A Successful Approach to the Management of Children Part 2

The parents and children entering our offices today bear faint resemblance to those we encountered 2 and 3 generations ago. In the “olden” days, parents would speak and children would listen. It was the age of  “You wanna cry? I’ll give you something to cry about.” The answer to a child’s  “Why?” was a simple “Because I said so!”  The words, no, please, thank you, and I’m sorry were a requirement of existence! There were rules of engagement laid down by parents and other authority figures based on love and common sense, which were in the best interest of the child, the family, and society in general.

Parents today are confused and frustrated by so called “experts” who throw around terms like self-esteem, feelings, quality time, and time out as if they’ve discovered the cure for cancer. “Child-proof your house. Don’t yell! Don’t hit! Children are people too! Be pals to your children so they’ll like you! Emphasize the positive! Don’t mention the negative!” David Elkind says, “Young people may not like us when we set rules and standards…and that’s too bad. When we worry about our children liking us, however, we put our needs ahead of our children’s needs. When we try to be pals to our children, we deprive them of their most important source of internal rules, limits, standards, and controls.”

In short, many parents are at a loss when it comes to setting parameters of behavior and acting promptly and sensibly to the challenge of raising their children. As a result, the fathers and mothers are overstressed, overprogrammed, and are overanalyzing themselves in their search for the happy life and their obsession with providing the perfect existence for their “oh-so-special children.”

Figure 1. Grandparents provide children with a sense of family continuity and belonging.

Figure 2. The infant and toddler stage is the time to begin setting behavior patterns.

Figure 3. Sibling rivalry is overrated. Parents should teach cooperation and helpfulness.

Adding to the confusion are the societal pressures. Single-parent families are increasingly common, and both parents working is becoming the norm, resulting in a lack of continuity in daily family life. The fact that men and women are waiting longer before getting married and are therefore starting families at a more advanced age has changed the dynamics of family structure as well. The pressure of time often places the focus for pursuing careers and caring for the family in conflict. Something has to give. When the mother is no longer a full-time homemaker, there’s a limited amount of time and strength available to handle the infinite range of endurance that having children demands. Sure, there are day care centers,  grandparents (Figure 1), and babysitters, but it’s not the same.

Moreover, today’s parents are intent on exposing their children to every possible life experience: Tai Kwon Do, ballet, gymnastics, Little League, soccer, ceramics, theater class, piano and guitar, day camp, Sunday school, and Hebrew school just to name a few. Two-year-olds are in “early stimulation classes,” story reading, and don’t forget the play dates.  So you have overtaxed, hurried kids and overextended, harried parents living in a state of confusion. Since in many cases both parents are working, the children are handed from one caregiver or teacher or coach to another, with much less one-on-one time with the parents themselves.

Perhaps the key to gaining a perspective on today’s distorted relationship between adults and children is to remember that children are children. They see any given situation only from their own point of view. Bruno Bettelheim in his A Good Enough Parent observed that “good enough parents endeavor to evaluate and respond to matters both from their adult perspective and from the quite different one of the child and then to base their actions on a reasonable integration of the two, while accepting that the child because of his immaturity can understand matters only from his point of view.” Children want what they want when they want it. They generally don’t have the ability to put off immediate gratification in favor of eventual pleasure. And when they don’t get what they want, the whining, the crying, the screaming, and the tantrums begin. 

Parents today are ill-equipped to handle the daily regimen of child-rearing, partially because of their overstressed and hyper-extended lives and partially because they have been sold a bill of goods by overly solicitous experts who say things like “Children are people too,” “Just because you’re bigger and older doesn’t mean you’re right,” “Give your child choices,” and “Don’t lower self-esteem.” Parents are made to feel incompetent, forcing them to overanalyze and second-guess the everyday decisions they make with their kids.

Then there are the magic words quality time. Quality time is not just about “Mommy and Daddy love you so much.” It’s about “Brush your teeth,” “Let’s see your homework,” and “Did you practice the piano?” But the problem is that a mother who is working as well as trying to be there for her child feels conflicted. In the words of Anna Quindlen, “Since I’ve made a decision to be away from my children for a considerable portion of most days, I’ve got to make my peace with a couple of realities. One is that I’m going to miss some good stuff. There will be lots of fun had, questions asked, significant moments passed when I’m not there…I suppose I feel sometimes that I’ve substituted trying too hard for not trying hard enough and frankly from a child’s perspective, I’m not sure which is worse.” 

It’s this mother, burdened with those feelings, who enters your office for the dental appointment, so it’s important that we be in touch with that reality. 

There is no such thing as a perfect parent. Whatever happened to plain old common sense? Using your instincts? The woman’s intuition?  “Everybody gets so much information all day long that they lose their common sense,” reflected Gertrude Stein. We as parents, teachers, dentists, coaches, etc, are the personification of adulthood. And as adults, we should have the ability to look at life in the past and the present and hopefully make good choices for ourselves and our children, because we’ve been there and done that.

Parents and children deal with numerous critical moments in the continuum of family life.  Each of these moments in and of themselves may seem insignificant, but when viewed as a whole they make up a crazy quilt pattern of behavior, which sets the pattern for children’s behavior with people outside the family and later as adults in society.

Parents have been told by a flock of psychiatrists, psychologists, and social workers to ignore the bad behavior by the 2-year-old…to tolerate and condone tantrums because that’s the way they express feelings and it’s just part of going through the “terrible 2s” stage.   However, in my experience, if you don’t deal with the terrible 2s, you’ll have the terrible 10s, the horrible 16s, and the miserable 35s (Figure 2). It’s naïve to think that if your young children don’t listen to you when it comes to bedtime, mealtime, and playtime issues that they’ll suddenly start paying attention to you as teenagers when dealing with such issues as drugs and sex. The pattern for appropriate social behavior is set much earlier than most parents imagine. If you neglect to address negative behavior at 2 years old, then you’re asking for increasing difficulty in the years that follow.

CHOICES

A common mistake that parents make with their toddlers is offering too many choices and asking the child’s opinion about matters that are far beyond their ability to comprehend. When the 3-year-old gets up in the morning, the narrative sounds something like this: “Which underpants do you want? Your Little Mermaids or Aladdins? Which socks do you want? Your Jasmines or Cinderellas? Which bowl would you like? Your Hunchbacks or Shreks? Which spoon would you like? Your Pluto or Pinocchio? Which cereal would you like? Fruit Loops or Crispy Critters?”  Each step along the way, the parent is seeking the child’s approval or permission because they’re worried about antagonizing him.

On the surface, the “choices” routine is no big deal, but the pattern continues to the point where the child feels a sense of being in control. The epitome of the problem surfaces in my office when a parent asks the child in front of my face in a whiny voice, “Do you like this doctor, honey? Do you want to come back? You have some cavities, should we do them today?” What if the child says no? Then what?

As dentists, we have to change that pattern by doing more telling and less asking. Don’t preface every request with “would you like.” It’s “take a drink of water, please,” not “would you like a drink of water?” It’s “show me how you brush,” not “would you like to show me how you brush?”   

FEELINGS AND SELF-ESTEEM

“Always emphasize the positive. Don’t say anything negative otherwise you’ll lower your child’s self-esteem. Shower your child with compliments and you’ll give him self-confidence.”

More bad advice! There’s a distinct difference between correcting a child’s bad behavior and being demeaning. You bring a newborn baby girl home and your 3-year-old son is feeling jealous. So whenever he gets a chance, he throws the pillow or a toy bear in the baby’s face, he gives the baby a little elbow, or he covers her face with a blanket.

As a parent, you understand very well what your 3-year-old is feeling. He’s jealous, feeling neglected, and hates his new sibling, but you can’t allow him to injure his baby sister willfully. So, let him help you feed, bathe, or change the baby. “Since he’s the big boy in the house, he’s going to help you take care of the new baby.” Taking a positive but firm stance with him sends the message that his aggressive behavior will not be tolerated. It’s not a matter of preserving his self-esteem. It’s about teaching him to cope with his negative feelings in a nondestructive manner. It’s a matter of teaching a child right and wrong and helping him adjust to normal changes that often occur in the course of life. Otherwise, that child at some point ends up as a bad news item in the newspaper or on television.

Self-esteem does not come from parents overpraising their children: “You’re so pretty,” “You are the smartest,” “Who’s the best boy in the world?”

As those children mature, they suddenly face the reality of not being the best looking, not the smartest, and not the best athletes. They grow up unhappy with a false sense of importance and a narcissistic attitude that the world revolves around them. Self-esteem means self-esteem, which is acquired from something you accomplish by your own efforts. Riding your bike without training wheels, making on the toilet, learning to read, going to the dentist and being a cooperative patient. In other words, doing something of worth.

 “Don’t keep score in the game, winning is not important. Don’t give grades. Allow the child to use the sheet music at his piano recital instead of memorizing the piece so she doesn’t feel any pressure. Don’t make the child sit down when he spells a word wrong in the spelling bee because you’ll destroy confidence and lower self-esteem.”

Following this kind of philosophy does not prepare children for the realities of life because it doesn’t teach them to take responsibility or teach them that there are consequences for their behavior. Instead, excuses are made for inappropriate behavior.

To make matters worse, moms and dads feel the need to exaggerate even the smallest accomplishment and glorify it with a gold star, sticker, or medal. The toddler finishes all his cereal or makes on the toilet, and the band plays, giving him an overblown sense of importance.

Lynne Williams in The Too Precious Child expresses the thought, “Children today are pressured to get into the right nursery school, the right camp or the right college but they’re rarely required to do the right things which will make them good people and accomplish something important to the real world.”       

DISCIPLINE

Parents should discipline their children so that as they grow, they learn self-discipline. It’s part of parental love. Love is not unconditional. Love is not “never having to say I’m sorry.” The ongoing controversy over spanking or not spanking continues to plague parents. In my seminars, I jokingly recall that “time out” for me was long enough to duck. We’ve gone a little overboard in making parents feel guilty about administering even the most minor kind of physical punishment. There’s a huge difference between spanking your child on the rear end and child abuse. 

“Spanking and hitting may be antiethical to respectful relationships with our children, but the baby gets thrown out with the bathwater when we begin to doubt if any form of firm action is valid. It’s ironic in a society that is becoming increasingly out of control, that the bang-bang of a gun is tolerated but parents can’t spank their children,” says Diane Ehrensaft. 

Putting the spanking issue aside, there are dozens of other ways that parents can let their youngsters know that they’ve crossed the line. There’s the rise in volume and deliberateness of the voice, the body position, and perhaps most importantly, the facial expression that says you mean business... “the look” your mother or father gave you that followed you wherever you went like a Jiminy Cricket conscience;  that inner voice that said, “I’d better not do that.”                        

Praise and discipline are most effective when dispensed in the moment. Your toddler does something good? Now is the time for the exuberant compliment. He misbehaves? Now is the time for the reprimand. Whatever the disciplinary methods parents choose to employ, they should be consistent and prompt. The words of D.W. Winnicott are very relevant: “Punishment and aggrandizement postponed is ineffective. Timing is important.” Deal with the issues now. Don’t wait for a laundry list of offences. And don’t say,  “Wait until your father comes home.”  

A PARENT FRUSTRATION POTPOURRI

Parents deal with a multitude of issues with their children, but whether it be mealtime, bedtime, or playtime the parents should be the ones controlling the course of events.

Mealtime meltdown: This is a common parental complaint. Mom makes dinner, and the child is not eating it. He says he’s not hungry. She tries forcing, cajoling, and bribing,  but the end result is an unpleasant dinnertime for everyone. To add to the aggravation, a half-hour later the child is having a tantrum demanding potato chips or crackers and juice because he’s hungry.

Solution: Dinner is served. Put a minimal amount of food on the child’s plate. It should look achievable, not overwhelming: eg, 2 small pieces of chicken, 2 green beans, one tablespoon of mashed potatoes,  half of a piece of bread, and half a glass of milk. He has 2 choices: take it or leave it. He eats? Fine! He doesn’t eat? Fine! Next meal? Breakfast tomorrow morning—no snacks! The first time or two that you invoke this policy, it will be met by complaints and even tantrums. Continue this pattern, and very soon the child will get the picture.

Bedtime at the zoo: Bedtime should be a wonderful bonding time for parents and young children. It should be a peaceful ending to a day framed by a bath, a snack, tooth-brushing, a bedtime story, and a hug and a kiss goodnight. But in many households, it turns into a battlefield with parents not unified in purpose, begging, whining, and yelling “It’s time for bed.” And the kids, in their delay mode, screaming “We’re not tired,” “We’ve never seen this show,” or “We want to sleep in your bed!”

Solution: In days gone by, my mother told me when I was tired, and there was very little leeway. The difference was you could hear the resolve in your mother’s voice, and challenging her was not a smart move. The firmness and consistency in the message are essential, and the message should be delivered early on. The mistake is made the first time that parents don’t stand their ground.

The problem, as with so many issues, is that parents feel the need to justify their decisions to the complete satisfaction of the child. That’s impossible. Sometimes, as with bedtimes or what time you want them home, the rules are arbitrary. Why eight o’clock? Why not eight fifteen? Why? Because!  

Play nice! Don’t fight:  Teaching children the art of compromise and cultivating in them the ability to get along with other children is something parents today can’t seem to address (Figure 3).  You hear or watch children fighting over a toy or game and you want the bickering to stop, but you can’t yell or spank. What are the options?    

Solution: Allowing the children to work out their own problems, by fighting it out, is one alternative. But a quicker solution is to confiscate the toy over which they’re arguing. “If you can’t play nice together, then you don’t have to play at all.” It may not seem fair, but it certainly gets the point across.

THEY’RE COMING! ARE YOU READY? 

The point of this discussion is that the difficulties that some parents are experiencing with their children and the failure of many families to balance love and discipline often translate into a less-than-satisfactory dental visit. The parents who are uptight from trying to cope with their kids and those kids who have been treated as if they were “oh so special” make for a devastating combination and present an interesting challenge.

As I have emphasized over the years, it’s the general practitioner that’s most often on the firing line when it comes to treating children, not the pediatric dentist. There is such a sense of accomplishment in converting the reluctant child and the apprehensive parent from adversaries into allies. And don’t minimize the short-term and long-term economic benefits. The overhead factor is minimal, and the practice growth you will experience is monumental.  Remember, we are not merely tooth-fixers. We have to be teachers and guides to both the parents and the children. Whatever the chemistry that exists within that family, we must alter that chemistry, at least while they’re in our presence, in order to make the dental visit a productive one clinically and socially.

In the next article in this series, I will discuss the all-important first visit, including a practical method for the temporary separation of parents from children, the systematic introduction of the child to the world of dentistry, and the roles of the dentist and the dental team members in maximizing the success of that fateful encounter.


Sources

Bettelheim B. A Good Enough Parent: A Book on Child-Rearing. New York, NY: Vintage; 1988.

Ehrensaft D. Spoiling Childhood: How Well-Meaning Parents Are Giving Children Too Much—But Not What They Need. New York, NY: Guilford Press; 1999.

Elkind D. The Hurried Child: Growing Up Too Fast Too Soon. 3rd ed. Philadelphia, Pa: Perseus Publishing; 2001.

Elkind D. Ties That Stress: The New Family Imbalance. Cambridge, Mass: Harvard University Press; 1995.

Quindlen A. Is quality time really as good as a good time? The New York Times. June 9, 1988.

Shaw R. The Epidemic: The Rot of American Culture, Absentee and Permissive Parenting, and the Resultant Plague of Joyless, Selfish Children. New York, NY: Regan Books/Harper Collins; 2003.

Spencer P. Do Babies Need Discipline? Parenting. March 1996 

Spock B. Dr. Spock on Parenting: Sensible Advice From America’s Most Trusted Child-Care Expert. New York, NY: Simon & Schuster; 1988.

Williams LH, Berman HS, Rose L. The Too Precious Child: The Perils of Being a Super-Parent and How to Avoid Them. New York, NY: Warner Books; 1989.

Winnicott DW. Maturational Processes and the Facilitating Environment: Studies in the Theory of Emotional Development. London, England: Karnac Books; 1996.


Dr. Berman is an internationally recognized pediatric dentist with a career as a successful practitioner and lecturer spanning more than 4 decades. He has been an ambassador for dentistry as a health reporter on CBS (News Radio 78), via media appearances as a consumer advisor for the ADA, the Chicago Dental Society, and the Academy of Pediatric Dentistry, and as co-author of Essentials of Modern Dental Practice. He has published numerous articles in the dental literature as well as practice materials and education videotapes. His public relations expertise is in demand when shows like OPRAH are tackling difficult issues such as AIDS, amalgam, dental phobia, and consumer rights, and he’s still the principal dentist in a thriving practice in Chicago. For more information about his seminars, Dr. Berman can be reached at (773) 764-0007 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it .

 



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