "picky" about eating. He'll try almost anything. But it is almost impossible to get a full meal into him. Breakfast is usually oatmeal with fruit. Lunch is usually yogurt, mandarin oranges, and usually he'll pick at one of those "toddler" meals. At dinner, we usually will feed him whatever we are having and then fill him up the rest of the way with a jar of veggies and oatmeal with fruit. He drinks about 20 ounces of whole milk per day. Is this diet sufficient for now? I feel like I am making him eat. He is 31 inches tall and 22 pounds. My pediatrician said that physically he is OK in height and weight. What are your suggestions for getting a toddler to eat more voluntarily?

Parker: I am a big believer that most infants know exactly how much food they need to take to grow and be healthy. This certainly seems to be the case with your little guy. The proof is in the pudding; if a child is growing well on the growth charts, as yours seems to be, they're getting exactly as much food as they need (even if it's not as much as the parents might like). Trust your little guy to know what he needs around his nutrition much better than you or I can. Sounds like he's doing a great job of it without our help.

Member: My 8 year-old son's room is a MESS. Attempts to get him to clean up, including a reward system, have failed, and usually result in lots of tears. Any suggestions?

Parker: There are two ways you can go with this:

  • One, it's his room. Shut the door and let him live with his mess and endure the "natural consequences" of being a slob. This philosophy says that the room is his responsibility and he can deal with it as he will and learn on his own to make it more presentable and neat.

  • Two, it is the parents' job to teach him tidiness and cleanliness. In this case, one would call cleaning his room a "family chore." You would tie some sort of reward (like his allowance) to his performing the tasks you want. In general, it's best to break this up into specific responsibilities, rather than just say "clean your room." You can put up a chart with a number of responsibilities to start, but perhaps limit them to just a few. This could include making his bed and/or taking things off the floor, etc. You could discuss with him three things that he can do every day to clean his room and keep track of those. Once he begins to do those regularly, you can continue to add new aspects of the chore on to the list.

I personally do not have strong feelings whether you use plan A or plan B. You should do what feels best for you in the way you want your son to deal with this challenge. In the long run, it may not make that much of a difference, because most of us adults seem to end up either fairly neat or somewhat sloppy almost no matter what our parents forced us to do when we were little.

Good luck. I hope this is the biggest problem you son presents you with over the next few years.

Member: Is a crossed eye in an infant any indication of a future problem? We are adopting a child internationally, and only have pictures to go by right now, but someone mentioned it might be a sign of a mental problem and now I can't stop worrying.

Parker: A crossed eye, if that is the only problem that is identified, is usually called strabismusm. It is due to an imbalance of the eye muscles in one eye. If the eye has been crossed for a long time (meaning usually more than a year) without intervention, it's possible there could be visual problems with that eye.

The real question is if the rest of her development and health seem completely normal. Occasionally, the muscle imbalance of a crossed eye can be related to other muscle or nerve problems. But that is very difficult to say without seeing the child and watching other aspects of her development. So I don't have a definitive answer for you. Most likely it is the usual strabismusm and can be easily managed when she comes here. But I can't guarantee, without knowing her, that it is not a sign of potential other problems.

Bottom line, the development of kids is in many ways a crap shoot, whether adopted or biological children. The best thing to do with adopted children is to get as much information as you can, but accept the fact that there may not be answers to all of your questions. I wish you the best of luck. Let me know how things go.

Member: How do you determine when it is OK to move a child into a "big" bed from a crib?

Parker: The first obvious answer is based on size and motor skills. When a child has the ability to climb up the crib and jump out, it's time! Some children do seem to sleep better in a bed and have no problem staying in the bed through the night. In this case, you could make the switch whenever is convenient for your family. Other children become somewhat disorganized outside of the crib and, for example, begin to wander the house when they awaken. For a child like that, they may need the constraints of a crib for a longer time.

In general, I advise parents to use the crib as long as possible, so that nighttime roaming is not a concern, but there is really no "ideal age." Like almost everything else with your children, it has to be individualized to meet their developmental needs and the family's needs.

Member: What is the best technique to help my 12-year-old son with peer pressure?

Parker: I personally object to the expression "peer pressure." I think what is much more powerful is "peer culture." It is usually not a matter of a child being "pressured" into doing something they really don't want to do. It's often more a child's adapting and fitting in with the behaviors and morality and ways of seeing the world in a group they respect. I think this is much more subtle, but much more powerful in changing their behaviors and attitudes.

From my perspective, the most important role for a parent at this stage is not to feel rejected and angry that their child is being so influenced by the peer culture. Some parents feel they have, then, no influence on their child and talk and communicate and discuss even less than they had before. They feel their influence over their child is diminished and "what's the use?" This is a huge mistake. In many ways, your child will never need your advice and support and emotional closeness than when he or she is learning to negotiate their peer culture.

You need to be sure that the lines of communication are completely open, that your child knows he can come to you and ask questions and look for your advice on almost any topic, without worrying you're going to get so angry and upset that he's better off not raising it. You need to be a very strong presence in helping him to understand positive and negative aspects of what he may be thinking of doing with his peers. However, if you become too negative, judgmental, and critical, he may not discuss these sensitive areas with you at all. It's a very difficult balance to strike, but open channels of communication and your insistence on continuing to talk with him about these issues will never be more important.

Some of the best discussions you may have can be when you're driving him in the car, for example. That way, you don't need to make such close eye contact and things can seem a little less intense. Additionally, sometimes you may want to actually schedule a "planned discussion" about a certain area (drugs, sex) that you want to make sure you open up the lines of communication about. Every child is different, and you'll have to find your own way to make sure these channels of communication remain open. It's not easy, but it's really worth it. Good luck.

Member: My son is seeing a developmental pediatrician. He is almost 5 and has been diagnosed as PDD-NOS by a neuropsychologist. The dev. ped. believes that it may not be PDD and that my son has an anxiety disorder. He wants my son to take an SSRI on a trial basis. What are your thoughts on SSRIs and 5-year-olds? I don't feel comfortable medicating my son.

Parker: This is a question that is being raised more and more these days. It is certainly true that since I became a developmental pediatrician 20 years ago, the use of medications for different emotional and behavioral challenges has increased significantly. Younger and younger children are now being prescribed various medications such as SSRIs. Certainly medications for ADHD have increased enormously, and are being used in younger children, in the last 20 years. Is this a good thing or a bad thing? My view is that the latest generation of medications seems much safer than the ones we used to use.

To me, the answer to your question depends on your thoughts about how your child is doing. When considering medications, even in a 5-year-old, I ask myself:

  • "How much trouble is this child in?"
  • "How are these behaviors or emotions affecting his life?"
  • "How much suffering and unhappiness is it causing him and his family?"
  • "How much impact do these behaviors or emotions have on his getting along in the world, with friends, in school, with his family?"

If your child's anxiety is causing significant problems and worries in these areas, a trial of medication can often be a very helpful treatment. The first goal, if you were to try it, would be to see the effect the medications had. If he had a remarkably positive response and life became much better it would be worth considering keeping him on this relatively safe medication for a period of time. However, if there was minimal effect or side effects that worried you, you can always stop.

So I have no simple answer, except to say, personally, I have occasionally used this kind of medication in a child this young and decided, with the parents, if it seemed to be extremely helpful and worth continuing or not. For your part, I think you will need to pick one of his providers whose judgment you trust and make a decision based on how you and that person feel about this difficult situation. Good luck. Let me know how it goes on our WebMD message board.

Moderator: Dr. Parker, we are almost out of time. Before we wrap up for today, do you have any final comments for us?

Parker: I just want to remind all of you that you're not alone out there with these problems. All of these excellent questions are being asked by many parents throughout the country. I'm happy to give you advice as your cyberdoc, but most important is for you to find a trusted professional at home that you can run these questions by and feel confident in their counsel. Best of luck to all of you. Enjoy your kids! Dr. P.

Moderator: Our thanks to Steven Parker, MD.. Goodbye and good health!

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