How can I get my daughter to stop cracking her knuckles?

Posted on February 22, 2012 by Dr. Pat

My 14-year-old daughter is constantly cracking/pulling/crunching the joints/knuckles in her hands. Her friends and us (her parents) remind her stop – but it is a mindless habit. How can she stop?

Knuckle cracking is frowned upon by many parents. It is a mildly irritating habit. There have been several studies that have shown that it is not related to getting  arthritis in these joints. One study did show a relationship with swelling and weakness of the hands but it is not clear if the knuckle cracking caused the swelling and weakness. So there is no strong health reason to stop cracking knuckles.

I would suggest you ignore her knuckle cracking. If it bothers you, you can always look away or leave the room when she is cracking her knuckles. There are a lot worse things she could be doing.

Posted in Behaviour | Tagged , , , , , , , , , | Leave a comment

What can I do about my daughter being a very picky eater?

Posted on February 21, 2012 by Dr. Pat

My question is in regards to my eight-year-old daughter. She is very limited in the foods that she will eat and she is very unwilling to try anything new. She has been like this since about the age of one and a half when we were transitioning into finger foods and more adult-like foods. I was certain she would outgrow this but now at eight she is not willing to try anything new. I try to make certain she gets the nutrients she needs to be healthy and grow properly and I am certain she is fine in that regard but…we are very frustrated and embarrassed by her behavior. She is a great kid, very social, outgoing and smart.  She does well at school and takes great pride in her abilities. The problem I foresee is that she is missing out socially. I view it as more than a psychological problem than anything and I’m at my wits end as to what I should do. She loves cheese, yogurt, peanut butter, cereal, bananas, apple sauce, tomato soup and a few other things…but that’s it. When we ask her to try something new she becomes very upset, starts to gag and can not even try it.  She eats no meat or vegetables. I do often make “smoothies” which contain milk, bananas, yogurt, an instant breakfast and tofu-she loves them and has no idea they are full of good stuff. I need some advice. A friend of mine is an OT, she had mentioned something to me about “feeding clinics.” Is this something we should look into?  Any advice you can offer would be greatly appreciated.

You have done a magnificent job in insuring that she is doing well in terms of her nutrition. You are right that the issue is her perceptions.  First of all recognize that you have won at least 80% of the battle.  I would suggest that you emphasize to her, her incredible achievements.  You and her together have managed to keep her healthy and well functioning in spite of her severe food restrictions. Talk to her about the social part.  Help her understand that it is important for her to have a small amount of flexibility.

Encourage her to try extremely small amounts of a variety of foods.  Put it to her that this is a social issue…gagging, throwing up and getting upset are not very sociable responses.  In fact they are downright rude, even if it is done in her own home.  I would have a tryout dish before every meal. This can be a miniscule amount of a different food. Let her choose between two options e.g. four peas or four kernels of corn. Give lots of praise for success, ignore minor rudeness and punish major rudeness. Teach her how to be gracious in her refusals so that she can function socially.

Bring her into your confidence. Let her know, gradually, that the fantastic smoothies have a variety of foods in them. She has to get enough nutrition and she has to navigate a social environment in which food is an important component. Fortunately, the world has come to respect a wide variety of food sensitivities. In summary, continue doing what you are doing, just don’t tolerate her being rude in this area.  In the end, she will have to manage the social aspects of her sensitivity in her own way. Given what you have done I don’t think it will be a major problem. She will learn that food is as much a social vehicle as a source of nutrients.

Posted in Eating | Tagged , , , , , , , , , , | Leave a comment

How can I get my three-year-old to stop picking his nose?

Posted on February 20, 2012 by Dr. Pat

How can I get my three-year-old to stop picking his nose?

I don’t think you can. I would suggest you mention this to his/her family doctor to check his nose to see that there is nothing wrong.

You can insist that your child not nose-pick during meals, or maybe even in public. If you want to do this tell him it is not polite and that he should do it in private. Have him leave the table if he starts. Praise him for polite behavior.

Trying to control nose picking all of the time is doomed to failure. Focus on other goals.

Posted in Behaviour | Tagged , , , | Leave a comment

What are the pros and cons of raising a gender-less child?

Posted on February 16, 2012 by Dr. Pat

Lately there has been a lot of attention in the media on the subject of raising gender-neutral or gender-less children. It is a notion we are intrigued in and considering for our own baby when he or she is born. In your professional opinion, what are the pros and cons of raising a gender-less child?

In my opinion, it is probably impossible to raise a child without them becoming aware of his or her gender.  Moreover, many people will react to a child in a gendered way. By pretending to raise a gender-less child, you may heighten awareness of gender. You may increase the chances of your child being treated more like a boy or girl as the case may be.

My own opinion is that raising a child who is aware of and proud of being a male or female is a good thing. I believe we should raise each child to believe that he or she can do or think whatever he or she wishes.  There is no reason why girls cannot aspire to be brain surgeons or plumbers. Boys can aspire to be nurses or kindergarten teachers. Girls can be ambitious, aggressive and career oriented. Boys can be gentle and family-oriented.

We should model for our children and encourage them to follow their dreams and not be constrained by gender.

In summary I am all in favour of raising children who are not constrained by gender. I fear that attempting to raise a gender-less child is impossible and may cause more emphasis on gender than is wanted.

Posted in Development | Tagged , , , , , | Leave a comment

My five-year-old son is out of control when he doesn’t get his way.

Posted on January 19, 2012 by Dr. Pat

I have three kids so I do my best to keep everybody happy and under control, I spend all my time with my kids and give them everything they want. My husband works construction from 6 a.m. to 7 p.m. so I have to be the mom and the dad at the same time, I take them everywhere.  I have a hard time time with my five-year-old son, he said he wanted a Nintendo DS so I got him one. But now he spends all of his time playing it, if I take it away he starts screaming, crying and saying I’m stupid and he won’t talk to me anymore. He makes a mess all over the house when he gets mad. I need help, I don’t know what to do with him, I just want to cry. Why is he doing this to me?

You have a challenging job.  But it sounds you are managing quite well most of the time. Some of the time you have problems.  One problem is that you cannot make everyone happy. Sometimes your children will be unhappy. That is OK.  You have to be willing to have your children unhappy some of the time, if they are to grow up well.  If you cannot stand your son’s unhappiness, then you will not be able to help him.

Your son really likes his Nintendo DS. He thinks it is the best thing in the world. Hundreds of millions of these have been sold. Lots of other kids like their DS too. You have to get control of the DS use.  There are several steps to this process:

  1. Give him attention and praise when he is not playing the DS. Tell him how much you love him, how smart he is, how good he is BUT only when he is not playing his DS.  Do this for five days before you go to Step Two.
  2. Only after doing Step One, lock up his DS or hide it where he cannot get it when he is asleep. Make sure he cannot get it.
  3. Tell him there is a new family rule. He can play DS after supper but only if there is good behaviour.
  4. He may yell and scream and tell you that you are bad. Ignore him. Don’t argue. Don’t give in. You don’t need to punish him any more. You will reward his good behaviour with him playing the DS.
  5. Make sure the baby, your son and you are safe.  Think of what he might do, and make it safe.
  6. When he stops misbehaving, yelling and screaming, pay attention to him. Tell him you are proud he is behaving.  If he behaves for at least one hour and during supper, let him have his DS after supper. If not, do not let him play.

You may have two-three days of him being very badly behaved. Stick it out. He has to learn that you are in charge and that if he wants to have his DS, he has to behave. Keep the same rule. Don’t give in. If he argues that it is not fair or that you are mean, say once “This is the family rule.” Ignore the rest.

Continue to pay lots of attention to him when he is good. You will feel much better if you can teach him to behave. You also need to get some support. Can you get someone to mind the kids once a week for three hours?  Can you talk to someone about how you feel? A close friend or minister/priest if you have one. Maybe there is a women’s and children’s drop in centre near you. Maybe there is a parenting class you can take to learn more ideas.

Keep on trying. You are a really committed mom.

Posted in Behaviour | Tagged , , , , , , , , , , , , , , , | Leave a comment

Is this baby at risk of sexual abuse from the father?

Posted on January 18, 2012 by Dr. Pat

A young relative of ours has an infant child. She has been estranged from the father of the baby since shortly after the baby’s birth. She has some concerns about this man’s behaviour while around the baby. When he has been holding the baby or playing with the baby he has had (and by his own admission acknowledged) an erection. He maintains that this is only because he is so very happy and excited to hold the baby and has no sexual implication and that there is nothing “abnormal” about it. The baby’s mother is fearful of this behaviour. She has expressed her concerns to the father and explained that because of this she does not feel she can allow the baby to be alone in his care. Currently the baby is breast fed so this is temporarily stopping those visits from happening but the father is becoming more insistent about his right to more time with the baby in his own home. The baby’s mom has indicated that she is comfortable for him to come and visit the baby in her home but she can not accept the baby going to stay with him. He says he has a right to his weekends and that he has been assured by professionals that his behaviour is not abnormal. I have been trying to find some reliable research on this online but cannot. The fact that he acknowledged this behaviour rather than denying it would lend some credibility to his assertion but is not totally reassuring by a long shot. This young man has had a troubled past with abuse by adults in his own childhood. Would you be able to comment on this situation as I presented it here or would you be aware of any reliable studies we could look at?

Thanks for your very balanced and thoughtful question. I asked Dr. William Marshall, a world authority on the understanding and treatment of people who are sexually attracted to children, for advice on this question and have incorporated his wisdom into my answer.

There is no certain evidence that the child’s father will molest the baby if given the chance. However, there are significant “red flags” that would strongly suggest that this young man might have sexual interest in the baby.

First, having an erection while holding a baby is not a normal response. It is amazing to me that a professional would say that this is normal or acceptable.

Second, the lack of concern he has about his erections is worrisome. This shows a lack of insight into how others might view his behavior. Even more worrisome is that he appears to have no insight into his own potential behavior.

Finally, most men who have been sexually abused as a child do not become child molesters themselves.  However, a significant percentage of child molesters have been molested themselves.

You and the mother of the baby are right to be very concerned. I would encourage her to continue her insistence that there are no unsupervised visits. She should seek legal advice on how she can prevent these visits in the future.

Posted in Abuse | Tagged , , , , , , , , , , , , | Leave a comment

My daughter is struggling with the social dramas of middle school.

Posted on January 17, 2012 by Dr. Pat

My twelve-year-old daughter is having some issues with making and keeping friends. She is very sensitive and is having a hard time with all of the drama associated with middle school. I am concerned about how to make her feel better while reinforcing that she needs to develop skills that will help her deal with difficult people. I am sure I am not alone and am wondering if there is a workshop for moms and daughters that would help me with keeping the lines of communication open and healthy?

The workshop idea is great but I don’t know of any workshops like this. There are some strategies that you can use to help keep the lines of communication open and help her manage:

  1. You cannot, and should not, protect her unless there is an immediate serious danger such as someone threatening or serious bullying. She has to learn to deal with the middle school drama, such as shifting alliances and harsh rejections. If you were able to shield her, you would only make her weaker.
  2. Develop some regular, shared activities, things she likes to do with you.  She needs a close relationship with you to be able to endure the challenges of her life.
  3. Listen. When she tells you about things that bother her, don’t offer instant solutions. Let her tell you how it feels, what she is thinking.
  4. Avoid giving lots of sympathy. Be empathetic: “I know how it feels,” not sympathetic: “Oh, poor you, it must be awful.”
  5. Encourage her to come up with ideas of how to manage it. Ask her what she thinks.  Pay attention to sensible strategies. Ignore or joke about other solutions, “Yes, it would be nice to be able to poke her in the nose, but what do you think you would really do?”
  6. Hang in. Her being oversensitive is also a strength. She will be able to see the nuances of social relationships. She just needs to develop some toughness as well.
Posted in Relationships | Tagged , , , , , , , , , , , , , | Leave a comment

Can a father’s intoxication at the time of conception affect the baby?

Posted on December 19, 2011 by Dr. Pat

Is there a risk of a child having mental disorders if the father was intoxicated at the time of conception?

One time intoxication (I am going to assume alcohol) at the time of sex by the father may not result in harm to the child. However, his being a chronic alcohol abuser may have a significant effect.

The role of mother’s drinking at conception and during pregnancy is very clear. Women should not drink in the weeks before conceiving or any time during pregnancy.

Since the research is not entirely clear, men should not drink in the weeks before conception either.

There is emerging evidence that alcohol abuse in either parent produces changes in the expression of genes.  This problem may be carried over generations.

Fetal Alcohol Spectrum Disorders (FASD) are a range of problems that include physical and mental problems resulting from exposure to alcohol.  There is no cure for FASD.

Having an alcoholic father has many other risks. There is a genetic component to alcoholism and a learning component to alcoholism. So the child has a risk of having a drinking problem. As well there is higher risk of the mother drinking during pregnancy. Family violence and other stresses are also more common when there is alcohol abuse.

We have to change our culture of boozing. Alcohol excess causes serious problems that last.

Thanks to Dr. James Reynolds at Queen’s University for advice on this answer.

Posted in Development | Tagged , , , , , , , , , , , , , , , , , , , , | Leave a comment

I know Christmas should be a happy time but it fills me with dread.

Posted on December 12, 2011 by Dr. Pat

I know I should be looking forward to Christmas with my husband and children. My son (age 1) and daughter (age 4) are very excited about Christmas but I just think of Christmas with dread. I had a difficult childhood but for the rest of the year I feel pretty well adjusted and happy most of the time. Last year I found Christmas difficult and I worry that this year will be much worse. On top of this I feel guilty that I may ruin my children’s Christmas because I don’t share their excitement.

Christmas depression is well known. It is not clear how many people are affected.

Several things may trigger Christmas depression:

  • Lack of sunlight
  • Memories of difficult times in one’s past
  • Excessive demands of Christmas
  • Excessive expectations to have a perfect Christmas
  • Losses that are more keenly felt at Christmas
  • Holding on to past slights
  • Too much alcohol or eating
  • Too little sleep and exercise
  • Gatherings where people argue

The winter solstice, the shortest day of the year, occurs near Christmas. The lack of light will trigger depression in some people. This is called Seasonal Affective Disorder and can be treated by increasing exposure to light. The easiest way to do this is to get outside and take a walk during the day when it is light. Even 20 minutes of walking can be very helpful. Often, busy schedules mean that the only time we are outside is when it is dark. Light therapy or anti depressant medication may also help.

Memories of difficult times in the past could interfere with enjoying Christmas. Maybe Christmas is when a father started drinking heavily. Or maybe Christmas was the occasion for arguments. It is normal to try and forget bad Christmases from one’s childhood.

Avoiding thinking about the past will cause problems. Some people find it very helpful to write down what they experienced. Or find a friend who will listen without interrupting. You can face the ghosts from Christmas past. Facing them will help put them to rest.

Many people, especially moms, have unrealistic demands placed on them at Christmas. Sometimes these demands are self imposed. Sometimes family or friends demand too much.

The need to have everything perfect is a huge expectation. Be realistic. Be gentle on yourself. Aim to get a few things done and let go of unrealistic demands. Decide on the two or three things that matter most to you about Christmas.

If you aim for a  perfect Christmas, you will drive yourself to misery. If we have realistic expectations about Christmas, we are more able to enjoy the little things.

Loved ones who have died or relationships that have been broken are often remembered at Christmas. Don’t try and push these sad feelings from your mind. It won’t work. It is OK to reminisce about losses. Spending 20 or 30 minutes a day on deliberate thought and remembrance may help.

For many, there are remembered problems that come up at Christmas. Maybe it is the rude way someone behaved or the fact that a present was not appreciated. Unlike the big issues from your past that should be faced, these slights and minor grievances can be let go of and left in the past, you will be able to start fresh.

Unfortunately, with all the Christmas parties, it is easy for people to overindulge. If you are feeling low, avoid anything more than a minimum amount of alcohol. It is a depressant. Alcohol also interferes with restful sleep.

Maybe it is a spouse or relative who drinks or eats too much at Christmas. It may help to calmly and quietly discuss this with him or her before it happens. “Uncle Jim, we really like to have you over at Christmas, but I don’t want the kids to see you drunk. We are going to serve non-alcoholic punch this year.” It may help to talk with your children about a problem like this beforehand. “Uncle Jim may drink too much. We will talk about it after he leaves.”

Eating in moderation will not only help the waistline, it will help your mood and your sleeping. Eating small amounts of Christmas goodies is fine. Don’t deprive yourself of everything.

Sleep is one of the most under rated aspects of life. Most of us are constantly sleep deprived. Sleep deprivation can also trigger weight gain. Getting a good night’s sleep will really make a difference.

If there is a gathering where you know there will be arguments and hard feelings, try to figure out how to manage it. Maybe you stay clear of those who are feuding. Don’t feel you have to solve other peoples’ problems. Don’t get drawn in as a peacemaker, unless there is a good chance it will work.

Take time for small things over the holidays. Play with your children. You may not be able to change the behaviour of others around you but really noticing the small things that make you happy during Christmas will help with sadness.

In summary, I encourage you to try to reduce Christmas stress. Talk to your husband about how he can help. Focus on taking good care of yourself so that you can help your family enjoy Christmas.

I have confidence that you will be able to manage. Even if you don’t really enjoy this Christmas, you can give your children good Christmas memories despite the things that make you sad or leave you stressed.

Posted in Depression | Tagged , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment

Is tickling a cause for concern?

Posted on December 7, 2011 by Dr. Pat

My son is a wonderful father to two preschool girls. He is devoted to them. My concern is that he often wrestles with them and tickles them. He blows on their stomachs with his lips and makes them laugh. They love it. I am certain that he has no wrong intention but might the children allow someone with different intentions do this to them?

Children learn very early to alter their behaviour in different situations. They learn:

  • to go naked in the bathtub but not in school
  • to run outside but not in the house (well, sometimes they learn)
  • to eat pizza with their hands but not spaghetti
  • to allow mom to give a kiss but not a stranger

Even preschool children learn that different behaviours are right and wrong because of the circumstances. They will learn that it is OK for dad to roughhouse and tickle with them but it is not OK for others to do this.

I know of many fathers who have tickled their children in the way you describe. It is typically fun and harmless and is often a game that the child loves. It is sometimes called giving a “buffalo” or a “raspberry” or a “zerbering”.  I am sure there are other terms for it. This type of play can be a very warm and healthy interaction between a parent and a child.

I don’t think you should worry about your grandchildren. Thank goodness your son plays with his children.

There are two types of tickling that are of concern. Sometimes adults or other children tickle to the point of the child being miserable. Excessive tickling can be torture. Sometimes children are unable to say “Stop” because they are laughing so hard. Laughing or smiling during tickling is no guarantee that the child is happy. Sometimes children who are ticklish are held down and tickled as a form of bullying. If the child is upset afterwards, the tickling was excessive.

In addition, tickling, as you suggest, can be a form of sexual interference. Some situations are obvious but some are difficult to judge. If the child or an adult who sees the tickling is uncomfortable, then the tickling should be stopped.

Tickling that is fun for all concerned is not a problem. No matter what the reason for tickling, no child should be subjected to unwanted tickling.  Sometimes tickling is not a laughing matter.

Posted in Uncategorized | Tagged , , , , , , , , , , , , , , , , , , , , , , , | Leave a comment